It wasn’t until I started noticing adverts and images in magazines of good-looking men with muscular bodies that I started feeling anxious and depressed about my appearance.

“I was about 20 when I began compulsively buying magazines such as Men’s Health, Arena and GQ, which became my bibles for working out effectively at the gym. I’d train three or four times a week. I became more muscular and fit, and this brought me recognition from my friends, but it was never enough. In my mind, I wasn’t matching up to the images in the magazines and adverts. It made me obsess about my weight and how I looked — I would have highs and lows depending on how well I thought I was doing. It reached the point when I’d get a mild anxiety attack just from looking in the mirror or turning the page of a magazine and seeing a male model whose body I envied.”

Smith is not alone in his neurosis over body image. In a recent study conducted by the London School of Economics, British men were shown images of muscular males advertising Calvin Klein and Emporio Armani underwear. More than half said they felt intimidated by the images.

Rosalind Gill, a social psychologist at the LSE, says: “They were pressured, and felt it was unfair that, however much they worked out at the gym, they would never be able to achieve the sort of body you see in those adverts.”

At one extreme, the male preoccupation with developing the perfect physique can result in an addiction to body building and developing more and more impressive muscles, known as muscle dysmorphia, or “bigorexia”. For many men, body dysmorphic disorder (BDD), a pathological unhappiness with the body, face or skin, can lead to severe depression.

There is evidence that the problem is affecting men at an ever younger age. A recent study published in the British Journal of Developmental Psychology revealed that one in three 11- to 16-year-olds wanted to lose weight, and more than half said they would prefer to be better-looking than to play football better. Nearly a quarter would rather be handsome than wealthy, and one in eight would consider plastic surgery to improve his looks.

David Veale, a consultant psychiatrist at the Priory Hospital, in north London, says that half his caseload consists of men with serious body-dysmorphia issues. He beleives that their body preoccupation prevents them from living normal lives. “I see men who are preoccupied with their face, their skin or their chin, or have an eating disorder or depression.

“Very often, a BDD sufferer will also suffer from depression. It is a secondary problem. If the BDD is treated, then the depression normally improves,” he says.

For Stephen Westwood, 32, body dysmorphic disorder resulted in several suicide attempts. A case of problem skin led him secretly to start using his mother’s make-up to camouflage unsightly red blotches. “I thought I was a monster. My nose and cheeks were red. It was as if my skin had been peeled off.”

Being bullied and called ugly at school didn’t help matters, and the effects of that have lasted more than 15 years. At work, he would apply make-up every 30 minutes and use tweezers to pick dry pieces of skin from his face. He lost one job for being late for work every day because he spent more than two hours applying foundation in the morning. Two years ago, he was diagnosed with BDD and prescribed antidepressants. His depression has much improved, but he still wears foundation.

Smith, on the other hand, feels that he doesn’t need medical help. He is working on his own in his efforts to wean himself off his addiction to studying magazine images. “I wanted to be like them, but I also hated seeing them. I would analyse what they meant — a clear sign, I guess, that I had a neurotic obsession. I thought at one point that wanting a six-pack was just vain nonsense and looked really ugly. So, after that, my ideal became just a flat stomach; then I’d see a picture of a really attractive guy with rippling biceps and it would all change again.”

It’s not surprising that Smith was confused. Gill has found that images of male models in the media and advertising are more complex than initially thought. The images suggest that men should be strong, but also caring and understanding. “If you look at some of them, you will see that they have hard, muscular bodies, but soft, feminine faces, quite full lips, usually close-shaven faces, big eyes and soft-looking skin. In a way, these images are interesting for what they say about our contradictory expectations of men.”

Smith agrees. “You look at these images, and they say: be big, strong, attractive, but also be a new man. You’ve got to be caring, even intellectual. I felt pressure not just to go to the gym and stay trim, but to be on top of ideas and issues — I had to be well read. This isn’t just about being a muscular bimbo with a thick neck and no brains; you’ve got to have muscles with a head that can understand the problems in Palestine and Darfur, speak French and know about good wines.”

Smith also found that trying to develop the ideal body was playing havoc with his diet. “I’d starve myself to ensure that I kept lean, but because I was working out, I’d crave carbohydrates, so I’d binge on bread, crisps and pizza, then I’d work extra-hard to burn it all off. Sometimes, I’d throw it all back up.”

Steve Bloomfield, from the Eating Disorders Association, says that the organisation has seen an increase in the number of men seeking help for eating disorders. More than 10% of the 90,000 people in the UK with an eating disorder are male, he says. Yet the problem is probably much bigger, as men can be unwilling to admit to it.

“They are ashamed, because they think it is a girlie disorder, or because of the stigma associated with mental-health problems,” Bloomfield says. “It can be hard to diagnose an eating disorder in a man — they are often gym-users who have muscular bodies. So you get men with toned bodies also having an eating disorder. Many GPs won’t make the connection.”