Kim Mills: Young men today receive a lot of messages about how they should look. Scroll through social media and you’ll find influencers peddling advice on building muscle, losing body fat, improving your jawline, and maximizing your attractiveness. Entire online communities exist around the idea that a male’s appearance can and should be constantly improved.
What are these messages doing to men and boys? For years, body image concerns were seen as something that primarily affected women and girls, but today there’s increasing recognition that boys and men also struggle with body dissatisfaction and eating disorders and that social media might be making the problem worse.
So how common are body image concerns among boys and men? In what ways do eating disorders and body dysmorphic disorders in men look different than they look in women and girls? Why do they so often go unrecognized? What role is social media playing in shaping men’s perceptions of their bodies and what can parents, clinicians, and others do to help boys and men develop a healthy relationship with their appearance?
Welcome to Speaking of Psychology, the flagship podcast of the American Psychological Association that examines the links between psychological science and everyday life. I’m Kim Mills.
My guest today is Dr. Roberto Olivardia, a clinical psychologist at McLean Hospital in Boston and a lecturer in psychology at Harvard Medical School. He and his colleagues coined the term ”muscle dysmorphia” nearly 30 years ago as a subtype of body dysmorphic disorder that primarily affects men. Today, he specializes in the treatment of body dysmorphic disorder and eating disorders as well as ADHD and obsessive compulsive disorder. He is a coauthor of the book The Adonis Complex: The Secret Crisis of Male Body Obsession, and he’s spoken widely to the media about issues related to body image in boys and men.
Dr. Olivardia, thank you for joining me today.
Roberto Olivardia, PhD: Oh, thank you for having me. It’s a pleasure.
Mills: Well, let’s start with the big picture. I mentioned in the introduction that body image is often viewed as a concern primarily for girls and women. Why is that and how has our understanding of body image concerns in boys and men changed over the past few decades?
Olivardia: Yes. So contrary to what people believe is that 25% of people who have eating disorders are boys and men. Now, many years ago when I started entering into this research arena, we didn’t see that epidemiological data and part of it was A, there weren’t a lot of studies looking at boys and men, or the assessment measures were not really valid or reliable for male populations. Boys and men were not presenting clinically and so it was difficult in terms of getting research because a lot of research on boys and men were just, being in the early '90s, were being drawn from just clinical samples, which represented just a slice of the boys and men who were struggling. So we know that it’s much more common than people think it is. And having done this work for over 30 years, I’ve seen just increased awareness and at the same time there are issues like as you mentioned with social media that are absolutely escalating this issue with boys and men.
Mills: You and your colleagues coined the term muscle dysmorphia. What is muscle dysmorphia and how is it different from simply wanting to get stronger or more fit?
Olivardia: Yeah. So in research studies that I was doing at the time on eating disorders, I would get a lot of calls from men who said, Well, I don’t have an eating disorder, but I used to. I used to have, and many of them would say I used to have anorexia nervosa. And now they would say, I sort of have this other thing where the pendulum kind of swung in the other direction. I’m still obsessed with food and with calories except I’m eating food, but I’m obsessed with working out. So instead of wanting to be lean, I can’t get big enough. I’m worried about losing size. And many of those men with anorexia said that they were never really seeking to be skinny or thin. They were seeking to be lean, which is a little bit different in male body image than typically what you would see with female populations.
So these were men who were, some of them had disordered eating or full on clinical eating disorders, some did not, but they were often muscular, big guys who were obsessed with working out. When they looked in the mirror, they saw someone who looked scrawny, weak, puny were the words that they would use. And despite people telling them, What are you talking about? You’re a big guy, you’re muscular, they didn’t see it. And even if they saw it, the fear that tomorrow they could lose that drove them to compulsively work out at the gym. Many of them were engaging in anabolic steroid use, engaging in a lot of harmful supplement use, avoiding situations—and these are not men who are proudly showing off their physiques at Venice Beach, California. The men with muscle dysmorphia were, because they had this disordered body image, were covering their bodies up. They wouldn’t leave the house because they felt that they looked too small.
