Adonis Complex: How to Identify, Treat and Prevent Body Obsession in Men and Boys

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Overview

A HEALTH CRISIS THAT STRIKES MEN OF ALL AGES
Trying everything from compulsive weight lifting to steroids, more and more boys and men are taking the quest for physical perfection beyond the bounds of normal behavior. The Adonis Complex — the groundbreaking book that first gave a name to this phenomenon and sparked nationwide interest in the subject — identifies for the first time the symptoms and warning signs of this dangerous problem, including:

  • An obsession with exercise, sometimes to the exclusion of all other activities
  • Binge eating, anorexia nervosa, and bulimia
  • The abuse of steroids, muscle-building supplements, and diet aids

But perhaps more important, it offers readers an explanation of the underlying causes of the Adonis complex, together with hands-on advice for those who have experienced body obsessions themselves, or who see these problems in a boy or man they love.
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Editorial Reviews

From the Publisher
William Pollack, Ph.D. author of Real Boys: Rescuing Our Sons From The Myths Of Boyhood Ten years after The Beauty Myth we finally understand the relationship between society's expectation of boys and men and how they think about their bodies.

Time magazine cover story Groundbreaking. Ripped male bodies are used today to advertise everything that shapely female bodies advertise: not just fitness products, but also dessert liqueurs, microwave ovens, and luxury hotels. The authors of The Adonis Complex want guys to rebel against those images, or at least see them for what they are: a goal unattainable without drug use.

Publishers Weekly Compelling [and] convincing...A provocative look at what has been, until now, a largely unexplored subject.

Publishers Weekly - Publisher's Weekly
The impossible ideal of the Body Beautiful induces feelings of inadequacy not only among women and girls, claim the authors of this book, but, increasingly, among men and boys. Drawing upon their own clinical work, new studies and cultural observations, the authors--Pope and Olivardia teach at Harvard medical school, and Phillips at Brown University--make a compelling argument that growing numbers of males are exhibiting compulsive behaviors, chronic depressions and eating disorders, and are engaging in the use of dangerous steroids and "supplements." Although they ignore the nearly century-old popularity of Charles Atlas-like muscle-building "courses," the authors use a broad range of examples--including comparisons of the physiques of bodybuilders in the 1960s and the 1990s, a look at the evolution of the G.I. Joe doll's bulk and an examination of the nearly unobtainable body ideal that prevails among Chippendale dancers and Calvin Klein models--to make the convincing case that many men resort to dire actions to assuage their feelings of inadequacy. They bolster their claim with numerous interviews with men and a survey of the existing medical and psychological literature, and include tests by which readers can ascertain if they have an eating disorder or suffer from Body Dysmorphic Disorder. While some readers might take exception to the authors' assertion about the prevalence of the "Adonis complex," their book offers a provocative look at what has been, until now, a largely unexplored subject. Agent, Todd Schuster. (June) Copyright 2000 Cahners Business Information.|
Library Journal
In the last 20 years, increasing numbers of men and boys have become obsessed with obtaining the perfect body exemplified by body builders, male models, and professional wrestlers. This excessive concern with appearance can lead to compulsive exercise, steroid abuse, eating disorders, and, in extreme cases, body dysmorphic disorder, a serious psychiatric condition. Acknowledging that few men will admit these preoccupations, the authors of these two books seek to bring these issues to a wider audience and to promote more realistic goals for male physique and fitness. Written in a popular, almost sensational style, The Adonis Complex discusses and summarizes research coordinated by Harvard researchers Pope (psychiatry) and Robert Olivardia (psychology) and Katharine A. Phillips (psychiatry, Brown Univ.; The Broken Mirror: Understanding and Treating Body Dysmorphic Disorder). Pope and his associates first document changes in advertisements, Playgirl centerfolds, and toys such as G.I. Joe to demonstrate how the steroid-hyped male torso became an ideal beyond the capability of most men. They then report on results of a computerized body image test given to male college students that showed, across cultures, a dissatisfaction with physical appearance and a tendency to misjudge the physique desirable to the opposite sex. Using case studies and self-tests, the team goes on to describe and outline treatment for specific problems and dispel myths about weight and steroid use. Separate chapters address concerns for boys, gays, lovers, and friends. Andersen (psychiatry, Iowa State Univ.; ed., Males with Eating Disorders), Leigh Cohn (ed., Eating Disorders, the Journal of Treatment and Prevention), and Thomas Holbrook, a medical specialist, also address men's concerns with physical appearance, drawing attention to fat as a men's issue and focusing on obesity and eating disorders. After extended discussions on the developmental, social, and evolutionary factors contributing to appearance ad self-esteem, the authors provide "a proactive proposition for men who want to feel and look better" in "Ten Steps to Healthy Living," with advice on nutrition, exercise, relationships, and social and spiritual concerns. Holbrook relates his own story of recovery from eating disorders and excessive exercise. Courses of treatment are described, and a final chapter offers advice for families and loved ones. Both books give reading lists and resources on where to seek further help, and both are recommended for public library collections.-Lucille M. Boone, San Jose P.L., CA
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Product Details

  • ISBN-13: 9780684869117
  • Publisher: Free Press
  • Publication date: 1/1/2002
  • Edition description: Reprint
  • Pages: 304
  • Sales rank: 730,774
  • Product dimensions: 0.69 (w) x 5.50 (h) x 8.50 (d)

Meet the Author

Harrison G. Pope, Jr., M.D., is a professor of psychiatry at Harvard Medical School and chief of the Biological Psychiatry Laboratory at McLean Hospital. He lives in Concord, Massachusetts.

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Read an Excerpt

Chapter One: Secrets of the Men at the Olympic Gym

It is 6 P.M. on a warm spring evening in a small city ten miles west of Boston. In an industrial park near the highway, the two-storied, white-brick Olympic Gym is surrounded by nearly half an acre of parking, but the lot is overflowing with cars. Some are old Fords and Chevys belonging to students at the nearby college; others are the pickups and delivery trucks of tradesmen and service men who've stopped to lift weights after work. There are also pristine Corvettes and Porsches, a Mercedes or two, and half a dozen BMWs. Every social class in America has come here to work out.

Inside, the frenetic beat of "Get Ready for This" is punctuated by the occasional clanging of a weight stack on a machine, or a 45-pound plate being loaded onto a bar. Although the gym has half an acre of floor space, it still seems crowded. Groups of weightlifters cluster around the cables and the squat racks; others wait to use the lat pull-down machine or the Roman chair. A blond-haired twenty-six-year-old trainer instructs a prominent Boston attorney on the fine points of abdominal exercises. The gym's owner is out on the floor, giving a tour of the facilities to two young high school students who want to sign up. Wide-eyed and slightly frail-looking, they glance furtively at two big bodybuilders doing shoulder presses at the dumbbell rack nearby. Dozens of treadmills, StairMasters, stationary bicycles, and ergometers hum and whir on the balcony overhead. At the front counter, a handsome, highly muscular staff member, still in his teens, smiles brightly and mixes protein shakes in a blender as groups of clients joke together, read magazines, and search for their car keys among the hundreds of key rings hanging on the big pegboard on the wall. And this is only the evening crowd. At five-thirty tomorrow morning, twenty or thirty people will line up at the door, waiting eagerly for the gym to open. A hundred more will show up over the next couple of hours to lift weights before work. They will be followed by dozens of lunchtime regulars, with many stragglers in between.

The Olympic Gym has 2,400 members, and it is only one of several gyms in this small city of 60,000. All over the United States, in small towns, suburbs, and cities, big gyms like this one have their own large and faithful followings. In greater Boston alone, the major gyms collectively count well over 100,000 members — and some metropolitan areas have far more. As recently as twenty or thirty years ago, you would hardly ever see a crowd like this at any gym, with the possible exception of a few hard-core bodybuilding establishments in Southern California. But over the last two decades, gym memberships have exploded across America.

More than two-thirds of the people working out at the Olympic Gym tonight are men. Some wear old T-shirts and dirty cutoff shorts; others are carefully dressed in striped workout pants and Olympic Gym sweatshirts; a few wear deep-cut tank tops and tight spandex shorts, carefully chosen to show off their musculature. But the "muscleheads" are only a small minority of the gym community. Most of the members are ordinary-looking guys: they're a slice of America, ranging from squeaky-voiced boys of twelve or thirteen to gray-haired elders in their seventies.

You would think that the men at the Olympic Gym, or any gym, would be happy with their bodies. After all, they're here getting in shape rather than vegetating on the couch watching TV after work. But surprisingly, many aren't content at all. Many, in fact, harbor nagging anxieties about how they look. They don't talk about it publicly — and they may not even admit it to themselves — but they suffer silently from chronic shame and low self-esteem about their bodies and themselves. And many are obsessed with trying to change how they look. Beneath the seemingly benign exterior of this scene at Olympic, and among millions of other men around the country, a crisis is brewing.

If we begin to look carefully around the gym, we see hints of this crisis everywhere. John and Mark, both twenty-four-year-old graduate students at a nearby university, are at the counter debating what kinds of protein supplements to buy from the bewildering display of boxes that crowd the wall. Many of the boxes boast "supermale" images: photographs of smiling bodybuilders with massive shoulders, rock-hard pectorals, and impossibly sculptured and chiseled abdominal muscles. All of the supermales exude health, power, and sexuality. Not even the biggest bodybuilder at the Olympic Gym resembles these images, and John and Mark don't come close — even though they've been lifting weights for years and have spent thousands of dollars on nutritional supplements they hoped would thin their waists, stomachs, and buttocks, while swelling their chests, arms, and thighs. Privately, John and Mark are slightly embarrassed that they don't even begin to look like the guys in the pictures. But they've never admitted these concerns to anyone.

Supermale images appear not only on the boxes of protein powder, but throughout the gym. They're on magazine covers in the waiting area, on posters on the walls, and on a clothes advertisement posted on the bulletin board. John examines a magazine showing amazing "before" and "after" pictures of a middle-aged man who appears to have transformed in three months from a couch potato into a muscle-bound hunk, allegedly with the help of the food supplement advertised. John has tried a lot of food supplements himself, and he wonders why he still hasn't achieved the same Herculean image. All of these displays convey the same message to men: If you're a real man, you should look bigger and better than you do.

While John may feel as though he's the only guy at the gym who's so worried about his appearance and size, in reality he's surrounded by many others with similar secret feelings. But lost in his own thoughts of insecurity, John doesn't seem to notice all the other men who are covertly checking out their reflections in the big mirrors that line the walls. When they're sure that nobody is looking, some flex their arms, puff out their chests, or suck in their stomachs, almost as a reflex gesture. They don't say anything, of course. But many, like John, can't stop thinking about the discrepancy between the image in the mirror and the one they desperately want.

Alan, a math teacher from nearby Cambridge, notices, for the tenth or the twentieth time that day, the stubborn ring of fat that has accumulated around his abdomen in the years since college. Bob, a truckdriver, wears a baseball cap with the visor turned back, even though he's thirty-eight years old and the baseball-cap look is usually reserved for teenagers. But he'd rather wear the cap than expose his "prematurely" receding hairline. Meanwhile, John himself wears three layers of shirts — a T-shirt, then a regular shirt on top, and then a sweatshirt on top of that. He's sweating inside all of those layers, but they make him look bigger, and he's ashamed of how small he'd look without them. Bertrand, an attorney in his fifties who arrived a few minutes earlier in an immaculate, six-foot-high sport utility vehicle, despondently eyes his unappealing reflection in the mirror next to the drinking fountain. Above the drinking fountain, a poster of a famous bodybuilder twice his size, majestically posing on a rocky summit in the desert, stares back at him.

These are men who have achieved success in their careers; some are leaders in their community. They come from different classes, races, and sociological backgrounds. But they are all victims of a relentless message: You don't look good enough. Most of the time, men are unable to talk to each other about this message and the inferiority it makes them feel. So the message gets louder, the problem becomes bigger, and the isolation grows deeper.

Three college students arrive and head into the locker room. They're laughing and joking with each other, exchanging gossip about a party last weekend, while they get ready to go out onto the gym floor. But once they're in the locker room, none of them actually takes off his clothes in front of the others. Although they haven't shared their feelings with one another, one of the young men is terribly ashamed of the acne scars on his back. Another is convinced he's too fat, and he's especially upset at the "female" fat that he thinks has accumulated under his nipples. The third privately worries that his penis is too small. Even though they've been good friends for years, none of these young men has felt comfortable enough to reveal these secret concerns to any other person.

MALE BODY IMAGE OBSESSION:

A TROUBLING DOUBLE BIND

In our research at Harvard and Brown Medical Schools, and in studies collaborating with scientists across the country and overseas, the three of us have met countless otherwise "normal" boys and men who share these same feelings of inadequacy, unattractiveness, and even failure. By interviewing hundreds of men working out at gyms, and compiling our collective clinical experience with the hundreds more who have seen us at our offices, we've learned that men like John, Alan, Bob, Bertrand, and the three college students represent a broad and growing group who feel insecure and anxious — even paralyzed — by how they look. Society is telling them now, more than ever before, that their bodies define who they are as men. Because they find it impossible to meet this supermale standard, they are turning their anxiety and humiliation inward.

On the surface, most of the boys and men we've talked with, and the millions of other men like them across the country and around the globe, lead what appear to be regular, well-adjusted lives. In fact, the vast majority would never dream of going to see a mental health professional. But behind the smiling, behind the cheerful athletic bravado, many of these men worry about their looks and their masculinity. Some are even clinically depressed, and many are intensely self-critical. Because these men carry a secret that they're uncomfortable sharing even with their closest loved ones, their self-doubts can become almost toxic, insidiously eating away at their self-esteem and self-confidence as men.

