The Art of Manliness - #520： The Surprising Origins and Prevalence of Bigorexia and Male Body Image Issues

00:00:00.000 Brett McKay here and welcome to another edition of the Art of Manliness podcast and we typically

00:00:11.320 associate body image issues with women. My guest today says that a quarter of people

00:00:15.380 with eating disorders are male and that there are millions of men in America silently struggling

00:00:19.440 with obsessing over how they look even to the detriment of their health, careers and

00:00:23.280 relationships. His name is Dr. Roberto Olivardia. He's a professor of clinical psychology at

00:00:27.420 Harvard and the co-author of the book, The Adonis Complex, How to Identify, Treat and

00:00:31.220 Prevent Body Obsession in Men and Boys. We begin our conversation discussing how the Adonis

00:00:35.200 Complex manifests itself in men and why male body image disorders are a fairly recent phenomenon.

00:00:40.400 Roberto and I then dig into how the ideal male body has changed over the past few decades

00:00:44.560 and how we've seen these inflated standards of male attractiveness show up in advertising,

00:00:48.420 movies and even action figures. Roberto then shares possible causes of male body image issues,

00:00:52.660 which include, interestingly enough, increasing gender egalitarianism in the West. We then dig

00:00:57.380 into specific ways body image issues appear in men, including bigorexia or muscle dysmorphia,

00:01:02.640 in which super jacked dudes think they're still too scrawny. Roberto then explains how eating

00:01:06.980 disorders like bulimia or anorexia manifest themselves differently in men compared to women.

00:01:11.480 And we end our conversation discussing the line between caring about how you look in a healthy way

00:01:15.260 and having a disorder, what to do if you're having problems with body image issues, and what

00:01:18.900 parents can do to inoculate their sons from the Adonis Complex. After the show's over,

00:01:22.700 check out our show notes at aom.is slash Adonis Complex. Roberto joins you now via clearcast.io.

00:01:36.300 All right, Dr. Roberto Olivardia, welcome to the show.

00:01:39.860 Oh, thank you for having me.

00:01:41.400 So you co-authored a book about, it came out 20, almost 20 years ago.

00:01:45.860 I know.

00:01:46.600 It's been a while. It's called The Adonis Complex,

00:01:48.860 How to Identify, Treat, and Prevent Body Obsession in Men and Boys.

00:01:52.900 I remember seeing this book when it first came out. I thought it was interesting because it's

00:01:55.840 all about body issues that men have, but that's something we typically associate with women. 1.00

00:02:00.660 So let's talk about the Adonis Complex. How do you all define what it is sort of on a big picture

00:02:06.360 view in the book?

00:02:08.120 Sure. So when we, as researchers and as clinicians, I specialize in the treatment of working with boys

00:02:15.280 and men with anorexia and bulimia and binge eating disorder, men who use anabolic steroids because

00:02:22.320 they feel like they can't get big enough. And when we were thinking of a title of the book,

00:02:27.240 we were sort of trying to think of something that encapsulated all of those manifestations.

00:02:31.760 And Adonis is this mythological Greek character. He was half man, half God, and he represented

00:02:39.540 the ideal in masculine beauty and strength and in appearance. And so we thought to call it Adonis

00:02:47.180 Complex to sort of represent all of the ways that men are striving in this pursuit of the ideal male

00:02:55.540 body. And it is strange to think that was almost 20 years ago that that book came out. And I remember

00:03:01.740 when it did come out, I mean, there were so many people that said, do boys and men even struggle

00:03:07.860 with this? I mean, is this even, how is this a rarity? And unfortunately, it is not a rarity. And

00:03:14.720 so our purpose really in getting that book out was to take what we were knowing from the research we

00:03:21.660 were doing and clinically what we were seeing and letting people know this is a big problem with

00:03:26.900 males as well as with women and girls.

00:03:30.260 So I remember in the 80s and 90s, watching like PSAs about anorexia or like binge eating,

00:03:36.700 but it was always geared towards girls.

00:03:38.820 Yes.

00:03:39.280 When did you, so there was like an awareness that was happening with women and young women.

00:03:43.720 When did you and your colleagues start noticing it with men? Was this like a, 0.65

00:03:47.220 is this a fairly recent phenomenon?

00:03:48.520 Fairly. So probably in the late 70s, early 80s, if you look in the scientific literature,

00:03:56.260 that's when we started to see eating disorders in males studies start to pop up, but they were

00:04:01.880 very limited samples and they were men who were primarily in treatment programs or were hospitalized.

00:04:08.320 And I was, when I was a senior in college, I went to Tufts University and I'm from the Boston area.

00:04:14.220 And I had known actually a couple of male students who independent of each other had

00:04:20.640 disclosed to me that they were struggling with the eating disorders and were completely shameful

00:04:27.160 about it. They said they had never told anybody about it. They were silently suffering. And I thought

00:04:32.740 this would be something interesting to study. So I actually ended up doing a thesis on it. And as part

00:04:39.280 of it, I told my thesis committee, I'm going to place ads in basically every college in the

00:04:45.280 Massachusetts area, which we have many in Massachusetts, and just to recruit these men.

00:04:50.720 And at that time, unbeknownst to me at that time, that was the first study that had recruited men

00:04:56.200 from a community sample. So not men who were patients in hospitals or treatment centers, but

00:05:02.060 sort of men who, most of whom may never have sought treatment for it.

00:05:06.100 And I remember my committee saying, well, you probably want a plan B because you may not get

00:05:11.460 a lot of men respond to this ad. Well, I didn't need a plan B. I actually had many men. I remember

00:05:18.600 my answering machine tape was full by the end of a couple of days of men saying, oh my gosh,

00:05:25.000 I can't believe you're studying this. I thought I was the only one. And when we brought these men in

00:05:29.580 and interviewed them, questionnaires, the overwhelming majority of them had never

00:05:34.860 sought treatment for the eating disorder. And in fact, there were some men in that sample who

00:05:39.860 were in treatment for depression, for substance abuse, and even in the context of that therapy,

00:05:45.880 never disclosed to their therapist that they might've been binging or purging or compulsively

00:05:50.540 exercising because of the stigma that they felt they had, that they would be seen as less masculine,

00:05:57.080 it's weak, that people would question their sexuality because there was a stereotype that

00:06:02.380 it was only something that affected women. So this book was published 20 years ago and you all

00:06:07.380 provide numbers, but I imagine those numbers have changed since then. Do we have an idea of how many

00:06:12.720 men are dealing with some sort of body issue, whether it's an eating disorder, like they're trying to

00:06:17.120 lose a lot of weight or they're spending a lot of time in the gym trying to get bigger? Do we have

00:06:21.260 any concrete numbers there? So generally, and part of it is that from the bottom up,

00:06:27.480 I mean, males in particular are still heavily under-researched. In fact, less than 1% of research

00:06:35.680 on eating disorders is focused on male subjects. So we still need a lot more work in even identifying

00:06:43.940 these individuals. But generally speaking, the statistics say about anywhere from 10 to 15

00:06:49.660 million men in the US are affected by eating disorders like anorexia, bulimia, binge eating

00:06:56.640 disorder. About anywhere from 2 to 3 million men have something called body dysmorphic disorder,

00:07:04.500 which is where you are preoccupied with a part of your body. It could be your nose, it could be your

00:07:09.940 penis size, it could be your hair, your muscularity, to a point that really gets, is significantly 0.97

00:07:15.580 interfering in their lives and in which they obsess and often avoid situations because of their negative

00:07:21.880 body image. And then when you include what we call subclinical body image and eating disorders,

00:07:28.340 so people that might not meet the kind of clinical criteria but are close to it, that amounts actually

00:07:35.820 in anywhere from 5 to 10 million men. And in fact, a lot of men might fall right under that radar where

00:07:42.460 even in research studies or in treatment samples might not be picked up because maybe they're not,

00:07:49.480 because again, a lot of the criteria of how we even define some of these, particularly with eating

00:07:54.340 disorders, was almost exclusively based on women. I mean, even the studies, I mean, if you look at some

00:08:00.860 of the very popular eating disorder questionnaires and surveys, there'll be items like, I don't like

00:08:06.480 my thighs, and you have to rate your level of agreement with that. You know, I don't like my

00:08:11.540 butt, I don't like my breasts, you know, terms that are, you know, men don't really relate to the 0.98

00:08:17.300 concept of thighs. Now, if you ask, if you word that to say, I don't like my quads, you know, I don't, 0.97

00:08:23.880 I'm not satisfied with my fitness shape or things like that or my muscle size, then you're going to have

00:08:29.780 a different endorsement of how men respond to that. So there's still a lot more work

00:08:34.440 in identifying. But I know just clinically, with the majority of men that I treat who struggle with

00:08:41.300 these things, I am one of few, if not the only person that knows that they struggle with it.