So we first kind of coined reverse—is this reverse anorexia? And because it’s not always an eating disorder, we really classified it as a subtype of body dysmorphic disorder and that’s where it sort of lies.
Mills: Are there triggers that essentially push men or boys into body dysmorphia or muscle dysmorphia? I’ve read that there’s an association, for example, between having been bullied, but a lot of boys who are bullied don’t end up with muscle dysmorphia. So what do we know about its etiology?
Olivardia: So if we look at this from various lenses kind of in a biopsychosocial social cultural model, we do know that many of the boys and men with muscle dysmorphia do have very often family histories of depression, of obsessive compulsive disorder, of eating disorders. Typically psychologically you’ll often hear, I hear a lot in my patients either histories of being bullied and sometimes just, unlike with girls with negative body image, you’ll often find that girls who mature earlier are at higher risk of body image issues and receiving unwanted attention for their bodies. With boys, it’s the opposite. The boys who mature later tend to be at higher risk. And when I say being bullied particularly, I mean sometimes for things that are unrelated to appearance, but being bullied for appearance is not always being bullied for having a larger body, but actually being bullied for being too thin because with male body image, being thin is associated with being quote unquote weak and not being masculine enough.
And so the idea of building this muscular body now became more than just, Oh, I want to have this big body. It’s kind of this armor of masculinity and the symbol that that sort of represents. We also know I see as far as comorbid or associated disorders, things like depression social anxiety disorder is actually a very common one. And what I hear from a lot of my patients will say, I feel so awkward in social situations and particularly in dating kind of romantic relationships that if I just look a certain way, my body can sort of do the speaking for me in a way. And of course we know that that doesn’t work. I mean, it might have people approach you, but then you still have to talk and converse. And then from a sociocultural manner that there’s no question that, I mean, unlike with women who historically have been promoted these sort of imagery, this imagery of thinness, I mean, going back to the 1600s, with boys and men, it’s been a little bit different that in our research we found that it was really the late '70s and early '80s where we really saw this sort of promotion of muscular bodies.
I mean, if you think—as a kid that grew up in the '80s, the biggest box office stars were Sylvester Stallone and Arnold Schwarzenegger who, their bodies were like kind of a commodity, and Calvin Klein ads and more men featured in advertisements with their chest and the fitness boom and bodybuilding really kind of came into it. Men’s fitness and health magazines exploded. And I have to tell you—I mean social media, doing this work, unlike any other condition, diagnosis that I work with, I have never seen something be so impacted by something on a sociocultural level as I have with the impact of social media on body image. I mean, it put gasoline on a fire with this issue.
Mills: We’re going to talk about that more, but I want to ask a question about how you know when somebody has crossed over from just wanting to be fit and looking good to having muscle dysmorphia. In other words, how do you diagnose this?
Olivardia: Yeah, it’s a great question because this can be easily missed because unlike something like anorexia where sometimes it becomes more obvious when someone is malnourished and emaciated, we celebrate if you have a teenage boy that’s going to the gym 5 days a week, it’s like, great, he’s not playing video games 14 hours a day and he’s active. I usually put it in these different categories. One is, is there a presence of a body image distortion? So with people with muscle dysmorphia, they’re not seeing themselves the way that other people are seeing them. There’s a sort of like desperation that they feel around they’re not just going to the gym because they enjoy it and they want to build their muscle and feel confident. They feel like they have to. I mean, many of the men that I work with with muscle dysmorphia hate going to the gym.
They hate working out. They feel imprisoned to it, like enslaved by it is how they sort of describe it. But the feeling for them if they don’t do that can really plummet them sometimes into, I mean, depressive, if not suicidal states at times. The pandemic was very, very hard for a lot of these people where gyms were closed and their accessibility to certain things. So is there a body image distortion? And because if someone is starting from a place where they’re not seeing themselves accurately, that’s a red flag that there’s a higher risk in terms of where they see that boundary is going to be very different of health and where things cannot be healthy.
