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Overcome disordered eating and find peace with food
by Victoria Stockwell on November 28th, 2020

By Victoria Stockwell

Over the past few decades there has been an increase in the exploitation of male body image insecurities. Thanks to an aesthetics driven media and a $100 billion-dollar global fitness industry, men are now more than ever under pressure to conform to a certain type of physique.[1] This means that body dysmorphia is a growing issue amongst men, who compare themselves to society’s idea of the perfect masculine body. Today, men are told that they should be muscular and lean, with a chiselled jaw and six pack abs.

 23 years ago, the trend to embody this muscular ideal led to the diagnosis of a new body dysmorphia subtype. This was known as muscle dysmorphia (aka reverse anorexia or bigorexia). Individuals with this condition believe that their body is insufficiently muscular, regardless of actual muscle size and definition.

 Male athletes are particularly vulnerable to developing muscle dysmorphia, especially those who take part in aesthetic sports such as competitive bodybuilding.[2] Bodybuilding epitomises the social ideal of muscularity: it is a sport judged solely on appearance.

  When muscle dysmorphia first entered the literature in 1997, it was introduced as an aspect of what was coined the Adonis Complex by Harvard professors Harrison Pope et al. Their work documented the body dissatisfaction experienced by millions of men worldwide which led to ‘compulsive weightlifting and exercising, steroid abuse, eating disorders, and body dysmorphic disorder.’[3]

  Muscle dysmorphia has also been placed on the obsessive compulsive disorder spectrum. This is because it is characterised by obsessive thoughts of increasing muscularity and reducing body fat, and a compulsive drive to achieve these goals. These compulsions assume the form of camouflaging; and repetitive body checking behaviours, such as measuring the size of muscles, flexing muscles in the mirror and frequent weighing.

 CRITERIA

 Despite its somewhat confused aetiology, muscle dysmorphia is now included in the DSM V as a form of body dysmorphic disorder. In order to be diagnosed, individuals must meet two of the following four criteria:

 1: The individual frequently gives up important social, occupational or recreational activities because of a compulsive need to maintain their workout and diet schedule.

  During my own research, all bodybuilders confessed that they are obsessed with training, and frequently turn down or cancel social events because of their weight lifting regime. Training also significantly interferes with their jobs and their relationships. If they are forced to forego a training session, athletes experience depression and anxiety and feel compelled to make up for the missed workout.

  2: The individual avoids situations where their body is exposed to others, or endures such situations only with marked distress or intense anxiety.

 In Pope’s original research, 88% of men with muscle dysmorphia reported being afraid to take their shirt off in public.[4] This is also true of the bodybuilders I interviewed. Despite being able to stand on stage in nothing but the smallest of shiny posing trunks, they otherwise avoid situations or activities, such as swimming, where their bodies would be exposed.

 This anxiety may originate from a desire for social acceptance. Meeting sociocultural expectations means that they are rewarded with encouragement in the form of attention and compliments. Conversely, if they do not feel that their bodies are lean enough, or muscular enough then they fear appearance-based rejection.
  
 3: The preoccupation about the inadequacy of body size or musculature causes clinically significant distress or impairment.

  Despite other people commenting on their muscle mass, all of the bodybuilders who took part in my research believe that they are insufficiently muscular. They even confessed to hating their bodies and are constantly preoccupied with negative body-image related thoughts. One study found that men with muscle dysmorphia spent more than five hours a day worrying that they are not muscular enough.[5]

  Competitive bodybuilders set themselves such high standards of physical perfection that it leads to relentless comparison and self criticism. The nature of competitive bodybuilding lends itself to this kind of judgement since competitor’s physiques will be compared to determine who goes home with the winning trophy.

  The belief that they are insufficiently muscular has a direct effect on bodybuilders’ mental health, leading to lack of confidence, low self-esteem and anxiety.

  4: The individual continues to work out, diet or use performance-enhancing substances despite knowledge of adverse physical or psychological consequences.[6]

  Despite being aware of the risks bodybuilders, make conscious decisions to engage in health-compromising practices. These include excessive training, extreme dieting and anabolic steroid use.

  Aside from a decrease in physical performance, excessive strength training can cause a wide range of adverse health effects. These include ‘adrenal insufficiency, chronic injuries, gastrointestinal distress, and immune dysfunction.’[7] These conditions occur because the human body is not naturally designed to endure such large physical stress.
  