00:08:46.940 It's still something that's very, very shameful. Now with the boys that I treat, obviously their

00:08:51.560 parents and family members know, I have been seeing a trend where there's better identification

00:08:58.160 now and people are coming into treatment earlier, which is a good thing. And at the same time,

00:09:04.140 I've also seen an increase in these problems with boys and men.

00:09:07.960 So let's talk about what's going on there. As you highlight in the book, like this really wasn't a

00:09:11.980 problem, let's say for my grandfather's generation, like that World War II generation.

00:09:17.320 But you started seeing it happening in the 70s and 80s. Like what changed? What's going on that's

00:09:21.820 causing this uptick? Yeah, so that's absolutely true. So historically, we can document eating

00:09:28.740 disorders in women to the 1600s. I mean, it's historically for spiritual, religious, media,

00:09:35.760 pop culture, all of those reasons. With men, we really didn't see it so much until again,

00:09:42.680 those late 70s, early 80s. And we attribute a couple things to that. So one is that if we,

00:09:49.260 and we've done studies looking at even advertising and media, that somebody had the brilliant idea of

00:09:56.660 probably realizing, well, hey, we have half the population hating their bodies and profiting off

00:10:02.840 of that. Why don't we make the other half of the population not like the way they look and profit off 0.97

00:10:07.700 of that? And so we started to see, particularly in the early 80s, this rush of advertising featuring

00:10:15.680 half-nude male models, things like designer underwear. Think about it. I mean, would our

00:10:22.120 grandfathers have cared about designer underwear like Calvin Klein or Armani? Absolutely not.

00:10:29.580 It would have been Fruit of the Loom or Hanes, something just very functional. So the idea of

00:10:35.260 men even thinking about those things started to become much more advertised for them.

00:10:40.600 Also, if you think about the early 80s, in Hollywood, you have people like Sylvester Stallone

00:10:46.320 and Arnold Schwarzenegger and actors who clearly rather their bodies were these issues of commodity

00:10:54.820 and currency for them as opposed to the Hollywood actors in the 40s and the 50s. But also, we started

00:11:02.280 to see a whole tide changing in a very positive way around how women and men started to see

00:11:10.300 themselves. And obviously, in the late 60s and in the 70s, we had the women's liberation movement 0.85

00:11:16.160 and feminist movement, which we talk about in the book as being a very positive cultural change.

00:11:23.200 And in that change, it changed the way that women saw their gender roles and the roles that they took. 1.00

00:11:30.120 And up until that point, men pretty much defined themselves in their masculinity by how strong

00:11:36.920 they were, how much money they made. And when that is shared more with women, which again, 1.00

00:11:43.460 I highlight is a positive thing. But I think one of the ways that now came from that is that men

00:11:49.920 had to figure out what it meant to be a man if it wasn't being the breadwinner, when maybe your spouse

00:11:57.320 was making more money than you are, or being the strongest person when there could be women in 0.79

00:12:04.040 positions of strength and power. And the easiest, I guess the most concrete way to do that is through

00:12:11.220 the body. That men really, you started to see bodybuilding becoming much more the rage,

00:12:17.040 like from Pumping Iron and that documentary. Also, anabolic steroid use became much more accessible

00:12:23.420 to the average man. It wasn't just relegated to elite bodybuilding circles that you, you know,

00:12:29.140 in the fifties that you would see. So all of that together, I think kind of create this way of like

00:12:35.560 how to build a body that is representative of, of being masculine, you know, and a lot of the men

00:12:43.000 that I work with who struggle with eating disorders at that issue of masculinity often comes up.

00:12:47.480 So that's an interesting point because I've read similar studies in anthropology research about

00:12:51.720 when countries that have high levels of gender egalitarianism, you actually see this weird thing

00:12:57.240 where the genders start accentuating their differences even more. Correct. Because they 0.98

00:13:01.800 want to find a way like, Hey, we're saying this way, but how are we different? And so in this case,

00:13:06.560 men's like they can put on a lot of muscle and get the big shoulders, something women, you know, 1.00

00:13:11.440 they can, but not as well as men because they've men have androgen receptors in those muscles

00:13:15.600 increase more testosterone. But yeah, I mean, in some countries, women, like they act more feminine, 0.93

00:13:20.220 even though they can do everything else that a man can do. They're just trying to differentiate

00:13:24.540 themselves. Right. It's, it's interesting because one of the, the anthropological studies we came,

00:13:30.140 we came across was research of this tribe in Africa called the Wodabi tribe. And this is a tribe where

00:13:36.880 women have a lot of, a great degree of sexual liberation. If they decide that their husband is 0.99

00:13:42.440 unattractive, they could have an extramarital affair and that is sanctioned sort of in the tribe

00:13:48.180 and that culture. So men, what we also see is that men in this tribe are very, very astute to their

00:13:56.020 body image. I mean, they're, they adorn themselves with certain kinds of colors and feathers and costumes

00:14:02.140 and it all actually culminates in the ceremony called the Jerawal ceremony, which is basically a

00:14:08.300 male beauty pageant where, you know, men will show off their teeth and their height and their,

00:14:14.760 their bodies and adorn themselves again with, with clothing and women will judge them and they'll mock 1.00

00:14:21.860 and humiliate the men that are not up to par. And the men who are sort of seen as more attractive

00:14:28.580 are applauded and, you know, might be, you know, getting, getting some sex that night. So it's

00:14:34.740 interesting that in this culture now, it doesn't mean that it's a completely egalitarian culture,

00:14:40.260 but at least sexually it is that there's a great degree of sexual liberation. And, and that certainly

00:14:45.940 came about, you know, in the seventies and eighties where with the invention of the birth control pill and,

00:14:51.740 and again, shifting gender roles and women being seen as individuals who are, could have sexual

00:14:58.120 satisfaction and, and are entitled to that, that it did shift this way. And even now, I mean,

00:15:04.580 it's so interesting, which is how gender is talked about and, and gender fluidity and everything,

00:15:10.280 what we're going to see and how that sort of impacts, you know, the way that body image gets

00:15:15.700 looked at even today. It is interesting. I think that I was talking to my wife about that,

00:15:20.640 that the studies you guys talked about, about how egalitarianism led to differentiation. I was like,

00:15:26.400 we were like, that explains like when you go to the toy store now, there's like a pink aisle and

00:15:30.940 then there's like the blue aisle. Like, I don't know, growing up in the eighties, there wasn't

00:15:34.760 that there was like Legos and there was, that was it. Like there weren't pink Legos. It was just,

00:15:38.760 you had Legos and it's sort of, it's just sort of weird that that that's happened.

00:15:42.780 Yes, definitely.

00:15:44.080 Yeah. So there's a combination of things going here. Egalitarianism. So men are trying to find a

00:15:48.100 way to differentiate themselves. So they're putting on muscle. There's the change in advertising

00:15:52.880 that's been going on. That's, you know, been, you know, laid, you know, we, we've attributed the

00:15:58.160 problem with female body image disorders with these sort of the Photoshop fakeness of beauty 1.00

00:16:03.380 advertising. And you talk about movie stars. Yeah. Movie stars now, like they're all jacked. Like

00:16:07.960 Hugh Jackman is literally jacked. But if you go back to the fifties, like, you know, John Wayne,

00:16:13.800 Robert Mitchum, Paul Newman, like they just looked like regular dudes. Like they didn't,

00:16:18.260 they weren't like super, they weren't super huge or super jacked.

00:16:22.020 Absolutely. I mean, even like with, with cigarette ads featuring the Marlboro man, you know,

00:16:27.340 who is this sort of rough and tumble kind of masculine dude that, yeah, he wasn't, he didn't

00:16:33.460 have a six pack. And that was, that's all it took. You had to have a certain level of this

00:16:39.820 kind of air and confidence about you. I mean, all of those actors of yesteryear certainly had

00:16:44.840 a certain confidence and a certain way about them, but it was not connected to their bodies.