Indeed, many of these men, we believe, are caught in a double bind they can neither understand nor escape. On the one hand, they're increasingly surrounded with media images of masculine perfection — not just here in the gym, but in advertisements, on television, in the movies. And if this alone weren't enough to make them feel inadequate about their bodies, they're also bombarded with messages from burgeoning multibillion-dollar industries that capitalize upon their body insecurities. These "male body image industries" — purveyors of food supplements, diet aids, fitness programs, hair-growth remedies, and countless other products — now prey increasingly on men's worries, just as analogous industries have preyed for decades on the appearance-related insecurities of women.

But the problem gets compounded further. Women, over the years, have gradually learned — at least to some extent — how to confront society's and the media's impossible ideals of beauty. Many women can now recognize and voice their appearance concerns, speaking openly about their reactions to these ideals, rather than letting them fester inside. But men still labor under a societal taboo against expressing such feelings. Real men aren't supposed to whine about their looks; they're not even supposed to worry about such things. And so this "feeling and talking taboo" adds insult to injury: to a degree unprecedented in history, men are being made to feel more and more inadequate about how they look — while simultaneously being prohibited from talking about it or even admitting it to themselves.

And so, trapped between impossible ideals on the one side and taboos against feeling and talking on the other, millions of boys and men are suffering. For some, body image concerns have grown into outright psychiatric disorders, ruining their own lives and often the lives of those who care about and love them. And for every boy or man with a full-scale body image disorder, there are many more with milder cases of the same body obsessions — not disabling in any way, but still enough to hurt.

THE ADONIS COMPLEX:

MEN UNHAPPY WITH THEIR BODIES

We call this syndrome the "Adonis Complex." In Greek mythology, Adonis was half man and half god — the ultimate in masculine beauty. So beautiful was his body that he won the love of Aphrodite, queen of the gods. But Persephone, who had raised Adonis, refused to give him up to Aphrodite. So Zeus, the king of the gods, brokered a deal: Adonis would spend four months out of every year in the underworld with Persephone, four months with Aphrodite, and four months on his own. It is said that he chose to spend his own personal four months with Aphrodite as well.

Throughout the centuries, many a great artist has attempted to depict the physical perfection of Adonis. Most famously, the Renaissance painter Titian shows him about to go hunting with his dogs, with Aphrodite clutching his body in her arms. The body of Adonis presumably represents the ultimate male physique imaginable to a sixteenth-century artist — but Titian's Adonis looks fat and out of shape in comparison to the men pictured on the boxes of protein powder at the Olympic Gym.

We should note that "Adonis Complex" isn't an official medical term, and it doesn't describe any one body image problem of men. We use it in this book to refer to an array of usually secret, but surprisingly common, body image concerns of boys and men. These concerns range from minor annoyances to devastating and sometimes even life-threatening obsessions — from manageable dissatisfaction to full-blown psychiatric body image disorders. In one form or another, the Adonis Complex touches millions of boys and men — and inevitably, the women in their lives.

Nowadays, it seems, increasing numbers of boys and men, including some of those lifting weights tonight at the Olympic Gym, have become fixated on achieving a perfect, Adonis-like body. Take Scott, for example. He's a twenty-six-year-old personal trainer at the gym. Right now, he isn't training anybody because it's his own time to lift. He's just started his leg routine — three sets of squats, two sets of leg presses, two or three sets of leg extensions on a Nautilus machine, three sets of leg curls on another machine, and then on to some hack squats, leg abductions, and side leg raises. The whole routine will take him an hour and a half, and then he still has to do his calves for another half hour after that. He's working out alone, because he doesn't like any distractions to come between him and the weights.

To a casual observer, Scott seems like a perfect picture of fitness and health. Five feet nine inches tall, with shortly cropped dark brown hair and handsome facial features, Scott weighs 180 pounds and has only 7 percent body fat, making him leaner than at least 98 percent of American men his age. Beneath his worn gray sweatpants and sweatshirt, he has the proportions of a Greek statue. He has a 31-inch waist, a "six-pack" of sculptured abdominal muscles, a 46-inch chest, and shoulders as big as grapefruits. But surprisingly, and unknown to even many of his closest friends, Scott constantly fears that he isn't big enough.

As a result, Scott has surprisingly low self-esteem. He puts all his hopes and dreams into his workouts and not into his daily life. This makes him withdraw from others and hold himself back from social situations he would otherwise enjoy. Although women are enormously attracted to Scott, he secretly thinks he isn't really big enough or masculine enough to appeal to them. In fact, he doesn't have a girlfriend right now, partly because his self-image is so poor and his confidence about dating so crippled.

Scott came to see us at our research laboratory in response to a notice we put on the bulletin board at the Olympic Gym, looking for bodybuilders who weren't satisfied with their physiques. In this study, we were comparing male bodybuilders who were insecure about their appearance with those who felt comfortable with how they looked. The study involved an office visit in which we measured each man's height, weight, and body fat, had him fill out some questionnaires, and then interviewed him about his body image and other psychological issues.

When Scott arrived for his interview, he was ill at ease, almost embarrassed to be coming to see us for such a study. "You've really had a lot of guys who've called about your ad?" he asked. He was surprised when we told him that we'd already seen many men like himself.

Scott took a chair, seeming a little relieved. He wore loose cotton pants with a drawstring at the waist, and an oversized blue sweatshirt with a bodybuilding logo on the back. The words TAKE NO PRISONERS were emblazoned under a figure of a muscled bodybuilder wearing combat fatigues.

Scott soon grew relaxed and told us his story in a warm, soft-spoken, almost self-effacing manner. An honors graduate of a prestigious New England college and holder of a business degree, Scott was highly educated. But his heart, it turned out, had never been in business.

"I started going to the gym fairly regularly when I was in college," he said. "But I don't think it was until I started business school that it became an obsession. I remember, one day when I was in business school, looking at myself in the mirror and hating how I looked. I started wondering how I'd ever tolerated what I looked like when I was back in college. Gradually, I got more and more fixated on getting my time in the gym each day, and I got more and more impatient with all of the demands at school. The other guys were all talking about companies that they wanted to work for, and how much money they were going to make, but I could never seem to get into it."

By the time Scott graduated from business school, his body obsession dominated his life. "I had several good job offers," he continued, "but I just couldn't picture myself working in an office. I was afraid that if I was forced to sit behind a desk all day, I'd turn into a fat slob. In fact, even at school, I couldn't sit in front of a computer screen for more than about fifteen minutes before I started worrying that I wasn't getting any exercise."

During his graduate studies, Scott worked as a personal trainer at a local health club. After business school, it became his full-time job. "This probably sounds strange," he said, "but it was the only job I could think of that gave me enough time to do my own training."

He paused and studied our faces for several seconds, seeming to fear we would have a negative reaction to what he had said. Instead, we asked questions to hear more about and understand his concerns.

"Did people criticize you for not going on to a business career?" we asked.

"Everybody," he said with resignation. "Especially my mother, and also my girlfriend at that time. They just couldn't understand why I'd throw away my years of education to work at a gym. I guess it does seem a little weird. But I couldn't imagine going back to a business job now. I guess I've just become too wrapped up with working out."

As the interview progressed, Scott began to reveal the full extent of his preoccupations. "If you could see what I was thinking about during the day, ninety percent of the time it would have something to do with either my weightlifting, my diet, or the way I look. I can't go past a mirror without posing just for a minute to check out my body — as long as I'm sure nobody's watching. I even check myself out when I see my reflection in a store window or car window." He laughed nervously. "Sometimes when I'm in a restaurant, I even study my reflection in the back of a spoon."

Most of the time, Scott explained, he sees his reflection as small and puny, even though he's actually massively built. "I know it sounds silly," he said, "but there are times that even on hot summer days, after getting a bad shot of myself in the mirror, I'll put on heavy sweatshirts to cover up my body because I think I don't look big enough." For the same reason, he explained that he almost always wears heavy sweats when working out at the gym. He sometimes even turns down invitations to go to a swimming pool or the beach, for fear that when he takes his shirt off, people will notice him and think he's too small.

"How would you feel if you were forced to miss working out for a day?" we asked.

He looked shocked. "I'd probably go bananas and start breaking things. In fact, one day last winter there was a blizzard and I couldn't get out of my house to go to the gym. I felt trapped. I got so frustrated from not being able to work out that I put on my weight belt and started bench-pressing the furniture in my living room. My girlfriend thought I was crazy."

"Has your relationship with your girlfriend been affected by your weightlifting preoccupations?"

Scott fell silent, and for a brief moment, tears seemed to form in his eyes. "Actually, my girlfriend broke up with me because of my weightlifting. It got to be too much for her. Sarah could never really understand why I needed to go to the gym or why it mattered so much to me what I looked like. I'd ask several times a day whether she thought I looked big enough or muscular enough. I guess she got pretty tired of my asking her. She also complained a lot because she said I was too inflexible. She'd want to go out and do something, and I'd say that I couldn't because I needed to go to the gym and train. But I'd warned her that I was that way. I told her that when we first started living together: the gym comes first, my diet second, and she was third. I guess she couldn't take being in third place anymore. And I don't really blame her.

"It's weird," he continued. "I think the truth is that I actually thought Sarah would break up with me if I didn't work out enough. I actually thought she'd leave me for some bigger guy. But the real reason she left me was because I was so caught up in working out that I didn't do anything or go anyplace with her. She told me that I was screwed up and that our relationship was getting 'lost.' When I think about it, I guess maybe she was right."

"Why do you think you have such intense feelings about your body and about working out?" we asked.

"I don't know. I guess I've really never stopped to think about just how much this muscle thing has affected my life. At first, it was a healthy thing, wanting to pursue a healthy lifestyle and be in shape. But now, it's gotten out of control. It's a trap. I can't get out of it."

"Have you ever considered some type of therapy to look at your feelings about your body?"

"Yeah, I've thought about it sometimes, but it would never work. Someone who doesn't lift weights himself would never understand." As he spoke, Scott flexed his arm unconsciously.

Over the last several years, we've interviewed many men with Scott's condition. We call it "muscle dysmorphia" — an excessive preoccupation with body size and muscularity. Many of these men, like Scott, revealed that this preoccupation had spiraled out of control and profoundly affected their lives — causing them to change their careers, or destroying relationships with people they loved. But practically none of them had sought treatment for their condition — usually because they doubted that any type of professional would actually understand or be able to help them.

MUSCLE DYSMORPHIA: "PUNINESS" IN THE MIND

The body image distortions of men with "muscle dysmorphia" are strikingly analogous to those of women (and some men) with anorexia nervosa. In fact, some people have colloquially referred to muscle dysmorphia as "bigorexia nervosa" or "reverse anorexia." People with anorexia nervosa see themselves as fat when they're actually too thin; people with muscle dysmorphia feel ashamed of looking too small when they're actually big. A recent study of ours illustrates these parallels. In this study, we compared interview and questionnaire responses from twenty-four young men with muscle dysmorphia, recruited from gymnasiums in the Boston area; thirty young men without muscle dysmorphia, recruited from the same gymnasiums; twenty-five college men with eating disorders such as anorexia nervosa and bulimia nervosa (binge eating and vomiting); and twenty-five ordinary college men without eating disorders. On question after question, the men with muscle dysmorphia showed levels of pathology similar to the college men with eating disorders. In particular, the men from these two groups shared a need to exercise every day, shame about their body image, feelings of being too fat, dislike of their bodies, and often, lifetime histories of anxiety and depression. By contrast, the group of weightlifters without muscle dysmorphia closely resembled the ordinary college men on all of these same indices. In other words, men with muscle dysmorphia report that they are suffering just as badly as men with anorexia nervosa.

Also like people with anorexia nervosa, men with muscle dysmorphia often risk physical self-destruction. Frequently, they persist in compulsive exercising despite pain and injuries, or continue on ultra low-fat, high-protein diets even when they are desperately hungry. Many take potentially dangerous anabolic steroids and other drugs to bulk up, all because they think they don't look good enough.

But these men's nagging worries are rarely relieved by increasing their bodybuilding. In psychological terms, we call such persistent worries "obsessions." And in response to these obsessions, people are driven to repetitive behaviors — in Scott's case, constant weightlifting — which, in turn, we call "compulsions." Though people may realize, on one level, that their obsessive beliefs are irrational and their compulsive behaviors futile, they still cannot "shut off" their endless and often self-destructive behaviors. Scott is a case in point. Although his feelings of self-criticism were utterly irrational, Scott was so convinced of his deficiencies that, at the end of the day, he chose catering to his muscle obsession over maintaining his relationship with Sarah.

The sources of Scott's muscle obsessions and weightlifting compulsions are not known with absolute certainty, but most likely are threefold. First, there's almost certainly a genetic, biologically based component. In other words, some people like Scott inherit a chemical predisposition to developing obsessive-compulsive symptoms. But genetics do not act alone. The second likely component is psychological — obsessive and compulsive behavior stems, in part at least, from one's experiences growing up, such as being teased. Scott still remembers being called "dorky" and "wimpy" in school, and these memories still fuel his muscle obsession and his compulsion to work out. And finally, we believe that society plays a powerful and increasing role, by constantly broadcasting messages that "real men" have big muscles — just like the bodybuilders in the pictures on the walls of the Olympic Gym. Men like Scott have been exposed to these images ever since they were small boys, thus laying the groundwork for muscle dysmorphia and other forms of the Adonis Complex in adulthood.

