What You Need To Know About Muscle Dysmorphia And How To Overcome it – Men’s Health


Posted: January 9, 2020 at 8:41 pm

During the previous year Mitch had transformed from a lean, lightly muscled 22-year-old into a Goliath whod have looked at home in the Wallabies front row. Though he was enrolled in a university course and showed up to lectures sometimes, mostly he thought about the proportions of his physique and how to expand them. At home he moved as little as possible so his body could use its reserves of energy to build muscle rather than to fuel counterproductive activities like taking out the rubbish.

Id eat six meals a day. And by meal I dont mean a piece of toast. I mean a big serving of meat, rice and vegetables, says Mitch. After rinsing his plate he would go lie on his bed and watch bodybuilding videos on YouTube until it was time to eat again. His transformation was Hulk-like, his heft topping out at 113 kilograms, up from the 81 kilograms he weighed during what he calls his last year of being normal.

To his mates Mitch looked colossal and they told him as much while asking for his training program. But was Mitch happy? Not one bit. In his mind he was still too small, and the man in the mirror looked nothing like the musclemen he admired on YouTube and in bodybuilding magazines. His heart raced in bed at night and his doctor told him his blood pressure was elevated. Getting big meant everything to him. Why was no amount of training or attention to diet delivering? And what else could he do? Through a mist of anxiety and frustration he could see a single ray of hope: anabolic steroids.

Unbeknown to Mitch he was suffering from a psychological disorder called muscle dysmorphia (MD), more commonly known as bigorexia. While MD started appearing in the medical literature only in the late 1990s, it was an affliction well-known in bodybuilding circles long before then, though devotees regarded it not as some dire malady but rather as an almost inevitable side effect of their calling the common cold of lifters.

RELATED: What Is Body Dysmorphic Disorder - And Could You Have It?

A helpful way to think of muscle dysmorphia is to imagine the reverse of anorexia, says Scott Griffiths, a psychologist and NHMRC research fellow at the Universityof Melbourne. Instead of people who want to be thin at all costs and who are never satisfied with how thin they get, you have individuals who are preoccupied with getting muscular. They devote a lot of effort into getting there and often are very muscular, but its never enough for them. This preoccupation is MDs defining symptom. For sufferers, the average time spent every day thinking about getting bigger, or yearning to be more defined, or loathing their smallness is a staggering five hours. Tack on the hours dedicated to tinkering with workout routines, pumping iron and prepping meals and you can see theres not a lot of time left to keep your career ticking along or listen sympathetically to your partners account of a rough day.

Someone with muscle dysmorphia would be able to see other people quite accurately . . . its himself he wouldnt be able to see, says Tracey Wade, a professor in psychology at Flinders University and a clinician whos spent 30 years treating eating disorders. He will look in the mirror and focus on every perceived flaw. Theres a sense of inferiority and even self-disgust about how his body looks, even though it looks absolutely fine to everybody else. MD sufferers cant be reassured, however. Even if they resemble Chris Hemsworth in Thor, they wont believe you when you tell them theyre jacked.

Best estimates are that MD affects between 1-3 per cent of men. Theres no definitive statistic, researchers say, because someone with MD is as likely to suffer in silence or consult a plastic surgeon about calf implants as to see a doctor.

But prevalence is rising. We know that because theres excellent data on anabolic steroid use in Australia, and for six of the last seven years the most commonly reported last-injected drug among new injection-drug users has been steroids. Every indication is that steroid use in this country is increasing, and because half of MD sufferers also use steroids its inconceivable that MD is also not increasing, says Griffiths.

Heres something else to think about: experts reckon its a fine line between the dedicated recreational trainer (someone like you, perhaps) and the intense bloke you see on Wednesdays at the squat rack who actually has MD. Underneath, I think were more similar than we are different to these guys, says Mair Underwood, an anthropologist at the University of Queensland.

Underwood is well-placed to know. In 2015, as a mother-of-two in her forties, she began a research project into Australias bodybuilding community. Over several years she spoke with hundreds of bodybuilders in person and to thousands more in online forums and Facebook groups. (By bodybuilder, she clarifies, she means anyone who lifts weights with the aim of improving their appearance.)