00:16:51.100 It wasn't sort of connected. I mean, they were seen as attractive men or handsome men by,

00:16:55.880 by people. But a lot of times, even the way we think of what we find attractive is often linked

00:17:02.300 to what we find in other attributes. If somebody is confident, we tend to find more confident people

00:17:08.100 attractive. And so it was a very stark change compared to, you know, you're right, what we

00:17:14.800 see now. I mean, with Hugh Jackman, with, I remember when Fight Club, when that movie came

00:17:19.640 out and so many of my patients, that was like one of those movies that all of them responded

00:17:25.360 to this idea that it, that was a shift actually to where it became less about being just big

00:17:31.380 and muscular, like sort of like the kind of pumping iron, but more about looking ripped

00:17:37.140 and looking lean. And I remember that movie getting a lot of attention around that, this

00:17:43.440 idea that, you know, Brad Pitt had this just cut body. And that was the beginning I felt

00:17:48.520 of that shift in that trend to not always being sort of this big muscle and fitness guy in

00:17:54.480 the room, but still being very fit and being very defined.

00:17:58.180 Yeah. I remember that. That's that scene where that first thing, he has a shirt off and he's

00:18:01.680 like, you know, he's carved from wood, I guess it was like this. Yeah. And what, but yeah,

00:18:05.980 people saw there like, I want that. But what they forget is that, you know, Brad Pitt was

00:18:09.100 probably hadn't eaten anything in like a day, was probably hyper dehydrated, right? To get

00:18:13.860 all the fluid out. So he looked like that.

00:18:16.120 Without a doubt. I mean, some of the, the, in Adonis complex and some of which, most of which

00:18:21.740 got in the book, but some of the stuff that didn't get in the book was, you know, interviews

00:18:25.580 or people that I had met who talk about, I remember this one woman I met with who was 0.94

00:18:30.380 an underwear model stylist and photographer. So her job was to photograph men in famous

00:18:37.320 underwear ads. And she said that basically they have men wear underwear that is two to 0.99

00:18:43.240 three sizes too small for them. And perhaps multiple of those underwear, they'll often enhance

00:18:49.880 their bulge with everything from Wonder Bread to, you know, sort of sexual toys, anything

00:18:56.640 because she said, that's what you're, if you can convince a guy that he's going to have 0.99

00:19:00.360 a bigger penis wearing an underwear, then he's going to buy it. Or the women in their lives 1.00

00:19:06.220 or the other men in their lives, in the case of gay men, will buy it for them. And so she

00:19:11.540 said, there's so much that she says gets manipulated. I mean, you can manipulate abs. I talked to a

00:19:17.800 makeup artist who said that she could draw abs in for men that just don't have a six pack, 0.98

00:19:23.660 but she could draw them in in a way that could look, I mean, you wouldn't even know the difference.

00:19:28.480 And so there is so much of that manipulation that we know happens. But I think again, you know,

00:19:33.820 there's a lot of attention and I, and I never, it's not about taking the attention away from women,

00:19:39.720 but also understanding to put men in the dialogue as well and understanding, you know,

00:19:45.000 because there are lots of boys and men who are, who are suffering and I'm seeing it younger also.

00:19:50.200 I mean, I've worked with boys as young as nine who struggle with significant body image and eating

00:19:55.500 disorders. And I imagine social media has only amplified this even more.

00:20:00.020 Oh, without a doubt, without a doubt. That, now that's something that, you know, I've always thought

00:20:04.740 if I ever, if we ever do the sort of revised or updated edition of Adonis Complex, it would have,

00:20:10.660 we'd have to have a whole chapter just on social media because I have a teenage son who's 14.

00:20:16.500 I have a daughter who's 12 and there's no question. He actually showed me an app. I was

00:20:22.600 giving a presentation. He said, Oh dad, you should talk about, I think it was called FaceTune. And

00:20:27.200 he said, it's this app where people take a picture and by a couple clicks, you can remove all your acne

00:20:33.400 off the, you can whiten your teeth. You could, and when you go on, when I, when I think it was on the

00:20:39.520 website, there were just as many before and afters of males as there were to females. I mean, they,

00:20:45.960 they market to both teenage boys and to teenage girls to basically enhance their appearance.

00:20:51.360 And I think it's so destructive because, so, okay, you have this picture now of what your ideal,

00:20:58.800 what you have now seen as your ideal self. And now you put that where you put that on Facebook,

00:21:05.120 on Instagram, but you don't really look like that. So what is that going to do? It's just a

00:21:09.340 setup to just feel even worse about yourself or not. I've worked with adult men who are in the

00:21:15.720 dating scene and will put a picture in their dating profile that is kind of, is Photoshopped,

00:21:21.580 is enhanced, is using that kind of app. And then they're, they're frightenedly anxious about meeting

00:21:27.760 the person on the first date because they don't a hundred percent look that way. And it's just,

00:21:33.380 it's, it's so, I find it very destructive. I mean, which is why right now my kids don't have any

00:21:39.340 social media and I'm going to try to have it be that way until they're in college.

00:21:43.340 I mean, honestly, I think there are a lot of issues with it. I mean, I think it could be very

00:21:46.980 helpful, but in terms of, for in other areas and venues, but for a body image, I've seen it

00:21:53.560 be nothing but a very negative influence. And also on social media, particularly on Instagram,

00:21:59.360 a lot of the influencers there, like they make their money peddling products that improve your

00:22:04.580 appearance, right? So weight loss teas, supplements, teeth whitening, whatever. That's how a lot of

00:22:10.440 those guys make their money.

00:22:11.580 Oh, without a doubt. And, and for people to understand, I mean, how kind of manipulative

00:22:18.100 and how they're there. And it sounds, this sounds very, you know, conspiracy, but it's true because

00:22:23.720 I had an experience with, it was a very popular men's magazine. I won't name the magazine, but it was

00:22:28.980 very popular men's magazine. They did an article when Adonis Complex came out.

00:22:33.000 And one of the things I talked about in the article were all these supplements that are

00:22:37.520 out there. And I said, some of them are useless. Some of them are actually harmful for you.

00:22:43.500 And maybe there are some that might have proven could increase muscle mass by like a very,

00:22:49.720 very small percentage. And I basically went on to kind of slip slam them and got a call from the

00:22:55.680 editor of the magazine and said, well, you know, we've really want to run this and we want this to be

00:23:00.800 the cover story. But a lot of our advertisers are those supplements that you kind of trash. 0.66

00:23:07.220 And so could you say, would you be willing to say something different about it? And I said,

00:23:12.320 no, I feel how I feel about it. And then basically the whole conversation changed where maybe they

00:23:19.480 wouldn't run the article. And I said, well, then don't run the article. Like I'm not,

00:23:23.240 I'm not going to say something different.

00:23:24.960 So they ended up running it. It became, it wasn't as prominently featured as it was originally

00:23:30.480 intended to, but they deleted everything that I said about supplements. And I thought, wow,

00:23:35.520 isn't this interesting that they're, here's information that I'm sharing with the public

00:23:40.720 and they have a right, you know, to edit and I, it's their magazine. However, it is,

00:23:46.060 it is motivated from, from profit. You know, it's motivated because these companies basically said,

00:23:52.480 like, we don't like this and we are trying to sell this product. And, you know, so the public

00:23:58.460 is not getting sometimes the right information.

00:24:01.600 So another way that sort of body image has changed for men, you guys showed this too,

00:24:05.580 you guys do a great job. You guys became amateur toy collectors in the process of writing this book.

00:24:09.640 And you show like, you know, show like a, like a GI Joe from the 1960s to a GI Joe from like the

00:24:14.860 late nineties. And like sixties GI Joe, I mean, he just looked like a regular guy,

00:24:19.520 but nineties GI Joe, like he's got biceps that are like the size, like half the size of his waist.

00:24:25.240 And so that's changed as well.