The other part is how much is it getting in the way of other things in their life? If you have someone who’s working out every day, an hour a day, they do their workout, then they attend to their studies or their jobs and their relationships, great. There’s nothing wrong with that. Where it starts to take precedence over other things, my patients who come in with muscle dysmorphia, some of them have gotten fired from jobs because they’re at the gym, they can’t stop working out and they’re 2 hours late for work or they feel like they have to leave work early. Some of them, many relationships have ended because their partners are like, You’re just so obsessed with working out or you’re asking me a hundred times in the last couple hours, whether you’re bigger than that guy or this guy, do you look smaller than you did yesterday? And sort of that compulsive reassurance seeking behavior. So they can lose relationships, they can lose jobs. They’re obsessed. With muscle dysmorphia, there’s a lot of obsessive thinking around it. There’s a lot of compulsive behaviors, whether it’s working out, whether it’s mirror checking, measuring themselves, weighing themselves, putting skin body fat calipers to measure their body fat.
So a lot of these men know this is not normal. This shouldn’t be totally dominating all of my thoughts and my actions. So that’s another piece. Certainly the other piece is when it encroaches into very unhealthy behaviors. So working out and exercise is great for our health, but now if you’re engaging in substance use, anabolic steroid use or harmful supplements that are now harming your health, if you are developing an eating disorder or having very disordered eating behaviors that are impacting your health, well, then now we know that’s not fulfilling the value of health. I have patients who sometimes they compulsively lift weights or do exercise and their body’s in so much pain that they start taking opiates. And I’ve worked with many men with muscle dysmorphia who develop opiate dependencies to deal with the chronic pain from working out so much. And then that obviously becomes its own issue and problem.
And the other piece is I ask patients, how much of your self-esteem and identity rests upon the way you look? And there’s nothing wrong with having some part of our self-esteem for some people be like, Hey, I like the way I look and my appearance, but it cannot be a dominant factor because we both know, Kim, I mean, the things that really are going to create our identity and last us through life are those crystallized factors, our intelligence, our sense of humor, the way we relate to people, those things pretty much stay consistent throughout our life. The one thing I can guarantee that will change is the way you look. How I look today is going to be very different than how I look 20 years from now and what my body can do.
Mills: Can’t stop the clock.
Olivardia: You can’t stop the clock and that is frightening to a lot of these men who often have, again, this sort of high perfectionistic kind of traits and need to control things and you can only do so much and control the body so much. So when people encroach in those territories, that’s when we know we have a problem as opposed to someone who just might be a fitness enthusiast and it’s just part of their lives and they have active social lives, they’re healthy, they’re sleeping well, eating well, then it’s not an issue.
Mills: Just out of curiosity, do you ever see muscle dysmorphia in women?
Olivardia: So, yes, muscle dysmorphia can absolutely affect women. I mean, it predominantly affects men. And part of that is because socioculturally that muscularity is sort of much more promoted towards boys and men, but absolutely I’ve worked with women who also have muscle dysmorphia. Interestingly, early studies, there aren’t many that have looked at muscle dysmorphia in women, but some of the few out there, one in particular found that up to 50% of the women with muscle dysmorphia reported having a sexual abuse history or rape trauma in their lives and that they developed sort of muscle dysmorphia as a sort of defensive protective measure in a lot of ways. I’ve seen that with men as well who might have histories of trauma or I’ve seen like with gay men, for example, who have muscle dysmorphia who felt like they had to build their body to sort of almost protect themselves around homophobic violence that they might have experienced in their lives.
So, yeah, absolutely and steroid use is not just relegated to men for body image purposes.
Mills: Is there any good data around muscle dysmorphia? Do we know the prevalence in the male population?
