Articles written by me on Self-care and Palliative Medicine
On Self-Care & Palliative Medicine

Buff Enough

“The American ideal of masculinity. . .has created cowboys and Indians, good guys and bad guys, punks and studs, tough guys and softies, butch and faggot, black and white. It is an ideal so paralytically infantile that it is virtually forbidden–as an unpatriotic act–that the American boy evolves into the complexity of manhood.” James Baldwin

As an aging baby-boomer father, I celebrated yet another Father’s Day yesterday with mixed feelings. Proud to be a Dad, appreciative to have two healthy teenagers, I am one of the many men in this country who works to maintain a youthful energy. . .and to age as ‘gracefully’ as I can. Yet, there can be a fine line in such aspirations. Some men become obsessed with body image. . .to the point that unrealistic perceptions of their body type, and hair pattern, and overall ‘attractiveness’ become an illness. The clinical term for this is: Body Dysmorphic Disorder–but Harrison Pope Jr., M.D., a professor of psychiatry at Harvard University, has coined a catchier term: Adonis Complex (AC). In fact, he and two colleagues, wrote a book last year discussing this phenomenon. This week, with men recently in the limelight of Father’s Day, I’d like to highlight the Adonis Complex. . .so man your positions. . .there’s a Testosterone Storm ahead. . .

From a cultural standpoint, the Adonis Complex is generated by distortions of the ideal body. Over the last decade, there’s been a 30% to 50% rise in male grooming products, a rise in plastic surgery for men, and a bulge in anabolic steroid use. The media is telling us that the ideal male is big, and buffed, and V-shaped. We overlook the probability that many of the unattainably perfect male bodies who beef up shaving cream and deodorant commercials or pose on covers of Fitness Magazines are steroid-fueled, or surgically altered, or both! As part of their research, Pope et al examined advertising fromGlamour and Cosmopolitan magazines over the last 40 years. Over this time period, the percentage of women shown in a “state of undress” remained essentially constant, while the percentage of unclothed men rose from essentially zero to surpassing the number of undressed women by the 1990s.

Body Dysmorphic Disorder is not to be confused with a benign dissatisfaction for one’s looks. It is estimated that up to 40% of Americans express the desire for a different body or overall look. . .but such feelings do not affect the person’s quality of life. So, the Adonis Complex is much more than attention to staying fit and being well groomed. The distinguishing feature in this complex and all Body Dysmorphic Disorders is a preoccupation with a perceived defect in appearance. The preoccupation usually becomes an obsession. So, unlike normal weightlifters, men with the muscle-dysmorphia aspect of the Adonis Complex weightlift obsessively and compulsively. As a consequence of this obsession, there’s an inevitable interference with relationships, school and work performance. Additionally, for many men who are obsessed with the quest for an unrealistically perfect physique, there’s often a deep insecurity, and body building is an attempt to compensate; it’s an effort to control when a sense of controlling life doesn’t exist.

As a caveat to this thinking, some men are losing their traditional identities as breadwinners and protectors as women have advanced in their socioeconomic status in America. Consequently, in a subset of U.S. males, the body has become the last bastion of masculinity. So, the meat of the mindset here is that bringing home the beef has replaced bringing home the bacon.

Dr. Pope and colleagues feel that the Adonis Complex falls into three categories: one focuses on body fat and can lead to anorexia, bulimia or binge eating, another focuses on excessive muscularity, and the third is characterized by obsessive dissatisfaction with a specific part of the body, such as hair, nose, or genitals. Men with the Adonis Complex simply don’t have a realistic perception of their own appearance and physiques. They’re not “big enough, strong enough, or thin enough” even when they are. And, results of such misconceptions include exercise compulsion, eating disorders, steroid abuse, and depression. Characteristically for the American male, men suffering from this complex rarely talk about it. . .as we have great difficulty talking about any feelings as our baseline of communication.

The “GI Joe-like” figure now competes with the ‘Barbie-like’ figure. I was interested to read about the physique changes in the GI Joe action figures between 1964 when he was introduced and the current G.I. Joe Extreme figures. If the 1964 figure were just under six feet tall, he would have a 32 inch waist, 44 inch chest and 12 inch biceps. The current action figure still has approximately the same chest and waist measurements, but biceps have swelled to 27 inches–almost as big as his waist. Physiologically, the only reliable way to achieve such proportions would be by using anabolic steroids. One thinks of women–starving themselves. . .vomiting and using laxatives to achieve a model-like thinness. . .and yet a male equivalent has evolved. “Bigorexia Nervosa” is a misconception of whimpiness. . .no matter how muscular a man becomes.

Statistics tell us that up to 3 million men in the U.S. have taken anabolic steroids to bulk up, and that as many as 500,000 teen and young adult American males are currently using performance-enhancing drugs. With short term use, steroids have few immediate medical dangers. However, with longterm use, steroid complications/problems include: increased risks of heart disease, stroke and prostate cancer. Also, psychiatric disorders can result from regular use of steroids–so the beefcake blues can have a multifactorial basis after a while! Apparently, there’s also an increased rate of addiction to opiates in anabolic steroid users as well.

In-sinew-ating that the Adonis Complex has far fewer lifethreatening consequences than the female body dysmorphic disorders which include a much higher percentage of anorexia nervosa, researchers do admit AC is probably underdiagnosed because men are reluctant to discuss these preoccupations and insecurities. However, therapy combining appropriate medications and counselling is available to help men develop healthy body images and to maintain reality-based exercise and eating regimens. Be aware guys, that long term steroid use may cause those muscles to bulge, but it can also cause your sexual equipment to atrophy. Remember, Ken. . .the muscular, studly sidekick of Barbie, is true beefcake perfection, but he has no penis.

Stephen L. Hines, M.D.
June 2001

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