00:24:26.820 Yes. Oh my gosh. Without a doubt. I mean, that was actually a very fun paper that we wrote and

00:24:31.920 we were actually surprised by how, you know, big of a disparity the measurements would be. And that,

00:24:38.640 that's inspired by the very famous Barbie doll study that was done in 1980, which showed that if

00:24:44.520 Barbie were a real life human female, that her dimensions would be completely unrealistic. 1.00

00:24:50.520 Like you just couldn't create that body. And, and you may have heard that for years,

00:24:55.940 Mattel was getting a lot of pressure from moms groups and from feminist groups and body image 1.00

00:25:01.540 advocacy groups, and they refused to change. And then eventually they did start to change Barbie's

00:25:07.240 proportions. And so technically she is, it's doable to have that body. If you were, you know,

00:25:14.080 severely underweight with breast implants pretty much. And so we thought, what would be the analogy

00:25:19.420 to that? And I thought, well, I used to play with action figures when I was a kid. And so I went to a

00:25:25.120 toy store and with the permission of parents, I said, can I ask your kid, like what kind of action

00:25:30.740 figures they would like? And these boys, and they pulled them out and I bought them all and we measured

00:25:36.040 them. And that's exactly what we found that if these, these like Batman today, the action figure

00:25:42.040 was not Adam West, you know, from the TV show. But what was striking, the most striking about that

00:25:47.660 were the Star Wars action figures, because unlike GI Joe, which you could argue that the GI Joe in the

00:25:53.900 1960 is a different character than the GI Joe in 1990. And yes, even though the GI Joe's now are much

00:26:00.940 more muscular and ripped and, and just leaner. But with Star Wars, it was, so Star Wars came out in

00:26:07.760 the seventies, as you know, and then in the mid to late nineties, when we were doing this study,

00:26:12.620 it was re-released in the theaters because it was digitally remastered. So they re-released the

00:26:16.960 action figure line. So now these are based on the same character. Mark Hamill, Luke Skywalker is the

00:26:22.920 same character from the 1970s movies, 1990s. And those action figures, if you see, you know, anyone can

00:26:29.900 Google it, they're probably, it's probably online, is so strikingly different. It's almost laughable

00:26:34.840 that, I mean, even Mark Hamill, the actor was quoted as saying, oh my God, they put me on steroids

00:26:40.700 when he saw the new action figure. It's just, it's, it doesn't even look like him. His waist size is

00:26:46.440 dramatically smaller. His pectoral muscles are defined with his, his robe open more to show more

00:26:53.080 chest. Han Solo looks like he's been at the gym significantly over the 20 years. I mean, it's just,

00:26:59.040 and that was shocking to us because we're like, why are you changing that? Like you're not even,

00:27:04.860 it, it's not like they made it look more realistic. It actually looks more a further away from what

00:27:10.700 those characters look like in the film. We're going to take a quick break for your word from

00:27:14.200 our sponsors. And now back to the show. And so this has all led to a change in how a lot of

00:27:21.260 American or Western men picture the ideal male body. You've done, you talk about these interesting

00:27:26.520 research studies you did with different types of people, different ages, where you asked them to

00:27:31.160 pick their ideal body. And you asked this to men who were younger, women who were younger and older

00:27:37.540 men. And I thought it was interesting is, you know, a lot of times men focus working on their bodies.

00:27:41.980 They think, well, what a woman wants is a super muscular shredded guy. But when you ask women, 0.99

00:27:49.380 like their ideal body, it wasn't that.

00:27:51.040 Right. So that, that was a great study. That was my dissertation actually from when getting my PhD

00:27:57.460 where, so we developed this computer program called the somatomorphic matrix. And when you go on the

00:28:04.440 computer, you're presented with an image that is corresponds to a certain percent of body fat

00:28:09.340 and a certain percent of muscularity. So unlike women with body image, generally that most women 1.00

00:28:16.780 being overweight and being over fat are the same thing. So women, you know, they step on a scale. 1.00

00:28:23.160 If they see a number that's too high, they don't like that, you know, if they feel that they're

00:28:27.920 overweight. With men, what made those studies often invalid is that a lot of those earlier studies,

00:28:34.300 when they would do for men, because with women, they would present them with different images,

00:28:38.820 not on a computer, but on a piece of paper. And they would say, what's your ideal?

00:28:42.140 How do you perceive yourself? And what these, for heterosexual women, how do you think that,

00:28:47.300 what are men's ideal of the women's body? And invariably, what you find is women prefer an 0.99

00:28:53.920 image that is very underweight, often like restrictive. They see themselves as fatter than

00:29:00.120 they actually are. And they think that men want them to be thinner than men actually want them to be. 0.97

00:29:05.240 So when those studies were done with men, they kind of said, well, men aren't really

00:29:10.640 dissatisfied because some men want to lose weight, some want to gain weight, and so it cancels each

00:29:15.620 other out. Well, what they weren't accounting for was muscle mass and muscularity. Because most of the

00:29:21.200 men that I work with, they don't mind if they're 250 pounds, let's say, when they're, you know,

00:29:26.880 quote unquote, supposed to be 200, as long as they're all muscle. So being overweight really is

00:29:32.140 less integral to their body image is, is seeing themselves as being over fat. So when we did that

00:29:38.840 study, and these were college men who were, had to pick what is their ideal body? How do they see

00:29:44.840 themselves? And these were heterosexual men. How do you think a woman your age wants how, what she 0.97

00:29:51.460 prefers? And we found that men preferred a body image that was about eight pounds less body fat,

00:29:58.700 which was actually not that significant. However, that had 25 pounds more muscle, which was

00:30:05.880 statistically significant. And then when we actually polled women and had women take the study,

00:30:11.840 the survey, we found that women preferred a less muscular body than what men thought women preferred.

00:30:19.980 And what was actually the very interesting to me was, I had hypothesized that men's ideal body

00:30:27.080 would be, would match what he thought the, that women would prefer. And in fact, that wasn't true.

00:30:34.060 That in fact, men preferred a body that was even bigger than what they thought the average woman 1.00

00:30:39.600 even preferred. But the, the factor that really shone through was how big they thought the average guy

00:30:46.660 was. So there was something very important about men being bigger than other men, even if that was

00:30:54.100 to the exclusion of what women actually preferred. Now, one could argue, maybe if you're the biggest 0.60

00:30:59.000 guy in the room, you have your choice of any partner in the room or you have the best

00:31:04.120 options. But the fact that that variable didn't even pan out where it really didn't even matter what

00:31:09.700 women preferred. It just mattered how big they were as compared to other men. 0.55

00:31:13.880 Yeah. I wonder when I read that, I wonder if it's like, are men really doing it for like women or are they

00:31:18.660 just trying to compete with other men, right? It's like, you know, there's that, you know, saying like

00:31:22.360 my, I think I've heard like women don't dress for men, they dress for other women. Right. And when 1.00

00:31:27.060 there's like, there's an intra sexual competition going on between men.

00:31:31.800 Oh, I think so. Yeah. I think there's definitely something, the idea of, you know, men in a locker

00:31:36.900 room, you know, kind of comparing penis size and men in the gym, you know, looking at their, their

00:31:42.820 muscles and who's bench pressing. And we see it with women, as you mentioned as well. I mean, 1.00

00:31:47.100 there have been studies that have had, that have asked men how attractive they find women

00:31:53.000 wearing makeup is. And actually a lot of men, you know, prefer less makeup, you know, than more

00:32:00.220 for women. So that there are, there's definitely this intra sexual competition going on. Now, whether 0.97

00:32:06.420 that's for this ultimate goal of, again, having the most options to, you know, who you mate with and

00:32:13.180 and whatnot, that, you know, remains to be, you know, seen. But without a doubt, I mean, a lot of

00:32:18.620 them, the men that I work with, particularly the ones who are obsessed with their muscle size and

00:32:24.020 muscularity, they're more concerned about how weak they feel they look in comparison to other men.

00:32:32.580 And they're constantly comparing themselves to, is that guy bigger than me? Is he more muscular than me?

00:32:37.900 And part of it is that what makes body image problems so, you know, so difficult for people

00:32:44.080 is that it doesn't really have to do with the body. It's more around what we feel we get by having an

00:32:50.800 ideal body. So it's, if I have this ideal body, then I'm going to be more confident. I'm going to be

00:32:57.060 more powerful. I'm going to be seen as more attractive. It's, it's all of that, that we have to sort of

00:33:02.580 break down and unpack in, in working with these boys and men. Well, one more thing with the study

00:33:08.360 you did, not only did you pull college age men and women, but you also pulled like older men and

00:33:13.600 women, like I think in their fifties or sixties. And what I thought was interesting there, there was

00:33:17.120 no difference between men and women on what they thought the ideal male body was.

