When the father of one of my students came to see me about concerns over his child’s body image issues, I was shocked. I’d asked to see the parents of this particular student because they had become increasingly disengaged from learning, defiant, disrespectful and unhappy.
The student’s father explained how the behaviour just wasn’t at school, and that his 15-year-old was becoming distressed, crying and staying locked in the bedroom for hours, lashing out at the family when they tried to intervene.
After living through the nightmare of a daughter with an eating disorder, I knew the torment, helplessness and bewilderment this father was feeling — but there was one major difference, gender. It was his 15-year-old son who was so full of self-loathing and self-disgust.
The incidence of men — and not just young men — being diagnosed with an eating disorder is on the rise, a claim supported by statistics presented by the eating disorder support group, the Butterfly Foundation. Its latest report, Investing in Need, on the economic cost of eating disorders in Australia this year, found one in four children with anorexia in Australia are boys and almost a third of Year Nine boys use dangerous methods to try and keep thin. It also stated that of Australians aged 11–24 years, approximately 28 per cent of males are dissatisfied with their appearance.
Is it a trend that has started only recently with the constant assault through social media, television and films of the idealised male body?
But is it a trend that has started only recently with the constant assault through social media, television and films of the idealised male body? Or is it only now that eating disorders have come out from the dark in which sufferers used to hide that professionals are beginning to realise this is not a privileged, first world, caucasian girl disease of vanity but a mental illness that knows no bounds?
According to the National Eating Disorders Collaboration (NEDC) Australia, the rates of body dissatisfaction in males are rapidly approaching those of females, but for men this body dissatisfaction is more commonly manifested as the pursuit of a muscular, lean physique rather than a lower body weight.
According to the NEDC, male athletes have an increased vulnerability to eating disorders, particularly those in sports with a greater emphasis on weight classes and aesthetic ideals such as weight lifters, wrestlers, gymnasts, dancers, jockeys and body builders. For some males, heightened concerns about muscularity may become part of an eating disorder, characterised by distorted perceptions about muscle bulk, and /or distorted eating and exercise patterns.
Clinical psychologist and UOW alumnus Rodney Ward specialises in body dysmorphia and eating disorders and says he has noticed a rise in referrals for men.
“I believe men may be less likely to ask for help on these issues and I believe that therapists need to be vigilant and ask specific questions regarding body image if they suspect body image concerns with their client,” he says.
“Body image concerns are often co-morbid with depression and other anxiety disorders, especially obsessive-compulsive disorder and social anxiety disorder. I have noticed a younger, early-to-late adolescent age group; however, I have seen these concerns in males into their 40s.
“I believe that because the factors that we draw our esteem from become more multidimensional as we get older (career, family, relationships), this may moderate the body image concerns somewhat.”
UOW Professorial Fellow Jan Wright has been studying body image and eating disorders among pre-teen boys and says it is a complex issue, the causes of which cannot be neatly divided into easily 'digestible' parts.
“Eating disorders among pre-teen boys are not necessarily to do with just their bodies. They are much more complex and have a lot of emotional issues as well,” Wright says.
“Of course pre-teen boys, like pre-teen girls, are concerned with their bodies and the masculine ideals they are exposed to through social media and other areas, but the development of eating disorders is a lot more complicated.”
Anorexia Athletica is a condition in which people over-exercise because they believe this will control their bodies and give them a sense of power, control and self-respect
Eating disorders can be put into five main categories. The most common are Anorexia Nervosa and Bulimia and these are the two that get most recognition.
But there is an increasing number of women and men falling prey to eating disorders that are much harder to categorise. Orthorexia is an obsession with health and healthy eating, Eating Disorder Not Otherwise Specified (EDNOS) is characterised by extremely disturbed eating habits, a distorted body image and an intense fear of gaining weight and Anorexia Athletica is a condition in which people over-exercise because they believe this will control their bodies and give them a sense of power, control and self-respect.
More commonly men and boys are falling into the last three categories, especially Anorexia Athletica and Orthorexia, and it is these which Dr Gabrielle O’Flynn, a lecturer in the School of Education at UOW, is trying to help teachers understand so they can, in turn, educate the next generation of young men.Dr O’Flynn has been studying how young men and women define health in general, and she believes the changing definition of health has in part contributed to the rising incidence of body dysmorphia and eating disorders among young people.
