You've Come A Long Way, Bubba

From the WebMD Archives

July 21, 2000 -- What's the difference between "Look at Joe Six Pack" and "Look at Joe's six pack"? The difference is about a decade, if you take the amount of time it took for the phrase to evolve from a reference to an average guy (probably with a beer gut) to a compliment on a buff belly.

"It was only in the last 10 years that it even came into our language as meaning the way your body looks," Harrison Pope, MD, tells WebMD. "That's a testimony of the change that's happened over the last few decades."

Pope, a professor of psychiatry at Harvard University, and two colleagues have written a book called The Adonis Complex. Call it inevitable, or call it payback, but many men are now suffering from the same insecurities about their bodies that women have dealt with for centuries, they say.

Men are "getting a taste of the same medicine that women have had to put up with, [as] women have had to look at perfectly airbrushed pictures of unattainably beautiful female models on magazine covers. Now, men are looking at steroid-fueled bodies of unattainably perfect male bodies and have to deal with the same insecurity," Pope says.

"Culturally, it's just an exaggerated reflection of the images that are in the media, says therapist Dina Zeckhausen, PhD, of the Atlanta Anti-Eating Disorders League, "The ideal male is big, and buffed, and V-shaped, and the ideal woman is getting taller and thinner, and so these disorders are just distortions of that, the cultural body ideal."

Pope says the Adonis complex is not about vanity or narcissism. Instead, it refers to the various body-image disorders that Pope and his colleagues say are increasing, based on their research involving more than 1,000 men over the past 15 years.

These disorders start with obsessions about body image, which lead to compulsive behaviors, some of which can be harmful, even lethal. They fall into three categories, Pope says: a focus on body fat, which can lead to anorexia, bulimia, or binge eating; a focus on excessive muscularity, called "muscle dysmorphia;" and body dysmorphic disorder, in which the sufferer is obsessively dissatisfied with a specific part of his body, like his hair or nose.


Staying fit and being well groomed are not the issue. When behavior crosses the line and impairs social or academic functioning or causes distress, it may require professional help, medication -- or, at least, serious support from family or friends, Pope says.

The Adonis complex, Pope says, has caused some men to lose relationships, forgo career or job opportunities, or train while injured. He says that among some competitive bodybuilders he's known, no matter how much they worked out, they still thought they weren't big enough. And this behavior can go beyond spending long hours in the gym to the detriment of job or family; a teen with body dysmorphic disorder, for example, might be loath to leave the house because he thinks he is frighteningly ugly.

"I think men with these issues, similar to women with these issues, oftentimes feel like they don't have a lot to offer on the inside, so they focus on the outside," Zeckhausen says, adding that working on their bodies may help some people get a sense of control over feelings or circumstances that are out of control.

Not all bodybuilders have the Adonis complex, of course, nor do most men who are concerned about looking attractive. But Pope and his colleagues believe a lot of men out there are dealing with Adonis-type issues to some degree. "For every man who has a severe form of the Adonis complex ... there may be five, or 10, or 20 who have lesser forms of the complex, who are not severely dysfunctional, but chronically distressed," Pope says.

According to Pope:

  • One million American men fit the criteria for body dysmorphic disorder
  • Three million men admit to binge eating twice a week or more at some time
  • 1 million to 3 million men in the U.S. have taken anabolic steroids
  • In 1996, men underwent 700,000 cosmetic procedures

"More and more males are getting plastic surgery, things like pec implants and liposuction to suck away any little bits of fat around the midsection so they can have those six-pack abs," Zeckhausen says. "And you know, its normal to have a little bit of fat around there."


Pope's main concern, though, is the use of steroids. Anabolic steroids, or synthetic testosterone, are not available over-the-counter, but that hasn't stopped men, and boys, from using them. According to the National Institute on Drug Abuse, 500,000 young Americans are taking the performance-enhancing drugs.

The drugs, which have been around for decades, came into widespread use in the 1970s, and, through TV, movies, and advertising, created an "ideal" male image that is impossible to recreate naturally, Pope says. Say it ain't so: The GI Joe, pro wrestler, skin-stretched-tight-as-plastic-wrap-over-the-muscles look ... is all due to steroids?

"Obviously the possibility exists that there might be some rare or exceptional men who might achieve levels of muscularity beyond the upper limit shown in our formula without using steroids," Pope tells WebMD, but the great majority of men with extremely low fat-to-muscle ratios "have almost certainly used these drugs."

Steroids have few short-term, immediate medical dangers, but they can have serious, long-term health consequences. "Typical kids in the gym don't witness any obvious short-term medical dangers," Pope says, "so they erroneously conclude that the drugs aren't that dangerous."

Pope says one reason he wanted to write the book was because the public is "surprisingly naïve" about steroids. "If the public realized... how many of the bodies that they see were simply products of drugs, I think the allure of steroids would be reduced, because steroid users would be deprived of their secrecy."

Steroids are not the only culprits, though, according to Pope and his colleagues. In a time when women can join the Citadel, muscles may be the last ramparts for some men. "Although the Supreme Court can rule that an all-male military school has to admit female cadets, the Supreme Court cannot rule that women shall be able to bench press 315 pounds," Pope says.

Also, as women became more financially and sexually independent, they may have shifted from wanting a man who can bring home the bacon to a man who can supply a little beefcake. The researchers looked at advertisements over the last 40 years in Glamour and Cosmopolitan magazines. Over that time, Pope says, the women shown in a "state of undress" stayed roughly constant, but the percentage of men showing skin "rose from virtually zero, until it surpassed the number of undressed women by the 1990s."


Many men who suffer from body-image disorders do so in silence, Zeckhausen says: "In our society, 'real men' aren't supposed to fuss about what they look like; it's considered effeminate."

But, she says, if you think you may have such a disorder, the first thing to do is get an evaluation by a physician or psychiatrist to see if there might be an antidepressant that could help. "A lot of times there's an underlying depression or anxiety that sort of gets manifested by this focus on the body," she tells WebMD.

Psychotherapy can also help, but for a few people, hospitalization may be necessary: "If it's really impacting their life and hurting their functioning in terms of relationships and work and health, they may want to go to an inpatient facility," she says.

Long before things reach that point, though, some education and a simple reality check may keep a concern with appearance from developing into something more serious.

"A lot of these people, they immerse themselves in those images and tape pictures to the walls, and they get this notion that that's their goal in life, to look like that," Zeckhausen says. "And I think it's important for them to have some media literacy to know that people don't really look that way, (to) start looking around at what real bodies look like, instead of comparing themselves to an impossible-to-attain ideal."

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