BODY-DISSATISFIED MEN: A SILENT EPIDEMIC

Cases as severe as Scott's may be uncommon. But for every man with severe muscle dysmorphia, dozens of others experience at least some distress about their muscularity. For example, a 1997 study found that an amazing 45 percent of American men were dissatisfied with their muscle tone — almost double the percentage found in the same survey in 1972. Thus, we can calculate that there are presently well over 50 million muscle-dissatisfied men in our country. And these millions of men are surrounded by many millions of very perplexed family members, friends, and loved ones, who probably can't quite understand what this anxiety about bigness and muscles is all about.

Why is muscle dissatisfaction, together with other body-appearance preoccupations, becoming so common among modern men? Our grandfathers didn't seem to worry about how muscular they looked. They didn't do bench presses or abdominal exercises three days a week, or go to the gym to work out on the StairMaster, or worry about their percentage of body fat. Why has the Adonis Complex infected so many men over the last thirty years or so?

One reason is that our grandfathers were rarely, if ever, exposed to the "supermale" images — aside from Charles Atlas on an occasional matchbox cover — that Scott and his friends see every day. In modern society, these images aren't confined to pictures in the gym — they're everywhere. Look at television over the last several decades. The hard-bodied lifeguards in Baywatch are viewed by over 1 billion viewers in 142 countries — figures unmatched by any previous television series. Or look at the movies. Hollywood's most masculine men of the 1930s, 1940s, and 1950s — John Wayne, Clark Gable, Gregory Peck — look like wimps in comparison to modern cinema's muscular action heroes — Arnold Schwarzenegger, Sylvester Stallone, or Jean-Claude van Damme. Today, while growing up, a young man is subjected to thousands and thousands of these supermale images. Each image links appearance to success — social, financial, and sexual. But these images have steadily grown leaner and more muscular, and thus more and more remote from what any ordinary man can actually attain. And so society and the media preach a disturbing double message: a man's self-esteem should be based heavily on his appearance, yet by the standards of modern supermale images, practically no man measures up.

It becomes understandable, then, that millions of modern American men are unhappy with how they look. And it isn't surprising that among these millions, we are seeing increasing numbers of serious casualties — men like Scott, whose lives have been damaged by these trends. Growing up in the 1970s and '80s, Scott steadily absorbed the stream of supermale images from the modern media. In fact, he described to us how he watched Rambo movies and Schwarzenegger action thrillers and, even as a child, fantasized that he would someday look like those heroes. Gradually, body appearance became the dominant basis — and ultimately the only basis — for his self-esteem. To lose even a little of that muscle, or to gain even a little body fat, brought him instant shame and humiliation. For Scott, a muscled body became more important, much more important, than being a successful businessman. It became so important that it brought him nearly complete social isolation and even cost him his relationship with the woman he loved.

BILL AND STACY: FALLOUT FROM FAT

Back at the Olympic Gym, another man is suffering from a very different form of the Adonis Complex. Bill is tall, thin, and in his early thirties. He's drenched with sweat after thirty-five minutes of running on the treadmill at seven minutes per mile. He's wondering, at this moment, whether he's run long enough or fast enough, whether he's burned off enough calories to compensate for the food he ate earlier in the day, and whether he still looks a little too fat. And he's already beginning to feel guilty about the eating binge that he knows will happen after he gets home tonight.

On his way home from the gym, Bill will purchase two large Italian submarine sandwiches, two large bags of Doritos, two cans of onion dip, and a quart of chocolate-chip cookie-dough ice cream. After shutting off the ringer on his phone, he'll begin to eat as fast as he can — sometimes even using both hands to feed himself, grabbing food with his left while eating from his right. Before he even has a chance to think about it, nothing will be left but a bunch of empty bags, containers, and wrappers.

Bill told us about his secret eating binges when he came to see us for one of our research studies of men with eating disorders. Even though he knew that we were familiar with this type of problem, it still took him a long while to let down his guard and tell us the full story.

"As soon as I've finished the last potato chip or the last gulp of ice cream," he said, "I feel totally guilty and disgusted with myself. I just can't believe that I've done it again, that I've lost control. When I was younger, I even tried to make myself vomit in the bathroom after the eating binges. But I wasn't very good at it. Now, I just try to diet in between the binges. Or I'll go and run some extra miles to try to burn off the food. Sometimes, I've even gone running at three o'clock in the morning. No one in the world knows that I do this. For years, I even kept it a secret from my wife. When I didn't show much interest in sex, she kept thinking I was having an affair. Actually, I was just too caught up in the binge eating and my weight. I hated the way I looked."

He grew visibly uncomfortable. "It probably sounds ridiculous, but my food problem ruined my marriage. Early on, we had a really close relationship — we'd been high school sweethearts and best friends. I really loved Stacy and felt I was the luckiest guy in the world to be married to her. But when my food problem started, I began to retreat. I retreated into this little world where food was really all that mattered, where I spent my entire day planning my meals and thinking about my weight. I gradually shut her out even though I really didn't want to. I just lost control."

Stacy eventually divorced Bill. She never found out that Bill's real problem was an eating disorder. In fact, she'd thought she was to blame — that something was wrong with her. Bill had tried to reassure her that it wasn't her problem, but he was still unable to reveal to her that the real problem was his chronic feeling of worthlessness. Despite all of the love he and Stacy shared, Bill felt he wasn't good at anything. He felt fat, mediocre, and unattractive.

Bill's self-hatred crept up on him insidiously. First, he began to withdraw from Stacy, his sex drive waning daily. Next he started going to the gym excessively in an attempt to convert his body into a mass of muscle. And then he became obsessed with food, so obsessed that it destroyed the most important relationship of his life.

"I loved Stacy so much. I still really love her. I wish I could have her back," he said plaintively. "She was my soul mate. I could tell her a lot of things — except this."

Bill's condition is called "binge-eating disorder." Only recently has this condition been recognized by professionals as an actual psychiatric problem. In fact, Bill told us that for many years he hadn't even known that his peculiar eating pattern had a name. And when he found out, at last, that he wasn't alone with his illness, he refused to see a therapist, or even tell his family doctor.

"I guess I never really wanted to admit that I had a serious eating problem," he said. "I was really ashamed, because I felt that it was a female thing to have eating problems like that. I'd never heard of a man with an eating disorder. I got more and more worried about being too fat. When I was younger, there was a time when it got to the point where I would weigh myself four or five times in a day. Sometimes if I gained even a pound, I would go to the gym or go running because I thought I was getting fatter. But then, half the time, I'd get hungry again, and then I'd go on another eating binge and be right back where I started. I mean, how many guys struggle with that?" Bill took a deep breath and sighed, "I feel I don't measure up."

"Where do you think those feelings come from?" we asked.

"I guess I've pretty much always felt like a failure," Bill explained. "I came from a family with five older sisters and no brothers at all. When I was born, my parents put all their hopes in me."

"That must have been pretty hard on you, being the only son with your parents' high expectations," we offered.

"Well, especially when you understand what my father was like. He was a well-meaning man, but he was very tough with me. He couldn't understand why I was scared to go to school as a child, and he would yell at me until I cried in the morning when I was forced to get on the school bus. I had a lot of little fears like that while I was growing up, and my father just couldn't figure out why I couldn't just instantly overcome them."

"It sounds as though your father put a lot of pressure on you."

"Yes. A lot of pressure — pressure to play sports, pressure to act tough, pressure to be masculine. But it was also about control. He had a pretty hard childhood himself — his father was a violent alcoholic who would get drunk and beat him — so for my father everything had to do with keeping a stiff upper lip and showing no fear."

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"And what happened if you failed to meet his expectations?"

"He would just become a horrible person if you didn't do what he wanted or didn't live up to his expectations. He'd say: 'You're such a disappointment' or 'I'm ashamed to be the father of such a little cry baby' or 'You're a spoiled brat.'"

"How did you handle it back then?"

"I don't know. I just recall feeling totally helpless and hopeless. I felt like the world's biggest loser — shy, stupid, ugly, you name it. My mother was always afraid of my father, so she stood behind whatever he did. I felt like there was nowhere to turn."

"Well, it's little wonder that you don't feel completely good about yourself now, as an adult."

"I don't feel good about myself at all. I still feel like that little kid, terrified to get on the school bus with the other kids. Only now, to make matters worse, I also constantly feel as though I'm fat and overweight."

In fact, Bill wasn't fat at all. His body fat measured only 11 percent — making him far leaner than an average American man of his age.

"But you realize that, in reality, you're not fat all?" we asked.

"Yeah, I know, I know. Everybody says that," he admitted. "I look around at other guys and realize that I'm thinner than they are, but it still doesn't make the feelings go away.

"When I was a teenager, I went on this mission to improve my appearance. I started lifting weights and running every day after school. It made me feel good because I felt like I was proving myself to my father. Also, I figured that if I kept it up, I'd be more confident in social situations, because I'd be more muscular and athletic."

Bill went on to describe an episode of depression he experienced during his senior year of high school. He began to feel hopeless about what he would do after graduating. He started sleeping ten or eleven hours each night, he couldn't concentrate on anything, and he felt guilty and down on himself for no reason. "I felt like shit. I couldn't talk to anyone about it. And no one asked about what was going on even though they must have been able to see something was wrong."

Bill suffered through the blackness of the depression for another year, and gradually discovered that exercise made him feel better. But when he went to college, he injured his ankle while running and was forced to stop exercising for many weeks. The depression returned, more severely. About that time, Bill discovered that binge eating would temporarily alleviate his depression.

"It was a high. It kind of numbed me," he said. "All of those messages inside of my head about being too shy, being stupid, being ugly — for a moment those voices went quiet and I could feel at peace with myself."

At first, Bill binged only occasionally, but gradually he became drawn into a cycle of binge eating, dieting, working out, and binge eating again. This cycle seemed to keep the depression at bay, but increasingly, he became preoccupied that he was getting too fat. He began to weigh himself and look at himself in the mirror more and more often. Soon the thoughts of food, body weight, exercise, and fat came to consume virtually all of his day.

"But I still couldn't talk about it with anybody. I didn't think any of my friends would understand. In fact, I'm surprised I'm here right now. Guys aren't supposed to get all hung up about their appearance."

And so Bill's preoccupations remained secret for years. Despite all of his physical and emotional problems, despite having been severely depressed, Bill's visit to our research laboratory was the first time he'd ever seen a mental health professional — the first time he had ever reached out for help.

SECRET DIETARY RITUALS

Among men suffering from the Adonis Complex, secrets like Bill's are common. Not only does society forbid men to talk about their feelings of vulnerability and inadequacy, but it also indoctrinates them with the idea that only women are supposed to worry about their looks. Men, according to our society, do not — and should not — worry about their appearance or the shape of their bodies. A man who does focus on his appearance is often seen as vain, narcissistic, or "feminine." For a man like Bill, then, a Catch-22 situation arises when he begins to dwell on his body. If he doesn't talk about his feelings, the pain gets internalized and the problem persists. If he does find the courage to do so, society tells him he's being inappropriate, that he's not acting in a healthy, masculine way. Then, of course, he feels worse: more ashamed, more vulnerable, more troubled. The result of this Catch-22 situation is that most men coping with eating disorders simply keep quiet about their painful feelings. No one, therefore, can calculate exactly how many men suffer from covert eating disorders and chronic body image preoccupations like Bill's. But there's little question that today's professionals are seeing cases like his with increasing frequency. In our own clinical practice, more and more men are telling us about their concerns with eating, their bodies, and their appearance. Of course, this raises the question as to whether eating disorders are actually more common among men nowadays, or whether we are simply becoming more aware of them. We believe that both of these changes have occurred.

Many people, like Bill, still think that eating disorders are "women's diseases." But binge-eating disorder seems almost as common among men as among women, with studies in the United States typically showing a ratio of about 40 percent male to 60 percent female. That translates into a million or more men in America today with binge-eating disorder. And then, too, there are hundreds of thousands of others who actually make themselves vomit, or do other drastic things to lose weight after binges, like taking large doses of laxatives. This disorder, called "bulimia nervosa," was first recognized in women about twenty years ago, but is now increasingly being recognized in men. And we're even seeing more men with anorexia nervosa — dieting to the point of becoming emaciated — even though this condition has traditionally been assumed to affect women almost exclusively.

Furthermore, for every man who suffers from one of these eating disorders, many others have developed milder but still dysfunctional eating patterns in response to their appearance concerns. In fact, probably a third of the men in the Olympic Gym are involved in dietary rituals that affect their day-to-day lives. Jonas, a blond graduate student running on a treadmill, is constantly thinking about the fat content of his food. Sometimes he'll decline invitations to eat at restaurants for fear that he won't be able to order anything sufficiently low in fat. Last night, he went to an ice-cream shop with his girlfriend, but found to his dismay that they offered only "low-fat" rather than "nonfat" frozen yogurt. A serving of the "low-fat" yogurt contained only four grams of fat, but he wouldn't compromise, and ordered nothing at all, even though he was hungry.

Charles, a businessman in his early forties and an Olympic Gym "regular," is simultaneously listening to headphones and reading a magazine to distract himself from the tedium of his workout on a StairMaster. Dozens of times per day, he silently laments his slowly enlarging stomach and "love handles." At breakfast and lunch, he practices a rigorous dietary routine, counting every calorie that he consumes, frequently consulting his pocket "calorie counter" book. But invariably, sometime in the evening, his resolve collapses and he polishes off several hundred calories worth of M&M's and Tootsie Rolls. Tomorrow, when he wakes up, he'll resolve to be good — but inevitably, the pattern will repeat itself. The StairMaster workouts don't keep up with his candy habit; as a result, he's wondering about liposuction.

