Pscarb

I think this article relates to most Bodybuilders male or female.

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by Harrison G. Pope Jr., M.D.
Psychiatric Times March 2001 Vol. XVIII Issue 3
http://www.psychiatrictimes.com/p010353.html

Much has been written about body image problems in women, but only recently has it been recognized that similar preoccupations frequently afflict men. In The Adonis Complex: The Secret Crisis of Male Body Obsession (Pope et al., 2000), my colleagues and I documented the wide variety of body image problems that have quietly risen to epidemic levels among boys and men today-both relatively mild appearance concerns and those that qualify for a psychiatric diagnosis. Several of these disorders are described in this article, as are some of the potential reasons behind the emergence of what we have termed the Adonis complex.

Clinical Forms
Muscle dysmorphia. Our first encounter with male body image disorders arose during our research on anabolic steroids in the 1980s. Since then, my colleagues and I have conducted ongoing studies in this field. During interviews of men recruited from gyms in the Boston and Los Angeles areas, we met several bodybuilders who confided that they perceived themselves as small and frail, even though they were actually large and muscular. Some had become so preoccupied with their supposed smallness that they even refused to be seen with their shirts off at the beach (Pope et al., 1993).

They obsessively lifted weights for hours a day, sometimes sacrificing important social relationships, jobs or physical health (Phillips et al., 1997). Some men held degrees in business, law and medicine, but they had relinquished their careers because they needed extra time at the gym (Olivardia et al., 2000; Pope et al., 1997). Others had broken family relationships, lost girlfriends or even divorced their spouses, all because the need to work out took priority over everything else.

In many cases, these men had taken anabolic steroids or other drugs to get bigger; paradoxically, many felt even more insecure about their size after taking steroids. In short, these men manifested a sort of "reverse anorexia nervosa," yet none had ever consulted a clinician about their obsessions.

In one series of 160 weightlifters, we found 16 (10%) who reported at least some compromise of social or occupational function from muscle dysmorphia, suggesting that some hundreds of thousands of American men may experience symptoms of this often-secret condition (Pope and Katz, 1994).
Anabolic-androgenic steroid abuse. Equally secret is abuse of anabolic steroids-drugs associated with substantial morbidity-by boys and men seeking to simply look bigger. In these cases, steroids are not taken for athletic performance, but simply to gain muscle (Buckley et al., 1988; Pope et al., 1988).

Epidemiologic data suggest that at least 1 million-and possibly even 2 to 3 million-American men have used these drugs, often learning as young teen-agers to inject themselves (DuRant et al., 1993; Pope et al., 2000; Pope et al., 1988). Use of these drugs is a problem because of potential long-term medical problems and the short-term risk of psychiatric symptoms, such as manic and aggressive symptoms during steroid exposure and depressive symptoms during steroid withdrawal (Pope and Katz, 1994). Remarkably, parents, teachers and even trained clinicians often remain naive about steroid use; they are unaware that steroid abuse may often be diagnosed simply by glancing at the abuser's body.

In The Adonis Complex, we present a previously published formula for fat-free mass index (FFMI), a measure of muscularity (Kouri et al., 1995), and argue that "any man who exceeds a certain threshold of muscularity (an FFMI of approximately 26), and who claims that he did so without drugs, is almost certainly lying." Using photographs of actual steroid users and non-users, we suggest that surreptitious use of these drugs is much more common than popularly believed (Pope et al., 2000).

Eating disorders in boys and men. Some men with the Adonis complex become preoccupied with fat as opposed to muscle and, hence, may develop eating disorders. Once again, the outstanding feature of these disorders is their secrecy. Over the last 20 years, women with eating disorders have become more willing to disclose such problems, but men often remain too embarrassed to do so.

Among individuals seeking treatment for eating disorders, it is estimated that only one in 15 is male, whereas in the community, the proportion of men with eating disorders may be one in six (Andersen as cited in Pope et al., 2000). In one study of 25 men meeting DSM-IV criteria for eating disorders who were recruited by advertisements, we found that only two (8%) had ever sought professional treatment (Olivardia et al., 1995). Many had kept secret their compulsive eating binges or their "purging" behaviors for years.

Although frank bulimia nervosa-with vomiting or laxative abuse-is certainly less common in men than women, the rate of compulsive binge-eating may be almost equal between the sexes. Studying a Canadian community, Garfinkel et al. (1995) found that 3.2% of women and 3.3% of men reported a history of binge-eating at least twice a week-a figure that would translate into several million men in North America.