“A generation ago people equated health with being free of disease,” Dr O’Flynn says.
“What we have found now that is most compelling is that young people see health as having a ‘fit body’. Young men conflate this with having fit, purposeful bodies, and there was a pattern of how they defined health with the male idealised body but also defined health as a strong body.
“This leads to health being much more about an image — so there is then guilt, self-loathing, dissatisfaction with themselves — and what young people are then missing is that there are ways to experience health that is not about image. What is silenced are the ways of engaging with their body for pleasure, fun and happiness.”
Dr O’Flynn says that culturally young men and women are now fixed on body shape as a way of defining health, but she says that this can not all be blamed on the media.
“The idea of the perfect body is taken up by young men who are quite educated, and it results in actions that are very calculated,” she says.
“For example, these young men may know the dangers of taking drugs like steroids but they believe the risk far outweighs the benefits of having what they see as a strong, healthy body which transfers into an image of self-control and strength.”
Dr O’Flynn says pre-service teachers still come to university with a preconceived and narrow definition of what health is, and it is imperative they are taught the broader definition of health in order to educate the young people under their care.
The diagnosis of an eating disorder among men is much harder to ascertain according to the NEDC because of the reluctance of men to admit they may have a problem which is usually associated with women.
This reluctance to seek help because they don’t want to appear weak or vulnerable has led to a stigma around mental illness that has delayed treatment and support for many males with eating disorders.
However, the NEDC notes there are physical, psychological and behavioural warning signs that can signal the onset or the presence of an eating disorder in a male or a female but there are some warning signs that are more likely to occur in males.
These include a preoccupation with body building, weight lifting or muscle toning, weight lifting when injured, lowered testosterone, anxiety/stress over missing workouts, muscular weakness, decreased interest in sex, or fears around sex, possible conflict over gender identity or sexual orientation, and the use of anabolic steroids.
Compounding this is the socio-cultural influences that imply that over-exercising and the extreme pursuit of muscle growth are seen as healthy behaviours for men and can even be actively encouraged when in fact these activities can indicate a significant disorder and lead to severe physical health problems.
Imparting the message about a balanced approach to nutrition and exercise is one of the main challenges UOW alumnus Brendon Smith faces in his business VO2 Vitality Fitness.
After graduating from UOW in 2010 with a Bachelor of Arts and Commerce, Smith found himself working not in the finance industry but in the fitness industry where he is an advocate of bringing a healthy balance to his clients’ exercise and lifestyle needs.
Within the fitness industry there is a preoccupation by some operators on the way clients look rather than on the health benefits of proper exercise and nutrition
He does admit however, that within the fitness industry there is a preoccupation by some operators on the way clients look rather than on the health benefits of proper exercise and nutrition.
“There are polar opposites in the industry when it comes to body ideals and it depends on the culture in which people train,” he says.
“In my business we try to emphasise a very relaxed atmosphere, where there is no ego and not a strong drive to look a certain way. We promote good health rather than body image.”
Smith says this vulnerability to achieve the ideal male body shape crosses all demographics and although younger men may be more impressionable, the tipping point into an eating disorder can happen at any stage.
Smith says he believes strongly in getting the message across to his clients that every body is different and should not be trained in the same way.
“Having good nutrition and being healthy has to be a lifestyle. Taking diet as an ideology has its flaws,” he says.
Ward warns however, that there is a misconception that eating disorders and body dysmorphia symptoms are concerned only with wanting to lose weight.
“In fact, body image being weight-related can be a criterion against a diagnosis of body dysmorphia. The Body Dysmorphic Disorder (BDD) diagnostic criteria specifies that the concern must be a preoccupation with an imagined defect in appearance rather than purely weight concern, and if weight concern is identified a clinician should ascertain whether an eating disorder is a more accurate diagnosis,” he says.
Sufferers of ‘Muscle Dysmorphia’ (a form of BDD) may think they look too small or inadequately muscular and may wear layers of clothing to enhance their size, excessively lift weights or use potentially dangerous anabolic steroids to ‘bulk up’.”
