By Assistant Professor Vivienne Lewis MAPS, School of Psychology, University of Canberra

Body image is an issue that has been extensively researched for women, but has only recently been acknowledged and seen as a significant focus for men (Cohane & Pope, 2001). Alarmingly, body image dissatisfaction for Western men is estimated to have tripled in the last 25 years from 15 to 45 per cent (Victorian Government, 2009) yet very little scientific research has been conducted on the body image concerns of men. A 2010 Mission Australia survey of Australian male youth aged 12 to 25 years found that body image was their number one concern. Body dissatisfaction even in young boys has been linked to engagement in body change strategies such as dieting and body bulking strategies (see Ricciardelli and McCabe, 2004 for a review). Although disturbances of body image are still primarily seen in females, it is important that clinicians recognise their presence in men and understand how to assist them. 

Muscle dysmorphia

Muscle dysmorphia is considered to be a form of body dysmorphic disorder (as identified in DSM-IV) and is a significant and distressing condition involving a preoccupation with muscularity and leanness. The condition is most prevalent in men and centred on a distorted body perception where muscles and body size are perceived to be smaller than they actually are. Often these men are already muscular and lean but are on a relentless pursuit to define their bodies even further, obsessively trying to become more lean, toned and muscular. This perception is accompanied by engagement in excess behaviours such as exercise, weight lifting, dieting and use of often dangerous body enhancement products to build muscle, including the use of steroids. 

Men with this condition spend a large amount of time consumed with their appearance usually at the expense of their relationships with others, jobs and study, and at the same time potentially damaging their health. These men often talk about feeling unhappy with their appearance and selves. They may suffer from depression, anxiety and suicidal thinking as well as becoming addicted to weight loss and body changing products, including drugs. The incidence rate of muscle dysmorphia is unclear as these men rarely present for treatment, although it is estimated that 100,000 or more people worldwide may have the condition (Leone, Sedory & Gray, 2005).

Why do men worry about their appearance?

The pervasive influence of the media in how the male body is portrayed, including its increasing slenderness and an emphasis on appearance away from functionality, seems to be a significant factor in this phenomenon. Men’s bodies seem to be sexually objectified now in a way that has been identified as a problem for women for many years. For instance, where advertisements used to focus on men’s strength, mateship and handiness, now men are frequently portrayed in the media sprawled across beds displaying their lean, well-toned torso or enhanced genitals through revealing underwear. It is these images that make the male body one to be looked at and admired rather than one that is functional. The physiques portrayed are almost impossible for most men to achieve, particularly as men age, and comparison with these apparently ‘normal’ male bodies can lead to significant body dissatisfaction. 

Just as for women, there are a multitude of reasons why men develop body image concerns: being teased about appearance, peer pressure to look a certain way, family factors, personality factors such as perfectionism, and many others. Desire to feel and be seen as masculine is also a big factor and this is becoming increasingly difficult for men as fewer issues differentiate men from women apart from appearance. Where in the past men demonstrated masculinity through their jobs, providing for their family, being the bread winner and the Mr Fix It, women are now able to achieve in all these areas. So it’s little surprise that men turn to their appearance for reassurance of their masculinity. However, achieving muscularity and leanness is hard work and unrealistic for most men, so many are left feeling less than masculine with little that defines them uniquely as a man (see Stanford and McCabe’s 2002 research on influences on Australian boys). 

Assessing men for body image concerns 

Men with body image concerns will not usually turn to health professionals in the first instance, and are much more likely to go to their personal trainer, partners or friends. Therefore, clinicians should be aware that by the time a male seeks assistance it is likely he has stigmatised himself and has entrenched behaviours which may be hard to shift. 

Clinicians should try to gain insight into body image concerns by asking men about their perception of their body and what behaviours they engage in to try to modify and maintain it. Questions should carefully probe for any preoccupation with body image and whether this causes significant distress and has an impact on social and occupational functioning. There are psychometric tools which are useful including the Body Areas Satisfaction Scale, Physique Anxiety Scale, and Situational Avoidance Scales (see Cash, 2011 for an overview of assessment). Ricciardelli and McCabe (2004) have developed a body change scale which includes questions about the different things boys and men may be doing to try to change their bodies. The difficulty with many psychometric tools for assessing body image is their appropriateness for assessing problems in males, as most focus on weight and shape and don’t include issues such as muscularity. There has only recently been body image assessment tools developed specifically for men. 