 CAUSE

  The cause of muscle dysmorphia is multifaceted with various cognitive, biological, psychological and sociocultural factors that influence its expression.

  The biological model proposes that the condition may be ‘a problem of somatoperception’ (a problem with knowing your own body). This is thought to be ‘related to organic lesions or processing issues in the right parietal lobe of the brain.’[8]

 Other research suggests that some individuals have a genetic predisposition to developing muscle dysmorphia. This biological theory also involves an environmental component since it proposes that the condition only emerges following exposure to certain trauma such as domestic violence, physical assault, bullying or abuse.

 Given the correlation between muscle mass and strength, it is understandable how the desire for a strong, muscular body may be a reaction to physical abuse or feelings of vulnerability. Being muscular is a way of safeguarding and defending oneself against future mistreatment.

  Several of my interviewees had experienced bullying and even serious trauma, leaving one man I spoke to suffering from complex PTSD. He confessed that his muscular physique makes him feel more able to protect himself, and others: it is his ‘safety blanket.’

  In addition, athletes tend to have psychological factors that predispose them to muscle dysmorphia, such as perfectionism and high levels of competitiveness.[9] These are linked in the world of competitive bodybuilding where success depends upon having a perfect, balanced physique.
  
  TREATMENT

  Despite its increasing prevalence and potentially serious consequences, muscle dysmorphia goes largely untreated. This is partly because it is difficult to diagnose. Identifying the disorder can be problematic since competitive bodybuilders have an outward appearance of health. The characteristics that are associated with muscle dysmorphia, such as exercise and good nutrition, along with the discipline and motivation required to build a muscular physique, are typically viewed as positive traits.

  Even if individuals with muscle dysmorphia are aware that they might need some kind of intervention, many are ashamed of their condition. There are social taboos both against men having body image concerns in the first place, and also against expressing their feelings about them.

  Current treatment methods are the same as those prescribed for general body dysmorphia. These include cognitive behavioural therapy and antidepressant medications.[10] Their efficacy remains controversial, however, and the relapse rate is high.[11]

  Regarding future diagnosis and treatment, it is important that fitness coaches and health care professionals are informed about the signs and symptoms of muscle dysmorphia; and its potential dangers. This will enable them to identify who may be at risk and to prescribe the correct treatment.

  In order to tackle muscle dysmorphia on a wider sociocultural level, however, ultimately there has to be a paradigm shift in how male bodies are portrayed by media and advertising. It is important for us to remember that while Adonis was a demigod, everyone else is only human.
       
   [1] https://www.businessinsider.com/fitness-has-exploded-into-a-nearly-100-billion-global-industry-2019-9?r=US&IR=T
   [2] https://journals.sagepub.com/doi/pdf/10.1177/1557988318786868
   [3]https://www.researchgate.net/publication/247715403_The_Adonis_Complex_The_Secret_Crisis_of_Male_Body_Obsession_Looking_Good_Male_Body_Image_in_Modern_America_Making_the_Body_Beautiful_A_Cultural_History_of_Aesthetic_Surgery_Body_Modification
   [4] Pope, H.G.; Phillips, K.A.; Olivardia, R, The Adonis Complex: How to Identify, Treat, and Prevent Body Obsession in Men and Boys (Touchstone, New York, 2000)
   [5] Pope, H.G.; Phillips, K.A.; Olivardia, R, The Adonis Complex: How to Identify, Treat, and Prevent Body Obsession in Men and Boys (Touchstone, New York, 2000)
   [6] https://www.researchgate.net/publication/23225701_Bigorexia_Bodybuilding_and_Muscle_Dysmorphia
   [7] http://darwinian-medicine.com/the-dangers-of-excessive-strength-training/
   [8] https://ziggibson.wordpress.com/2017/02/05/muscle-dysmorphia-and-the-adonis-complex-mirror-mirror-on-the-wall-why-am-i-not-the-biggest-of-them-all/
   [9] https://en.wikipedia.org/wiki/Muscle_dysmorphia
   [10] http://eprints.worc.ac.uk/4859/1/Muscle%20Dysmorphia%20Current%20insights.pdf
   [11] https://ziggibson.wordpress.com/2017/02/05/muscle-dysmorphia-and-the-adonis-complex-mirror-mirror-on-the-wall-why-am-i-not-the-biggest-of-them-all/


by Harriet Frew on November 21st, 2020

Read article at the Counselling Directory

by Harriet Frew on November 21st, 2020

Read article at the Counselling Directory

by Harriet Frew on October 25th, 2020


I consider myself to have surprisingly good body image. I’d say a solid 8 out of 10 most of the time.