Like women, men are affected by what they see and what they hear, says Ward. Although there is no specific research or findings on the way in which social media especially is influencing the incidence of male body dysmorphia, he says the media does often portray an idealised image of what it means to be a male.
“You have only to watch TV programs such as The Footy Show that often has professional muscular athletes with their shirts off in the program and other promotions on TV such as the Fireman’s Calendar also showing heavily muscular males,” he says.
“If you were an individual with these [body image] concerns and values, you could be influenced by what you are seeing on the media and would obviously be drawn to such programs and advertisements.”
Ward says that although he personally believes there is more expectation and focus on women’s bodies and body types than men, he also believes there are now similar manifestations in regards to foods, and these obsessions over healthy (clean) foods are evident in males with body image concerns.
“Generally speaking, [body dysmorphia] can affect men in areas such as social functioning, occupational functioning and activities of daily living. It may also affect them interpersonally in relationships due to the amount of time spent on their obsession or the safety behaviours they carry out,” he says.
“Sometimes individuals have a peer group with similar behaviours so the behaviours may not be as noticeable if a large part of their peer group have the same value, however, when they step away from that peer group it may be more obvious.”
Cathy Anderson, Psychologist, with the Illawarra Eating Disorders Service and graduate of UOW says the prevalence of body dysmorphic disorder in males is difficult to estimate because of underreporting by those who suffer it, and under-diagnosis as presenting for help is usually around an associated issue and not the BDD itself.
“Generally, BDD usually starts in adolescence, but unless they present for treatment of another problem such as anxiety, or social phobia, it usually goes undetected for many years. Various reports suggest it can be present for up to 10 to 15 years prior to first presentation for psychological treatment,” she says.
Stigma abounds around many mental illnesses. Eating disorders and [Body Dysmorphic Disorder] are no different
“Stigma abounds around many mental illnesses. Eating disorders and BDD are no different. When the preoccupation is muscle dysmorphia, it is easy to see why this could be misconstrued as a ‘lifestyle choice’ with excessive time spent working out and obsessing about diets.
“These men and women see themselves as defective, become isolated, and at its worst find it difficult to maintain relationships or employment — this is where we see the impairment of this mental illness is significant, and certainly not a lifestyle choice.
“Eating disorders are ways of coping with psychological and emotional issues, that serve a function — the name is a misnomer as the illness is not really about food, but the food is the tool by which they get their needs met.”
Anderson says although the media and the rise of social media have made an impact on the way men view themselves, they can’t be wholly ‘blamed’ for the rise in male eating disorders.
“The NEDC has released a document for the sporting and fitness industry which states ‘Eating disorders and disordered eating may occur in people who are regarded by society as being extremely fit and healthy. Both males and females engaged in competitive physical activities, including sports, fitness and dance, have increased rates of body dissatisfaction, disordered eating and eating disorders’. Clearly there is a place for fitness and health related practices, and NEDC is committed to working collaboratively with these industries to achieve a balance where eating disorders exist.
“What we can surmise is that for those men with vulnerability to the development of an eating disorder, they have also had this visual explosion of male lean, muscular, powerful bodies alongside a multitude of other predisposing factors (genetic vulnerability, psychological factors and socio-cultural influences) which in turn have contributed to eating disorders in men,” she says.
- KEELI CAMBOURNE, AUTHOR
Master of Arts (Journalism), UOW (1994 )
Graduate Diploma in Education Secondary, UOW (2013)
Keeli Cambourne is a UOW alumna with a Master of Arts (Journalism) and a Graduate Diploma in Education Secondary. She worked for Australia’s major newspapers in her journalism career and is now teaching secondary students the joy of writing.
- CATHY ANDERSON
Bachelor of Science (Psychology), UOW (1996)
Masters of Science (Mental Health), UOW (1998)
- DR GABRIELLE O'FLYNN
Bachelor of Education (Physical Health and Education) (Hons), UOW (1999)
Doctor of Philosophy (Education), UOW (2004)
- BRENDON SMITH
Bachelor of Arts and Bachelor of Commerce (English Literature and Finance), UOW (2010)
- RODNEY WARD
Bachelor of Psychology, UOW (2001)
- PROFESSOR JAN WRIGHT
Doctor of Philosophy (Education), UOW (1992)