The Times: Rise of the new neurotics - Men and body dysmorphic disorder
A male model feels too ugly to go out, a Porsche owner seeks his second penis extension. David Rowan finds modern life is making men as insecure as women
For a former catwalk model, Mark Adams is strangely insistent that he is ugly. At six foot three (1.90m), well-muscled and with a stylish dress sense, Mark, in his mid-thirties, has no problems finding girlfriends -indeed, he separated only recently from his partner of three years. But even though he is often told how attractive he is, Mark, based in Liverpool, persistently sees a very different truth. So convinced is he that he looks like a "freak" that at one stage he locked himself in his room for almost six months.
"I've been suffering like this since I was 18, not wanting to talk about it for years, as it was unheard of for someone to be too uncomfortable with their appearance to leave the house," he says. "At times I considered ending it all. It's hard to explain it, but I'm just uncomfortable with what I see on me. If you have an off day, you might relate to that - except that for me, it's 24/7. It takes over your life."
The physical self-repulsion did not diminish even after Mark was invited to model clothes, having been spotted by a fashion designer in the Covent Garden cocktail bar where he was working. That led to a three-year career on the catwalk, until his discomfort at being photographed left him unable to continue. "I've had a lot of girlfriends, and people tell me I'm nice, but I see what I see," he sighs wearily. "I know I'm a bit of a contradiction. A lot of people don't believe me. But it's not attention I seek -I just want to get better."
It was only when he read a newspaper article about a man with body dysmorphic disorder (BDD) did Mark decide to seek help. The symptoms were all too familiar: BDD, as defined by psychiatrists, gives sufferers a distorted sense of their physical imperfections, so that they exercise or diet or shun mirrors beyond all reason. Many doctors were initially sceptical that the condition existed among men, but diagnosis and treatment programmes have been boosted in the past four years by a bestselling book by clinicians that has caught the media's attention: The Adonis Complex: The Secret Crisis of Male Body Obsession.
Having undergone psychotherapy, hypnotherapy and psychoanalysis - he is also on an NHS waiting list for cognitive behavioural therapy - Mark has come to understand more about what he calls his illness. Why, for instance, he has been working out obsessively at the gym for the past 11 years, "I suppose that in order to combat how I feel, I need to make up in other ways", and how his family upbringing contributed to his uncontrolled self-hatred.
"My Dad was very negative towards me, sometimes violent. That can set the seed for BDD," says Mark. His occasional lapses into therapy-speak suggest that its jargon provides a protective wall, but he can also be painfully honest. "Dad would mock me, be very critical," he recalls. "You grow up feeling you're not right, somehow inadequate."
Yet he also believes that the relentless media onslaught of "perfect" male images has contributed. "It's like how some women were feeling about Page Three girls 20 years ago," he says. "These media images portray men in ways that, for most of us, are not achievable. They're leading women to want men with six-packs, making that the ideal. The magazine editors ought to point out that Freddie Ljungberg has the time to work at looking like that."
Having learnt more about the condition, and been in touch with the obsessive compulsive disorder support group OCD Action, Mark now believes that BDD is where anorexia was 20 years ago, when it became more widely accepted as an illness. "BDD will become increasingly common over the next few years as men face more of these unrealistic pressures to look better," he says. "Look at all these magazine cover stars who have had plastic surgery. That's what people are aspiring to. And that's only going to grow as these images make us feel more insecure and imperfect."
The authors of The Adonis Complex would tend to agree. One of them, Professor Katharine Phillips - a psychiatrist who runs a body-dysmorphic disorder and body-image programme at Butler Hospital, Rhode Island - is certain that body image concerns have been growing among men in recent years.
"It's probably a result of an actual increase, as well as better diagnosis and greater awareness, that many men have such concerns," she says. "As we emphasise in The Adonis Complex, it has been taboo for men to disclose worries about looks. Historically, such concerns have been considered a 'women's problem', so men suffer in silence."
These anxieties, Phillips believes, are not simply caused by cultural messages - genetic and psychological factors are also at play. "However, there is increasing media emphasis on the male body - in particular, on attaining a body that's unattainable unless you use steroids. There are several studies that have found that socio-cultural influences, including seeing attractive bodies in the media, tend to make men feel worse about their own bodies."
