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Mirror, mirror on the wall ... are muscular men the best of all? The hidden turmoil of muscle dysmorphia.

Muscle dysmorphia is a new syndrome emerging behind gym doors. You might notice it in your gym's weight room. Some weightlifters pathologically believe their muscles are too small. They have poor body image (i.e., are ashamed of, embarrassed by and unhappy with their bodies) and a passionate desire to not only build muscle, but also avoid gaining fat. This preoccupation with building muscles manifests itself in excessive weightlifting (e.g., spending four or more hours per day at the gym), attention to diet (e.g., consuming protein shakes on a rigid schedule), time spent "body-checking" (e.g., looking in mirrors, CDs, window reflections, etc.), excessively weighing themselves (i.e., 10 to 20 times per day), too little time spent with family and friends and, not uncommonly, anabolic steroid use.

Is this overconcern with body size a new obsession? Perhaps. In the past few years, we have been increasingly exposed to half-naked, muscular male bodies (e.g., Calvin Klein underwear ads). Evidently, even brief exposure to these images can affect a man's view of his body. In a study of the media's effect on male body image, a group of college men viewed advertisements featuring muscular men, while another group viewed neutral advertisements without partially-naked male bodies. Then, the men (unaware of the hypothesis being tested) were given a body image assessment. Those exposed to the muscular images showed a significantly greater discrepancy between the body they ideally want to have and their current body size (Leit, Gray and Pope 2002). Another study suggests up to a third of teenage boys are trying to gain weight to be stronger, fitter, attain a better body image and perform better in sports (O'Dea and Rawstone 2001).

The irony is while college-age men believe a larger physique is more attractive to the opposite sex, women report desiring a normal-sized body. In a study of men from the United States, Austria and France, the subjects were shown a spectrum of body images and asked to choose:

* the body they felt represented their own

* the body they would ideally like to have

* the body of an average man their age and

* the male body they felt women preferred.

The men chose an ideal male body that was about 28 pounds more muscular than their current bodies. They also reported believing women prefer a male body with 30 pounds more muscle than they currently possessed. Yet, an accompanying study indicated women actually preferred an ordinary male body without added muscle (Pope 2000).

At the 2003 Massachusetts Eating Disorders Association's (MEDA) annual conference, Dr. Roberto Olivardia shared his research on adolescent boys' body image. Olivardia is a psychology instructor at Harvard Medical School and co-author of The Adonis Complex: The Secret Crisis of Male Body Obsession (Free Press, 2000). The title alludes to Adonis, the Greek god who exemplifies ideal masculine beauty and desire of all women. Olivardia explained that adolescence is a time for exploring "Who am I?" Without a doubt, so much of who a teen is, is defined by his body. Because today's boys have been exposed from day one to GI Joe action figures, Hulk Hogan and Nintendo's Duke Nukem, they have relentlessly received strong messages that muscular bodies are desirable. Those at risk for muscle dysmorphia include adolescent boys who were teased as children about being too fat or short. Individuals at highest risk are those who base their self-esteem solely on their appearance.

In our society, muscularity is commonly associated with masculinity. According to Olivardia, compared to ordinary men, muscular men tend to command more respect and are deemed more powerful, threatening and sexually virile. Muscular men perceive others as "backing off" and "taking them seriously." Not surprisingly, men's desire for muscles has manifested itself in a dramatic increase in muscle (and penile) implants.

Olivardia expressed concern the "bigger is better" mindset can often lead to anabolic steroid use. He cited statistics from a study with 3,400 high school male seniors: 6.6 percent reported having used steroids; more than two-thirds of that group started before age 16 (Buckley et al. 1988). Olivardia regrets males commonly use steroids in secrecy and shame. "Men will tell someone they use cocaine before they admit to using 'juice.'" This commonly keeps them from seeking help.

Steroids carry with them serious medical concerns: breast enlargement, impotence, ache, mood swings, risk of heart disease, prostate cancer, liver damage and AIDS (from sharing needles)--not to mention sudden death, although it may occur 20 years from current use. "Roid rage," the fierce temper that contributes to brutal murders and violence against women, is an immediate danger.

What's the solution? According to Olivardia, young men need education about realistic body size to correct the distorted thought "if some muscle is good, then more must be better." They might also need treatment for obsessive-compulsive disorder. Sadly, most men believe they are the only ones with this problem and, thereby, take a long time to admit needing therapy. When they do, too few programs exist to help them explore the function this obsession serves in their lives--a sense of control. They mistakenly believe control over their bodies equates to control over their lives.

If you are a male struggling with dysmorphia, read The Adonis Complex: The Secret Crisis of Male Body Obsession and other books available at A Web search on "muscle dysmorphia" can also yield hundreds of articles with helpful information. Most importantly, know you are not alone--seek help and find peace.


For help with eating disorders and body image, visit the Massachusetts Eating Disorders Association's Web site,


Buckley, W.E., et al. "Estimated prevalence of anabolic steroid use in high school seniors." JAMA, 260 (1988): 3441-5.

Leit, R.A., Gray, J.J. and Pope, H.G. "The media's representation of the ideal male body: A cause for muscle dysmorphia?" Int'l. J. Eating Disorders, 31 (April 2002): 334-8.

O'Dea, J.A. and Rawstone, P. "Male adolescents identify thcir weight gain practices, reasons for desired weight gain, and source of weight gain information." J. Am. Diel. Assoc. 101, no. 1 (January 2001): 105-7.

Pope, H.J., et al. "Body image perception among men in three countries." Am. J. Psychiatry, 157 (August 2000): 1297-301.

Nancy Clark, M.S., R.D., offers private nutrition consultations to both casual exercisers and competitive athletes at SportsMedicine Associates in Brookline, Massachusetts. Her books, Nancy Clark's Sports Nutrition Guidebook, 3rd Edition ($23) and Nancy Clark's Food Guide for Marathoners: Tips for Everyday Champions ($20), can be purchased at or by sending a check to Sports Nutrition Materials, 830 Boylston St. #205, Brookline, MA 02467.
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Title Annotation:Nutrition
Author:Clark, Nancy
Publication:American Fitness
Geographic Code:1USA
Date:Jan 1, 2004
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