Steve, a thirtyish plumbing contractor, worries mostly about carbohydrates. He religiously uses sugar substitutes in his coffee, drinks only Diet Cokes, and never eats dessert. But most nights, when he gets home, he makes up for his carbohydrate deficit by drinking beer. After four or five beers, totaling 600 to 750 calories, he has more than erased any of the calorie savings that he achieved through carbohydrate restriction during the day. Strikingly, he worries a lot more about the look of his belly than about his level of alcohol consumption.

Armand, a lanky teenager, also suffers from food preoccupations, but he's worried that he's too thin. In an attempt to bulk up, he's constantly counting the grams of protein in everything that he eats; sometimes, in his own words, he'll "force-feed" himself to ensure that he gets at least 150 grams of protein per day. He spends more than $50 per week — a substantial portion of his income — on protein bars, protein shakes, and various other food supplements that he hopes will make him hard and muscular. It seems strange that he should worry, for in reality, Armand is already a gifted athlete, playing varsity soccer and varsity lacrosse at his high school. But he refuses to be happy with his tall, lean body. No one, not even his closest friends, and certainly not his parents, knows how much he secretly despises his appearance. In a vain attempt to quell his anxieties and overcome his own genetics, he keeps stuffing himself with protein. He's heard that excessive protein might be bad for his kidneys over the long term, but his body obsessions today override any concerns about possible damage to his body in the distant future.

The eating patterns of these men can almost all be traced to the Adonis Complex — overconcern, dissatisfaction, or outright obsessions with body image. Men who have eating disorders, especially the more severe forms, may suffer not only from a distorted image of their bodies, but also from a profoundly distorted image of themselves as men. Tragically, they often think that their preoccupations are rare or unique; they have trouble believing that other men around them in the gym could possibly be victims of similar concerns.

Some of the men with more serious eating disorders, like Bill, may also be clinically depressed. With techniques like brief psychotherapy or an antidepressant medication like Prozac, both the depression and the eating disorder — along with the associated nagging preoccupations about fatness and body image — may vanish. But since most of these men don't reveal their symptoms to anyone, they continue to suffer needlessly.

If only we could get out the message to men with eating problems that they are not alone, much of their suffering might be relieved. In the past twenty years, this approach has greatly benefited women. Since the early 1980s, news stories, magazine articles, and books have educated women about binge eating, compulsive dieting, and obesity. As a result, more and more women dared to voice their eating problems. They joined self-help groups, contacted educational organizations devoted to helping women with eating disorders, and sought therapy from knowledgeable professionals. Within less than a decade, practically every young woman in America had heard about eating disorders, knew that they were common, and knew that help was available. If a similar trend could occur for men, then men like Bill might no longer have to suffer in silence.

BIGGER BODIES THROUGH DRUGS

Elsewhere in the Olympic Gym, the Adonis Complex has bred another type of secret. In the free-weight area of the gym, Jerry, Cliff, and Vince, three high school seniors, are busy doing bench presses. All three boys are hoping to enter a local bodybuilding competition this summer, and they're feverishly working out to bulk up. They're enormously muscular, dressed in Olympic Gym sweatpants and stringy tank tops. Their tank tops are ripped, seemingly worn to shreds from long and heavy use. But actually, the rips don't quite look accidental; they're in just the right places to show off their bulging chests and shoulders.

Jerry, Cliff, and Vince are particularly distinctive because their necks and shoulders look unnaturally big in comparison to the rest of their bodies. And for good reason: they are unnatural. Over the last several years, these boys have each taken multiple "cycles" of "juice" — drugs known as anabolic steroids. Anabolic steroids are a family of drugs that includes the male hormone, testosterone, as well as numerous synthetic derivatives of testosterone. Steroids have few legitimate medical uses, and doctors won't prescribe them to athletes simply trying to gain muscle. Unless prescribed for specific medical treatment, steroids are illegal in the United States and many other countries. But these drugs are widely available on the black market through underground dealers in gyms everywhere. Taken in pill form or by injection, steroids can allow boys and men to gain huge amounts of muscle, far beyond the limits of muscularity that any ordinary man could attain without these drugs.

Vince, a good-looking boy of average height with wavy sandy-blond hair and dark brown eyes, is on a cycle of steroids right now. Every three days, he uses a needle to inject himself with almost a teaspoonful of testosterone cypionate, alternating with occasional shots of Equipoise, another anabolic steroid. Actually, Equipoise is a veterinary preparation intended only for horses — but Vince knows that it also works effectively on people, and it's cheaper on the underground market than human steroids. Vince has also managed to score some bottles of Anavar and Hemogenin pills, which he takes on top of his injectable steroids — a standard practice that steroid users call "stacking." The four steroids for this "stack" cost Vince almost all of his savings — $800 — and he's considering dealing some steroids to make a profit so he can buy more for his own use.

Amazingly, these boys' parents aren't aware that their sons are taking steroids. They think their sons' muscles are all the result of hard work, good diet, and protein supplements. Like most parents, they don't realize that it's medically almost impossible to get this big without chemical assistance. Our research indicates that there's a fairly sharp limit to the degree of muscularity that a man can attain without drugs. We believe that most boys and men who exceed this limit, and who claim that they did so without drugs, are lying.

Jerry, Cliff, and Vince can't stay this big without continuing to take steroids periodically over the years. And the longer you take steroids, the greater the danger to your body. Many scientific studies, including those from our own laboratory, have shown that steroids decrease the proportion of "good" cholesterol in the bloodstream (technically known as "HDL cholesterol") relative to the "bad" cholesterol (the "LDL cholesterol"). As a result, atherosclerosis, or "hardening of the arteries," speeds up. For every month that you take large doses of steroids, your arteries may "age" by two or three months or even more — scientists don't know for sure. But it certainly appears possible that long-term use of high-dose steroids could take ten or twenty years off your life expectancy, leading to an early death from a heart attack or clogged arteries in the brain.

Vince and his friends know these risks. Vince even witnessed the ominous change in his own cholesterol numbers when he was on steroids, because we actually measured them while he was taking a "cycle." But he tries not to think about the dangers he might face when he's older. Occasionally, he tells us, the risk crosses his mind — but the prospect of never again taking steroids, and gradually losing his muscle size, frightens him a lot more than the prospect of a stroke or heart attack decades in the future. Vince's fear of getting smaller — of no longer feeling strong, confident, and athletically successful — trumps any fears that he might be slowly killing himself.

And steroids aren't the only drugs in the bodybuilding business. Also available from local underground dealers are human growth hormone, thyroid hormones, human chorionic gonadotropin, amphetamines, gamma-hydroxybutyrate, clenbuterol, Nubain, and an array of other drugs. Some of these drugs are legally available only by prescription; others are not marketed for human consumption at all. Jerry, Cliff, and Vince know the names and uses of every one of these black market substances. They've even tried several of them along with their steroids. Each boy owns copies of underground guides on how to use these drugs to increase muscularity and lose body fat.

We know Vince well because he participated in one of our studies of anabolic steroid users. Although the study has been completed, he calls us every few months to find out if we've published any new papers on the subject, and asks us to send him copies. He reads everything he can find — all of the monthly muscle magazines, reports on bodybuilding foods and supplements, anything that contains information about bodybuilding drugs. He knows more about bodybuilding physiology and anabolic steroids than 99 percent of practicing physicians. But then, that's his business — the gym is his world.

When we first asked Vince what prompted him to take steroids, he had no trouble explaining. "I saw what it did for a couple of my friends, and I said, 'I want that for myself.' I was tired of being a small kid and being picked on at school."

"When you first started out taking steroids, did you realize that we scientists still can't estimate the long-term risks?" we asked.

"Yeah, but you can die getting hit by a truck, too," Vince rationalized. "And steroids have done more for me than any other single thing I've done in my life."

"More for you in what way?"

"In making me feel good about myself. In making me self-confident. In making me more confident with girls."

WHAT DO WOMEN REALLY THINK?

Vince's last remark brings to mind another consequence of the Adonis Complex: the strange and striking disparity between men's and women's views of the ideal male body. Recently, we developed a computerized test to look at this difference between the sexes in body perception. In this test, the computer presents an image of a male body, and then invites the user to make the image more or less muscular and more or less fat by using the mouse to click on "buttons" on the screen. The computer then poses a series of questions about body image, and asks the user to choose the body image that best answers each question. When we give the test to men, one of the questions is, "choose the male body image that you think is the most attractive to women." When we give the same test to women, we rephrase the question to read, "choose the male body image that you feel is the most attractive."

In test after test, the results of this comparison have been dramatic. The body that men think women like is typically about 15 to 20 pounds more muscular than what women actually like. We've found this discrepancy in our studies of men and women in both the United States and Europe.

If watermelon-sized muscles aren't appealing to most women, why are so many men attempting to get so big? For some men, it's simply an erroneous belief that massive muscles will improve their sex appeal. But for other men, we believe that there may be another, more surprising explanation: a new emotional problem, unique to modern society, that we call "threatened masculinity."

"Threatened masculinity" arises from the long-standing desire of boys and men to establish their "maleness" within their societal group. Throughout most cultures in history, men who exhibited traditional "male" behaviors and who succeeded at traditional "male" pursuits have received approval and respect. But nowadays, what are these male behaviors and pursuits? What can a modern boy or man do to distinguish himself as being "masculine"?

In professional settings, modern women can do almost anything that men can do. Women can fly jet fighters in combat. They can be police captains or brain surgeons or chief executive officers of multinational corporations. Women have penetrated even the most hallowed of male sanctuaries: venerable all-male military schools now accept female cadets, female journalists are allowed into the locker room to interview professional football players, and the all-male club has become nearly extinct. Of course, there's still more work to be done to give women full equality, but women's gains are impressive. As positive as these advances obviously are, however, perhaps they cause some men to wonder, in effect, "What is there left for me to do to distinguish myself as a man?"

For some men, there may be only one such thing: no matter what the triumphs of feminism, no matter what laws are passed to ensure equality between the sexes, no matter what crowning achievements women accomplish, they will never, ever, be able to bench-press 350 pounds.

In other words, muscles are one of the few areas in which men can still clearly distinguish themselves from women or feel more powerful than other men. But muscles are a tenuous foundation on which to base all of one's sense of masculinity and self-esteem.

LESSONS FROM THE LOCKER ROOM

There are at least a hundred other men in the Olympic Gym tonight, and most aren't as badly afflicted with the Adonis Complex as Scott, Bill, and Vince. But as we move back into the locker room, we continue to catch glimpses of men who, to varying degrees, are feeling embarrassed by their bodies. For example, most of the men don't take showers at the gym. They simply pack up and go home. Is it really more convenient to drive all the way home in their sweaty gym clothes than to take a shower in the locker room? How many, in reality, are simply uncomfortable with having their bodies seen in public? Looking around the locker room, we see that even some of the men who are changing their clothes do so quickly, almost furtively, as if they don't want anyone to see them. Here are big, muscular men who seem worried about exposing their bodies to other men. Curiously, the only men who seem unconcerned about taking off their clothes are forty, fifty, or sixty years old. Why are the older men seemingly more comfortable with their bodies than the younger, fitter ones?

Again, this difference between the age groups may be a symptom of important changes in our society and its attitudes toward men and masculinity. When the older men were growing up, in the times of Elvis and carhops and beatniks in the 1950s, or with the Beatles and the flower children of the 1960s, fitness and muscularity weren't a big deal. There were few media images to suggest that body appearance should be the main basis for a man's self-esteem. Steroid use was confined only to a small circle of elite bodybuilders, mostly in Southern California. Men rarely worried about their body fat. Eating disorders, such as binge eating and vomiting, were almost unheard of among males. Admittedly, the young men of the fifties and sixties had their own repertoire of hangups — but embarrassment about their appearance and muscularity wasn't typically one of them.

And so, perhaps, the older men in the locker room today may never have gotten obsessed with their bodies when they were growing up. As a result, they're not embarrassed to be seen naked by other men.

Of course, if we casually asked the younger men in the locker room, they'd probably protest that they're not really worried about their appearance at all. They'd probably provide quick explanations for why they don't need to change their clothes at the gym, or why they plan to take a shower somewhere else. But consciously or unconsciously, they may be more embarrassed about their bodies than they would like to admit. Many are unwitting victims of one aspect of an insidious masculinity code: men aren't supposed to be bothered by preoccupations with their looks. Only women are supposed to get hung up about such things. To speak of anxieties about their bodies or physical appearance, for most men, is to violate the taboo. Many men would far prefer to disavow their worries — thus internalizing their self-criticism — rather than risk the "loss of face" that would come with disclosure.

BECOMING ADONIS: THE IMPOSSIBLE IDEAL

But behind the denials, body concerns have increasingly infected millions of modern American men. For every severe or dangerous case, such as Scott, Bill, or Vince, there are dozens of less severe cases — men who cope quietly with emotional pain about some aspect of how they look. The suffering affects not only men who go to gyms like Olympic, but millions more who are too embarrassed about their appearance to be seen at a gym in the first place. In extreme cases, men may become so concerned about parts of their bodies — a balding head, a potbelly, a small penis, or some other perceived deficiency — that they do their best to avoid being seen in any public settings at all.

