Male body image disorders.

When we think of body image issues, most of us will think of the image of a young girl, so thin she looks ill, and all she thinks of is her weight. She diets constantly, she may exercise all the time, and she may even binge then purge the food she does eat. These are the classic examples of these issues, and they are very serious. But there is a disorder that is only now getting the attention it needs. It is a male-based problem labeled Muscle Dysmorphia. This problem is growing at a rapid pace.

I recently read of this problem, and then I had the opportunity to see several examples that help to feed it. Much as women's groups point out the images we see as examples of how ideal females should look, the same issue is now surfacing with men. On television soap operas the average male is young, square jawed, and built like Michelangelo's David--lean and muscular. Taking it a step farther, if GI Joe Extreme were life-sized, he would have a 48-inch chest, 32-inch waist (with cuts) and impossible 32-inch biceps. The problem with these images, just as with super thin females, is that they create a blueprint for the masculine man that is impossible for most men to achieve without resorting to unhealthy measures, such as working out obsessively, taking steroids, using laxatives, and becoming anorexic or bulimic.

Here is the American Psychiatric Association's Diagnostic and Statistical Manual (DSM-IV) listing for these problems:

Anorexia Nervosa: Eating disorder marked by extreme dieting and starvation. Is underweight by 20% and refuses to reach appropriate body weight for height and age. Has intense fear (phobic) of gaining weight, even though underweight. Denies seriousness of underweight problem, and self evaluation is affected tremendously by weight and shape. Females may have missed menstrual cycles.

Bulimia Nervosa: Eating disorder marked by binge eating and practices to get rid of the consumed food. Has recurring episodes of eating larger than normal amounts of food and feels lack of control while binge eating. Has recurring compensatory behaviors to prevent weight gain, such as self-induced vomiting, misuse of laxatives, diuretics, enemas and other medications, fasting and excessive exercise. Influenced tremendously by body shape and weight.

Binge Eating: Disorder marked by eating abnormally large amounts of food and lack of control while eating. Eats more rapidly than normal. Eats until feeling uncomfortable. Eats large amounts of food, even when not hungry. Eats alone because of feeling embarrassed about the amount of food consumed. Feels distressed, depressed, very guilty, or disgusted with him/herself because of eating behavior.

Muscle Dysmorphia: Man believes body not sufficiently lean and muscular. A man must have at least two of these symptoms: Gives up important work, social, or leisure activities because of compulsive need to maintain workout or diet schedule. Avoids situations when body is exposed to others, or endures those situations with stress or anxiety. Experiences significant distress or is unable to function day to day because of preoccupation with inadequacy of body size or musculature. Continues to work out, diet, use performance-enhancing substances despite knowledge of adverse affects.

Men who seek help are often left out because of several factors: Is it that it's a new issue just coming to light; they have the mistaken idea that only women experience these issues; and the fact that most support groups are primarily female?

I had a client who was in the advanced stages of Bulimia. When he first presented, he wanted to lose weight. Since he was not apparently overweight, I asked him his goal. He stated he needed a way to control his weight besides throwing up. When I brought up Bulimia, he said no way, that's a girl's disease. He only came in because a friend caught him purging after eating some pizza and convinced him to come in for some help.

Since I have treated these problems in the past, I started by giving him a lot of information on these problems. I brought up the fact that eating problems are rarely about food itself. They may be a metaphor for something else. A man who manifests an eating problem and body obsession sometimes thinks he can control food, but the food really controls him. I worked with him by using some time line conversion techniques, mainly re-parenting. I had him re-program himself with a better body image, proper use of food, and also a lot of male imaging techniques.

I had another client, a professional body builder, who came in for some motivation. While we were talking (using rapport skills), he revealed that to this day when he looks in the mirror, he still sees the scrawny little guy who could not make the freshman football team. At that time he was 5 foot 5 inches tall and weighed 134 pounds. He was now 5 foot 10 inches tall and his contest weight was 215-225 with 2.5% body fat. He was huge. But he wanted motivation to get bigger. He still saw that little boy. He also had masculine issues, again with body image. Much as the girl who is starving to death only sees fat, he only saw the distorted image. This is what we need to reprogram.

Here are the steps for re-parenting:

1. Identify Problem State. Think of a time when your parent(s) did not make the best choice in your life, something that has affected you ever since.

2. Access and ANCHOR Problem State. When you think of this now, do you feel bad? ANCHOR the state with a touch. ANCHOR #1

3. Identify Resource. What resource (courage, humor, compassion, etc.) do you now have that you wish your parents had back then?

4. Think of a time you had a lot of this resource. ANCHOR #2

5. Integration. Take this special resource (fire ANCHOR #2) back into this memory with the parent(s) (fire ANCHOR #1) and find out what happens with this resource available to you and your parent(s). Watch and listen as you relive that old memory in a new way. Take your time, and then come on back.

6. Test. Ask the client about that memory. What difference do you now notice? Check nonverbal responses.

Please take this to heart; this is a serious problem that is growing.

Steroid use for young males is up, as is the use of other substances which compound this problem.

References:

DSM IV

Looking Good: Male Body Image in America by Lynne Luciano

National Association of Anorexia Nervosa and Associated Disorders

American Anorexia Bulimia Association

Eating Disorders Awareness and Prevention Network

Dr. Wil Horton is a member of IMDHA; http://www.nfnlp.com.