She started her research, she says, with no intention of lifting anything heavier than a pen, but came to believe her subjects would respect her more if she had visible abs. She started lifting weights and working with a sports nutritionist, and before long was counting macronutrients.

The resultant changes werent confined to her body. Some days Id look in the mirror and go, Oh, youre nearly there, youre looking great! And the next day I could look in the mirror and go, Oh, you are fat and disgusting. You are so far from your goal. Youre never going to make it, recalls Underwood. The swings in my body image got wilder and my relationship with food became problematic. A year ago she decided to pull back because I could see how slippery the slope is.

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While psychologist colleagues had warned her that immersing herself in the milieu of hardcore bodybuilding could mess with her head, she all but scoffed. As an academic I felt my mind was who I am and my body is just this vessel that carts it about, she says. Training her body, however, awakened her to its power. The sensations of surging strength and expanding musculature are intoxicating. As a woman she was much less vulnerable than you are to having psychological issues around muscularity, yet still she felt she was on the verge of a body-image crisis.

Kieran Kennedy, a doctor based in Melbourne whos also a natural bodybuilder and fitness model, agrees theres a grey area separating a healthy motivation to build muscle and the pathology of MD. Even for me thereve been times when Ive felt the drive for a certain aesthetic starting to take over, he says. In the end you have to ask yourself whether your training is, on the whole, producing more positive feelings than negative ones.

Among seasoned lifters, Underwood says, its accepted that only during a guys first few months of training will he experience a pure satisfaction with his body. Beginner gains are exhilarating! In time, however, you can too easily slide into a quest that brings only the merest trickles of joy interspersed with torrents of frustration, self-loathing and despair. Youre losing size! Your triceps are lagging! Youre not cut enough! Its not that only mentally disturbed guys get hooked on bodybuilding. Rather, bodybuilding itself can take hold of perfectly rational men and send them a little bit mad.

Mitch had dabbled in weight training in his teens with no ill effects. The turning point came when a cousin gave him a copy of Samuel Fussells Muscle: Confessions of an Unlikely Bodybuilder. A rollicking account of the authors descent into obsession, Muscle is ultimately a cautionary tale though great slabs of it could easily be interpreted by the malebrain as a celebration of the pursuit of mass.

juice at a cafe on Sydneys north shore. Steered into this story by a third party, he tells me straight off that Mitch isnt his real name. He works in the fitness industry these days, he explains, and doesnt want colleagues or clients knowing that he lost the plot for a while.

Looking back on the five or six years he spent in the grip of MD, Mitch says his dominant emotion is grief. Hed been an avid cricketer and soccer player but quit both sports because they were interfering with his physique goals. Hed loved parties and hitting the city with his mates to meet girls but stopped staying out past 9pm in order to maximise repair during sleep. The need to be muscular became more important than anything else, his health included. I wastedwhat could have been the best years of my life.

As to what might have predisposed him to MD, he says he often felt lost and angry as a teenager (join the club!), bored by school and unsure of his strengths, which certainly werent academic. At the same time he was drawn to hypermasculine entities Rambo and Terminator movies, the Bra Boys, rugby league, heavy metal. Putting on muscle got me noticed, says Mitch, who these days looks fit though not conspicuously like someone who pumps heavy iron. It got me respect. Guys who wouldnt have given me much at school wanted to hang around with me.

What leaves you open to MD are the same factors that predispose you to any obsessive-compulsive disorder, researchers say. Perfectionism interacting with low selfesteem is a particularly potent mix. People who dont feel good about themselves will try harder and harder to control their body in order to feel better, but they dont feel better, says Wade. Its a vicious cycle because the real problem is not how they appear; its how they feel about themselves.

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Mitch came close to using steroids but in the end stopped short. I cant remember how it came up but I remember my dad said to me, If you start using steroids Ill kick you out of the house. That stunned me because hes never talked to me like that before or since. It made me think that I might have been going too far. I still thought about using steroids another thousand times, but I never did.