Body dysmorphic disorder in males. Another million or more American men suffer from body dysmorphic disorder (BDD) (Phillips and Diaz, 1997; Phillips et al., 1993). Boys and men with BDD become obsessed that one or more parts of their bodies are ugly or deformed, even though they look perfectly normal. In a study of 95 men with BDD, we found that most were obsessed with their hair, skin and facial features, although any body part could be the focus of concern (Phillips and Diaz, 1997). About 15% reported that they were preoccupied with the size of their penis, but this figure likely represented underreporting, as the thriving penis-enlargement industry might suggest (Pope et al., 2000).

Penis enlargement, in fact, is only one of many cosmetic procedures sought by men. In 1999, according to the American Society of Plastic Surgeons and the Plastic Surgery Educational Foundation (2000), 107,575 men received cosmetic procedures, including 29,782 liposuctions; in 1996, 73,921 men had cosmetic procedures, including 12,184 liposuctions. Some men are satisfied with the results of such procedures. But men with BDD may receive multiple surgeries, only to grow increasingly dissatisfied with their appearance. Some even become suicidal (Phillips, 1996).
Increasing Prevalence?

Millions of contemporary boys and men exhibit frank symptoms of at least one of the four disorders above, and possibly tens of millions experience some distress about body image. Why has the Adonis complex grown so prevalent? Our fathers and grandfathers didn't worry about going to the gym or working out on a treadmill. A generation ago, high school boys didn't flock to buy nutritional supplements like protein powders, amino acids and creatine. The most masculine icons of Hollywood-John Wayne, Gregory Peck or James Dean-were wimps in comparison to the muscled superheroes of the modern screen.

Cosmetic surgery for men was almost unheard of. The term a six-pack of abdominal muscles, now known to every schoolboy, had not yet been coined. What has changed in the last 30 years? While space does not permit a full answer to this question, two major changes are unique to the present generation: the appearance of anabolic steroids and the empowerment of women.

Anabolic steroids were developed in the 1930s and '40s, but it was not until the 1970s and '80s that usage became widespread (Yesalis, 1993). Steroids have shattered a million-year-old equilibrium of nature by making it possible to create men far leaner and more muscular than any naturally occurring man. The images of these steroid-pumped bodies have propagated into advertising, television soap operas, professional wrestling shows, movies and magazine covers.

Even action figures-the little plastic heroes used by young boys in play-now sport huge muscles in comparison to their counterparts of a generation earlier (Pope et al., 1999). Thus, from early childhood, boys are assaulted with thousands of images of steroid-sized bodies, all conveying the subtle message that this is how an ideal man should look. For decades, women have had to cope with images of impossibly beautiful female bodies-which have likely fueled women's anxieties about their body appearance (Garner et al., 1980). Now men are getting a dose of the same medicine.

A second possible source of men's body insecurities is the growing empowerment of women. Although inequities between men and women still exist, today's women can fly combat aircraft, run multinational corporations, and compete with men in most jobs and professions. Men's traditional sources of masculine self-esteem-as breadwinners, soldiers and defenders-have eroded.

What does a man have left to distinguish himself as a man? Some men, consciously or unconsciously, may see their bodies as a last refuge: women can have equal rights in every walk of life, but they cannot bench-press 300 pounds. Thus, men may focus increasingly on their bodies.
My colleagues and I hypothesize that these social forces combine with biological and psychological risk factors to create body image concerns and disorders in men.

What Should Be Done?
Bona fide body image disorders in men require professional treatment, often with cognitive-behavioral techniques or medications such as serotonin reuptake inhibitors (Hudson et al., 1999; Pope et al., 2000). But what is the remedy for the far larger number of boys and men suffering from milder but still distressing body preoccupations that do not qualify for a psychiatric diagnosis?
One strategy may be to help liberate them from the messages of the unrealistic images that surround them. Today's men should recognize that many of these muscled bodies are products of steroids and other drugs; they should also recognize that large industries profit by nurturing male body obsessions, just as similar industries prey on women.

Men should remember that muscularity is not masculinity and that self-esteem is not built on a six-pack of abdominal muscles. Perhaps if we can help boys and men to rise above the messages of contemporary society and the media, they can regain the simple comfort with their bodies that previous generations took for granted.