Olivardia: We don’t really 100%. I can tell you, it’s definitely more common now than when I was looking at this 30 years ago and what I’ve seen clinically is much more frequency affecting younger ages and older ages too. So I’ve seen like almost the spectrum whereas years ago, at least what I would see clinically would be maybe between the ages of like 17 to 30, but I’m working with boys as young as 12 who have used anabolic steroids, who have gotten supplements from the mail, who follow influencers online who are espousing such dangerous information to bodies that haven’t even developed yet, I mean, from a pubertal perspective. So it’s become much more common. And with social media in particular, there’s this whole community known as the manosphere where these sort of messaging around building your body that often have these sort of misogynistic undertones to them, promoting to young boys and men that it’s their obligation to have a certain body for this express purpose of achieving dominance and power and to basically take the choice out of women’s hands where if you are like the perfect specimen, everyone is just going to gravitate to you.
That’s what’s being fed to a lot of young men who if you’re insecure, as most of us are when we’re teenagers and preteens, but particularly if you might have a history of social anxiety or you might—somebody who feels inadequate in a lot of ways. I also specialize in ADHD and people with learning disabilities. I see that associated a lot with this as well. That messaging can really speak to these young men to think, Okay, if this is what I need to do, because who doesn’t want acceptance and who doesn’t want to be respected? So those values are fine. The problem is they get perverted in a sense in social media. So we don’t have a real prevalence. We know with eating disorders in men, again, the 25% of people with eating disorders are boys and men. With muscle dysmorphia, we’re not there yet in terms of really well done epidemiological data.
Mills: Well, speaking of social media, there’s a trend that’s gained a lot of attention online recently. They call it looksmaxxing. And for listeners who might not be familiar with the term, it refers to efforts to maximize your physical attractiveness sometimes through really extreme measures like surgery. What does the existence of looksmaxxing tell us about the pressures that young men are facing today?
Olivardia: Yeah. This is where it’s interesting is I remember years ago when I was working in working with young men or men who were doing very extreme things for appearance modification, putting a hammer to their jawline, talking about chipping their bones. From a diagnostic perspective, it was almost conceptualized as psychotic behavior because it was so bizarre and so off the grid. In ways this looksmaxxing kind of community—I mean, there’s a very popular influencer who does just that. He takes a chisel to his jaw and has many, many followers and now you’re like, wow, this diagnostically, this has almost gone mainstream in some ways. So with some of my young patients, they come in and there isn’t a sense of almost like a lot of times in the past I might have someone who has some hesitation and they’re like, Yeah, I know this is kind of probably unhealthy or harmful. Now they’re like, Oh, I’m doing this thing. And they have pride.
And I don’t want people to feel like shame around it, but there’s almost no sense of how harmful this could be, how ineffective it could actually be. And so, yeah, it could be things like putting a hammer to one’s jaw, this notion of, oh, yeah, you can change whatever you want to change. Of course, you have to have unlimited financial resources to do surgeries, but some of these influencers are in their young 20s and have had 20 to 30 plastic surgeries, jaw lifts and chin implants and cheekbone implants and forehead lifts. I mean, we’re talking at 20, but again, there’s that piece which is dangerous, but the messaging behind it too is a sense of it is your sort of masculine obligation to do this because if you don’t do this, you will be the quote unquote beta male. You’re going to be the inadequate, you’re going to be the nice guy that gets stomped on and steamed rolled over and the dominant alpha male is going to get access to all the women or in the case of gay men, all of the men, and the power and the respect, that’s what is almost like just as dangerous.
And so what I’m hearing, I mean the first session I have with men who have muscle dysmorphia, who have these body image issues, I ask them, who do they follow on social media? And many of them I know and the ones that I don’t know, I instantly start to follow because I want to know who I’m competing against because honestly, our credibility as mental health providers, as physicians, I wouldn’t even say is on par with these influencers. It’s almost like below that because somebody gets 10 million followers, there’s this instant credibility that of course what they’re saying must be accurate or must be correct. And that’s what’s so insidious and dangerous around it.