As clinicians and researchers in psychiatry and psychology, we've witnessed this growing male distress more and more in recent years. We've seen how the Adonis Complex can affect the lives of ordinary American men, young and old, producing a crippled masculine identity, chronic depression, compulsive behaviors, and often seriously impaired relationships with family members and loved ones.

What's particularly worrisome is that so many of these men are unaware of the societal forces that are constantly undermining their self-esteem. Boys and men have grown so accustomed to the constant barrage of supermale images in the media, and in advertising by the male body image industries, that they don't stop to question them. Rarely do they realize the extent to which they have accepted these Herculean images as sensible representations of male beauty. Instead, they change their behavior to try to make their own bodies conform to the new standard. Rarely do they consider that no previous generation in history was ever assaulted with comparable images — partly because it was impossible to create many of these modern supermale bodies before the availability of anabolic steroids. Rarely, also, do modern men fully acknowledge, even to themselves, how much their self-esteem and sense of masculinity is linked to their body image concerns. As a result of these feelings, they may become increasingly focused on deficiencies in their bodies, without really understanding why.

The starting place for healing this crisis of male body obsession — a crisis that extends across race, nationality, class, and sexual orientation — is to help men understand that they are not alone with these feelings, that millions of others share the same concerns and tribulations. It is time to help men appreciate the underlying social forces that contribute to their negative feelings about their bodies. Men must learn to acknowledge and talk about these feelings, to overcome the "feeling and talking taboo" that society has long imposed on them. And in our society, it is time to create widespread awareness about body-appearance concerns in men, and allow men to voice these concerns to those who care about and love them. We need to expose the societal and cultural forces that are inculcating new unattainable male body standards, and share the stories and voices of scores of men who have become frustrated and ashamed by their failure to meet these standards. In the pages that follow, we will describe how we, as professionals, have counseled men faced with these painful feelings. We hope to help men achieve the freedom and relief that has been attained by many women with eating disorders and other body image concerns: the ability to acknowledge their problems, seek new ways of perceiving their bodies and themselves, and find new paths toward self-confidence and fulfillment.

Copyright © 2000 by Harrison G. Pope, Jr., M.D., Katharine A. Phillips, M.D., and Roberto Olivardia, Ph.D.

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Table of Contents

Contents

Acknowledgments

Preface

ONE Secrets of the Men at the Olympic Gym

TWO The Rise of the Adonis Complex:

Roots of Male Body Obsession

THREE Do You Have the Adonis Complex?

Two Tests and Their Astonishing Results

FOUR Muscle Dysmorphia: Muscularity Run Amok

FIVE Anabolic Steroids: Dangerous Fuel for the Adonis Complex

SIX Fear of Fat: Men and Eating Disorders

SEVEN Beyond Muscle and Fat:

Hair, Breasts, Genitals, and Other Body Obsessions

EIGHT Boys at Risk

NINE Dealing with the Adonis Complex: Women's Voices

TEN Straights and Gays: Not So Different After All

ELEVEN Rx for the Adonis Complex:

A Guide for Men and Their Loved Ones

APPENDIX I The Fat-Free Mass Index (FFMI)

and How to Calculate It

APPENDIX II Diagnostic Criteria for Body Image Disorders

APPENDIX III Where to Get Help

Notes

Index

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First Chapter

Chapter One: Secrets of the Men at the Olympic Gym

It is 6 P.M. on a warm spring evening in a small city ten miles west of Boston. In an industrial park near the highway, the two-storied, white-brick Olympic Gym is surrounded by nearly half an acre of parking, but the lot is overflowing with cars. Some are old Fords and Chevys belonging to students at the nearby college; others are the pickups and delivery trucks of tradesmen and service men who've stopped to lift weights after work. There are also pristine Corvettes and Porsches, a Mercedes or two, and half a dozen BMWs. Every social class in America has come here to work out.

Inside, the frenetic beat of "Get Ready for This" is punctuated by the occasional clanging of a weight stack on a machine, or a 45-pound plate being loaded onto a bar. Although the gym has half an acre of floor space, it still seems crowded. Groups of weightlifters cluster around the cables and the squat racks; others wait to use the lat pull-down machine or the Roman chair. A blond-haired twenty-six-year-old trainer instructs a prominent Boston attorney on the fine points of abdominal exercises. The gym's owner is out on the floor, giving a tour of the facilities to two young high school students who want to sign up. Wide-eyed and slightly frail-looking, they glance furtively at two big bodybuilders doing shoulder presses at the dumbbell rack nearby. Dozens of treadmills, StairMasters, stationary bicycles, and ergometers hum and whir on the balcony overhead. At the front counter, a handsome, highly muscular staff member, still in his teens, smiles brightly and mixes protein shakes in a blender as groups of clients joke together, read magazines, and search for their car keys among the hundreds of key rings hanging on the big pegboard on the wall. And this is only the evening crowd. At five-thirty tomorrow morning, twenty or thirty people will line up at the door, waiting eagerly for the gym to open. A hundred more will show up over the next couple of hours to lift weights before work. They will be followed by dozens of lunchtime regulars, with many stragglers in between.

The Olympic Gym has 2,400 members, and it is only one of several gyms in this small city of 60,000. All over the United States, in small towns, suburbs, and cities, big gyms like this one have their own large and faithful followings. In greater Boston alone, the major gyms collectively count well over 100,000 members -- and some metropolitan areas have far more. As recently as twenty or thirty years ago, you would hardly ever see a crowd like this at any gym, with the possible exception of a few hard-core bodybuilding establishments in Southern California. But over the last two decades, gym memberships have exploded across America.

More than two-thirds of the people working out at the Olympic Gym tonight are men. Some wear old T-shirts and dirty cutoff shorts; others are carefully dressed in striped workout pants and Olympic Gym sweatshirts; a few wear deep-cut tank tops and tight spandex shorts, carefully chosen to show off their musculature. But the "muscleheads" are only a small minority of the gym community. Most of the members are ordinary-looking guys: they're a slice of America, ranging from squeaky-voiced boys of twelve or thirteen to gray-haired elders in their seventies.

You would think that the men at the Olympic Gym, or any gym, would be happy with their bodies. After all, they're here getting in shape rather than vegetating on the couch watching TV after work. But surprisingly, many aren't content at all. Many, in fact, harbor nagging anxieties about how they look. They don't talk about it publicly -- and they may not even admit it to themselves -- but they suffer silently from chronic shame and low self-esteem about their bodies and themselves. And many are obsessed with trying to change how they look. Beneath the seemingly benign exterior of this scene at Olympic, and among millions of other men around the country, a crisis is brewing.

If we begin to look carefully around the gym, we see hints of this crisis everywhere. John and Mark, both twenty-four-year-old graduate students at a nearby university, are at the counter debating what kinds of protein supplements to buy from the bewildering display of boxes that crowd the wall. Many of the boxes boast "supermale" images: photographs of smiling bodybuilders with massive shoulders, rock-hard pectorals, and impossibly sculptured and chiseled abdominal muscles. All of the supermales exude health, power, and sexuality. Not even the biggest bodybuilder at the Olympic Gym resembles these images, and John and Mark don't come close -- even though they've been lifting weights for years and have spent thousands of dollars on nutritional supplements they hoped would thin their waists, stomachs, and buttocks, while swelling their chests, arms, and thighs. Privately, John and Mark are slightly embarrassed that they don't even begin to look like the guys in the pictures. But they've never admitted these concerns to anyone.

Supermale images appear not only on the boxes of protein powder, but throughout the gym. They're on magazine covers in the waiting area, on posters on the walls, and on a clothes advertisement posted on the bulletin board. John examines a magazine showing amazing "before" and "after" pictures of a middle-aged man who appears to have transformed in three months from a couch potato into a muscle-bound hunk, allegedly with the help of the food supplement advertised. John has tried a lot of food supplements himself, and he wonders why he still hasn't achieved the same Herculean image. All of these displays convey the same message to men: If you're a real man, you should look bigger and better than you do.

While John may feel as though he's the only guy at the gym who's so worried about his appearance and size, in reality he's surrounded by many others with similar secret feelings. But lost in his own thoughts of insecurity, John doesn't seem to notice all the other men who are covertly checking out their reflections in the big mirrors that line the walls. When they're sure that nobody is looking, some flex their arms, puff out their chests, or suck in their stomachs, almost as a reflex gesture. They don't say anything, of course. But many, like John, can't stop thinking about the discrepancy between the image in the mirror and the one they desperately want.

Alan, a math teacher from nearby Cambridge, notices, for the tenth or the twentieth time that day, the stubborn ring of fat that has accumulated around his abdomen in the years since college. Bob, a truckdriver, wears a baseball cap with the visor turned back, even though he's thirty-eight years old and the baseball-cap look is usually reserved for teenagers. But he'd rather wear the cap than expose his "prematurely" receding hairline. Meanwhile, John himself wears three layers of shirts -- a T-shirt, then a regular shirt on top, and then a sweatshirt on top of that. He's sweating inside all of those layers, but they make him look bigger, and he's ashamed of how small he'd look without them. Bertrand, an attorney in his fifties who arrived a few minutes earlier in an immaculate, six-foot-high sport utility vehicle, despondently eyes his unappealing reflection in the mirror next to the drinking fountain. Above the drinking fountain, a poster of a famous bodybuilder twice his size, majestically posing on a rocky summit in the desert, stares back at him.

These are men who have achieved success in their careers; some are leaders in their community. They come from different classes, races, and sociological backgrounds. But they are all victims of a relentless message: You don't look good enough. Most of the time, men are unable to talk to each other about this message and the inferiority it makes them feel. So the message gets louder, the problem becomes bigger, and the isolation grows deeper.

Three college students arrive and head into the locker room. They're laughing and joking with each other, exchanging gossip about a party last weekend, while they get ready to go out onto the gym floor. But once they're in the locker room, none of them actually takes off his clothes in front of the others. Although they haven't shared their feelings with one another, one of the young men is terribly ashamed of the acne scars on his back. Another is convinced he's too fat, and he's especially upset at the "female" fat that he thinks has accumulated under his nipples. The third privately worries that his penis is too small. Even though they've been good friends for years, none of these young men has felt comfortable enough to reveal these secret concerns to any other person.

MALE BODY IMAGE OBSESSION:
A TROUBLING DOUBLE BIND

In our research at Harvard and Brown Medical Schools, and in studies collaborating with scientists across the country and overseas, the three of us have met countless otherwise "normal" boys and men who share these same feelings of inadequacy, unattractiveness, and even failure. By interviewing hundreds of men working out at gyms, and compiling our collective clinical experience with the hundreds more who have seen us at our offices, we've learned that men like John, Alan, Bob, Bertrand, and the three college students represent a broad and growing group who feel insecure and anxious -- even paralyzed -- by how they look. Society is telling them now, more than ever before, that their bodies define who they are as men. Because they find it impossible to meet this supermale standard, they are turning their anxiety and humiliation inward.

On the surface, most of the boys and men we've talked with, and the millions of other men like them across the country and around the globe, lead what appear to be regular, well-adjusted lives. In fact, the vast majority would never dream of going to see a mental health professional. But behind the smiling, behind the cheerful athletic bravado, many of these men worry about their looks and their masculinity. Some are even clinically depressed, and many are intensely self-critical. Because these men carry a secret that they're uncomfortable sharing even with their closest loved ones, their self-doubts can become almost toxic, insidiously eating away at their self-esteem and self-confidence as men.

Indeed, many of these men, we believe, are caught in a double bind they can neither understand nor escape. On the one hand, they're increasingly surrounded with media images of masculine perfection -- not just here in the gym, but in advertisements, on television, in the movies. And if this alone weren't enough to make them feel inadequate about their bodies, they're also bombarded with messages from burgeoning multibillion-dollar industries that capitalize upon their body insecurities. These "male body image industries" -- purveyors of food supplements, diet aids, fitness programs, hair-growth remedies, and countless other products -- now prey increasingly on men's worries, just as analogous industries have preyed for decades on the appearance-related insecurities of women.

But the problem gets compounded further. Women, over the years, have gradually learned -- at least to some extent -- how to confront society's and the media's impossible ideals of beauty. Many women can now recognize and voice their appearance concerns, speaking openly about their reactions to these ideals, rather than letting them fester inside. But men still labor under a societal taboo against expressing such feelings. Real men aren't supposed to whine about their looks; they're not even supposed to worry about such things. And so this "feeling and talking taboo" adds insult to injury: to a degree unprecedented in history, men are being made to feel more and more inadequate about how they look -- while simultaneously being prohibited from talking about it or even admitting it to themselves.

And so, trapped between impossible ideals on the one side and taboos against feeling and talking on the other, millions of boys and men are suffering. For some, body image concerns have grown into outright psychiatric disorders, ruining their own lives and often the lives of those who care about and love them. And for every boy or man with a full-scale body image disorder, there are many more with milder cases of the same body obsessions -- not disabling in any way, but still enough to hurt.


THE ADONIS COMPLEX:
MEN UNHAPPY WITH THEIR BODIES

We call this syndrome the "Adonis Complex." In Greek mythology, Adonis was half man and half god -- the ultimate in masculine beauty. So beautiful was his body that he won the love of Aphrodite, queen of the gods. But Persephone, who had raised Adonis, refused to give him up to Aphrodite. So Zeus, the king of the gods, brokered a deal: Adonis would spend four months out of every year in the underworld with Persephone, four months with Aphrodite, and four months on his own. It is said that he chose to spend his own personal four months with Aphrodite as well.

