MHM Magazine

cultural and gender norms have long contributed to the systemic underreporting of mental illness among men. Efforts such as ‘Movember’— originally focused on prostate and testicular cancer—have expanded in recent years to include mental health advocacy. Campaigns during this month aim to educate the public, reduce stigma, and normalise help-seeking behaviour among men. However, much work remains to be done, particularly in the identification of disorders that don’t fall into traditional categories such as depression or anxiety. Understanding Body Dysmorphic Disorder Body Dysmorphic Disorder is defined in the DSM-5 as a preoccupation with one or more perceived defects or flaws in physical appearance that are not observable or appear slight to others. These preoccupations can result in significant distress or impairment in social, occupational, or other important areas of functioning. Common behaviours include mirror checking, excessive grooming, skin-picking, reassurance seeking, and in some cases, seeking cosmetic procedures. BDD is often underdiagnosed, particularly in men, due to overlapping symptoms with other psychiatric conditions and a general lack of awareness among clinicians and patients alike. Recent data suggests that the prevalence is relatively equal between genders, with approximately 2.2% of men and 2.5% of women affected globally. However, the manifestations in men often differ, requiring a more nuanced diagnostic approach. Muscle Dysmorphia: A Male- Predominant Subtype One subtype of BDD that is particularly prevalent among men is muscle dysmorphia. This form is characterised by an obsessive belief that one’s body is insufficiently lean or muscular, even when objectively well-developed. Patients with muscle dysmorphia may engage in compulsive weightlifting, strict dietary regimes, and may misuse anabolic steroids or supplements to achieve their desired body image. “These individuals often appear physically fit or even athletic to outsiders, but they themselves perceive significant flaws in their physique,” notes Dr. Korb. “Their lives revolve around achieving an unattainable body ideal, often to the detriment of social functioning, career, and general wellbeing.” Korb recalls a patient who, despite being in Grade 11, was convinced he was losing his hair. He consulted multiple dermatologists and underwent numerous treatments, yet no objective abnormality could be identified. “The distress was not rooted in vanity but in a deeply held, fixed belief that something was fundamentally wrong with his appearance”, Korb explains. Another case involved a patient who underwent cosmetic surgery to alter his nose but remained dissatisfied post-operatively— again highlighting the persistent nature of the disorder and its resistance to physical correction. Diagnostic Challenges and Comorbidities Body dysmorphic symptoms often present alongside other psychiatric conditions such as major depressive disorder, obsessive-compulsive disorder (OCD), social anxiety, and substance use disorders. This comorbidity can complicate the diagnostic picture, particularly if clinicians are not specifically trained to assess for BDD. Additionally, men are less likely to report appearance-related concerns due to stigma or a belief that such worries are “feminine” in nature. This often leads to misdiagnosis or under-detection in clinical settings, particularly in primary care, where time constraints and lack of mental health training may preclude comprehensive psychiatric evaluations. Clinical Implications and Recommendations Health professionals must consider the following best practices when assessing potential BDD in male patients: 1. Routine Screening: Incorporate appearance-related questions into mental health screenings, especially when patients present with anxiety, depression, or signs of low self-esteem. 2. Nonjudgmental Language: Use language that destigmatises appearance concerns and normalises body image issues across all genders. 3. Awareness of Subtypes: Understand the specific symptoms and behavioural patterns associated with muscle dysmorphia and other male-dominant subtypes. 4. Integrated Treatment Approach: Cognitive Behavioural Therapy (CBT) remains the gold standard for BDD, particularly when combined with pharmacological treatment such as SSRIs. Coordination between psychologists, psychiatrists, dermatologists, and even cosmetic surgeons is often essential for managing cases where patients pursue unnecessary procedures. 5. Cultural Competence: Consider the patient’s cultural and social context, particularly in communities where traditional masculinity norms may discourage emotional openness or mental health help-seeking. As mental health professionals, we are uniquely positioned to detect and treat underrecognised disorders like Body Dysmorphic Disorder, particularly in vulnerable populations such as men. A greater emphasis on education, screening, and de-stigmatisation can improve early intervention outcomes and help reduce the profound distress associated with BDD. As Dr. Korb aptly concludes, “The more we talk about these issues—openly, compassionately, and without judgment—the more we break down stigma. No one should suffer in silence.” References available on request. MHM | 2025 | Volume 12 | Issue 2 | Understanding Body Dysmorphic Disorder in Men: MHM Issue 2 | 2025 | MENTAL HEALTH MATTERS | 7 MHM