Bigorexia - when bulking up can bring you down
While everyone is aware of anorexia, a condition that usually affects women and causes sufferers to mistakenly believe they are fat, fewer of us may know about the inverse form of the disease that affects men - muscle dysmorphia.
Those affected tend to over-exercise because they become convinced they are small or puny. However, the condition causes the same obsessive and unhealthy behaviour as anorexia. Muscle dysmorphia has even been dubbed "bigorexia" in recognition of the link.
Despite several recent studies, no one knows how many men are affected. One US study found half of the bodybuilders at a Boston gym were showing symptoms, and another discovered that 6-7 per cent of US high school boys were taking steroids, possibly as a result of the condition.
Sufferers obsess that they are small or underdeveloped and, even though they tend to have significantly more muscle mass than the average man, continue to believe they are inadequate. This leads to compulsive exercise and weight lifting and, more dangerously, unsuitable diets and muscle-building drugs such as steroids.
And the problem is likely to get worse before it gets better. Peter Baker, director of the Men's Health Forum, says, "All the evidence suggests this is a growing problem. More and more men are being affected and are growing addicted to exercise and steroids."
Overworking the body, eating low-fat, high-protein diets and using steroids is a potentially fatal combination, frequently responsible for kidney failure and various forms of cancer.
However, the psychological effects are just as damaging. Acknowledged expert in this field, psychiatrist Katharine Phillips of Brown University School of Medicine in the US has found that men with the condition become preoccupied with their appearance and in fixing "defects".
Many constantly seek reassurance, or carry out excessive grooming - sometimes even wearing hats to disguise themselves. This behaviour can cause social isolation, anxiety, stress, problems with work and personal life, unemployment and depression. In some cases sufferers even seek surgical solutions, and suicide and violence are a continual danger.
So why do men get muscle dysmorphia? One researcher into the condition, Dr Precilla Choi of Victoria University in Melbourne, Australia, says the illness could be one negative consequence of physical exercise behaviour, in a changing culture where men's bodies are becoming more visible and working out is accepted as a desirable activity.
Peter Baker sees it as the manifestation of a wider problem. "This is just the tip of the iceberg," he says. "There is a much wider group of men that feel anxious due to the changing role of men in society. A lot of men are feeling diminished, feel they are losing power and so they turn to the one area where they can feel bigger and more powerful."
Men are also faced with an increasing number of media images of "perfect" bodies. It used to be only women who were bombarded with pictures of models but now good-looking men sporting that modern shorthand for healthiness, a six-pack stomach, are everywhere. "It's not surprising if men become increasingly insecure," says Peter.
Tackle the problem
The important thing though is to recognise and tackle the problem. Bigorexia remains chronically under-diagnosed. This is partly because those in a position to notice potential sufferers are not aware of the condition.
But then men can also be their own worst enemy. Many are reluctant to reveal what they are doing out of embarrassment or shame; many more reject any advice given.
Peter Baker says people in the health industry are best placed to detect possible cases. "Of course, they have a vested interest," he says. "But they also have a responsibility to encourage healthy exercise."
But if someone can be persuaded to deal with the problem, help is out there. Katharine Phillips says counselling has little effect and points to cognitive behavioural therapy - getting people to think about what they do and why they do it - as the best way of tackling bigorexia.
For example, men can be encouraged to get rid of a weight scale, limit how long they spend in front of a mirror, and recognise that many women prefer athletic rather than big men, and so on.
Serotonin selective re-uptake inhibitors like Prozac can also help people deal with muscle dysmorphia by tackling long-standing emotional problems.
The most important thing, though, is for men suffering from muscle dysmorphia to recognise and deal with their problem. Otherwise they could find that building themselves up actually starts to knock them down.
Men's Health Forum - www.menshealthforum.org.uk