Throughout the centuries, many a great artist has attempted to depict the physical perfection of Adonis. Most famously, the Renaissance painter Titian shows him about to go hunting with his dogs, with Aphrodite clutching his body in her arms. The body of Adonis presumably represents the ultimate male physique imaginable to a sixteenth-century artist -- but Titian's Adonis looks fat and out of shape in comparison to the men pictured on the boxes of protein powder at the Olympic Gym.

We should note that "Adonis Complex" isn't an official medical term, and it doesn't describe any one body image problem of men. We use it in this book to refer to an array of usually secret, but surprisingly common, body image concerns of boys and men. These concerns range from minor annoyances to devastating and sometimes even life-threatening obsessions -- from manageable dissatisfaction to full-blown psychiatric body image disorders. In one form or another, the Adonis Complex touches millions of boys and men -- and inevitably, the women in their lives.

Nowadays, it seems, increasing numbers of boys and men, including some of those lifting weights tonight at the Olympic Gym, have become fixated on achieving a perfect, Adonis-like body. Take Scott, for example. He's a twenty-six-year-old personal trainer at the gym. Right now, he isn't training anybody because it's his own time to lift. He's just started his leg routine -- three sets of squats, two sets of leg presses, two or three sets of leg extensions on a Nautilus machine, three sets of leg curls on another machine, and then on to some hack squats, leg abductions, and side leg raises. The whole routine will take him an hour and a half, and then he still has to do his calves for another half hour after that. He's working out alone, because he doesn't like any distractions to come between him and the weights.

To a casual observer, Scott seems like a perfect picture of fitness and health. Five feet nine inches tall, with shortly cropped dark brown hair and handsome facial features, Scott weighs 180 pounds and has only 7 percent body fat, making him leaner than at least 98 percent of American men his age. Beneath his worn gray sweatpants and sweatshirt, he has the proportions of a Greek statue. He has a 31-inch waist, a "six-pack" of sculptured abdominal muscles, a 46-inch chest, and shoulders as big as grapefruits. But surprisingly, and unknown to even many of his closest friends, Scott constantly fears that he isn't big enough.

As a result, Scott has surprisingly low self-esteem. He puts all his hopes and dreams into his workouts and not into his daily life. This makes him withdraw from others and hold himself back from social situations he would otherwise enjoy. Although women are enormously attracted to Scott, he secretly thinks he isn't really big enough or masculine enough to appeal to them. In fact, he doesn't have a girlfriend right now, partly because his self-image is so poor and his confidence about dating so crippled.

Scott came to see us at our research laboratory in response to a notice we put on the bulletin board at the Olympic Gym, looking for bodybuilders who weren't satisfied with their physiques. In this study, we were comparing male bodybuilders who were insecure about their appearance with those who felt comfortable with how they looked. The study involved an office visit in which we measured each man's height, weight, and body fat, had him fill out some questionnaires, and then interviewed him about his body image and other psychological issues.

When Scott arrived for his interview, he was ill at ease, almost embarrassed to be coming to see us for such a study. "You've really had a lot of guys who've called about your ad?" he asked. He was surprised when we told him that we'd already seen many men like himself.

Scott took a chair, seeming a little relieved. He wore loose cotton pants with a drawstring at the waist, and an oversized blue sweatshirt with a bodybuilding logo on the back. The words TAKE NO PRISONERS were emblazoned under a figure of a muscled bodybuilder wearing combat fatigues.

Scott soon grew relaxed and told us his story in a warm, soft-spoken, almost self-effacing manner. An honors graduate of a prestigious New England college and holder of a business degree, Scott was highly educated. But his heart, it turned out, had never been in business.

"I started going to the gym fairly regularly when I was in college," he said. "But I don't think it was until I started business school that it became an obsession. I remember, one day when I was in business school, looking at myself in the mirror and hating how I looked. I started wondering how I'd ever tolerated what I looked like when I was back in college. Gradually, I got more and more fixated on getting my time in the gym each day, and I got more and more impatient with all of the demands at school. The other guys were all talking about companies that they wanted to work for, and how much money they were going to make, but I could never seem to get into it."

By the time Scott graduated from business school, his body obsession dominated his life. "I had several good job offers," he continued, "but I just couldn't picture myself working in an office. I was afraid that if I was forced to sit behind a desk all day, I'd turn into a fat slob. In fact, even at school, I couldn't sit in front of a computer screen for more than about fifteen minutes before I started worrying that I wasn't getting any exercise."

During his graduate studies, Scott worked as a personal trainer at a local health club. After business school, it became his full-time job. "This probably sounds strange," he said, "but it was the only job I could think of that gave me enough time to do my own training."

He paused and studied our faces for several seconds, seeming to fear we would have a negative reaction to what he had said. Instead, we asked questions to hear more about and understand his concerns.

"Did people criticize you for not going on to a business career?" we asked.

"Everybody," he said with resignation. "Especially my mother, and also my girlfriend at that time. They just couldn't understand why I'd throw away my years of education to work at a gym. I guess it does seem a little weird. But I couldn't imagine going back to a business job now. I guess I've just become too wrapped up with working out."

As the interview progressed, Scott began to reveal the full extent of his preoccupations. "If you could see what I was thinking about during the day, ninety percent of the time it would have something to do with either my weightlifting, my diet, or the way I look. I can't go past a mirror without posing just for a minute to check out my body -- as long as I'm sure nobody's watching. I even check myself out when I see my reflection in a store window or car window." He laughed nervously. "Sometimes when I'm in a restaurant, I even study my reflection in the back of a spoon."

Most of the time, Scott explained, he sees his reflection as small and puny, even though he's actually massively built. "I know it sounds silly," he said, "but there are times that even on hot summer days, after getting a bad shot of myself in the mirror, I'll put on heavy sweatshirts to cover up my body because I think I don't look big enough." For the same reason, he explained that he almost always wears heavy sweats when working out at the gym. He sometimes even turns down invitations to go to a swimming pool or the beach, for fear that when he takes his shirt off, people will notice him and think he's too small.

"How would you feel if you were forced to miss working out for a day?" we asked.

He looked shocked. "I'd probably go bananas and start breaking things. In fact, one day last winter there was a blizzard and I couldn't get out of my house to go to the gym. I felt trapped. I got so frustrated from not being able to work out that I put on my weight belt and started bench-pressing the furniture in my living room. My girlfriend thought I was crazy."

"Has your relationship with your girlfriend been affected by your weightlifting preoccupations?"

Scott fell silent, and for a brief moment, tears seemed to form in his eyes. "Actually, my girlfriend broke up with me because of my weightlifting. It got to be too much for her. Sarah could never really understand why I needed to go to the gym or why it mattered so much to me what I looked like. I'd ask several times a day whether she thought I looked big enough or muscular enough. I guess she got pretty tired of my asking her. She also complained a lot because she said I was too inflexible. She'd want to go out and do something, and I'd say that I couldn't because I needed to go to the gym and train. But I'd warned her that I was that way. I told her that when we first started living together: the gym comes first, my diet second, and she was third. I guess she couldn't take being in third place anymore. And I don't really blame her.

"It's weird," he continued. "I think the truth is that I actually thought Sarah would break up with me if I didn't work out enough. I actually thought she'd leave me for some bigger guy. But the real reason she left me was because I was so caught up in working out that I didn't do anything or go anyplace with her. She told me that I was screwed up and that our relationship was getting 'lost.' When I think about it, I guess maybe she was right."

"Why do you think you have such intense feelings about your body and about working out?" we asked.

"I don't know. I guess I've really never stopped to think about just how much this muscle thing has affected my life. At first, it was a healthy thing, wanting to pursue a healthy lifestyle and be in shape. But now, it's gotten out of control. It's a trap. I can't get out of it."

"Have you ever considered some type of therapy to look at your feelings about your body?"

"Yeah, I've thought about it sometimes, but it would never work. Someone who doesn't lift weights himself would never understand." As he spoke, Scott flexed his arm unconsciously.

Over the last several years, we've interviewed many men with Scott's condition. We call it "muscle dysmorphia" -- an excessive preoccupation with body size and muscularity. Many of these men, like Scott, revealed that this preoccupation had spiraled out of control and profoundly affected their lives -- causing them to change their careers, or destroying relationships with people they loved. But practically none of them had sought treatment for their condition -- usually because they doubted that any type of professional would actually understand or be able to help them.


MUSCLE DYSMORPHIA: "PUNINESS" IN THE MIND

The body image distortions of men with "muscle dysmorphia" are strikingly analogous to those of women (and some men) with anorexia nervosa. In fact, some people have colloquially referred to muscle dysmorphia as "bigorexia nervosa" or "reverse anorexia." People with anorexia nervosa see themselves as fat when they're actually too thin; people with muscle dysmorphia feel ashamed of looking too small when they're actually big. A recent study of ours illustrates these parallels. In this study, we compared interview and questionnaire responses from twenty-four young men with muscle dysmorphia, recruited from gymnasiums in the Boston area; thirty young men without muscle dysmorphia, recruited from the same gymnasiums; twenty-five college men with eating disorders such as anorexia nervosa and bulimia nervosa (binge eating and vomiting); and twenty-five ordinary college men without eating disorders. On question after question, the men with muscle dysmorphia showed levels of pathology similar to the college men with eating disorders. In particular, the men from these two groups shared a need to exercise every day, shame about their body image, feelings of being too fat, dislike of their bodies, and often, lifetime histories of anxiety and depression. By contrast, the group of weightlifters without muscle dysmorphia closely resembled the ordinary college men on all of these same indices. In other words, men with muscle dysmorphia report that they are suffering just as badly as men with anorexia nervosa.

Also like people with anorexia nervosa, men with muscle dysmorphia often risk physical self-destruction. Frequently, they persist in compulsive exercising despite pain and injuries, or continue on ultra low-fat, high-protein diets even when they are desperately hungry. Many take potentially dangerous anabolic steroids and other drugs to bulk up, all because they think they don't look good enough.

But these men's nagging worries are rarely relieved by increasing their bodybuilding. In psychological terms, we call such persistent worries "obsessions." And in response to these obsessions, people are driven to repetitive behaviors -- in Scott's case, constant weightlifting -- which, in turn, we call "compulsions." Though people may realize, on one level, that their obsessive beliefs are irrational and their compulsive behaviors futile, they still cannot "shut off" their endless and often self-destructive behaviors. Scott is a case in point. Although his feelings of self-criticism were utterly irrational, Scott was so convinced of his deficiencies that, at the end of the day, he chose catering to his muscle obsession over maintaining his relationship with Sarah.

The sources of Scott's muscle obsessions and weightlifting compulsions are not known with absolute certainty, but most likely are threefold. First, there's almost certainly a genetic, biologically based component. In other words, some people like Scott inherit a chemical predisposition to developing obsessive-compulsive symptoms. But genetics do not act alone. The second likely component is psychological -- obsessive and compulsive behavior stems, in part at least, from one's experiences growing up, such as being teased. Scott still remembers being called "dorky" and "wimpy" in school, and these memories still fuel his muscle obsession and his compulsion to work out. And finally, we believe that society plays a powerful and increasing role, by constantly broadcasting messages that "real men" have big muscles -- just like the bodybuilders in the pictures on the walls of the Olympic Gym. Men like Scott have been exposed to these images ever since they were small boys, thus laying the groundwork for muscle dysmorphia and other forms of the Adonis Complex in adulthood.


BODY-DISSATISFIED MEN: A SILENT EPIDEMIC

Cases as severe as Scott's may be uncommon. But for every man with severe muscle dysmorphia, dozens of others experience at least some distress about their muscularity. For example, a 1997 study found that an amazing 45 percent of American men were dissatisfied with their muscle tone -- almost double the percentage found in the same survey in 1972. Thus, we can calculate that there are presently well over 50 million muscle-dissatisfied men in our country. And these millions of men are surrounded by many millions of very perplexed family members, friends, and loved ones, who probably can't quite understand what this anxiety about bigness and muscles is all about.

Why is muscle dissatisfaction, together with other body-appearance preoccupations, becoming so common among modern men? Our grandfathers didn't seem to worry about how muscular they looked. They didn't do bench presses or abdominal exercises three days a week, or go to the gym to work out on the StairMaster, or worry about their percentage of body fat. Why has the Adonis Complex infected so many men over the last thirty years or so?

One reason is that our grandfathers were rarely, if ever, exposed to the "supermale" images -- aside from Charles Atlas on an occasional matchbox cover -- that Scott and his friends see every day. In modern society, these images aren't confined to pictures in the gym -- they're everywhere. Look at television over the last several decades. The hard-bodied lifeguards in Baywatch are viewed by over 1 billion viewers in 142 countries -- figures unmatched by any previous television series. Or look at the movies. Hollywood's most masculine men of the 1930s, 1940s, and 1950s -- John Wayne, Clark Gable, Gregory Peck -- look like wimps in comparison to modern cinema's muscular action heroes -- Arnold Schwarzenegger, Sylvester Stallone, or Jean-Claude van Damme. Today, while growing up, a young man is subjected to thousands and thousands of these supermale images. Each image links appearance to success -- social, financial, and sexual. But these images have steadily grown leaner and more muscular, and thus more and more remote from what any ordinary man can actually attain. And so society and the media preach a disturbing double message: a man's self-esteem should be based heavily on his appearance, yet by the standards of modern supermale images, practically no man measures up.