00:33:21.660 Right. Yeah. That there is something, I mean, with, with body image, we do see changes kind of,

00:33:27.940 you know, developmentally. Um, although I have, I work with men in their forties and fifties who

00:33:33.860 either struggle with eating disorders or who have body dysmorphic disorder. They, you know,

00:33:39.640 they don't want to have wrinkles and they don't want their hair to go gray or they don't want to

00:33:44.660 lose their hair. Um, and I've been seeing more of that, but typically in, in previous body image

00:33:51.420 research, you, people tend to get more satisfied with their body image as they age, which is

00:33:57.860 interesting because we associate being older with kind of, you know, being not liking sort of our

00:34:04.100 bodies. But actually I don't, I think part of that is, you know, when you get older, you value health

00:34:09.300 a lot more, you become much more aware of your mortality. And so, you know, you kind of realize

00:34:15.700 that there's almost something very trivial about worrying about how other people see you when you

00:34:21.660 have sort of a more fully lived experience. Um, but it's very normative for us to worry about that,

00:34:27.740 when we're younger. And again, it's not just around, Oh, I want people to like my skin and

00:34:33.500 my hair and my body, but I want to be accepted. I want to have connections. I want to have

00:34:38.520 relationships. And unfortunately there's a cultural script around, well, a way to get that is by

00:34:45.940 looking good or the only way to get that is by looking a certain way.

00:34:51.120 Well, so let's delve in deeper to some of these different ways the Adonis complex manifests itself.

00:34:55.820 So you mentioned muscle dysmorphia or body dysmorphia in one of that ways you guys call

00:35:00.360 this bigorexia, which you introduced a whole new word of the lexicon. So this idea that,

00:35:05.360 you know, so it's the opposite of anorexia where people, someone thinks they're, they're

00:35:09.340 fatter than they really are. Bigorexia is someone is not as muscular as they think they really are.

00:35:16.880 Right. That they, their fear is that they're not as muscular as in fact that they can be.

00:35:21.600 Some of the men I work with muscle, so we, you're right. So it was first we called it bigorexia and

00:35:27.040 then we kind of changed it to a more clinical name of muscle dysmorphia. And some of these men I work

00:35:33.180 with are very muscular guys. I mean, they're objectively big guys, muscular guys, but they

00:35:39.960 don't see it just like the 80 pound woman with anorexia who really thinks she's fat. So these are

00:35:46.440 not the guys that you would see at Venice beach with their shirts off kind of pumping. They,

00:35:51.400 even though they might have those bodies, they come to my office on a 90 degree day and they have

00:35:55.860 long sleeve shirts on because they fear that someone might see their quote unquote scrawny legs,

00:36:00.920 scrawny arms. They might be wearing pants because they don't want people to see their scrawny,

00:36:05.160 puny legs. They work out incessantly. A lot of them do steroids. So it, it is very much like

00:36:13.200 everything you see with anorexia, but just kind of almost as if the pendulum is just swinging in the

00:36:18.180 other direction. And in fact, studies that I've done that have compared men with anorexia with men

00:36:24.160 with muscle dysmorphia find that they actually look more similar than different in a lot of profiles

00:36:30.180 because it's, we kind of see it as just the same thing. It's just different variants of the same

00:36:35.460 thing. And I mean, so you mentioned like the extreme cases where people are wearing baggy clothes,

00:36:40.080 but you also highlight in this book, you know, people that you saw, men, you saw that,

00:36:43.760 you know, their muscle dysmorphia got in the way of their career. Like they, they got fired from

00:36:48.620 their jobs. They're spending too much time at the gym, got in the way of healthy relationships

00:36:52.520 because they're, you know, spending time with their significant other. They were spending time

00:36:56.400 at the gym where they're just bugging their significant others. Like, am I big enough? Am I

00:36:59.040 big enough? Am I big enough? And like, you know, for some people like that, that insecurity is

00:37:02.920 unattractive. Oh, absolutely. I mean, it, it really is. I, you know, when we started talking about

00:37:09.000 this and doing research, I mean, unfortunately it didn't garner any sympathy from people because

00:37:14.320 people were like, oh, you know, bodybuilders, like, oh, they're so vain and they're so arrogant

00:37:18.920 and, and all that. But this is not that, like, this is not vanity any more than an eating disorder

00:37:25.260 is about vanity. You know, we shouldn't look at someone with anorexia and think, oh, they're just

00:37:29.880 doing that for attention. It's all about, it's a, it's a serious, serious issue. And with the,

00:37:34.980 the men that I work with, they really feel like they're, almost their survival sort of depends

00:37:41.580 upon their, the way their body is. And so they will do anything. I mean, I've had, you know,

00:37:48.060 calls from, I remember a call from a dad I got years ago whose son, he was 18, struggled with,

00:37:54.020 with this. And he said, it started with his son asking, dad, do I look as muscular today as I did

00:37:59.700 yesterday? Is that guy across the street, does he look bigger than I do? Do you, do, does my bicep

00:38:06.320 look as big as it did, you know, yesterday? And he said it started out maybe three to four times a

00:38:10.340 day. And it got to a point where he literally counted, it was, it was up to 80 to 90 times a

00:38:16.240 day his son was asking for reassurance. And in, he said it was almost like delusional. And there's,

00:38:23.220 it's this incredible anxiety around it. And, and instead of, you know, going, you know,

00:38:29.820 to functions that they're supposed to be going to school or work, they were at the gym working out.

00:38:35.860 They felt compelled to do it. These are men who are boys and men who, if there was, you know,

00:38:42.720 I live in the Boston area, we get blizzards sometimes in the winter and gyms will close,

00:38:47.020 that they will have serious panic attacks. Some of them will feel suicidal if they feel

00:38:53.080 like they're losing muscle mass. I mean, it seems very strange probably to a lot of people to,

00:38:58.840 to hear, but, you know, if we think about it, if we flip it to eating disorders, you know,

00:39:03.700 15 to 20% of men and women with eating disorders will die. And of that 15 to 20%, half are due to

00:39:12.700 suicide and the other half are due to the medical complications of the eating disorder. But there's

00:39:18.240 a high suicide rate in this population and body dysmorphic disorder or BDD of which muscle

00:39:24.320 dysmorphia is, is a subtype of body dysmorphic disorder. It has outside of bipolar disorder

00:39:30.800 and schizophrenia and depression has one of the highest suicide rates. So these are individuals,

00:39:36.120 this is not, again, somebody who is just kind of vain. It's, it's much more serious than that.

00:39:43.260 I mean, as you talk about in the book, it's, you know, it's actually, there's a, there's an

00:39:47.340 element of obsessive compulsive disorder going on there. Like someone who would, you know,

00:39:51.600 you know, compulsively wash their hands are probably more likely to obsessively work out

00:39:55.720 of the gym if, you know, they caught that bug for whatever reason.

00:39:58.760 Yes. So we, we think of in, in psychiatric disorders, we sort of can group them almost in

00:40:05.000 different families, so to speak. And one of the families that share a genetic and underlying

00:40:10.320 genetic predisposition is what we call the obsessive compulsive spectrum disorders that includes OCD or

00:40:16.600 obsessive compulsive disorder, body dysmorphic disorders in that there could be generalized

00:40:21.620 anxiety disorder, trichotillomania, which is compulsive hair pulling, you know, certain

00:40:26.820 variants of panic disorder that all kind of have this genetic. So we'll, in doing family history

00:40:33.540 studies, uh, oh, anorexia would certainly be in there that you might find kind of runs in families

00:40:39.500 as well, that a lot of the people that I've treated for muscle dysmorphia, you'll often see

00:40:44.420 a family member that might not have muscle dysmorphia, but will likely have OCD, a history

00:40:50.100 of anorexia, you know, something of that. It just doesn't, you'll often see it run, run in families.

00:40:56.980 So what's the treatment for muscle dysmorphia like, like for extreme cases?

00:41:02.220 Yes. So typically the, the men that I see with muscle dysmorphia, they come into my office,

00:41:07.920 they never say, I want to come in and stop working out. They often come in because their

00:41:13.300 lives have hit a real bottom. They've gotten fired from their third job because they are late

00:41:19.040 constantly because they're at the gym. They are getting it, their wife is divorcing them

00:41:23.440 because they are, you know, chronically obsessed, you know, with, with this and they won't leave the

00:41:29.600 house, let's say for social functions because they feel that they don't look good enough.