Interventions for men with body image concerns

The key to assisting a man to overcome significant body image concerns is in changing his attitude towards his body. Cognitive behavioural therapy, with a focus on behaviour and attitude change, is the treatment of choice for body image concerns and has been the most researched technique to date (see Devaraj and Lewis, 2010 for a review).

The first step is helping men realise that they may have lost perspective on what may have once been reasonable goals of health and fitness. For some men, the goal posts keep moving and the more they try to achieve a perceived fitness or health goal the further they actually move away from health and fitness, sometimes leading to eating disorders. Preoccupation with appearance can lead to anxiety and mood disorders and needs to be taken very seriously. 

Challenging thinking and reality testing around assumptions associated with people’s appearance is an important focus of treatment. Strategies for managing anxiety associated with poor body image should be provided, particularly for situations where the body is more exposed or more likely to be judged. Some men engage in obsessive behaviours such as checking of the appearance and excessive exercise, and will need structured help around these issues. Mindfulness around eating and enjoying eating can also be of benefit to those where food has lost its pleasure or where eating disturbances have developed. 

Groups of men are notorious for making fun of each other’s appearance, so providing assertiveness training for managing teasing about appearance can be of assistance. Encouraging men to tune into those who care about them and to be able to accept compliments can also assist in changing poor attitudes towards body image. Men should also be encouraged to set goals associated with exercise for health, fitness and fun to improve their mood and feeling towards their bodies. 

Conclusion

Just like women, men need to be able to access assistance and not be afraid to seek help for appearance-related distress. Men are usually very reluctant to ask for help for body image concerns so often suffer in silence. Psychologists have an important role in identifying men with body image concerns and providing effective assistance. On a broader level, psychologists should use their knowledge and skills to influence the ways in which men’s appearance is increasingly portrayed in the media and society, and to destigmatise help-seeking for men who are affected with body image distress. 

INTERVENTIONS FOR POOR BODY IMAGE IN MEN
  • Psychoeducation about the issue and normalisation for those who feel stigmatised for their concerns 
  • Challenging appearance assumptions and attitudes
  • Identifying cognitive errors in thinking about the body 
  • and self
  • Behaviour change around eating and exercise – e.g., eating for function and exercising for fun and fitness rather than appearance
  • Strategies to address avoidance situations concerning appearance
  • Relaxation to reduce body distress 
  • Assertiveness training around appearance teasing
  • Self-acceptance of the body as it is and for its function
  • Self esteem building 

The author can be contacted at vivienne.lewis@canberra.edu.au

References

  • Cash, T.F. (2011). Crucial considerations in the assessment of body image. In T.F. Cash & L. Smolak (Eds.), Body Image: A Handbook of Science, Practice, and Prevention (pp. 129-137). New York: Guilford Press.
  • Cohane, G.H., & Pope, H.G. (2001). Body image in boys: A review of the literature. International Journal of Eating Disorders, 29, 373-379.
  • Devaraj, S. & Lewis, V. ( 2010). Enhancing positive body image in women. An evaluation of a group intervention program. Journal of Applied Biobehavioural Research, 15(2), 103-116.
  • Mission Australia. (2010). Youth Survey of Young Australians. Retrieved from http://www.missionaustralia.com.au/downloads/national-survey-of-young-australians/2010
  • Leone, J.E., Sedory, E.J., & Gray, K.A. (2005). Recognition and treatment of muscle dysmorphia and related body image disorders. Journal of Athletic Training, 40(4), 352-359.
  • Ricciardelli, L.A., & McCabe, M.P. (2004). A biopsychosocial model of disordered eating and the pursuit of muscularity in adolescent boys. Psychological Bulletin, 130, 179-205.
  • Stanford, J.N., & McCabe, M.P. (2002). Body image ideal among males and females: Sociocultural influences and focus on different body parts. Journal of Health Psychology, 7, 675-684.
  • Victorian Government. (2009). Body image in men. Retrieved from http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Body_image_issues_for_men?OpenDocument

 

InPsych August 2012