Seeking perfection: body image among gay and bi men

Body image concerns and body dissatisfaction among men have only recently started to be addressed within society, but not nearly as extensively as the body image concerns among women. Recent studies have demonstrated that there is a trend in men focusing on the muscular, toned and lean male physique (mesomorphic muscular body) in Western culture.

This trend parallels a rise in anabolic-androgenic steroid (AAS) use among men and an increasing prevalence of muscle dysmorphia (MD), a disorder in which men become obsessed with muscularity.

The societal obsession with the cultural ideal of an exaggerated musculature (hypermesomorphy) for men may be just as dangerous to men as is the anorexic ideal for women. This ideal may be especially dangerous because some male images in the media may not even be attainable without drugs (e.g. anabolic steroids) or even cosmetic surgery.

Alongside this, body dissatisfaction among men has been shown to be associated with several health problems, including depression, low self-esteem, increased alcohol and drug use and eating disorders.

With this new focus on male body image issues, society has neglected to examine the role of sexual orientation. What little has been done, suggests that body dissatisfaction is associated with similar problematic health issues (including substance use disorders, other addictions, eating disorders and depression) for gay and bisexual men, which are greater than for heterosexual.

To understand this complex issue more fully, it is important to understand what Body Dysmorphic Disorder (BDD), and Muscle Dysmorphia are. Doctors or clinicians use the Diagnostic Statistics Manual (DSM V), which indicates the following criteria for DBB:

A. Preoccupation: That the individual exhibits a preoccupation with one or more perceived defects or flaws in physical appearance that are not observable or appear slight to others.

B. Repetitive Behaviours: At some point during the course of the disorder, the individual has performed repetitive behaviours (e.g., mirror checking, excessive grooming, skin picking, reassurance seeking) or mental acts (e.g., comparing his or her appearance with that of others) in response to the appearance concerns.

C. Clinically Significant Distress or Impairment: The preoccupation causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

D. Not better explained by other disorders: Not better explained by concerns with body fat or weight in an individual whose symptoms meet diagnostic criteria for an eating disorder.

Eating disorders and BDD are often confused, as the symptoms appear to overlap, with both disorders sharing distorted body image preoccupation concerns. What has been found is that there is a large percentage of people who have both disorders at the same time.

Muscle Dysmorphia occurs almost exclusively in males with normal or even muscular-appearing bodies, with men exhibiting a preoccupation that one’s body build is too small or insufficiently muscular.

Men with MD have a preoccupation that they are insufficiently muscular and lean, which manifest into behaviours focused on increasing muscularity, including excessive weight lifting, maintaining a high volume, muscle-enhancing diet, and using performance-enhancing supplements (e.g., steroids). Numerous studies have confirmed this pattern of behaviour throughout the United States, Western Europe, and South Africa.

When it comes to BDD in men, what can be agreed upon is that more gay and bisexual men have DBB and MD, than their heterosexual counterparts.

This is due to the socially accepted gendered body image ideals that purportedly make it more likely that a person will obtain a partner for a relationship or to engage in sex. In order to cope with these ideals, some gay and bisexual men may engage in dieting, excessive exercise, frequent changing of clothes, and cosmetic surgery.

So where does this come from within the gay and bisexual community?

For gay and bisexual men, the potential for BDD or DM to exist, along with other health conditions, is much higher than for heterosexual men, with many experiencing substance use disorders, or other addictions. This is because they face unique psychosocial stressors that lead to an increase in risk for the development of the disorders. Many may use drugs and alcohol as a way of coping with these stressors, which are largely related to homophobia and transphobia (transgender phobia).

The most common problems that gay and bisexual men face, stems from homophobia, heterosexism, and even transphobia. Individuals who are “double minorities” – sexual minorities and ethnic minorities – face many challenges that are often not understood by others. In addition to the discrimination and stigma that each group deals with, there is additional stress from the conflict that arises between the two minority identities.
Trying to cope with homophobic attacks, both physical and psychological, and risking rejection by peers, family, and teachers, gay and bisexual teens often feel helpless and alone. When individuals become victims of such attacks, their sexual orientation itself becomes a source of pain and danger. As victims try to make sense of their attacks, many internalise the beliefs of their aggressors, and they believe that the attacks were justified punishments for being gay or bisexual. This internalised self-hatred can lead to profound feelings of anxiety, helplessness, depression and body dissatisfaction as the person strives to fit into society and its subcultures. These then drive mental and behavioural problems, such as MD, BDD and substance use disorders.

The societal pressure to conform to what a male should look like is critical among gay or bisexual men, who strive to prove their male sexual identity and masculinity. They do not want to be viewed as “unmanly” or rejected by society and other gay or bisexual men, thus making the muscular physique desirable.

The internal and external pressure to be lean and muscular causes many gay and bisexual men to attempt to achieve this ideal body at any cost. Another significant reason to meet the ideal male physique involves the promotion of personal attraction and the desire to attract sexual and romantic partners. This promotes the linkage of appearance to a sense of self-worth among gay and bisexual men that is not as prevalent among heterosexual men.

Most gay and bi men have experienced or witnessed anti-fat bias

Muscularity among gay and bisexual men is a unique sociocultural phenomenon, above beyond what is seen among heterosexual men. This drive for muscularity plays a significant role among gay and bisexual men, where being masculine and muscular are highly valued qualities, as they are linked to attracting potential sex partners.

Gay and bisexual men as a result diet more, have higher rates of eating disorder symptoms and are more fearful of becoming fat than heterosexual men. They are more fearful of being stigmatised and are more likely to have higher rates of body dissatisfaction and stress in achieving a masculine body ideal. The existence of stigma, due to anti-fat bias among gay and bisexual men is very common, with most gay and bisexual men having experienced or witnessed anti-fat bias.

One of the most common forms of this is the rejection by potential romantic partners due to their physique or weight. This means that most gay and bisexual men expect to be rejected by an attractive counterpart, which is not seen among heterosexual men to the same degree. This stigma is another driver of body dissatisfaction, DBB, DM and alcohol and drug use. In order to control body image and weight, gay and bisexual men may engage in disordered eating, dieting, the use of diet pills, and vomiting.
Substance use disorders and other addictions among lesbian, gay, bisexual, transgender and require special attention, because patterns of substance use differ markedly between gay and bisexual men than the general population, especially if they have BDD, DM or eating disorders alongside.

When we then look at the complex drivers of BDD, DM and related health problems, such as substance use disorders or eating disorders, among gay and bisexual men as compared to heterosexual men, it makes it imperative that services targeting their specific needs are imperative. Unfortunately, within South Africa, there are very limited resources for gay and bisexual men to obtain support for these conditions.

Inner Peace, a non-profit organisation, provides residential treatment to LGBTQ people with substance use, BDD, DM and other disorders. It’s a unique safe place for treatment for all LGBTQ individuals. If you feel that substance use or other related issues are taking control of your life, contact Inner Peace on their website or call 023 741 1029.