Saturday, September 20, 2008

Men and Body Dysmorphic Disorder

I've been opening tabs for the past couple of weeks for articles that I wanted to include in this post. At this point, there is more than enough information to say what I think needs to be said.

As men and women become more equal in this culture, women are acquiring some of the traditionally male health issues, such as stress-related illness; and men are acquiring some traditionally female health issues, such as an unhealthy body image, also known as body dysmorphic disorder. The following, from the Mayo Clinic, explains the symptoms of BDM:

Signs and symptoms of body dysmorphic disorder include:

  • Preoccupation with your physical appearance
  • Strong belief that you have an abnormality or defect in your appearance that makes you ugly
  • Frequently examining yourself in the mirror or, conversely, avoiding mirrors altogether
  • Believing that others take special notice of your appearance in a negative way
  • Frequent cosmetic procedures with little satisfaction
  • Excessive grooming, such as hair plucking
  • Feeling extremely self-conscious
  • Refusing to appear in pictures
  • Skin picking
  • Comparing your appearance with that of others
  • Avoiding social situations
  • Wearing excessive makeup or clothing to camouflage perceived flaws

Body features you may obsess about include:

  • Nose
  • Hair
  • Skin
  • Moles or freckles
  • Acne and blemishes
  • Baldness
  • Breast size
  • Muscle size
  • Genitalia

The body feature you focus on may change over time. You may be so convinced about your perceived flaws that you become delusional, imagining something about your body that's not true, no matter how much someone tries to convince you otherwise.

This is a form of obsessive-compulsive disorder (OCD). This brief article looks at how OCD plays into body image issues in a more general way, without tackling the specifics of any one manifestation.
A nose that's too big, hair that's too curly or a beauty mark in the wrong place – who hasn't focused on a small detail of their appearance while staring at a mirror?

But when these imperfections take over our thoughts, or exist only in our heads, it's a sign that such obsessing is a disorder, according to Université de Montréal psychiatry professor Kieron O'Connor.

About 350,000 Canadians suffer such a phobia, while the prevalence is higher among those already experiencing some type of anxiety. "Sufferers are convinced that part of their body is abnormal, which is not the case," says the psychologist who also works at the Fernand-Seguin Research Centre. "They have difficulty separating what is real from what is not."

And it has nothing to do with vanity, he insists. It's a bit like hypochondria, where people are convinced they are sick or may get sick, or anorexia, which comes from poor body image, he adds. People suffering from this phobia will focus on the physical attribute they consider flawed, constantly viewing it in a mirror or asking the opinions of others. They may go to obsessive lengths to "fix" the problem by wearing too much make-up, going to a tanning salon or getting plastic surgery.

"It's as if these people are looking at themselves in a mirror that deforms their image," says O'Connor, who completed his clinical training in England. "They'll carry on an internal conversation and convince themselves that there's a problem with their bodies, although it's not based in reality. I've seen people who have flagrant physical flaws, yet are preoccupied by a completely different aspect of their appearance."

Skin receives the most attention from sufferers (73 percent), while the chest gets the least (21 percent). The hair, nose and stomach are also popular objects of obsession.

O'Connor's approach to treatment is to look at the reasons a person starts criticizing a part of his or her body in the first place. The source is difficult to pin down – whether genetic, parental influence or stress – but the consequences can be serious, including suicide.

"This problem can affect all aspects of life, work, studies and love and family relationships," says O'Connor. "It can stop someone from going out, or at least hiding the body part about which he or she is obsessing."

Men are feeling more pressure than ever before to look a certain way -- the same pressure women have been dealing with for decades now. With the pressure comes various manifestations of OCD, especially in those who are already dealing with some form of anxiety disorder (general anxiety or social anxiety in particular) or childhood trauma (often abuse of some form).

Among men dealing with bigorexia, steroid use often becomes a problem. Steroids are not physically addictive the way crack or heroin are (although the body does quit making its own testosterone when the drugs are abused for too long), but the increase in self-confidence and size that comes with use can be very psychologically addictive.

The result is that even among those educated in steroid use, they don't cycle off, staying on the drugs far too long at too high of a weekly dose. The results can be devastating, as these pictures from Wired illustrate.

Steroidwarning_3Know anybody who's using steroids and just won't stop, despite all your good advice?

Then show them this picture. (Potentially NSFW, and gross -- hence its after-the-jump position.)

Depicted is a 21-year-old amateur bodybuilder who arrived at a clinic in Dusseldorf, Germany with severe acne on his chest and upper back.

He was a constant user of anabolic-androgenic steroids, of which acne is a side effect -- as is damaged sperm and shrunken testicles, both of which he also possessed.

Doctors ordered the patient to quit steroids and start taking antibiotics. Two months later, the acne was gone. So was the muscle. Only gruesome scarring remained -- and as his doctors wrote last week in the Lancet, that "is likely to remain with the young man for the rest of his life."

Clinical Picture: The Dire Consequences of Doping [Lancet]

See Also:

Scary, eh?

That is an extreme case. What generally happens is easier to look at, unless you happen to be the guy who gets "bitch tits," more appropriately known as gynecomastia (notice the swollen nipple area in the first picture above).

The breast tissue forms as a result of the increased testosterone, which then increases estrodiol levels (the most potent estrogen form), thus producing the growth of breast tissue. The body likes to maintain equilibrium so increasing one hormone results in the increase of others, in this case through the process of aromatase converting testosterone to estrogen and estrodiol.

This can be equally devastating for young men, resulting in more drug use and if the issue persists, the need for surgery. The damage to the psyche of someone already dealing BDD can be overwhelming.

* * *

It's impossible to nail this issue down to one cause. Among the many contributing factors are low self-esteem, anxiety, childhood trauma, social pressures, media pressures, and many other lesser, more personal triggers.

This post over at the Neurocritic looks at the issue of media images and men's lifestyle magazines (FHM, Nuts, Maxim, GQ, Esquire, Zoo, Loaded, Bizarre and Stuff) and how they might contribute to BDD. He also notices that English women like their men a bit femme, or, uh, metrosexual.

In the end, it all comes down to how we raise our boys. Do they have an inner sense of self-worth and agency in their lives, or do they worry too much about what others think and how they are perceived? Boys develop one way or the other depending on how they are raised, their friends, and the degree of self-reliance they accrue. It certainly isn't all about parenting, but good parents shape what kids are exposed to and help them contextualize harmful images.

1 comment:

Anonymous said...

There are a number of stressful medical conditions affecting many of us today. One of the broadest topics is anxiety disorders, with millions of people suffering to some degree or another. Specific symptoms vary greatly from person to person. As anxiety disorders grow progressively worse without treatment you should see your doctor immediately if you suspect that you may be suffering from one of these illnesses.