00:41:33.880 So in that treatment is a combination of what we would call cognitive behavioral therapy,

00:41:40.160 which would include really looking at their cognitions or their thoughts. Things like,

00:41:45.440 if I lose muscle mass, then nobody will like me. If I go out in public and people see me as weak

00:41:52.020 and, and you try to examine with them the evidence for that, you know, how, how accurate are these

00:41:57.920 thoughts? And most of them are not, there's a very, almost this level of delusionality that you'll see

00:42:04.160 in individuals with, with body dysmorphic disorder, um, where, you know, they'll say,

00:42:09.480 oh, that person is looking at me clearly because they think I look ugly or they think I look too

00:42:14.640 skinny. And it's like, no, they're looking at you because you just walked in the room or they could

00:42:19.560 be looking at you because you look like their brother or because you have this cool shirt on.

00:42:24.100 And there are many other reasons someone could be looking at you or they might think you're

00:42:27.520 attractive. So you try to really work at deconstructing those thoughts. And then the

00:42:32.760 behavioral part is anything that they're avoiding, you expose them to something called exposure plus

00:42:39.300 response prevention therapy, which is the hallmark of treatment for obsessive compulsive disorder.

00:42:44.580 So if somebody, for example, has contamination fears and they're avoiding touching doorknobs and

00:42:50.220 shaking people's hands, the, the best and really only way that you can treat that is having the

00:42:55.580 person touch doorknobs and not only touch doorknobs in other people's hands, but touching dirty toilet

00:43:01.540 seats and not washing their hands for an hour or two and basically have them get used to the anxiety.

00:43:08.200 We call it the process of habituation, that they're habituating to the anxiety and recognizing

00:43:12.640 that the anxiety will come and go. What goes up must come down.

00:43:16.700 And when it goes, you realize that that, that, that feeling that you have that compels you to do

00:43:24.200 the compulsion or to avoid a situation that if we just stick through the emotion, kind of get through

00:43:31.120 it, that we realize that nothing bad is actually happening, that it's just, it's our mind kind of

00:43:36.940 thinking that way. And then with muscle dysmorphia, I'll work on things. A lot of the men that I've

00:43:42.260 treated with muscle dysmorphia also tend to have social anxiety, other sort of conditions and

00:43:47.540 disorders that I think feed into it. So we might do some assertiveness skills and social skills.

00:43:53.760 Some of them have histories of trauma, of sexual or physical abuse, which makes sense, you know,

00:43:59.620 building a big body becomes a way of defending yourself and not looking weak. If in the case,

00:44:06.460 I've worked with gay men who have muscle dysmorphia, who have used their bodies as a way to kind of 1.00

00:44:12.540 fight against this sort of homophobic stance that gay men are inherently less masculine than

00:44:19.300 heterosexual men, which, you know, isn't necessarily true. And that there are, you know, gay men and

00:44:25.720 straight men that, you know, whose gender identity is very different than their sexual orientation.

00:44:30.100 But I've worked with a number of gay men who really got into building their bodies as a way of

00:44:35.820 no one kind of questioning their masculinity, because unfortunately, gay men have to defend 0.99

00:44:41.440 their masculinity because of their sexual orientation. So there are a lot of different

00:44:45.660 causes that can feed into it. And so we try to address those roots. But most importantly,

00:44:51.920 honestly, is just getting them to do these behaviors. Not, you know, if they're weighing themselves 20

00:44:58.100 times a day, we remove the scale and how do you tolerate not knowing what your weight is and still

00:45:05.420 going out that day and not wearing the long sleeve shirts when it's 90 degree weather.

00:45:10.720 And I'll do these kind of exposures where I'll walk outside my office with the patient and they

00:45:14.640 have to wear short sleeves and shorts and we walk in a crowded place and it could be, and it works.

00:45:22.240 I mean, if someone can tolerate that.

00:45:24.180 Right. So, okay. One part of the Adonis complex is bigorexia, muscle dysmorphia. Another part you

00:45:29.800 mentioned is men with eating disorders and it's something we typically associate with women.

00:45:33.820 Yeah.

00:45:34.060 Thanks for those PSAs in the 80s and 90s. But here's a question. So how, is there a difference

00:45:38.380 between the way men and women manifest or experience eating disorders? Like they do it differently?

00:45:43.500 Does that question make sense?

00:45:44.500 Sure. Absolutely. So for the most part, it can look very similar. I would say that the

00:45:52.240 main difference is if you take with anorexia, that the overwhelming, I mean, certainly any woman I've 0.90

00:46:00.840 ever treated with anorexia, their goal is to look skinny and to look very thin. And that's kind of

00:46:10.360 their straightforward goal. With the majority of boys and men that I've treated for anorexia,

00:46:15.920 that they don't identify with the word skinny. They don't want to be skinny. They want to be

00:46:21.380 lean. And they'll say to you, and they say to me all the time, I know that I look really thin. So in

00:46:30.000 some ways, they actually have a clearer perception of what their body looks like. However, I am so

00:46:36.720 fearful of being fat and gaining weight that I just, I'm kind of stuck in this. But if you told

00:46:45.420 me that every bite of food that I ate would immediately convert into muscle in my body,

00:46:51.480 then I wouldn't have a problem eating. And of course, and what I tell these boys is, well,

00:46:56.960 in order to create muscle, you need to have fat. Like your body isn't going to just create muscle

00:47:01.500 without having fat. And so there is that bridge where you have to eat and you're going to need to

00:47:08.500 have a certain amount of body fat. And your body has to trust that you're going to hold on to a

00:47:13.020 certain amount of body fat. Because if you have no body fat, you will die. Your body won't be able

00:47:18.520 to survive. And so a lot of the males I treat, and what's interesting is that this actually almost

00:47:24.760 becomes a helpful factor in the treatment because they're not totally wedded in this ideal of being

00:47:32.900 skinny. But for them, it's the fear of that bridge. Now, a lot of times these men can lapse into muscle

00:47:41.120 dysmorphia. So when they start to gain weight and they're so fearful of gaining fat that they lapse into

00:47:47.520 this muscle dysmorphia paradigm. And so we tried to prevent that. So that's a big difference.

00:47:53.860 With bulimia nervosa, which is binge eating coupled with compensating behaviors like self-induced

00:48:00.300 vomiting or laxative use, compulsive exercise. Generally speaking, we don't see as much laxative

00:48:06.440 use with men as we would see with women. I would say I see just as much self-induced vomiting. 0.88

00:48:11.540 But certainly the overexercise is probably more common as a purging method. Whereas with women, 1.00

00:48:19.060 you'll see the self-induced vomiting or fasting. So women who might binge eat and then don't eat for 0.99

00:48:24.520 two days and then binge eat. This sort of almost like a coupling of anorexia and bulimia.

00:48:30.280 And then with binge eating disorder, which basically just got recognized since the mid to late 90s,

00:48:37.140 that unlike anorexia and bulimia, which certainly affect more women than men,

00:48:42.900 a binge eating disorder is almost at about a 50-50 gender distribution. Now, having said that,

00:48:48.700 what's very important for people to know is that about 25% of people who struggle with eating disorders

00:48:54.500 are male. And that is something that years ago, it would have been maybe less than 1% of individuals

00:49:04.820 with eating disorders are male. And studies have shown that if you look in treatment centers,

00:49:11.660 about perhaps 1 in 16 to 1 in 20 eating disorder patients are male. But in the community,

00:49:19.480 it's about 1 in 4 people with an eating disorder are male, which means there are a lot of men out

00:49:24.840 there who never come through treatment doors. Now, part of that is a lot of treatment centers don't

00:49:30.520 accept men. A lot of eating disorder programs are just exclusively for women. And then again,

00:49:36.820 some of that comes from just men themselves not having a hard time seeking treatment.

00:49:41.580 Something you also talk about in the book when it comes to eating disorders in men,

00:49:46.060 for a lot of these men, it starts off in high school if they were like a wrestler.

00:49:50.700 And it requires that cutting weight, and they do these extreme measures to get as much body weight

00:49:56.660 off of them as possible. And then after wrestling is over, it's still with them.

00:50:02.380 Yes. That was the very first study I did actually on eating disorders in men. I got calls actually

00:50:08.280 from a lot of wrestlers who... And I didn't have a wrestling team in my high school. I didn't know

00:50:13.200 any wrestlers when I was younger who said, oh, I could gain and lose 20 pounds in two to three days.