Mitch dodged a bullet. Once someone with MD starts taking steroids he can find it extremely hard to stop. Why? Because they work. If you use laxatives and diuretics to lose weight then youre out of luck because they dont work, says Griffiths. They dont work in your system fast enough to stop calorie absorption. But steroids, unfortunately, do work. And at least for a little while you feel good.

Alas, the preoccupation and underlying self-disgust persist. And if you come off the steroids you will literally shrink in a few weeks. So, you stay on them. And, in time, you probably up the dosage, wreaking havoc on your endocrine system and spiking your odds of having a heart attack or stroke. Even if, like Mitch, you refrain from using steroids, MD can still prove fatal: in a US study of MD sufferers, half reported having attempted suicide.

When it comes to the drivers of MD, Underwood believes theres something larger at play than an individuals psychological makeup. Although the muscular ideal dates back centuries, never has it been as pervasive nor as mainstream as it is now, and never has the perfect male body been so thoroughly ripped. (At Mens Health, by the way, wereclear-eyed about our own role in promoting the muscular ideal.)

Until recently action figures depicted regular-looking humans. Nowadays theyre often plastic behemoths; even little Luke Skywalker has been designed as positively swole. Superhero costumes come embellished with six-packs and bulging pecs. With their regular-Joe bodies, the screen heroes of yesteryear wouldnt have landed a role in todays blockbusters. Personal trainers report clients are eschewing reality for sources of physique inspiration, preferring the likes of Dragon Balls Goku or Street Fighters Ryu. Western cultures message to men, says Underwood, is that your body is a project. And unless youre working on it constantly striving ever more assiduously to make it bigger, leaner, more vascular then you should be ashamed of yourself, pencil-neck.

If your response to this onslaught is to become fixated on training and diet to the point where you develop MD, does that make you an outlier? Or are you actually an overconformist? What we label as pathological can be seen as a rational response to an irrational situation, says Underwood. MD sufferers need psychological treatment, she adds, but dont kid yourself theyre freaks while the rest of us are fine. We cant just treat the tip of the iceberg, which is what were doing now, she says. We dont consider how we, as a society, create an environment that is ripe for MD. We put it all on the individual.

Social media is upping the pressure on men to muscle up. Your Instagram feed is a 24/7 invitation to compare your body to others. Its an endless carousel of images that can and often will be curated such that you come out on the negative end, says Griffiths. Most adults can rationalise this stuff and understand they dont have to look this way, but thats prefrontal-cortex work and not a skill people are born with. Boys now are growing up in this space without the brain development to discern and resist.

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Tired of living in his own tormented head, Mitch finally put himself in front of atherapist, who delivered the MD verdict. He remembers being comforted to hear there was a label for how hed been feeling: I actually started crying a bit and thanked her.

Diagnosis, of course, isnt the finish line. Clinicians tasked with treating a client with muscle dysmorphia may feel overwhelmed by the complexity of the disorder and stymied by the paucity of clinical advice available to them, says Griffiths. In Mitchs case, treatment was cognitive behavioural therapy backed by SSRI antidepressants, which can slow the stampede of obsessive thoughts.

Over a period of months Mitchs therapist tried to unpick his conceptions of what it meant to be a man, as well as his fears about what would happen were he to back off on his training and shed some of his muscle. Gradually, Mitch says, he came to realise that his raison detre amounted to more than chiselling his body into a certain shape.

But is he cured? I dont know this ever leaves you completely, says Mitch. Im not obsessed with being big anymore, but I can still feel guilty if I dont touch a barbell for a week or I eat junk. I still dont like taking my shirt off in public unless I know Im in good shape, which is never.

In a way, he says, just growing up and taking on new responsibilities helped sort him out. My fiance handles me exactly right. When I start acting crazy she just makes a joke of it. These days I can see the funny side, too. He can even laugh about getting in the grill of his cat that time. I actually apologised to him for that.

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What You Need To Know About Muscle Dysmorphia And How To Overcome it - Men's Health

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