And so I have a lot of conversations with my patients around who are these people that they’re following and let’s kind of examine how do we become sort of more literate around that. Because I don’t blame the individuals. I was an impressionable adolescent boy myself. I am glad I did not grow up with this. I don’t blame the individual. I think we have to though have some pause button and some way of sort of examining that because there is, I mean, there are influencers, one that a lot of my young patients talk about basically advocates for anabolic steroid use and says, You know what? Don’t listen to these doctors, these boomers, they don’t know what they’re talking about. They probably never had sex in high school. And there’s this sense like they’re the losers, I’m the one that has all the information, says the influencer. And so we’ll literally prescribe what kinds of steroids to take, where to find them, where to get them. I mean, it is like a menu. It’s so easy now for people to get their hands on a lot of very dangerous stuff.
Mills: You’ve talked about the overlap with muscle dysmorphia and things like OCD and ADHD. Is muscle dysmorphia the people who have it, are they kind of addicted in the sense that they can’t stop doing these things to their bodies?
Olivardia: Yes, there is definitely an element to that of this sort of perfectionism, addictive behavior, a number of men with muscle dysmorphia I find either have a substance abuse issue, sometimes are in recovery of a substance abuse issue and they will often say like they wonder if they have almost like an addiction transfer that it sort of went from drugs and alcohol to maybe it started out as building their body to be healthy as in their sobriety journey and then it just, there was a slippery slope. And many of my patients will say they don’t know how to regulate. And that’s where the ADHD I see often that comorbidity and as someone myself that has ADHD, I can relate—regulation is hard for a lot of different things. So this sense of if I’m invested in something, it’s almost like I’m going to have to be into it 150%.
And many of these men, they will tell me, they’re like, I don’t know how to not be this way. And a lot of them kind of are dragged in because maybe they got fired, maybe it’s an ultimatum from a relationship and sometimes it’s they come in because they’ve had an injury and they can’t keep up the workout and they got very suicidal or very depressed and they realize this is a problem. Maybe they recently entered a bodybuilding competition and when you’re really around that culture, they realize, Oh, wait a minute, this is problematic. But, yeah, they feel they can’t stop. They don’t know how to get out of it.
And the other thing too is that this is a population that doesn’t sort of garner the kind of sympathy that you might see for, let’s say someone with classic anorexia nervosa, you see them, they look, they’re sick and they’re emaciated. Nobody thinks of a guy that might be 250 pounds and 7% body fat working out the gym is someone that might be suffering and struggling. And that’s what’s problematic is that, I mean, we know just men in general and then particularly when it comes to men and body image and eating disorders are less likely to seek treatment, but this population even more so because there’s almost this notion and there are studies that have actually looked at even how providers have biases around men with eating disorders, let alone men with muscle dysmorphia. And I have to tell you, this is a population of men who are some of the most sensitive kind of kind individuals who sometimes just don’t know or either feel a sense of shame that they’re wired that way because that’s what they’ve been told or they are trying to gain a level of assertiveness, which is fine, but it’s almost in this kind of overcorrected way that if I build this sort of body, I’m just going to command dominance and respect and that is absolutely being promoted and fed through social media in a way I’ve just never seen before.
Mills: Well, let’s talk about treatments. I mean, what is effective for men in particular who have muscle dysmorphia and are treatments for men different from what you might use with women and girls?
Olivardia: So generally it wouldn’t be that much different in terms of, so you’d have a combination of psychoeducation in terms of what is a healthy body, what is the expectations that some of my patients have around how much body fat they should have or how much muscle mass or what is normal working out is so skewed that, what is healthy eating, these healthy sort of practices. And when I say healthy, meaning even healthy for an athlete, let’s say, or someone who might be an avid weightlifter, which I understand someone who let’s say is a weightlifter is going to maybe eat differently than somebody who doesn’t do that.