It becomes understandable, then, that millions of modern American men are unhappy with how they look. And it isn't surprising that among these millions, we are seeing increasing numbers of serious casualties -- men like Scott, whose lives have been damaged by these trends. Growing up in the 1970s and '80s, Scott steadily absorbed the stream of supermale images from the modern media. In fact, he described to us how he watched Rambo movies and Schwarzenegger action thrillers and, even as a child, fantasized that he would someday look like those heroes. Gradually, body appearance became the dominant basis -- and ultimately the only basis -- for his self-esteem. To lose even a little of that muscle, or to gain even a little body fat, brought him instant shame and humiliation. For Scott, a muscled body became more important, much more important, than being a successful businessman. It became so important that it brought him nearly complete social isolation and even cost him his relationship with the woman he loved.

BILL AND STACY: FALLOUT FROM FAT

Back at the Olympic Gym, another man is suffering from a very different form of the Adonis Complex. Bill is tall, thin, and in his early thirties. He's drenched with sweat after thirty-five minutes of running on the treadmill at seven minutes per mile. He's wondering, at this moment, whether he's run long enough or fast enough, whether he's burned off enough calories to compensate for the food he ate earlier in the day, and whether he still looks a little too fat. And he's already beginning to feel guilty about the eating binge that he knows will happen after he gets home tonight.

On his way home from the gym, Bill will purchase two large Italian submarine sandwiches, two large bags of Doritos, two cans of onion dip, and a quart of chocolate-chip cookie-dough ice cream. After shutting off the ringer on his phone, he'll begin to eat as fast as he can -- sometimes even using both hands to feed himself, grabbing food with his left while eating from his right. Before he even has a chance to think about it, nothing will be left but a bunch of empty bags, containers, and wrappers.

Bill told us about his secret eating binges when he came to see us for one of our research studies of men with eating disorders. Even though he knew that we were familiar with this type of problem, it still took him a long while to let down his guard and tell us the full story.

"As soon as I've finished the last potato chip or the last gulp of ice cream," he said, "I feel totally guilty and disgusted with myself. I just can't believe that I've done it again, that I've lost control. When I was younger, I even tried to make myself vomit in the bathroom after the eating binges. But I wasn't very good at it. Now, I just try to diet in between the binges. Or I'll go and run some extra miles to try to burn off the food. Sometimes, I've even gone running at three o'clock in the morning. No one in the world knows that I do this. For years, I even kept it a secret from my wife. When I didn't show much interest in sex, she kept thinking I was having an affair. Actually, I was just too caught up in the binge eating and my weight. I hated the way I looked."

He grew visibly uncomfortable. "It probably sounds ridiculous, but my food problem ruined my marriage. Early on, we had a really close relationship -- we'd been high school sweethearts and best friends. I really loved Stacy and felt I was the luckiest guy in the world to be married to her. But when my food problem started, I began to retreat. I retreated into this little world where food was really all that mattered, where I spent my entire day planning my meals and thinking about my weight. I gradually shut her out even though I really didn't want to. I just lost control."

Stacy eventually divorced Bill. She never found out that Bill's real problem was an eating disorder. In fact, she'd thought she was to blame -- that something was wrong with her. Bill had tried to reassure her that it wasn't her problem, but he was still unable to reveal to her that the real problem was his chronic feeling of worthlessness. Despite all of the love he and Stacy shared, Bill felt he wasn't good at anything. He felt fat, mediocre, and unattractive.

Bill's self-hatred crept up on him insidiously. First, he began to withdraw from Stacy, his sex drive waning daily. Next he started going to the gym excessively in an attempt to convert his body into a mass of muscle. And then he became obsessed with food, so obsessed that it destroyed the most important relationship of his life.

"I loved Stacy so much. I still really love her. I wish I could have her back," he said plaintively. "She was my soul mate. I could tell her a lot of things -- except this."

Bill's condition is called "binge-eating disorder." Only recently has this condition been recognized by professionals as an actual psychiatric problem. In fact, Bill told us that for many years he hadn't even known that his peculiar eating pattern had a name. And when he found out, at last, that he wasn't alone with his illness, he refused to see a therapist, or even tell his family doctor.

"I guess I never really wanted to admit that I had a serious eating problem," he said. "I was really ashamed, because I felt that it was a female thing to have eating problems like that. I'd never heard of a man with an eating disorder. I got more and more worried about being too fat. When I was younger, there was a time when it got to the point where I would weigh myself four or five times in a day. Sometimes if I gained even a pound, I would go to the gym or go running because I thought I was getting fatter. But then, half the time, I'd get hungry again, and then I'd go on another eating binge and be right back where I started. I mean, how many guys struggle with that?" Bill took a deep breath and sighed, "I feel I don't measure up."

"Where do you think those feelings come from?" we asked.

"I guess I've pretty much always felt like a failure," Bill explained. "I came from a family with five older sisters and no brothers at all. When I was born, my parents put all their hopes in me."

"That must have been pretty hard on you, being the only son with your parents' high expectations," we offered.

"Well, especially when you understand what my father was like. He was a well-meaning man, but he was very tough with me. He couldn't understand why I was scared to go to school as a child, and he would yell at me until I cried in the morning when I was forced to get on the school bus. I had a lot of little fears like that while I was growing up, and my father just couldn't figure out why I couldn't just instantly overcome them."

"It sounds as though your father put a lot of pressure on you."

"Yes. A lot of pressure -- pressure to play sports, pressure to act tough, pressure to be masculine. But it was also about control. He had a pretty hard childhood himself -- his father was a violent alcoholic who would get drunk and beat him -- so for my father everything had to do with keeping a stiff upper lip and showing no fear."

"And what happened if you failed to meet his expectations?"

"He would just become a horrible person if you didn't do what he wanted or didn't live up to his expectations. He'd say: 'You're such a disappointment' or 'I'm ashamed to be the father of such a little cry baby' or 'You're a spoiled brat.'"

"How did you handle it back then?"

"I don't know. I just recall feeling totally helpless and hopeless. I felt like the world's biggest loser -- shy, stupid, ugly, you name it. My mother was always afraid of my father, so she stood behind whatever he did. I felt like there was nowhere to turn."

"Well, it's little wonder that you don't feel completely good about yourself now, as an adult."

"I don't feel good about myself at all. I still feel like that little kid, terrified to get on the school bus with the other kids. Only now, to make matters worse, I also constantly feel as though I'm fat and overweight."

In fact, Bill wasn't fat at all. His body fat measured only 11 percent -- making him far leaner than an average American man of his age.

"But you realize that, in reality, you're not fat all?" we asked.

"Yeah, I know, I know. Everybody says that," he admitted. "I look around at other guys and realize that I'm thinner than they are, but it still doesn't make the feelings go away.

"When I was a teenager, I went on this mission to improve my appearance. I started lifting weights and running every day after school. It made me feel good because I felt like I was proving myself to my father. Also, I figured that if I kept it up, I'd be more confident in social situations, because I'd be more muscular and athletic."

Bill went on to describe an episode of depression he experienced during his senior year of high school. He began to feel hopeless about what he would do after graduating. He started sleeping ten or eleven hours each night, he couldn't concentrate on anything, and he felt guilty and down on himself for no reason. "I felt like shit. I couldn't talk to anyone about it. And no one asked about what was going on even though they must have been able to see something was wrong."

Bill suffered through the blackness of the depression for another year, and gradually discovered that exercise made him feel better. But when he went to college, he injured his ankle while running and was forced to stop exercising for many weeks. The depression returned, more severely. About that time, Bill discovered that binge eating would temporarily alleviate his depression.

"It was a high. It kind of numbed me," he said. "All of those messages inside of my head about being too shy, being stupid, being ugly -- for a moment those voices went quiet and I could feel at peace with myself."

At first, Bill binged only occasionally, but gradually he became drawn into a cycle of binge eating, dieting, working out, and binge eating again. This cycle seemed to keep the depression at bay, but increasingly, he became preoccupied that he was getting too fat. He began to weigh himself and look at himself in the mirror more and more often. Soon the thoughts of food, body weight, exercise, and fat came to consume virtually all of his day.

"But I still couldn't talk about it with anybody. I didn't think any of my friends would understand. In fact, I'm surprised I'm here right now. Guys aren't supposed to get all hung up about their appearance."

And so Bill's preoccupations remained secret for years. Despite all of his physical and emotional problems, despite having been severely depressed, Bill's visit to our research laboratory was the first time he'd ever seen a mental health professional -- the first time he had ever reached out for help.


SECRET DIETARY RITUALS

Among men suffering from the Adonis Complex, secrets like Bill's are common. Not only does society forbid men to talk about their feelings of vulnerability and inadequacy, but it also indoctrinates them with the idea that only women are supposed to worry about their looks. Men, according to our society, do not -- and should not -- worry about their appearance or the shape of their bodies. A man who does focus on his appearance is often seen as vain, narcissistic, or "feminine." For a man like Bill, then, a Catch-22 situation arises when he begins to dwell on his body. If he doesn't talk about his feelings, the pain gets internalized and the problem persists. If he does find the courage to do so, society tells him he's being inappropriate, that he's not acting in a healthy, masculine way. Then, of course, he feels worse: more ashamed, more vulnerable, more troubled. The result of this Catch-22 situation is that most men coping with eating disorders simply keep quiet about their painful feelings. No one, therefore, can calculate exactly how many men suffer from covert eating disorders and chronic body image preoccupations like Bill's. But there's little question that today's professionals are seeing cases like his with increasing frequency. In our own clinical practice, more and more men are telling us about their concerns with eating, their bodies, and their appearance. Of course, this raises the question as to whether eating disorders are actually more common among men nowadays, or whether we are simply becoming more aware of them. We believe that both of these changes have occurred.

Many people, like Bill, still think that eating disorders are "women's diseases." But binge-eating disorder seems almost as common among men as among women, with studies in the United States typically showing a ratio of about 40 percent male to 60 percent female. That translates into a million or more men in America today with binge-eating disorder. And then, too, there are hundreds of thousands of others who actually make themselves vomit, or do other drastic things to lose weight after binges, like taking large doses of laxatives. This disorder, called "bulimia nervosa," was first recognized in women about twenty years ago, but is now increasingly being recognized in men. And we're even seeing more men with anorexia nervosa -- dieting to the point of becoming emaciated -- even though this condition has traditionally been assumed to affect women almost exclusively.

Furthermore, for every man who suffers from one of these eating disorders, many others have developed milder but still dysfunctional eating patterns in response to their appearance concerns. In fact, probably a third of the men in the Olympic Gym are involved in dietary rituals that affect their day-to-day lives. Jonas, a blond graduate student running on a treadmill, is constantly thinking about the fat content of his food. Sometimes he'll decline invitations to eat at restaurants for fear that he won't be able to order anything sufficiently low in fat. Last night, he went to an ice-cream shop with his girlfriend, but found to his dismay that they offered only "low-fat" rather than "nonfat" frozen yogurt. A serving of the "low-fat" yogurt contained only four grams of fat, but he wouldn't compromise, and ordered nothing at all, even though he was hungry.

Charles, a businessman in his early forties and an Olympic Gym "regular," is simultaneously listening to headphones and reading a magazine to distract himself from the tedium of his workout on a StairMaster. Dozens of times per day, he silently laments his slowly enlarging stomach and "love handles." At breakfast and lunch, he practices a rigorous dietary routine, counting every calorie that he consumes, frequently consulting his pocket "calorie counter" book. But invariably, sometime in the evening, his resolve collapses and he polishes off several hundred calories worth of M&M's and Tootsie Rolls. Tomorrow, when he wakes up, he'll resolve to be good -- but inevitably, the pattern will repeat itself. The StairMaster workouts don't keep up with his candy habit; as a result, he's wondering about liposuction.

Steve, a thirtyish plumbing contractor, worries mostly about carbohydrates. He religiously uses sugar substitutes in his coffee, drinks only Diet Cokes, and never eats dessert. But most nights, when he gets home, he makes up for his carbohydrate deficit by drinking beer. After four or five beers, totaling 600 to 750 calories, he has more than erased any of the calorie savings that he achieved through carbohydrate restriction during the day. Strikingly, he worries a lot more about the look of his belly than about his level of alcohol consumption.

Armand, a lanky teenager, also suffers from food preoccupations, but he's worried that he's too thin. In an attempt to bulk up, he's constantly counting the grams of protein in everything that he eats; sometimes, in his own words, he'll "force-feed" himself to ensure that he gets at least 150 grams of protein per day. He spends more than $50 per week -- a substantial portion of his income -- on protein bars, protein shakes, and various other food supplements that he hopes will make him hard and muscular. It seems strange that he should worry, for in reality, Armand is already a gifted athlete, playing varsity soccer and varsity lacrosse at his high school. But he refuses to be happy with his tall, lean body. No one, not even his closest friends, and certainly not his parents, knows how much he secretly despises his appearance. In a vain attempt to quell his anxieties and overcome his own genetics, he keeps stuffing himself with protein. He's heard that excessive protein might be bad for his kidneys over the long term, but his body obsessions today override any concerns about possible damage to his body in the distant future.

The eating patterns of these men can almost all be traced to the Adonis Complex -- overconcern, dissatisfaction, or outright obsessions with body image. Men who have eating disorders, especially the more severe forms, may suffer not only from a distorted image of their bodies, but also from a profoundly distorted image of themselves as men. Tragically, they often think that their preoccupations are rare or unique; they have trouble believing that other men around them in the gym could possibly be victims of similar concerns.

Some of the men with more serious eating disorders, like Bill, may also be clinically depressed. With techniques like brief psychotherapy or an antidepressant medication like Prozac, both the depression and the eating disorder -- along with the associated nagging preoccupations about fatness and body image -- may vanish. But since most of these men don't reveal their symptoms to anyone, they continue to suffer needlessly.