I enjoy the process of getting dressed and choosing one of my favourite dresses. It doesn’t take more than two minutes to make a choice and feel quite relaxed and happy about it. A quick glance in the mirror is enough to reassure myself that everything is facing the right way and no obvious bloopers.

I have radical acceptance of my pear shape, with the slimmer upper body and curves below. I’m never going to be in adoring love with my hips and thighs, but I’ve certainly made my peace with them.

The genetic lottery has bestowed me with toned arms, without doing a jot of exercise and if I do lift a weight, I get muscles!

And pre-children, I did have defined waist; not so much now, but you know, good clothes do hide a multitude of sins. Especially my favourite leopard print.

You win some and you lose some with genetics.

Dresses and flared skirts are my go-to body confidence boosters. Enhance the more favourable parts and celebrate the goodish bits!

I know that body aesthetics are fleeting and temporary to grasp onto.

I’m grateful for a healthy and strong body that has allowed me to walk into town today and kick the autumn leaves; run upstairs with a pile of washing without an ache or pain and shift the guinea pig hutch to a new found spot in the garden, without a thought.

And I know that in ten years time, I will be probably longing for this body that I have now, as I wrinkle further and things move slowly southwards.

But I have a confession.

A body image niggle that has been holding me back.

Jeans. Buying them. Wearing them. Liking them.

In my twenties, I had some Levi 501s that fitted to perfection. I bought them in the USA, when doing Camp America and they were in an in-between size that USA labels do.

In the UK, I’ve always struggled with jeans. Frequently, I’ve bought a pair that fit when standing up or not breathing too much (!) but are not a comfortable choice to wear for a full day of sitting, eating and moving around.

Fundamentally, they did not fit.

But I had resisted buying the bigger size.

Hey, diet culture, you got me here.

And I’ve been avoiding jeans because I didn’t want to admit this – instead, wearing leggings and sportswear, like - forever.

A BREAKTHROUGH!

You will be pleased to know that I have finally tackled this body image niggle full on.

This week, I have bought some jeans in a bigger size.

When wearing these jeans, I have blogged at my desk; eaten pizza and worn them from dawn till dusk.

And because they fit, I haven’t had to think about wearing them.

They are COMFORTABLE! They don’t dig in. I can even do deep breaths.

After an initial mini self-chastisement about not fitting into the smaller size (I am ashamed to admit), I have embraced the new ones and will continue to do so.

In disordered eating recovery, getting rid of clothes that are too small is a challenging but vital step forward.

Holding onto smaller sizes is like a having a psychological weight around your neck.

Be brave. Embrace the body you have. Celebrate it for health and vigour and strength.

Value it for everything it can do for you.

by Victoria Stockwell on October 11th, 2020


In the BBC One documentary ‘Living with Bulimia,’ former England Cricket Captain Andrew ‘Freddie’ Flintoff speaks openly for the first time about his 20 year struggle with the eating disorder bulimia nervosa. In the programme, he gives an honest account of his experiences with body dysmorphia, self-induced vomiting and compulsive exercise, which began during his cricketing career when his weight came under scrutiny from the British media.

Today 1.5million people in the UK are reported to have bulimia, 25% of which are men. The actual number of male sufferers, however, is likely to be much higher: a 2007 study suggests that it is closer to 40%.[1]

 The reason why this condition often goes unreported is owing to sex-related stigma. Eating disorders are often considered to be female illnesses, meaning that only 10% of men pursue treatment. Flintoff himself was prevented from disclosing his bulimia owing to his dietician’s discriminatory attitude towards men and eating disorders.

 Until being interviewed for this documentary, Flintoff kept his eating disorder secret for 2 decades. Ashamed of his condition, he still finds it difficult to even say the word, ‘bulimia.’ Instead, he refers to it as ‘being sick’.

 The secrecy and shame associated with bulimia gave him the sense of having a duel identity. Publicly, Freddie Flintoff is a famous TV presenter and international sportsperson; but privately, he suffers from such low self-esteem that he is compelled to vomit after every meal.

