Male body dysmorphia: when men are obsessed with their bodies

by Charles Downey

An extremely well-built man in his early 20s quit college and took an evening shift washing dishes in a restaurant to allow more time during the day for lifting weights. Whenever he got a chance, he dropped to the floor to knock off dozens of pushups. Nonetheless, he considered himself puny and unattractive.

Another young man in 20s landed a job in a prestigious law firm. But every hour on the hour, he fired up a shake machine on his desk because he thought regular protein drinks were necessary to fuel the continuing growth of his already bulging muscles, which he tortured for hours nightly in a gym.

Increasingly, more men are obsessed with their bodies. While the cases mentioned above are extreme, more and more men are displeased about the state of their muscularity.

When concerns about body and "pumped up" muscles take over a man's life, the condition becomes known as male body dysmorphic disorder, or male body dysmorphia. Compulsive exercise, steroid abuse and eating disorders are also usually involved.

"According to one survey, about 45% of men in the population are displeased with the state of their muscles," says Katharine A. Phillips, MD, associate professor of psychiatry at Brown University School of Medicine.

Based on research involving 1,000 men during the last 15 years, Dr. Phillips estimates that about a million U.S. men have body dysmorphic disorder. The obsession often results in the loss of employment, relationships, and other important things in life.

Doctors Arnold Andersen and Thomas Holbrook, authors of Making Weight: Men's Conflict with Food, Weight, Shape and Appearance, report that therapists are seeing 50% more men with eating disorders than they did 10 years ago. Forty percent want to bulk up. Complicating the problem is a view that fat is primarily a women's issue. That has lead to men being misdiagnosed and excluded from treatment.

To test the theory that society expects men to achieve impossible standards, three mental health experts studied centerfolds that appeared in Playgirl magazine from 1973 to 1997. Their research was published in the January, 2001, issue of The Journal of Eating Disorders. They found that over the decades, male centerfolds lost 12 pounds of fat and gained over 20 pounds of muscle.

Even toys designed for boys have become ripped. The G.I. Joe of 1982 looks puny when compared to today's G.I. Joe Extreme, who, in real life, would have a 55-inch chest and 27-inch biceps.

The condition is the reverse of anorexia nervosa, in which an 85-pound person, usually a woman, looks into a mirror and sees a fat person staring back. Likewise, some heavily muscled men look into a mirror and see a beanpole who needs to be bulked up.

"Science really does not yet know why such patients do not see themselves in a true light," says Dr. Phillips. "There could also be a perceptual disorder along with both conditions."

"We have become a society in which the first glance is the only glance," says Dr. Andersen, director of the eating disorders program at the University of Iowa. "Appearance is becoming more and more important as a billboard for what people want to think is inside."

"Men always want a ?six-pack' on their abdominals," says Jim McDonald, personal trainer and owner of Iron Works Gym in Claremont, California. "Then they want a larger chest and shoulders, then arms. Buff legs are last."

According to Dr. Phillips, 38% of men want bigger pectoral muscles while only 34% of women want bigger breasts.

No amount of muscle development is ever enough for these men. Treatment, according to Dr. Andersen, is a combination of cognitive behavior therapies in which mental health experts challenge distorted ideas. When major depression and compulsive disorders are involved, prescription antidepressant medications are prescribed.