Although research is still at an early stage, The Adonis Complex - which Phillips co-wrote with Harrison Pope and Roberto Olivardia - cites a 1997 American study suggesting that 43 per cent of men were dissatisfied with their appearance, almost three times as many as 25 years earlier. It also identifies a sharp rise in "muscle dysmorphia", or "bigorexia", in which men exercise obsessively in the mistaken view that their body is too puny. The number of men seeking clinical treatment - in other words, with severe BDD - is now, the book claims, on a par with the number of women. It is, the authors conclude, an "underrecognised yet relatively common psychiatric disorder", a high proportion of whose sufferers attempt suicide. Their critics suggest that Phillips and her co-authors have a vested interest in talking up a condition in which they are the "experts" but whose "rise" is backed by few statistics.
So what of Britain: is BDD really on the increase among men? "No one knows," says David Veale, a consultant psychiatrist who runs one of the country's leading treatment clinics at the Priory Hospital, in North London. "There are lots of opinions, but no one's done any comparative surveys from year to year."
Dr Veale has certainly seen no rise in the number of men he treats (making up almost half of his caseload). But then, he points out, he treats only the most severe cases, men whose body preoccupation has prevented them from living functional lives. "As for those at the milder end of the spectrum, I'm sure these are much more culturally determined," he reflects. "I can certainly believe there has been some growth in these aspects of our culture."
Only 5 per cent of the 25,000 calls each year to the Eating Disorders Association helpline are from men -but as Steve Bloomfield, of the EDA, says, the proportion is growing. Men are far less willing than women to admit to anorexia or binge-eating - but by the time they are seriously enough affected to need clinical treatment, the proportion of men affected rises to around 10 per cent. Male bulimia, in particular, is on the rise -often kicking in when men first enter the job market after university and face new pressures to "look right" for their competitive careers. "These pressures leave them seeking relief, which they may find in binge-eating, especially if they've already tried to control their weight," Bloomfield explains. "With that can come constant visits to the gym. It can be easy to get locked into that obsessivecompulsive cycle."
The problem, he says, is that male eating disorders are still a "hidden" condition. "Men who go to the GP feeling down might appear physically fit and well-muscled because of all the exercise. It might take a long time before they stop burning fat and start burning muscle and looking anorexic." Gay men, in particular, are vulnerable, with similar levels of anorexia to heterosexual women.
There is some debate about the EDA's claimed rise in male eating disorders. "Show me the evidence," says Deanne Jade, the principal of the National Centre for Eating Disorders, who rejects any suggestion that men will ever be as vulnerable as women to the social pressures that may lead to such illnesses. In the past two decades, she says, the proportion of heterosexual men seeking treatment has remained at 8 per cent.
"If you ask a class of adolescent boys what they least like about themselves, they talk about their character. Ask 15-year-old girls and they talk about their bodies. This difference will always transcend whatever's going on in the culture," Jade says.
Nonetheless, Bloomfield says that the gender gap is closing. "In the past ten years, we have seen a dramatic rise in male magazines, many centred on lifestyle and image, and these images are influencing how men think," he says. "I'm not saying that a man will pick up a magazine and simply develop an eating disorder, but if you are seeing all these pictures of six-pack men, and you've had a relationship breakup, you can think: 'If only I looked like him.' And that can start the whole process."
For a man looking to enhance his physical appearance, there have never been greater consumer opportunities. Male grooming represents an increasingly healthy sector for the cosmetics industry: the research company Mintel estimates that British men spent £827 million last year on grooming products, a market growing steadily year on year, with the biggest rises in "prestige" fragrances and toiletries.
Male-only spas are also booming: the Refinery, an upmarket "one-stop grooming and spa experience" with two branches in London, has seen its client list rise from 1,500 to 2,000 in a year, and is about to open a third branch. Alongside shaves and haircuts, its customers are now asking for more "feminine" treatments such as enzymatic mud wraps and pedicures.
"There were 150 full back and shoulder waxes this February, compared with 92 last year," notes Louise McIntosh, the general manager. "And facials are now our second-most popular treatment." Although perhaps 30 per cent of her clients are gay men, what McIntosh finds surprising is the growing popularity of treatments among "traditional businessmen from 30 to 50 who have been dying to do this for years. We're talking about the feminisation of the British male -it used to be macho not to groom yourself, but that's changed with the rise in magazines and role models such as David Beckham."
For men who can afford it, the market also offers ever more opportunities for surgical enhancement - often advertised in the very magazines blamed for boosting male anxieties. Maurizio Viel, a Harley Street surgeon who, with his twin brother Roberto, runs the London Centre for Aesthetic Surgery, has extended more than 1,000 penises in the past 14 years. The men often have no physical need for this, he admits, but for some £4,000 he is happy to make them feel better about themselves.