 When he began his sporting career age 16, Flintoff had what he describes as a ‘skinny’ physique.[2] At this time he became aware of the difference between his own teenage body and those of his teammates, who, in comparison, were more muscular.

 Over the next few years, Flintoff consequently attempted to increase his size in order to have ‘more presence’.[3] Yet, he was not fully aware of how much weight he had gained until his appearance caught the attention of the British press who christened him ‘The Fat Cricketer.’ It was this weight shaming that was the trigger for his 20 year long struggle with bulimia.

 By shaming Flintoff for his weight gain, the media reinforced the idea that a professional sportsperson should have a certain type of body, i.e. lean and athletic. Because he did not accord with their aesthetic ideal, Flintoff was publicly humiliated.

 This type of discrimination has been documented as posing a significant threat to psychological and physical health; and is also a risk factor for depression, low self-esteem, and body dissatisfaction.[4]

 As in Flintoff’s case, it is often weight stigma that causes eating disorders. It was only after the press commented on his appearance that he became concerned about his size. Constantly under the scrutiny of the public eye and known as ‘Fat Flintoff’, Freddie consequently began engaging in destructive behaviours in order to lose weight, making himself sick after every meal.

 This behaviour was reinforced by a subsequent improvement in his cricket performance and positive attention from the previously critical British media. This, therefore, confirmed his idea that a trimmer physique was his ticket to increased sporting performance and social approval.
 
Flintoff also admits that he derived a ‘perverse’ enjoyment from the act of purging itself. He describes it as being addictive, a descriptor commonly used by patients with bulimia since purging activates the opioid (or addictive) part of the brain.[5] For many individuals, being sick often provides feelings of comfort, euphoria or instant relief, which makes it difficult to stop.[6] 

 Although Flintoff states that he currently has his vomiting under control, he still purges via excessive exercise by carrying out an hour of fasted cardio every morning, becoming anxious if he is unable to train.

 Amongst male athletes like Flintoff, purging can lead to serious outcomes that may affect their particular sport. These include ‘increased susceptibility to injury, inconsistent performance, problematic recovery [and] muscle deficiencies.’[7] 

 Although his eating disorder is now functional, in addition to carrying out compulsive exercise, he still experiences guilt and an urge to make himself sick after eating.

 Despite these symptoms, however, Flintoff questions whether he is in need of treatment. His claims that he is in control of his eating disorder and can stop whenever he wants, however, are inconsistent with his previous comments that he feels out of control and isn’t able to stop.

 Despite bulimia’s medical diagnosis, Flintoff continues to perceive the condition, not as an illness, but part of who he is. It is perhaps owing to his strong identification with his eating disorder that he has not yet made a full recovery. Believing that it is an inherent aspect of his personality means that he will not be open to change.

 Flintoff’s reluctance to seek help also seems to be driven by the fear of renouncing his purging behaviours since, as he states, ‘gaining weight would be [his] worst nightmare’.[8] Yet, this help can be vital, since ‘almost half of all people with bulimia will not recover without treatment’.[9]
 
 The importance of Freddie Flintoff sharing his story is that not only is it a stepping stone towards his own recovery; but it will also help to break the stigma surrounding gender stereotypes and eating disorders, and encourage more men to seek the help that they need.

You can listen to Victoria's podcast HERE
 
     
   [1] https://www.nationaleatingdisorders.org/blog/males-dont-present-females-eating-disorders
   [2] Freddie Flintoff: Living With Bulimia, BBC Television, 28 Sep 2020
   [3] Freddie Flintoff: Living With Bulimia, BBC Television, 28 Sep 2020
   [4] Andreyeva, T., Puhl, R. M. and Brownell, K. D. (2008), Changes in Perceived Weight Discrimination Among Americans, 1995–1996 Through 2004–2006. Obesity, 16: 1129–1134. doi:10.1038/oby.2008.35
   [5] https://eating-disorders.org.uk/information/bulimia-nervosa-a-contemporary-analysis/
   [6] https://mirror-mirror.org/eating-disorders-2-2/bulimia-nervosa
   [7] https://journals.sagepub.com/doi/full/10.1177/1941738120928991
   [8] Freddie Flintoff: Living With Bulimia, BBC Television, 28 Sep 2020
   [9] https://eating-disorders.org.uk/information/bulimia-nervosa-a-contemporary-analysis/






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