Never Buff Enough

Reviewed by Annie Finnegan
From the WebMD Archives

Aug. 3, 2000 -- When pumping iron becomes an obsession, some young men develop a little known and often-secret syndrome called muscle dysmorphia. Focusing totally on getting big and buff, they exercise compulsively, shutting out much of the rest of their lives. The problem, though, is no matter how big they may get, they still feel they look small.

The disorder, according to a study in the August issue of the American Journal of Psychiatry, not only causes emotional problems but can also lead to the use of anabolic steroids, putting the men at risk for serious physical and mental side effects.

"Our study showed that men with muscle dysmorphia are very different from normal weightlifters,"says author Roberto Olivardia, PhD, a clinical psychologist and research fellow at Harvard Medical School's McLean Hospital in Belmont, Mass. "So weightlifting is only a problem when it interferes with relationships or school and work performance." Still, the incidence is on the rise and media images of an ideal V-shape may be the culprit, the authors suggest.

To study the little-known disorder, Olivardia interviewed over 50 male weightlifters, aged 18 to 30. All the men could bench press their body weight 10 times or more, but about half were still preoccupied with their perception of looking small. Along with comparing their exercise behavior, steroid use, and childhood environment, the researchers probed for eating disorders, depression, and anxiety.

Even though the men were actually big, those with muscle dysmorphia were less satisfied with their bodies, used more anabolic steroids, and had more eating disorders than the comparison group. Often describing shame or embarrassment, they also had a significantly higher incidence of depression and anxiety. But the study didn't find a clear pattern of how the disorder emerged, highlighting the need for further research, the authors suggest.

"Boys and men are now bombarded with the same unrealistic body images that girls and women are," says Katharine Phillips, MD, an expert in body image issues and an associate professor of psychiatry at Brown University School of Medicine in Providence, R.I. Phillips, Olivardia, and a co-author of this study all co-authored a book on the growing trend of muscle dysmorphia and similar conditions called The Adonis Complex.Citing action heroes or fashion models as their ideal, Phillips tells WebMD that some young men become overly preoccupied with the pursuit of bigness. "Kids often give us clues when they're getting into trouble, but we tend to ignore them. So keep an eye out for the following warning signs," she urges.

  • Exercising more than two hours a day, at the expense of friends, hobbies, or homework
  • Using large quantities of dietary supplements such as creatine and protein powder
  • A sudden onset of disproportionately large neck or shoulders
  • Preoccupation with muscularity
  • Avoiding social situations

If this sounds like your son, you may want to talk it over with him. "Kids often want to discuss what's going on, but we tend to minimize their concerns or hope that they'll go away. There's no need to panic," Phillips says, adding that it's a good idea to take the following initial steps:

  • Listen thoughtfully to your son, without criticizing, blaming, or teasing
  • Point out that muscular men in the media may have used anabolic steroids
  • Encourage other sources of self-esteem like school performance and hobbies

Unfortunately, some kids may need more than parental support. "If your son remains primarily focused on weightlifting, he may need professional help," Phillips tells WebMD. "Treatment of muscle dysmorphia is still under study, but antidepressant drug therapy is very effective," she explains. Drugs such as Prozac, Anafranil, Luvox, Paxil, and Zoloft are especially helpful in controlling these types of obsessive/compulsive symptoms.

Behavioral therapy is often combined with drug therapy. By using simple strategies to help reduce symptoms and modify distorted thinking, this practical approach allows young men to face the situations they've been avoiding. "Developing a weekly plan with less time devoted to exercise and more time with friends is one example," Phillips suggests.