Self-Image and Depression

By Frank Spinelli, M D

Originally published on Advocate.com September 29 2010 1:20 PM ET

 Recently the British mannequin manufacturer Rootstein debuted its latest male form — the “Homme Nouveau.” Feminized and less beefy, with a 35-inch chest and a 27-inch waist, it has led some to suggest that the change in design is a direct response to the growing number of metrosexuals. This term was coined by the British writer Mark Simpson, who in 1994 wrote about a trend among heterosexual men to care deeply about their outward appearance and how it pertained to their lifestyle. The reality is that many gay men have such an irrational preoccupation with their appearance that it borders on dysmorphism.

Body dysmorphism is a medical term used to define an anxiety disorder in which the affected person is so obsessed with their looks and body image that it often interferes with daily life, creating anxiety and depression. The result is a compulsive concern over the slightest defect in one’s appearance. This can lead to intense dieting, grueling workouts, and multiple attempts to correct one’s appearance with cosmetic procedures.

It is not known exactly what causes body dysmorphic disorder. Experts believe life experiences and culture may contribute to the disorder, as may long-term psychological or physical abuse. Researchers say factors that seem to put some people at higher risk include low self-esteem, a history of abuse, and sensitivity to social pressures to conform to images seen in the media.

In 2008, I wrote about manorexia, a growing trend of eating disorders in the XY chromosome world. Anorexia and bulimia are increasing among many of my patients, particularly gay men. In 1990 men made up 10% of the population with an eating disorder. Now they make up 25%. Eating disorders are linked to poor self-image and depression. Often depressed patients rely on extreme measures like cosmetic procedures, anabolic steroids, excessive dieting, and overexercising to mask the pain. These measures can become addictive, and these individuals are often dissatisfied with the results. That’s because they are focusing on the external instead of concentrating on the underlying issues.

Of course, good nutrition and exercise are healthy ways to maintain your appearance. Relying on drastic measures, however, will only exacerbate depression. If you feel you or someone you know has symptoms consistent with body dysmorphism, seek help from a doctor.