Viel, 44, also sells his male clients a series of fat injections into their face for £2,000, or course of Botox for £350. "But penoplasty is very popular," he says, using the clinical term for the loosening of the ligament that lets the flaccid (but not erect) member hang a little lower. "It's about how a man sees himself," Viel says, denying that businesses such as his contribute to these anxieties. "They may have a normal-sized penis according to the textbook but, if it's not right for them, and if I can do something with minimal risk to increase their size, then I'll do it."
His customer list, too, is growing, as men become more aware of how they look. "Men want perfection," he says.
Yet it is a quest that, in some cases, only enhances male dissatisfaction. When Viel offers to introduce The Times to a former patient, he presumably expects a glowing testimonial. In fact, after "successful" extension surgery, plus about 20 fat injections to add penile girth, the organ's 54-year-old owner sounds distinctly dissatisfied. The West Midlands man - let's call him Peter - says: "I'd like to say the £5,000 was money well spent, but I probably could have been happier," he says. "I don't consider a flaccid length of five inches as particularly long, and the erect length hasn't changed," he says. "I've seen images on the web from America that suggest it could be more."
Couldn't Peter have simply bought a sports car if he wanted to boost his confidence? "I've already got one - a Porsche - but I rarely use it," he replies. But, in principle, he believes there is nothing wrong in men spending money on their bodies. "If you can pay to get something done that makes you feel better, then why not?" he asks. "Women have been doing so for years."
[PANEL]
THE BEST A MAN CAN GET?
Are men really queuing up for cosmetic surgery?
* According to the British Association of Aesthetic Plastic Surgeons (BAAPS), which represents around 160 practitioners, there has been little change in recent years. "It's a misconception that men are getting more plastic surgery," says the BAAPS spokeswoman Tingy Simoes. "At around 8 per cent of total surgical procedures, the proportion hasn't changed. Men are just more open about it."
* The most common male operations - apart from non-surgical treatments such as Botox - are, in order of popularity, otoplasty (pinning back the ears), rhinoplasty (nose surgery), blepharoplasty (eyelid surgery), face and neck lifts, followed by liposuction.
* Last year, BAAPS members reported 174 nose jobs among men, compared with 1,023 for women. There were 69 men seeking major liposuction, compared with 754 women; and just 15 men paying for a brow lift, as against 281 women.
* "I have a steady 10 per cent male/female ratio," says Brent Tanner, a Kent based plastic surgeon, whose male clients are mainly asking for liposuction to trim their loins or beer guts. "Men who come to my practice for chemical peels usually come after their wives have had surgery."
(The Times, June 19, 2004)
For a former catwalk model, Mark Adams is strangely insistent that he is ugly. At six foot three (1.90m), well-muscled and with a stylish dress sense, Mark, in his mid-thirties, has no problems finding girlfriends -indeed, he separated only recently from his partner of three years. But even though he is often told how attractive he is, Mark, based in Liverpool, persistently sees a very different truth. So convinced is he that he looks like a "freak" that at one stage he locked himself in his room for almost six months.
"I've been suffering like this since I was 18, not wanting to talk about it for years, as it was unheard of for someone to be too uncomfortable with their appearance to leave the house," he says. "At times I considered ending it all. It's hard to explain it, but I'm just uncomfortable with what I see on me. If you have an off day, you might relate to that - except that for me, it's 24/7. It takes over your life."
The physical self-repulsion did not diminish even after Mark was invited to model clothes, having been spotted by a fashion designer in the Covent Garden cocktail bar where he was working. That led to a three-year career on the catwalk, until his discomfort at being photographed left him unable to continue. "I've had a lot of girlfriends, and people tell me I'm nice, but I see what I see," he sighs wearily. "I know I'm a bit of a contradiction. A lot of people don't believe me. But it's not attention I seek -I just want to get better."
It was only when he read a newspaper article about a man with body dysmorphic disorder (BDD) did Mark decide to seek help. The symptoms were all too familiar: BDD, as defined by psychiatrists, gives sufferers a distorted sense of their physical imperfections, so that they exercise or diet or shun mirrors beyond all reason. Many doctors were initially sceptical that the condition existed among men, but diagnosis and treatment programmes have been boosted in the past four years by a bestselling book by clinicians that has caught the media's attention: The Adonis Complex: The Secret Crisis of Male Body Obsession.
Having undergone psychotherapy, hypnotherapy and psychoanalysis - he is also on an NHS waiting list for cognitive behavioural therapy - Mark has come to understand more about what he calls his illness. Why, for instance, he has been working out obsessively at the gym for the past 11 years, "I suppose that in order to combat how I feel, I need to make up in other ways", and how his family upbringing contributed to his uncontrolled self-hatred.
