(This was originally published in GQ Style September 2013 - Zack)
Traditionally, us men aren't meant to get hung up on our bodies. John Wayne never asked if an outfit made his bum look big, and Humphrey Bogart managed to marry several beautiful actresses despite the duel burden of a face like a melted Dracula mask and the name "Humphrey".
But as we approached the millennium and the critical mass of masculine vanity that was the "metrosexual", we became correspondingly more body conscious. For some of us this means being less laissez faire with the booze and biscuits or joining the gym, but at the extreme it means something darker. While our tight-lipped approach to disclosing health problems makes hard stats tricky to come by, it’s estimated that there has been a 67 percent increase in UK males seeking treatment for eating disorders in the last five years.
One such issue is muscle dysmorphia, sometimes called "manorexia".
"It's an extreme anxiety about the size of your muscles and your physique in general. Typically, guys will be ashamed of their bodies - even if they are in great shape - and become extremely distressed if they miss a workout or eat the wrong foods," says Dr Mark Rackley, a clinical psychologist specialising in male eating disorders.
So what causes it? "There are multiple factors, but the way men are portrayed in popular culture is definitely key.” For example, since the 1960's the Action Man toy has lost three inches on his waist and gained three inches on his arms. “If you scaled him up he'd have bigger arms than any bodybuilder in history" says Rackley.
Of course it’s still predominantly women being portrayed as sex objects, but men are gaining ground. Witness Daniel Craig emerging from the surf under the cameras lascivious gaze for a recent cultural flashpoint of male body-worship. It’s a safe bet that as many men joined gyms as bought expensively product-placed wristwatches in the wake of the Bond reboot. One of those was Josh Mullin, a 25 year old personal trainer who struggled with muscle dysmorphia in his teens.
"My daily routine was all about muscle building,” says Josh. “My worst enemy was missing a meal, or, god forbid, a training session. I would train for two to three hours per day and eat obsessively. I found it difficult to socialise as any time spent away from the gym was a waste in my eyes."
In conditions like anorexia or bulimia, still overwhelmingly female issues, there is a very clear demarcation between disorder and normal behaviour; there's no such thing as moderate bulimia. But for men, the idealised physique is not emaciated. Low body fat is a prerequisite for sure, but so are gym-honed muscles, and you don't get those by starving yourself. Instead, an incredibly delicate balance must be struck. You must consume enough of the "right" foods to provide the raw muscle materials, which may mean six meals a day and thousands of calories. But there's a risk: eat too much and you'll obscure definition with excess fat.
It's a caloric high-wire act, requiring constant refinement and ascetic restriction. But the actual behaviours, focused exercise and good nutrition, unlike the binge and purge of other disorders, are not inherently unhealthy.
So where is the tipping point between enviable fitness fanatic and muscle dysmorphia?
"It comes down to how extreme the anxiety is," says Dr. Rackley. "A person might get a bit antsy if they miss a workout but it's no big deal in the scheme of things. But if you are getting incredibly stressed about diet and it's stopping you from having a normal social life, it could be muscle dysmorphia."
That guy at the changing room mirror, anxiously appraising his reflection and plucking at a millimetre of fat below his navel may not just be a narcissist, he may be a sufferer. Former sufferer Josh agrees. "I think there is a fine line between looking at your body for improvements and body dysmorphia and the two can easily merge. I remember looking at myself thinking I was in terrible shape, but now when I look back I was probably in the best condition of my life."
I found myself nodding along to Josh's story, recognising traits I once shared.
Muscle is an emotional issue, often a reaction to bullying or poor self confidence. Here's the difference: Most sports are self - selecting, a child is exposed to it, finds he has a natural aptitude and sticks with it. As a result, athletes have a relaxed mastery of their bodies, an ownership of their muscle. In contrast, those of us who train for aesthetics tend to do so precisely because of a lack of athletic ability. It appeals because of its solitary nature and the ideology of self -betterment as an end in itself. We're building confidence in proportion to our muscle, and have a proportional fear of losing it because so much of our self-image is tied up in our physiques.
But therein lies the inconvenient truth. Getting into truly remarkable shape requires an obsession with every morsel you put in your mouth on a par with, if not equal to, an eating disorder.
That's not necessarily a bad thing when done for a specific period of time and with a level of emotional detachment. It can be a powerful and transformative learning experience. But when it becomes a chronic state, creates constant stress and prevents us from having a life outside of the relentless pursuit of a physical ideal, the constantly moving target of the perfect body, the eating disorder tag becomes more appropriate.
Most men eventually get perspective, realising it's possible to be both in shape and a well-rounded person. But occasionally they get stuck, and when that happens Josh has some advice.
"Ask for help. It may seem like no one understands but there will always be family members, friends or medical professionals that can give you advice and repairing steps to take."