00:50:21.240 And I thought, how is that even possible for someone to do that? But then I got many calls from

00:50:26.220 various wrestlers from various colleges saying, talking about these practices. And the men that I

00:50:33.040 included in the study were men who engage in these behaviors even after wrestling season. But it opened

00:50:40.300 my eyes to sort of this practice of cutting your weight down and then binging and putting the weight

00:50:47.060 back on. And interestingly, there are sports, ballet dancing or wrestling or football, where weight

00:50:54.620 is very sort of is an integral variable. However, what I found in general and in patients that I work

00:51:02.040 with is, yes, engaging in these sports can sometimes trigger and create eating disorders in individuals,

00:51:08.460 particularly if you don't have healthy modeling from coaches or peers. However, a lot of the patients

00:51:16.160 that I work with who had eating disorders sometimes will gravitate to sports that emphasize keeping and

00:51:23.720 maintaining a certain body weight, almost like it's kind of fueling something that was already there to

00:51:29.880 begin with. But then it absolutely exponentially makes it worse. And that's a tough population in

00:51:37.160 general too, because I've worked with college students who are highly, highly competitive athletes,

00:51:42.300 whose college scholarships are because of their sport, who some of them are, you know, could be

00:51:48.400 Olympic athletes. And to them, you know, they see their eating disorder as something that's almost

00:51:55.460 integral to their success. And the fear of being, of not engaging in these behaviors mean, well, maybe I'm

00:52:03.380 not going to be as good of an athlete, then I'll lose my scholarship and I'm going to disappoint everyone

00:52:07.440 and I won't make it, I won't make these goals. And it's, it's a much harder sort of navigation to that, but it still

00:52:16.460 comes down to and what it ultimately comes down to in recovery for these people is you, they've had to

00:52:22.600 choose, you know, living or, you know, doing well in these sports because I've worked with men who are 20, 21 who have

00:52:30.340 had heart attacks because of their bulimia. It's very, very dangerous. We are not meant to treat our

00:52:37.360 bodies this way. And your body will do very, very strange things when you're, you know, making yourself

00:52:43.460 vomit all the time, when you're not eating, when you should be. It can really mess up the way your heart

00:52:49.040 regulates itself and your, you know, other parts of your body functions, your organ functions work.

00:52:55.680 And I've seen it happen and it's, it's, it's disturbing. And so that's what I think people

00:53:01.480 have to recognize. This is a public health issue. Yeah. And the sad irony is you said not only can

00:53:06.420 these cause these extreme health complications, but it also just, even if that doesn't happen to

00:53:10.900 you, it's probably hindering the athlete's performance, right? Because that extreme weight

00:53:15.540 loss can, you know, wreak havoc on your hormones. Oh, without, absolutely. And then, right. And then when you

00:53:20.740 bring in hormones into all of this, I mean, that is, you know, the interesting thing with,

00:53:25.220 particularly the men with muscle dysmorphia who use anabolic steroids of which about, I would say

00:53:30.740 about 50% of the men that I've worked with who have muscle dysmorphia will use steroids and it makes

00:53:35.440 sense. I mean, steroids are quick and easy way to gain muscle, except that it has so many adverse

00:53:41.780 medical effects to it. But one of which is that when you inject or bring in testosterone into your body,

00:53:49.600 your body stops producing its own natural testosterone because it basically says, oh,

00:53:54.820 we're getting it from somewhere else. We don't need to make it anymore. And so it can actually

00:53:59.900 create these sort of feminizing effects of gynecomastia, which is like breast enlargement, 1.00

00:54:05.480 testicular shrinkage, impotence, all of these things that of course go against what any man,

00:54:11.700 you know, would want and can actually create like a dependence on steroids. So it's not a dependence

00:54:17.660 in the same way that we would talk about with cocaine, for example, but it is, it's a physiological

00:54:23.500 dependence in that when men who do steroids for a period of time and they stop doing them

00:54:28.880 and their bodies are not just going to kick right back into producing testosterone,

00:54:34.640 their bodies will kind of lose that muscle mass and sometimes create these sort of feminizing effects 1.00

00:54:40.040 because now they're not getting any sort of free, you know, this free range of testosterone in their

00:54:44.340 bodies. So it, and then what that does to them mentally, you know, the concept of roid rage,

00:54:49.340 of being incredibly aggressive, low frustration tolerance. I've absolutely seen that happen.

00:54:54.600 That is a real thing. Some people would say it's a myth. It is not a myth. It's been scientifically proven.

00:55:00.720 I mean, it wreaks havoc on all of those things. And especially if you're a teenager who's struggling

00:55:05.260 with these things, these are, you know, particularly the boys I work with,

00:55:09.200 it is a critical, critical window in like some of the habits that they're doing and the ways that

00:55:15.900 they might be, you know, being very destructive in their bodies could literally affect them the rest

00:55:20.720 of their life. So that's why it's so important to get treatment, you know, as quickly as possible

00:55:26.120 and specifically during those developmental windows. But quickly to go back to the athletes

00:55:31.020 that when I have worked with athletes who have recovered, all of them will say,

00:55:35.200 oh my gosh, it is so much better. And I'm so much a better athlete being healthy. You know,

00:55:41.340 it's similar to, you know, a lot of musicians who, when I've worked with who are sober from drug addiction,

00:55:47.620 you know, who have attributed their creativity to drug use, realize, no, I'm still a creative person.

00:55:53.380 I can still write good songs and I can still be artistic and just actually be more mentally stable

00:55:59.780 and mentally sane.

00:56:01.360 And so I think a point we should make, which we haven't, but I think, you know, it's been implicit.

00:56:04.760 Like you're not talking about not caring about how you look at all. Like that's not the solution.

00:56:11.260 Like you should, you know, of course, be fit, exercise, basic grooming. You want to put out

00:56:16.500 that that's, that's, that's all good. It's like when it becomes all consuming and it becomes like,

00:56:22.100 it just, it ruins other aspects of your life. That's when it's a problem.

00:56:25.820 Correct. And I'm glad you brought that up because that is something that I get, you know,

00:56:30.880 we get accused of a lot is, is saying that we are promoting the Pillsbury Doughboy or I've heard it

00:56:37.920 so many, I mean, I've done radio shows where callers call in and, you know, they think, oh, you, you know,

00:56:42.680 just want everyone to be obese and not care about the way they look. No, that's not at all.

00:56:47.300 I, you know, first and foremost, I want people to be healthy. I want people to be physically healthy,

00:56:51.660 psychologically healthy. And at the same time, I want you to have a healthy body image. And part

00:56:57.640 of body image is I, to look, to feel good about the way you look. Like I, you know, wear certain

00:57:04.200 clothes that I feel, you know, fit me well and that I feel good about and kind of express who I am. I,

00:57:11.160 you know, style my hair in a certain way and, you know, do I go to the gym and I run. And so it's not

00:57:17.640 that I do that for health reasons, but I also do it for body image reasons. But like you said,

00:57:22.640 it doesn't dominate me, you know, and that's where I usually water it down to, you know, the line when

00:57:30.080 people ask me, like, what's that line that gets crossed over? And to me, it's, you know, are you

00:57:35.460 doing something that's destructive or that's unhealthy? So if you're engaging in purging behavior and

00:57:40.980 restrictive eating and anabolic steroid use and substance abuse that's meant to lose weight,

00:57:46.660 that's not healthy. If your self-esteem is primarily rested upon the way you look,

00:57:54.060 you're headed for disaster because there's one thing I can guarantee you is you will look different

00:57:59.500 five years from now than you do, you know, from now. Our bodies are changing. We age. So, you know,

00:58:07.120 can some, can you feel good about the way you look? And that represents some of your self-esteem?

00:58:12.100 Sure. But if the majority of your self-esteem is built on that or built on, honestly, you know,

00:58:18.420 anything that has any sort of comparative effect, like if you're primarily your self-esteem is based

00:58:24.600 on, let's say, your academic performance, that can be very tricky too because there are people that

00:58:30.700 could be getting better grades than you do and people who are higher ranked, you know, than you

00:58:34.840 are. But if you base your self-esteem on your intellect, well, that's something that's going to

00:58:39.600 carry with you the rest of your life. And it doesn't depend upon other people. It doesn't depend

00:58:44.000 upon the approval of other people. If your self-esteem is on your sense of humor, is on the

00:58:49.580 way you treat people, those are consistent factors. But when it's something on body image, it's dangerous

00:58:55.320 territory because then it means that there's a fragility around that self-esteem because your body

00:59:01.140 image today, I mean, even if we look at trends in what is even considered attractive, it could be

00:59:07.640 totally different 10 years from now. And so where does that leave people? And if it's impairing or

00:59:13.340 getting in the way of your life functioning, your social functioning, your relationships, your jobs,

00:59:19.280 your careers, then it's a problem. You know, that's when you know, okay, wait a minute. If the whole goal

00:59:24.900 is to be happy and this, the pursuit of this is actually getting in the way of my marriage,

00:59:31.620 is getting in the way of my friendships, then how is that fulfilling that goal of being happy?