"My Dad was very negative towards me, sometimes violent. That can set the seed for BDD," says Mark. His occasional lapses into therapy-speak suggest that its jargon provides a protective wall, but he can also be painfully honest. "Dad would mock me, be very critical," he recalls. "You grow up feeling you're not right, somehow inadequate."
Yet he also believes that the relentless media onslaught of "perfect" male images has contributed. "It's like how some women were feeling about Page Three girls 20 years ago," he says. "These media images portray men in ways that, for most of us, are not achievable. They're leading women to want men with six-packs, making that the ideal. The magazine editors ought to point out that Freddie Ljungberg has the time to work at looking like that."
Having learnt more about the condition, and been in touch with the obsessive compulsive disorder support group OCD Action, Mark now believes that BDD is where anorexia was 20 years ago, when it became more widely accepted as an illness. "BDD will become increasingly common over the next few years as men face more of these unrealistic pressures to look better," he says. "Look at all these magazine cover stars who have had plastic surgery. That's what people are aspiring to. And that's only going to grow as these images make us feel more insecure and imperfect."
The authors of The Adonis Complex would tend to agree. One of them, Professor Katharine Phillips - a psychiatrist who runs a body-dysmorphic disorder and body-image programme at Butler Hospital, Rhode Island - is certain that body image concerns have been growing among men in recent years.
"It's probably a result of an actual increase, as well as better diagnosis and greater awareness, that many men have such concerns," she says. "As we emphasise in The Adonis Complex, it has been taboo for men to disclose worries about looks. Historically, such concerns have been considered a 'women's problem', so men suffer in silence."
These anxieties, Phillips believes, are not simply caused by cultural messages - genetic and psychological factors are also at play. "However, there is increasing media emphasis on the male body - in particular, on attaining a body that's unattainable unless you use steroids. There are several studies that have found that socio-cultural influences, including seeing attractive bodies in the media, tend to make men feel worse about their own bodies."
Although research is still at an early stage, The Adonis Complex - which Phillips co-wrote with Harrison Pope and Roberto Olivardia - cites a 1997 American study suggesting that 43 per cent of men were dissatisfied with their appearance, almost three times as many as 25 years earlier. It also identifies a sharp rise in "muscle dysmorphia", or "bigorexia", in which men exercise obsessively in the mistaken view that their body is too puny. The number of men seeking clinical treatment - in other words, with severe BDD - is now, the book claims, on a par with the number of women. It is, the authors conclude, an "underrecognised yet relatively common psychiatric disorder", a high proportion of whose sufferers attempt suicide. Their critics suggest that Phillips and her co-authors have a vested interest in talking up a condition in which they are the "experts" but whose "rise" is backed by few statistics.
So what of Britain: is BDD really on the increase among men? "No one knows," says David Veale, a consultant psychiatrist who runs one of the country's leading treatment clinics at the Priory Hospital, in North London. "There are lots of opinions, but no one's done any comparative surveys from year to year."
Dr Veale has certainly seen no rise in the number of men he treats (making up almost half of his caseload). But then, he points out, he treats only the most severe cases, men whose body preoccupation has prevented them from living functional lives. "As for those at the milder end of the spectrum, I'm sure these are much more culturally determined," he reflects. "I can certainly believe there has been some growth in these aspects of our culture."
Only 5 per cent of the 25,000 calls each year to the Eating Disorders Association helpline are from men -but as Steve Bloomfield, of the EDA, says, the proportion is growing. Men are far less willing than women to admit to anorexia or binge-eating - but by the time they are seriously enough affected to need clinical treatment, the proportion of men affected rises to around 10 per cent. Male bulimia, in particular, is on the rise -often kicking in when men first enter the job market after university and face new pressures to "look right" for their competitive careers. "These pressures leave them seeking relief, which they may find in binge-eating, especially if they've already tried to control their weight," Bloomfield explains. "With that can come constant visits to the gym. It can be easy to get locked into that obsessivecompulsive cycle."
The problem, he says, is that male eating disorders are still a "hidden" condition. "Men who go to the GP feeling down might appear physically fit and well-muscled because of all the exercise. It might take a long time before they stop burning fat and start burning muscle and looking anorexic." Gay men, in particular, are vulnerable, with similar levels of anorexia to heterosexual women.
There is some debate about the EDA's claimed rise in male eating disorders. "Show me the evidence," says Deanne Jade, the principal of the National Centre for Eating Disorders, who rejects any suggestion that men will ever be as vulnerable as women to the social pressures that may lead to such illnesses. In the past two decades, she says, the proportion of heterosexual men seeking treatment has remained at 8 per cent.
"If you ask a class of adolescent boys what they least like about themselves, they talk about their character. Ask 15-year-old girls and they talk about their bodies. This difference will always transcend whatever's going on in the culture," Jade says.
