BDD in Men
There are more similarities than differences between men and women with BDD. However men may be more concerned about their genitals, body build, and thinning or balding hair.
Body image in men is different to women and is a neglected area of research. What we know is that heterosexual men are mainly worried by their body weight, penis size, and height and to a lesser extent on muscularity, head hair, and body hair. Thus some men feel they should be lean and muscular, have a large penis, be tall, have a full head of hair, and little body hair. The body part may be related to the degree to which it is (a) visible (b) controllable and (c) a symbol of masculinity. These issues may be greater in homosexual men but even less research has been done in this area. Sometimes one body part becomes dominant preoccupation and these will be described below.
Muscle Dysmorphic Disorder (MDD), or Muscle Dysmorphia is a type of Body Dysmorphic Disorder (BDD). It is popularly known as “Reverse anorexia” or “Bigorexia” by the media. It consists of a preoccupation with not being sufficiently muscular or lean (when this is not the case). Sports wrestling & body building gyms are a breeding ground for muscle dysmorphic disorder.
It is characterized by:
- Excessive time and over-exertion in weightlifting to increase muscle mass
- Preoccupation and panicking over workout if unable to attend
- Overtraining or training when injured
- Disordered eating, using special diets or excessive protein supplements
- Steroid abuse and often other substance misuse
- Distress if exposed leading to camouflage the body
- Compulsive comparing and checking of one’s physique
- Significant distress or mood swings
- Prioritizing one’s schedule over all else or interference in relationships and ability to work
- Often other body concerns, hair, skin, penis size
There is a fine dividing line between normal “body-building” and muscle dysmorphic disorder. It is sub-culture stigmatized from society but it is important to separate as MDD is often described as the same as body-building. A similar situation exists in describing the difference between a person with BDD and a person without BDD who is seeking cosmetic surgery. A person with normal body-building does not have a distorted body image. Normal body-building is a rigorous lifestyle but unlike MDD it is not a preoccupation with muscles that are too puny. It does not cause significant distress or interfere in one’s life. It is characterized by excessive time weightlifting. Like MDD, there are often special diets and supplements or steroid misuse.
Male pattern baldness (MPB)
Baldness is very common in men and consists of a progressive thinning of the scalp. It is viewed as less desirable than a full head of hair but it is just a genetic variation.
Baldness (or indeed too much or too little body hair) does not commonly presents as the sole concern in BDD. It is usually part of a bigger picture of multiple concerns about masculinity.
There are many BDD “solutions” such as hats, wigs, cutting hair short that are designed to camouflage the baldness. Drugs like Minoxidil, or hair transplants are designed to put it right. Unfortunately there is insufficient research on psychological effects of any of these solutions in BDD but it very unlikely to solve the problem.
Being tall is valued in men. A preoccupation with height does not commonly presents as the sole concern in BDD.
BDD solutions sometimes include the extra-ordinary surgery of leg lengthening in dubious parts of the world. At most this might lead to a few centimetres. No research has been done on the psychological effects of leg-lengthening in BDD but it very unlikely to solve the problem.