00:59:36.880 Something is off there. So absolutely. I mean, I want people to, you know, celebrate their body

00:59:43.180 image and to have a good relationship with it. Go to the gym, be healthy, eat well, but it's more

00:59:49.080 around not crossing that line, which can get very dangerous. And so if you feel like you have crossed

00:59:55.980 that line, it sounds like you should probably get professional help. This is probably not something

00:59:58.920 you probably can do on your own. Correct. Absolutely. I highly recommend it. And, you know,

01:00:03.980 especially, you know, for men who in general are less likely to seek therapy, to know that there

01:00:09.540 are people who really do understand it. A lot of the men that I work with will say, you know,

01:00:15.500 they come to see me because they know I wrote Adonis Complex, or they saw something and they

01:00:20.680 thought, oh, okay, I'm clearly not the first person that this, you know, psychologist has seen

01:00:26.220 with this. And there are many people who have experience with this. And so to absolutely seek

01:00:31.880 treatment because it can be a very, very tormenting disorder, eating disorders, body dysmorphic

01:00:39.260 disorder, it can get quite, quite severe. So please just, yeah, I just urge people to seek help if it

01:00:45.000 crosses that line. And if you're a parent of a boy, I mean, as you say, a lot of the people you see

01:00:49.420 are young men, like boys and teenagers. Correct. 0.89

01:00:52.060 And something you can start doing, I guess, is having that conversation with them when they

01:00:54.760 start bringing things up. Like, hey, dad, am I more muscular than yesterday? Doesn't mean he has

01:01:01.720 body dysmorphic disorder, but it's a time where you can have that conversation about it, right? It's

01:01:07.460 like, hey, what's going on there? Why are you concerned about that or whatever?

01:01:10.660 Absolutely. I mean, it's very normative. I mean, I remember being a teenager. It's very normative

01:01:16.440 to be insecure and to be insecure about your body image, especially when you're going through

01:01:21.360 puberty. I would not want to go through puberty again. And so I tell parents, don't be alarmed

01:01:28.180 that when you hear someone even say, oh, I hate my body. I hate the way this looks. Oh, I hate...

01:01:34.020 That's normative. But you definitely want to engage in it because I wouldn't dismiss it as

01:01:42.640 just normative either. So I don't overestimate it, but don't underestimate it either. And just

01:01:47.920 have conversations and notice, well, if he's saying, oh, I hate the way I look, but he's not

01:01:53.480 going out with his friends that night because his hair doesn't look right, then that's more

01:01:59.040 concerning. Versus he might say, oh, I don't like this acne, but he's still going out and he still

01:02:04.520 has friends and having a good time. That's sort of more normative. So to definitely keep your eye out,

01:02:10.660 especially for boys, because we're taught to be aware of how we talk about body and food with our

01:02:16.460 daughters as we should be. But we don't think about our sons in this. And many parents that I

01:02:23.800 work with will often feel very guilty. And I tell them not to because as parents, we all do the best

01:02:29.920 that we can do. And we don't know what we don't know all the time. But they'll say, it never occurred

01:02:36.240 to me to be aware of how I talk about my own body. And this is for moms or dads around my son.

01:02:43.360 Or it didn't even occur to me to say to my son, hey, you're looking a little chubby there,

01:02:48.540 that that could really produce a problem. Whereas no one, or hopefully people aren't

01:02:54.780 talking to their daughters that way. So that's another part that we just want to get awareness

01:02:59.720 out there is that, especially nowadays where with social media and everything, you're out there.

01:03:06.720 I mean, think about it as a teenager. You could be at a party and a picture could be taken of you.

01:03:11.700 And let's say you don't look your best. And now it's like all over social media. It's just,

01:03:17.380 there's more of an exposure in general to these young people to have to put a certain pressure

01:03:22.500 on them to look a certain way.

01:03:24.440 Yeah. I think it's also, you can have that conversation that we've had with young girls

01:03:28.000 about, okay, that picture of the model in the ad has probably been photoshopped, et cetera.

01:03:32.180 Like have that same conversation with your boys. Like, hey, that men's health cover model,

01:03:35.680 you know, he's probably been fasting and cutting weight and it's probably been photoshopped some.

01:03:41.220 So it's like not, it's not possible to look like that all the time. And I've even, I've had that

01:03:45.720 conversation with my son, he's eight. And you'll see some like really jacked dude. And he's like,

01:03:50.360 dad, cause I power lift. And he's like, dad, why don't you look like that guy? And like the guy,

01:03:54.140 of course, is like super ripped. I don't look like that. And I have to explain to him, well,

01:03:57.540 just because your muscles are ripped doesn't mean you're necessarily strong,

01:04:00.080 right. And healthy. And it's been, it's been good. And like, you know, he's eight, but like

01:04:04.160 he gets it. Like, I think sometimes we underestimate what our kids can understand.

01:04:08.660 That's absolutely true. I a hundred percent agree with that. And I have those same conversations with

01:04:13.080 my, with my son around, you know, that and around, you know, also just with celebrities. I mean,

01:04:18.920 this is their career, you know, that if, if the rock suddenly lost all of his muscle mass,

01:04:24.860 his career would be, you know, he'd lose his career for the most part. I mean,

01:04:29.180 his career is built upon, you know, that body. Now, could he act in movies, you know, without

01:04:34.640 that body? I'm sure, but he certainly wouldn't be getting the roles he's getting now. So his,

01:04:39.860 his livelihood is dependent upon that. So he has to go to the gym and he has to be super aware of

01:04:47.320 his diet and that's his job, you know, in that way. And I'm not saying, I'm not even commenting on

01:04:53.020 whether it's healthy or not, but just for people to understand it's, it's easier when your

01:04:58.300 livelihood is kind of dependent, you know, on that, even though, and again, I'm not even saying

01:05:02.680 that that's always a healthy thing, but when the average kind of ordinary individual looks at

01:05:08.420 someone and says, Oh, like, I want to look like that. It's like, well, but that person is spending

01:05:13.060 hours upon hours to look that way. And that's even assuming that everything you're seeing is not

01:05:18.760 Photoshopped, you know, but they have a trainer that they work with four hours a day and they have

01:05:23.700 a cook that's making, you know, but absolutely. I, I've had those same conversations even when my son

01:05:28.880 was young and he, he could, they could absorb a lot more than we think they can.

01:05:33.020 Yeah. You explained it like they don't, yeah, they looked like that at that moment. They probably

01:05:36.280 didn't look like that the next day. You know, like, you know, like Brad Pitt doesn't look like Brad

01:05:40.780 Pitt and fight club in that one scene anymore. It's a 50 year old guy now. Well, Roberto, this has

01:05:45.860 been a great conversation. Do you, is there someplace people can go to learn more about what you're doing,

01:05:49.620 your work? So unfortunately I don't have any social media and I don't have a website. And I,

01:05:55.520 you know, usually just urge people, if you Google my name, you know, you'll see articles, you'll see

01:06:01.200 YouTube videos of, of, from different outfits and platforms of whether it's in this topic of eating

01:06:07.280 disorders in men, or I also specialize in working with individuals with ADHD and learning disabilities.

01:06:12.520 So you'll see, you know, my name associated in that field as well. But yeah, if you, if you Google my

01:06:17.740 name, you'll see YouTube videos or things like that, documentaries around this particular issue.

01:06:24.180 Well, Roberto Olivardia, thanks so much for your time. It's been a pleasure.

01:06:27.080 Oh, absolutely. It's been a great pleasure for me as well.

01:06:30.420 My guest today was Dr. Roberto Olivardia. He's the co-author of the book, The Adonis Complex.

01:06:34.800 It's available on amazon.com and bookstores everywhere. You can check out our show notes

01:06:38.040 at aom.is slash adonis complex, where you find links to resources, where you delve deeper into this topic.

01:06:47.740 Well, that wraps up another edition of the AOM podcast. Check out our website at

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The Art of Manliness - June 26, 2019

#520： The Surprising Origins and Prevalence of Bigorexia and Male Body Image Issues

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