Then there’s sort of looking at things like the sort of literacy around what social media content and sort of what messaging they’re getting. And then the treatments are similar to what you would see with women, things like cognitive behavioral therapy, which is examining these inaccurate thoughts that people might have. For example, a man with muscle dysmorphia might say, Well, when I go to a party, I know people are looking at me and thinking, oh, he looks kind of scrawny. And with cognitive therapy, we don’t say, Oh no, that’s a wrong thought. We say, Well, what’s the evidence for that thought? I don’t know if people are thinking that or not. I’m not psychic, but what is the evidence? And if the evidence is, Oh, I just feel that they are. Well, we can feel lots of things. We can feel dumb and not be dumb. We can feel ugly and not be ugly. We can feel a lot of things.
And then what we know is that the behavioral part is being aware of what behaviors we’re doing that are feeding into the disorder and what behaviors we’re not doing in terms of avoidant behaviors that are feeding the disorder.
Then we sort of draw in from ACT, which stands for acceptance and commitment therapies, which really look at the—It’s like a value oriented therapy. And this is a question for years I would ask people, what’s the ultimate goal in this? So okay, you’re building this body or you’re shaping this body in a certain way, but it’s not really just for the sake of just looking good. What’s the value? What’s the currency of it? And I almost universally hear the same thing. I want acceptance, I want respect, I want to be loved. I want to basically be free of criticism, which of course none of us are going to be immune to criticism. And I tell my patients, those are great values. Those are human values, to be loved, to be accepted, to be connected. There’s no pathology associated with that. The problem is, and I always kind of almost personify the disorder or make it something different than the person to say, Well, an eating disorder, a muscle dysmorphia is lying to you because it’s making you think you’re going to get closer to that value through the disorder and it’s a lie that it’s not. In fact, it’s doing the very opposite. It’s moving you away from those values.
And a perfect example of that was in my very first research study I did on muscle dysmorphia and this was a man who said, Please feel free to share this example for as many years. Very bright guy. And he is in his mid-20s working out 5 hours a day was taking multiple anabolic steroids, obsessed, looking in the mirror, whatnot. He had already had some adverse health consequences. He had a severe kidney infection that put him at a very high risk of losing a kidney because of his substance use. Chronic pain, cystic acne, erectile dysfunction, hair loss.
I asked him that same question. What’s the ultimate? And he said, I just want to be successful with women. I mean, his exact quote was, I want to get chicks, was sort of his quote. And I said to him, and not in a mocking way, but I was like, But you understand everything you’re doing, you have no opportunity to. Your body is burnt out, you have erectile dysfunction, you’re so worn out, your life is at the gym. Where are you even going to meet these people? And he stopped and he looked at me in all sincerity. I was like, Wow, I never thought of that. And that was such a learning experience for me to think, wow, this is how deep someone can really be in a disorder that the very thing they think they’re seeking, it just gets lost. It’s over time. So that ACT, acceptance and commitment therapy really goes into what are the values that we’re really trying to espouse.
It can involve nutritional therapy, having a nutritionist on board. Medications can be helpful, particularly because depression, mood disorders, anxiety disorders are very common in this population. And then for people who might be married or in family or couples therapy could also be helpful. So it’d be very similar things.
The difference with women and men is undoubtedly the conversation around the meaning of muscle and the sort of construct of masculinity comes up a lot in terms of what does it mean to be a man. And interestingly, in this climate that we’re in is really a very interesting thing because there’s so much, again, this sort of really negative messaging that’s sort of in this manosphere culture on social media of these very kind of archaic ways of what it means to be a man. So that discussion, but it’s not dissimilar that with women, let’s say with eating disorders who might want to achieve a certain ideal to be quote unquote more feminine, those discussions could be, what does it mean to be a woman in that kind of way. So it’s similar, but it’s just a different kind of perspective.
