By Steven Gregor, InPsych production editor

Historically, body image has been seen by many to be a female concern; few would have considered these issues as being relevant to males. Certainly, these are very serious issues having affected the psychological wellbeing of many women for a very long time and the reported statistics are alarming. Figures collated by the Eating Disorders Association of South Australia conclude that: anorexia is the third most common disease in Australian females aged 15 – 24 years and morality rates after 20 years are between 15 – 20 per cent; the incidence of bulimia within the same age group is five in every 100; at least two studies have indicated that only about one tenth of bulimia cases are detected; and women who diet frequently (more than five times) are 75 per cent more likely to experience depression.

Dennis Kelynack, a Melbourne-based counselling psychologist with experience in treating men’s issues, believes men are less likely to present themselves with such concerns. “The presenting problem is seldom one of body image. Men worry about how they present to others; they worry about anything that may bring about a perceived loss (in social standing)”, he says.

Helen Fawkner, a PhD psychology student at the University of Melbourne, has been researching body image issues, including those relevant to males. Her research confirms that in recent years there has been an increase in the number of men seeking treatment for body image dissatisfaction. “Evidence suggests that more men are experiencing body image dissatisfaction than was previously thought. There is an increasing recognition that men can suffer from these problems.”

Traditionally, a male’s role in society has been clearly defined; the “ideal” man offered strength through security. Today, this male function is no longer as valid; today, it would seem, men feel the need to display strength, and indeed masculinity, through physical appearance. “It used to be that men were defined by their jobs; in a sense that has changed and it has been argued that their body is one of the few remaining ways in which they can differentiate themselves from women”, says Ms Fawkner.

Perhaps inevitably then, the statistics pertaining to men and body image are also concerning. It is believed that men’s body image dissatisfaction has tripled in the previous 25 years, from 15 per cent to 45 per cent (of all western men). Figures released on www.betterhealth.vic.gov.au reveal: approximately 17 per cent of men are dieting at any given time; one in 10 people with anorexia are male; four per cent of men purge after eating; three per cent binge eat; and an estimated three per cent of adolescent boys use muscle enhancing drugs (including steroids) to help achieve the “ideal” body.

Quite simply, recent research has shown that body dissatisfaction is a serious and growing concern for males, and their psychological and physical wellbeing is being adversely affected.

The weight of the media

Body image is big business; the men’s cosmetic and grooming industry boasted a 37 per cent jump in sales between 1991 and 1996. Also in 1996, men accounted for 30 per cent of all Australian cosmetic surgery procedures. These evolving cultural trends, arguably the result of the mass media and skilled global advertising campaigns, have given birth to the new “metrosexual” man – an urban heterosexual man who is image conscious and spends accordingly – and the pressure to conform to this image appears to be mounting.

Elaine Hosie, a registered psychologist and the Director of Counselling for an organisation working with adolescent males, acknowledges the power of the media. “The media promotes a certain idealised image of what it means to be a male. In regard to the body image debate, the media plays a large role in the idealised notion of what it is to grow from a child, to an adolescent, to an adult male.”

Research over the years has shown that body image dissatisfaction among females has concentrated on weight and, more to the point, wanting to lose it. Research into men and body image dissatisfaction shows the same weight preoccupation; however, it would appear that there are as many men wanting to increase their weight (with muscle mass) as those who want to lose it. “We have found that a very large percentage of men, as many as 85 per cent, are dissatisfied in terms of weight; around half want to lose weight and half want to gain weight. They are looking for the “ideal” – minimal body fat and a large amount of muscle”, says Ms Fawkner.

So, what does the “ideal” man look like? He is muscular, athletic, without body hair, trim to the point of being devoid of fat, his skin is flawless, and comes packaged neatly in a classic “V” shaped 190 cm frame. The danger with this, despite the characteristics describing what would appear to be a healthy man, is that the “average” male has little or no hope of achieving the “ideal” without deploying extreme measures; excessive gym visits, eating disorders, taking supplements to increase muscle mass, and drug abuse (including steroids) appear to be on the rise. In fact, Ms Fawkner’s research has discovered that 68 per cent of steroid users contributed their usage to its enhancement of body image and other appearance related issues.

These issues are not new; women and adolescent girls have had to deal with them for many years. What is new, however, is that men and adolescent boys are now under the exact same pressure; what is most worrying, subsequently, is the possibility that men and boys may be less equipped, or willing, to address such traditionally female concerns.

The mask of wellbeing

Body image dissatisfaction in males is the same as in females – it can directly affect self-esteem and behaviour. These feelings are most often coupled with a determination to change the body through excessive exercise.Alarming, though, is that many of these behaviours are seen as culturally acceptable in males – quite simply, these behaviours are seen as manly. As a result, the dissatisfaction often goes unnoticed by family and friends; in fact, the behaviours could very well be encouraged. Being a member of a gym and actually using that membership is healthy; however, excessive exercise and working-out to mask the feelings and inadequacies associated with body image dissatisfaction is, without question, unhealthy.

So, when does exercising stop being healthy? Ms Fawkner has identified two warning signs. “Exercising when you’re ill or injured (and the body needs to rest in order to heal) is one warning sign. The other is when there is no longer a balance between work, social life, and exercise – when exercise, in a sense, becomes the single most important focus in someone’s life.” Ms Fawkner acknowledges that it is different for a professional athlete, but, even then, she believes a balance is required.

Body image dissatisfaction in males has paved the way for what has been described as a secret phenomenon, muscle dysmorphia (or “bigorexia” as it has been dubbed). The opposite of anorexia, those with muscle dysmorphia want to increase their size with muscle mass. Even if a person has above average muscle mass, a patient with muscle dysmorphia can believe they are chronically underdeveloped to the point of being frail. An adjunct of body dysmorphic disorder (BDD), the associated misconception and shame of muscle dysmorphia can severely impair a patient’s ability to function socially and professionally; the patient becomes exercise dependant and steroid abuse is likely.

Eating disorders and males

The reported figures pertaining to males and eating disorders, as significant as they are, are believed by many to be on the conservative side of accurate; if male body dissatisfaction is unlikely to be reported due to it being perceived as a female concern, a male acknowledging an eating disorder must find it a real challenge to his masculinity. It would appear then that an awareness campaign is required to inform men that it is understandable and “normal” for them to succumb to the pressures that so often trigger eating disorders (regardless of gender). Traditionally, awareness campaigns working to combat such issues have had a distinct female bias; of equal importance now though, it would seem, is the promotion of understanding among males of the relevance of such issues to them.

Ms Fawkner continues: “There is a bias, but there is a bias for very good reason. And that is, the vast majority of people presenting for treatment, particularly for eating disorders, are female. The thing that is really concerning though, is that even though there is a smaller percentage of men with eating disorders (compared to females), the prognosis is not as promising for men as it is for women. It has been suggested that only 20 per cent of males, compared with 50 per cent of females, have a good outcome. The majority of men, 70 per cent, compared to only 30 per cent of women, have a poor outcome.”

Treating males with body image dissatisfaction

Marshall O’Brien, convener of the Australian Psychological Society’s Men and Masculinities Interest Group and registered psychologist, identifies the importance of obtaining the respect of male patients when identifying and acknowledging such issues. “When treating a male patient with body image dissatisfaction, psychologists need to work with the cognitive distortions of that patient’s body image in the same way they have traditionally with women. It is important to realise that psychologists need to help men elaborate on the ideal and establish realistic and healthy goals; men need productive goals on the board to help them have confidence in psychologists.”

Ms Hosie agrees, highlighting the need for psychologists, other practitioners, family members, and teachers (when working with adolescent boys) to work together to secure better physical, social, mental and spiritual outcomes. “I would say it (body image dissatisfaction) is not something that’s in their (adolescent boys’) awareness. The reason for coming to a counsellor would be about more concrete issues, such as: “I’m doing really badly at school, or my girlfriend has dropped me, or I can’t get a girlfriend, or I don’t like my teacher” – they externalise things; they blame the world. These are the presenting issues which often mask more serious health concerns like body image dissatisfaction. In turn, treatment for poor body image includes the development of an independent identity as a young adult. Treatment for adolescent males should not only focuses on identity, but should also include the building of behavioural strategies in support of a resilient and healthy self image. Treatment needs to encompass intrapersonal issues about the developing male identity as well as cognitive adjustment of distorted views about themselves.”

Body image is an important issue for today’s male, but Ms Fawkner concludes: “It is only one of many areas in men’s health that really needs attention."

Reference

Pope, H., Philips, K., & Olivardia, R. (2000). The adonis complex: the secret crisis of male body obsession. Simon & Schuster (Trade Division).

See also:

Psychology of Men and Masculinities Interest Group