Dr. Pope is professor of psychiatry at Harvard Medical School and chief of the biological psychiatry laboratory at the McLean Hospital Alcohol and Drug Abuse Research Center in Belmont, Mass. He is an author of more than 300 published papers on a range of topics in psychiatry.

References
American Society of Plastic Surgeons and the Plastic Surgery Educational Foundation (2000), National Clearinghouse of Plastic Surgery Statistics. Available at: www.plasticsurgery.org/mediactr/stats.htm. Accessed Oct. 23.
Buckley WE, Yesalis CE 3d, Friedl KE et al. (1988), Estimated prevalence of anabolic steroid use among male high school seniors. JAMA 260(23):3441-3445.
DuRant RH, Rickert VI, Ashworth CS et al. (1993), Use of multiple drugs among adolescents who use anabolic steroids. N Engl J Med 328(13):922-926 [see comment].
Garfinkel PE, Lin E, Goering P et al. (1995), Bulimia nervosa in a Canadian community sample: prevalence and comparison of subgroups. Am J Psychiatry 152(7):1052-1058.
Garner DM, Garfinkel PE, Schwartz D, Thompson M (1980), Cultural expectations of thinness in women. Psychol Rep 47(2):483-491.
Hudson JI, Pope HG Jr, Carter WP (1999), Pharmacologic therapy of bulimia nervosa. In: The Management of Eating Disorders and Obesity, Goldstein DJ, ed. Totowa, N.J.: Humana Press Inc., pp19-32.
Kouri EM, Pope HG Jr, Katz DL, Oliva P (1995), Fat-free mass index in users and non-users of anabolic-androgenic steroids. Clin J Sport Med 5(4):223-228.
Olivardia R, Pope HG Jr, Hudson JI (2000), Muscle dysmorphia in male weightlifters: a case-control study. Am J Psychiatry 157(8):1291-1296.
Olivardia R, Pope HG Jr, Mangweth B, Hudson JI (1995), Eating disorders in college men. Am J Psychiatry 152(9):1279-1285.
Phillips KA (1996), The Broken Mirror: Understanding and Treating Body Dysmorphic Disorder. New York: Oxford University Press.
Phillips KA, Diaz SF (1997), Gender differences in body dysmorphic disorder. J Nerv Ment Dis 185(9):570-577.
Phillips KA, O'Sullivan RL, Pope HG Jr (1997), Muscle dysmorphia. J Clin Psychiatry 58(8):361 [letter].
Phillips KA, McElroy SL, Keck PE Jr et al. (1993), Body dysmorphic disorder: 30 cases of imagined ugliness. Am J Psychiatry 150(2):302-308 [see comments].
Pope HG Jr, Katz DL (1994), Psychiatric and medical effects of anabolic-androgenic steroids. A controlled study of 160 athletes. Arch Gen Psychiatry 51(5):375-382.
Pope HG Jr, Phillips KA, Olivardia R (2000), The Adonis Complex: The Secret Crisis of Male Body Obsession. New York: Free Press Inc.
Pope HG Jr, Olivardia R, Gruber A, Borowiecki J (1999), Evolving ideals of male body image as seen through action toys. Int J Eat Disord 26(1):65-72.
Pope HG Jr, Gruber AJ, Choi P et al. (1997), Muscle dysmorphia. An underrecognized form of body dysmorphic disorder. Psychosomatics 38(6):548-557.
Pope HG Jr, Katz DL, Hudson JI (1993), Anorexia nervosa and "reverse anorexia" among 108 male bodybuilders. Compr Psychiatry 34(6):406-409.
Pope HG Jr, Katz DL, Champoux R (1988), Anabolic steroid use among 1,010 college men. The Physician and Sports Medicine 16(7):75-81.
Yesalis CE, ed. (1993), Anabolic Steroids in Sport and Exercise. Champaign, Ill.: Human Kinetics Publisher.

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jw007

Well i would definately have bigorexia if i wasnt so skinny :(

Pip

This has been floating on the yank boards for a long time. Great the flaming that started from it lol!

ParaManiac

Not the first time this question has been asked - we often wonder the same thing!

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When a man opens the car door for his wife, it's either a new car or a new wife.
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Pip

Maybe i am not conveying myself correctly and if i am not then i blame the diet lol!

The article posted by Pscarb has been floating around the US boards for a while.
What was funny was the ensued flame wars which errupted between members all calling each other due to the vanity issue addressed by the article.

What made it particularly funny was most of them looked like sh!t trampled over by an army of council workmen.