Mills: Well, let me ask a question for the parents among our listeners. What are some of the warning signs that they should be looking for if they’re concerned, say that their son is struggling with muscle dysmorphia or body image concerns?
Olivardia: Well, first, I think it’s so important for parents to know if your child is on social media, who are they following? That’s because when you know who someone is following to understand that unlike magazines and advertisements and movies and that kind of imagery that years ago we were talking about, social media, as you know, is curated for an individual where in a given day they can be exposed to hundreds to thousands of imagery of video posts. Some of them could even be personalized for individuals and you’re seeing other people’s responses to that. Other people that might be saying, Oh wow, I did this and it worked and this and this and this. I mean, no, I guess pun intended, but this is like all of that on steroids, all of that media imagery we were talking about from 2 decades ago to a whole other level.
And with curiosity, I say with parents, lean into it like, Oh, who are you following? And then rather than, Oh my gosh, you shouldn’t follow this, this is look into their stuff and then have conversations with your child around, tell me what you find appealing about this person. And with trying not to have judgment, even though obviously as parents, we’re going to be concerned because what you want is really to have a conversation. And a lot of times with the kids young or teens that I work with, when I ask them that question, they’ll tell me, Oh. And sometimes they’ll say, Oh, I know what he does and talks about what this is a little out there, but this stuff is normal. But the thing is I notice in my patients the stuff that they regard as being really out there 1 month, later that year, it’s not so out there anymore.
And this affects all of us. I mean, this isn’t just for young people. I mean, we just have become so desensitized in so many ways that what seems so outrageous 1 week could be sort of in the mainstream. So I think there’s that piece. If you notice that your son, if they’re verbal about their sort of language around their body, Oh, I’m scrawny if they’re really being picky in a way. Now part of this is also not unusual, certainly for adolescents where our bodies are growing and developing and it can be awkward at times, but if that language is frequent, if it’s intense and it’s negativity, if you see that they’re sort of looking at mirrors a lot or taking selfies a lot, refusing to wear certain clothes because they feel that those clothes kind of show a part of their body that they don’t like or don’t show.
Again, some of us might have that within reason, especially in puberty, but where it starts to get almost too extreme like, Oh, I can’t—if their eating habits, I can’t eat this and this and this and this and this and this and this. And it starts to—Because I often see something like muscle dysmorphia as interestingly the body, the whole pursuit is the body getting bigger, but their world is getting smaller in many ways. They start to associate only with other people who are kind of in that world as opposed to when it’s healthy exercise or whatnot, they can still have friends who maybe aren’t always into that. But with muscle dysmorphia, because it’s almost so all consuming that a lot of these men end up finding only comfort in other people that are sort of obsessed with it in that kind of way.
Certainly if your son is not wanting to go out or avoiding things because they feel they don’t look a certain way, I always say it’s always to be proactive and just get some help and support because even if it’s something that’s emerging and turns out to be quote unquote normal puberty, but that’s still important. I mean, we don’t want anyone feeling bad about their bodies. I mean, there’s even what we call quote unquote normative still can have its wounds and its scars. So the earlier you catch it, certainly the better, but also to normalize it.
Because especially with boys, what I hear a lot from parents and I feel for them, because of course every parent loves their child and wants the best for them, but very often I’ll hear from moms and dads who say, I know not to talk about my body or negative stuff, body image to my daughter. It never occurred to me how I talk about—And this is sometimes for moms who maybe they had a history of an eating disorder that they’re like, It never occurred to me that when I call myself ugly that that could affect how my son looks, I knew not to say that in front of my daughter. And this is what I see is that it’s not just the fathers that they’re looking, it’s how bodies and body image and appearance is talked about within a family. And not to say that it’s a causal factor, it’s one of many factors, but having conversations too around how do we talk to ourselves about the way we look? And for parents to be vulnerable too, to say, Yeah, I remember when I was younger and things that were so impactful in terms of how I felt about myself, it took me a while.
Because what kids or young people don’t want to hear is, