Steve Mululu, a tall man who towers over every-body, stops to talk to patrons sweating it out on workout machines spread across the gym floor. He is dressed in white shorts and a long-sleeved T-shirt that stretches tightly over the bulging muscles in his chest and arms.

Mululu, a part-owner of Dream Body Fitness, a lifestyle management centre in Sunninghill, Johannesburg, and a number of muscular personal trainers keep close watch over clients as they train.

A man is doing leg presses on one machine. Pausing, he says: “This is half the weight of a Mini Cooper,” pointing at the weights piled on the equipment. At the other end of the room another man is hunched over a machine doing bicep curls.

The quest for the perfect body is no longer seen as a female problem. A 2013 study conducted by the University of Sydney, Australia, found that “increasingly men are admitting to being unhappy with their body image. This may show itself in either a desire to lose weight and become thinner, or to gain weight and become more muscular.”

The desire to become more muscular is a body dysmorphic disorder commonly known as “bigorexia”. According to Linde Viviers, a clinical psychologist, bigorexia is not an official psychiatric diagnosis, but rather a term used to describe a group of symptoms seen in patients.

“In a nutshell, it is like the reverse of anorexia. The person suffering from it has a distorted image of their body. Where the person with anorexia always sees themselves to be bigger than what they really are, someone with bigorexia sees themselves as smaller than what they actually are,” she says. 

“And because they’re never big enough, that will feed the obsessive behaviour such as over-exercising and rigid dieting. At the end this will affect their emotional wellbeing and functioning.”

Mululu says he sees people who fit these criteria on a daily basis.

“We all want to be better versions of ourselves, but sometimes people have unrealistic expectations. For example, if you haven’t exercised or taken care of yourself for the last four years, you can’t expect to lose 20kg in two weeks or 10 days.”

He says that setting unrealistic goals puts people under pressure, at times leading them to extreme measures such as taking steroids to accelerate muscle growth – a “recipe for disaster”.

“South Africa is a very image-conscious society. Both men and women love beauty nowadays; it’s not like before. We’re living in a shallow society that will always award extrinsic achievements. People will respect and worship you based on what you have achieved rather than who you are. That is driving all of us to try to change who we are to fit into what society wants us to be.”

Distorted body image
Although bigorexia statistics are not available, a 2014 study published in the Journal of Child and Adolescent Mental Health reports that “more than a third of the teenage boys who participated in the research who were underweight were at a high risk of disordered eating, suggesting a possible link between body weight and shape/size control behaviours”.

Viviers says treating bigorexia patients is “the same as treating an anorexic person. They don’t see what other people see. Their image of themselves is really distorted. You will sit opposite this man who looks like a model, but he cannot see that. And his fear is constantly that he’s losing this muscle.”

There are many levels to address in treating bigorexia, she says. The first would be behavioural. 

“Whenever people are doing something from a behavioural point of view that is harmful to them, such as taking so many supplements that their kidney function is affected, you will have to intervene on that level, which is usually based on setting boundaries around eating and exercise.

“You will do body image exercises where you trace them and show them what their body really looks like and challenge them with what is real. And the psychological processes would be around finding out what the function of this illness is. Why does this man need to be bigger and bigger? Does he feel that small? Does it come from childhood? And that is very individual; everybody’s story is their story. But you will also look at other psychiatric conditions around anxiety disorders like your obsessive compulsive disorder. So it would be a holistic approach.”

Viviers says, if you suspect someone you know has an eating or body dysmorphic disorder, you should confront them as soon as possible.

“I find often people are afraid to confront because it will cause a lot of conflict. But if you don’t confront them because you’re afraid of the conflict, you’re enabling the illness. Don’t avoid it, because the longer the eating disorder goes on, the worse their prognosis is. The quicker you intervene the better their chances of survival.”

While body image issues are increasing among men, they are still more common among women. And, says Johannesburg-based clinical psychologist Linde Viviers, the patients she treats for eating disorders are getting younger and younger. 

“In the past they used to be in the age group from 15 and older. But now I get a lot of requests to assess girls as young as 10 years old.” 

Viviers’s observation is supported by a 2014 University of the Witwatersrand study among pupils from several Johannesburg schools which found that “disordered eating habits [are] now starting at an earlier age”. 

According to the study, “the increasing desire for a slimmer shape among girls … is a growing public health concern because of its association with eating disorders and poor weight management”. 

Viviers, who is a consultant at Akeso Crescent Clinic in Randburg, a psychiatric clinic that focuses on eating disorders, says these disorders need specialised attention because the illness has so many aspects. 

“Patients who suffer from eating disorders don’t actively seek treatment. They usually come to treatment because they’re forced into it by their families who are very worried. 

“But the person suffering from the eating disorder, especially anorexia, won’t seek treatment because they don’t think there’s a problem. So you work with a population that hides it and on some level doesn’t want to confront the illness,” she says. 

According to the American Psychological Association, eating disorders are abnormal eating habits that pose a risk to a person’s health, and even their life. 

The most common is anorexia nervosa, when a person believes they are fat even if they “are dangerously thin and restrict their eating to the point of starvation”. 

A person who eats “excessive amounts of food, then purges by making themselves vomit or using laxatives” has bulimia. 

The third most common eating disorder is binge eating, when a person has “out-of-control eating patterns, but doesn’t purge”. 

[This article was originally published on 9 October 2015]

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