If only we could get out the message to men with eating problems that they are not alone, much of their suffering might be relieved. In the past twenty years, this approach has greatly benefited women. Since the early 1980s, news stories, magazine articles, and books have educated women about binge eating, compulsive dieting, and obesity. As a result, more and more women dared to voice their eating problems. They joined self-help groups, contacted educational organizations devoted to helping women with eating disorders, and sought therapy from knowledgeable professionals. Within less than a decade, practically every young woman in America had heard about eating disorders, knew that they were common, and knew that help was available. If a similar trend could occur for men, then men like Bill might no longer have to suffer in silence.


BIGGER BODIES THROUGH DRUGS

Elsewhere in the Olympic Gym, the Adonis Complex has bred another type of secret. In the free-weight area of the gym, Jerry, Cliff, and Vince, three high school seniors, are busy doing bench presses. All three boys are hoping to enter a local bodybuilding competition this summer, and they're feverishly working out to bulk up. They're enormously muscular, dressed in Olympic Gym sweatpants and stringy tank tops. Their tank tops are ripped, seemingly worn to shreds from long and heavy use. But actually, the rips don't quite look accidental; they're in just the right places to show off their bulging chests and shoulders.

Jerry, Cliff, and Vince are particularly distinctive because their necks and shoulders look unnaturally big in comparison to the rest of their bodies. And for good reason: they are unnatural. Over the last several years, these boys have each taken multiple "cycles" of "juice" -- drugs known as anabolic steroids. Anabolic steroids are a family of drugs that includes the male hormone, testosterone, as well as numerous synthetic derivatives of testosterone. Steroids have few legitimate medical uses, and doctors won't prescribe them to athletes simply trying to gain muscle. Unless prescribed for specific medical treatment, steroids are illegal in the United States and many other countries. But these drugs are widely available on the black market through underground dealers in gyms everywhere. Taken in pill form or by injection, steroids can allow boys and men to gain huge amounts of muscle, far beyond the limits of muscularity that any ordinary man could attain without these drugs.

Vince, a good-looking boy of average height with wavy sandy-blond hair and dark brown eyes, is on a cycle of steroids right now. Every three days, he uses a needle to inject himself with almost a teaspoonful of testosterone cypionate, alternating with occasional shots of Equipoise, another anabolic steroid. Actually, Equipoise is a veterinary preparation intended only for horses -- but Vince knows that it also works effectively on people, and it's cheaper on the underground market than human steroids. Vince has also managed to score some bottles of Anavar and Hemogenin pills, which he takes on top of his injectable steroids -- a standard practice that steroid users call "stacking." The four steroids for this "stack" cost Vince almost all of his savings -- $800 -- and he's considering dealing some steroids to make a profit so he can buy more for his own use.

Amazingly, these boys' parents aren't aware that their sons are taking steroids. They think their sons' muscles are all the result of hard work, good diet, and protein supplements. Like most parents, they don't realize that it's medically almost impossible to get this big without chemical assistance. Our research indicates that there's a fairly sharp limit to the degree of muscularity that a man can attain without drugs. We believe that most boys and men who exceed this limit, and who claim that they did so without drugs, are lying.

Jerry, Cliff, and Vince can't stay this big without continuing to take steroids periodically over the years. And the longer you take steroids, the greater the danger to your body. Many scientific studies, including those from our own laboratory, have shown that steroids decrease the proportion of "good" cholesterol in the bloodstream (technically known as "HDL cholesterol") relative to the "bad" cholesterol (the "LDL cholesterol"). As a result, atherosclerosis, or "hardening of the arteries," speeds up. For every month that you take large doses of steroids, your arteries may "age" by two or three months or even more -- scientists don't know for sure. But it certainly appears possible that long-term use of high-dose steroids could take ten or twenty years off your life expectancy, leading to an early death from a heart attack or clogged arteries in the brain.

Vince and his friends know these risks. Vince even witnessed the ominous change in his own cholesterol numbers when he was on steroids, because we actually measured them while he was taking a "cycle." But he tries not to think about the dangers he might face when he's older. Occasionally, he tells us, the risk crosses his mind -- but the prospect of never again taking steroids, and gradually losing his muscle size, frightens him a lot more than the prospect of a stroke or heart attack decades in the future. Vince's fear of getting smaller -- of no longer feeling strong, confident, and athletically successful -- trumps any fears that he might be slowly killing himself.

And steroids aren't the only drugs in the bodybuilding business. Also available from local underground dealers are human growth hormone, thyroid hormones, human chorionic gonadotropin, amphetamines, gamma-hydroxybutyrate, clenbuterol, Nubain, and an array of other drugs. Some of these drugs are legally available only by prescription; others are not marketed for human consumption at all. Jerry, Cliff, and Vince know the names and uses of every one of these black market substances. They've even tried several of them along with their steroids. Each boy owns copies of underground guides on how to use these drugs to increase muscularity and lose body fat.

We know Vince well because he participated in one of our studies of anabolic steroid users. Although the study has been completed, he calls us every few months to find out if we've published any new papers on the subject, and asks us to send him copies. He reads everything he can find -- all of the monthly muscle magazines, reports on bodybuilding foods and supplements, anything that contains information about bodybuilding drugs. He knows more about bodybuilding physiology and anabolic steroids than 99 percent of practicing physicians. But then, that's his business -- the gym is his world.

When we first asked Vince what prompted him to take steroids, he had no trouble explaining. "I saw what it did for a couple of my friends, and I said, 'I want that for myself.' I was tired of being a small kid and being picked on at school."

"When you first started out taking steroids, did you realize that we scientists still can't estimate the long-term risks?" we asked.

"Yeah, but you can die getting hit by a truck, too," Vince rationalized. "And steroids have done more for me than any other single thing I've done in my life."

"More for you in what way?"

"In making me feel good about myself. In making me self-confident. In making me more confident with girls."


WHAT DO WOMEN REALLY THINK?

Vince's last remark brings to mind another consequence of the Adonis Complex: the strange and striking disparity between men's and women's views of the ideal male body. Recently, we developed a computerized test to look at this difference between the sexes in body perception. In this test, the computer presents an image of a male body, and then invites the user to make the image more or less muscular and more or less fat by using the mouse to click on "buttons" on the screen. The computer then poses a series of questions about body image, and asks the user to choose the body image that best answers each question. When we give the test to men, one of the questions is, "choose the male body image that you think is the most attractive to women." When we give the same test to women, we rephrase the question to read, "choose the male body image that you feel is the most attractive."

In test after test, the results of this comparison have been dramatic. The body that men think women like is typically about 15 to 20 pounds more muscular than what women actually like. We've found this discrepancy in our studies of men and women in both the United States and Europe.

If watermelon-sized muscles aren't appealing to most women, why are so many men attempting to get so big? For some men, it's simply an erroneous belief that massive muscles will improve their sex appeal. But for other men, we believe that there may be another, more surprising explanation: a new emotional problem, unique to modern society, that we call "threatened masculinity."

"Threatened masculinity" arises from the long-standing desire of boys and men to establish their "maleness" within their societal group. Throughout most cultures in history, men who exhibited traditional "male" behaviors and who succeeded at traditional "male" pursuits have received approval and respect. But nowadays, what are these male behaviors and pursuits? What can a modern boy or man do to distinguish himself as being "masculine"?

In professional settings, modern women can do almost anything that men can do. Women can fly jet fighters in combat. They can be police captains or brain surgeons or chief executive officers of multinational corporations. Women have penetrated even the most hallowed of male sanctuaries: venerable all-male military schools now accept female cadets, female journalists are allowed into the locker room to interview professional football players, and the all-male club has become nearly extinct. Of course, there's still more work to be done to give women full equality, but women's gains are impressive. As positive as these advances obviously are, however, perhaps they cause some men to wonder, in effect, "What is there left for me to do to distinguish myself as a man?"

For some men, there may be only one such thing: no matter what the triumphs of feminism, no matter what laws are passed to ensure equality between the sexes, no matter what crowning achievements women accomplish, they will never, ever, be able to bench-press 350 pounds.

In other words, muscles are one of the few areas in which men can still clearly distinguish themselves from women or feel more powerful than other men. But muscles are a tenuous foundation on which to base all of one's sense of masculinity and self-esteem.


LESSONS FROM THE LOCKER ROOM

There are at least a hundred other men in the Olympic Gym tonight, and most aren't as badly afflicted with the Adonis Complex as Scott, Bill, and Vince. But as we move back into the locker room, we continue to catch glimpses of men who, to varying degrees, are feeling embarrassed by their bodies. For example, most of the men don't take showers at the gym. They simply pack up and go home. Is it really more convenient to drive all the way home in their sweaty gym clothes than to take a shower in the locker room? How many, in reality, are simply uncomfortable with having their bodies seen in public? Looking around the locker room, we see that even some of the men who are changing their clothes do so quickly, almost furtively, as if they don't want anyone to see them. Here are big, muscular men who seem worried about exposing their bodies to other men. Curiously, the only men who seem unconcerned about taking off their clothes are forty, fifty, or sixty years old. Why are the older men seemingly more comfortable with their bodies than the younger, fitter ones?

Again, this difference between the age groups may be a symptom of important changes in our society and its attitudes toward men and masculinity. When the older men were growing up, in the times of Elvis and carhops and beatniks in the 1950s, or with the Beatles and the flower children of the 1960s, fitness and muscularity weren't a big deal. There were few media images to suggest that body appearance should be the main basis for a man's self-esteem. Steroid use was confined only to a small circle of elite bodybuilders, mostly in Southern California. Men rarely worried about their body fat. Eating disorders, such as binge eating and vomiting, were almost unheard of among males. Admittedly, the young men of the fifties and sixties had their own repertoire of hangups -- but embarrassment about their appearance and muscularity wasn't typically one of them.

And so, perhaps, the older men in the locker room today may never have gotten obsessed with their bodies when they were growing up. As a result, they're not embarrassed to be seen naked by other men.

Of course, if we casually asked the younger men in the locker room, they'd probably protest that they're not really worried about their appearance at all. They'd probably provide quick explanations for why they don't need to change their clothes at the gym, or why they plan to take a shower somewhere else. But consciously or unconsciously, they may be more embarrassed about their bodies than they would like to admit. Many are unwitting victims of one aspect of an insidious masculinity code: men aren't supposed to be bothered by preoccupations with their looks. Only women are supposed to get hung up about such things. To speak of anxieties about their bodies or physical appearance, for most men, is to violate the taboo. Many men would far prefer to disavow their worries -- thus internalizing their self-criticism -- rather than risk the "loss of face" that would come with disclosure.


BECOMING ADONIS: THE IMPOSSIBLE IDEAL

But behind the denials, body concerns have increasingly infected millions of modern American men. For every severe or dangerous case, such as Scott, Bill, or Vince, there are dozens of less severe cases -- men who cope quietly with emotional pain about some aspect of how they look. The suffering affects not only men who go to gyms like Olympic, but millions more who are too embarrassed about their appearance to be seen at a gym in the first place. In extreme cases, men may become so concerned about parts of their bodies -- a balding head, a potbelly, a small penis, or some other perceived deficiency -- that they do their best to avoid being seen in any public settings at all.

As clinicians and researchers in psychi atry and psychology, we've witnessed this growing male distress more and more in recent years. We've seen how the Adonis Complex can affect the lives of ordinary American men, young and old, producing a crippled masculine identity, chronic depression, compulsive behaviors, and often seriously impaired relationships with family members and loved ones.

What's particularly worrisome is that so many of these men are unaware of the societal forces that are constantly undermining their self-esteem. Boys and men have grown so accustomed to the constant barrage of supermale images in the media, and in advertising by the male body image industries, that they don't stop to question them. Rarely do they realize the extent to which they have accepted these Herculean images as sensible representations of male beauty. Instead, they change their behavior to try to make their own bodies conform to the new standard. Rarely do they consider that no previous generation in history was ever assaulted with comparable images -- partly because it was impossible to create many of these modern supermale bodies before the availability of anabolic steroids. Rarely, also, do modern men fully acknowledge, even to themselves, how much their self-esteem and sense of masculinity is linked to their body image concerns. As a result of these feelings, they may become increasingly focused on deficiencies in their bodies, without really understanding why.

The starting place for healing this crisis of male body obsession -- a crisis that extends across race, nationality, class, and sexual orientation -- is to help men understand that they are not alone with these feelings, that millions of others share the same concerns and tribulations. It is time to help men appreciate the underlying social forces that contribute to their negative feelings about their bodies. Men must learn to acknowledge and talk about these feelings, to overcome the "feeling and talking taboo" that society has long imposed on them. And in our society, it is time to create widespread awareness about body-appearance concerns in men, and allow men to voice these concerns to those who care about and love them. We need to expose the societal and cultural forces that are inculcating new unattainable male body standards, and share the stories and voices of scores of men who have become frustrated and ashamed by their failure to meet these standards. In the pages that follow, we will describe how we, as professionals, have counseled men faced with these painful feelings. We hope to help men achieve the freedom and relief that has been attained by many women with eating disorders and other body image concerns: the ability to acknowledge their problems, seek new ways of perceiving their bodies and themselves, and find new paths toward self-confidence and fulfillment.

Copyright © 2000 by Harrison G. Pope, Jr., M.D., Katharine A. Phillips, M.D., and Roberto Olivardia, Ph.D.

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