Nonetheless, Bloomfield says that the gender gap is closing. "In the past ten years, we have seen a dramatic rise in male magazines, many centred on lifestyle and image, and these images are influencing how men think," he says. "I'm not saying that a man will pick up a magazine and simply develop an eating disorder, but if you are seeing all these pictures of six-pack men, and you've had a relationship breakup, you can think: 'If only I looked like him.' And that can start the whole process."
For a man looking to enhance his physical appearance, there have never been greater consumer opportunities. Male grooming represents an increasingly healthy sector for the cosmetics industry: the research company Mintel estimates that British men spent £827 million last year on grooming products, a market growing steadily year on year, with the biggest rises in "prestige" fragrances and toiletries.
Male-only spas are also booming: the Refinery, an upmarket "one-stop grooming and spa experience" with two branches in London, has seen its client list rise from 1,500 to 2,000 in a year, and is about to open a third branch. Alongside shaves and haircuts, its customers are now asking for more "feminine" treatments such as enzymatic mud wraps and pedicures.
"There were 150 full back and shoulder waxes this February, compared with 92 last year," notes Louise McIntosh, the general manager. "And facials are now our second-most popular treatment." Although perhaps 30 per cent of her clients are gay men, what McIntosh finds surprising is the growing popularity of treatments among "traditional businessmen from 30 to 50 who have been dying to do this for years. We're talking about the feminisation of the British male -it used to be macho not to groom yourself, but that's changed with the rise in magazines and role models such as David Beckham."
For men who can afford it, the market also offers ever more opportunities for surgical enhancement - often advertised in the very magazines blamed for boosting male anxieties. Maurizio Viel, a Harley Street surgeon who, with his twin brother Roberto, runs the London Centre for Aesthetic Surgery, has extended more than 1,000 penises in the past 14 years. The men often have no physical need for this, he admits, but for some £4,000 he is happy to make them feel better about themselves.
Viel, 44, also sells his male clients a series of fat injections into their face for £2,000, or course of Botox for £350. "But penoplasty is very popular," he says, using the clinical term for the loosening of the ligament that lets the flaccid (but not erect) member hang a little lower. "It's about how a man sees himself," Viel says, denying that businesses such as his contribute to these anxieties. "They may have a normal-sized penis according to the textbook but, if it's not right for them, and if I can do something with minimal risk to increase their size, then I'll do it."
His customer list, too, is growing, as men become more aware of how they look. "Men want perfection," he says.
Yet it is a quest that, in some cases, only enhances male dissatisfaction. When Viel offers to introduce The Times to a former patient, he presumably expects a glowing testimonial. In fact, after "successful" extension surgery, plus about 20 fat injections to add penile girth, the organ's 54-year-old owner sounds distinctly dissatisfied. The West Midlands man - let's call him Peter - says: "I'd like to say the £5,000 was money well spent, but I probably could have been happier," he says. "I don't consider a flaccid length of five inches as particularly long, and the erect length hasn't changed," he says. "I've seen images on the web from America that suggest it could be more."
Couldn't Peter have simply bought a sports car if he wanted to boost his confidence? "I've already got one - a Porsche - but I rarely use it," he replies. But, in principle, he believes there is nothing wrong in men spending money on their bodies. "If you can pay to get something done that makes you feel better, then why not?" he asks. "Women have been doing so for years."
[PANEL]
THE BEST A MAN CAN GET?
Are men really queuing up for cosmetic surgery?
* According to the British Association of Aesthetic Plastic Surgeons (BAAPS), which represents around 160 practitioners, there has been little change in recent years. "It's a misconception that men are getting more plastic surgery," says the BAAPS spokeswoman Tingy Simoes. "At around 8 per cent of total surgical procedures, the proportion hasn't changed. Men are just more open about it."
* The most common male operations - apart from non-surgical treatments such as Botox - are, in order of popularity, otoplasty (pinning back the ears), rhinoplasty (nose surgery), blepharoplasty (eyelid surgery), face and neck lifts, followed by liposuction.
* Last year, BAAPS members reported 174 nose jobs among men, compared with 1,023 for women. There were 69 men seeking major liposuction, compared with 754 women; and just 15 men paying for a brow lift, as against 281 women.
* "I have a steady 10 per cent male/female ratio," says Brent Tanner, a Kent based plastic surgeon, whose male clients are mainly asking for liposuction to trim their loins or beer guts. "Men who come to my practice for chemical peels usually come after their wives have had surgery."
(The Times, June 19, 2004)
posted by David Rowan at Saturday, June 19, 2004
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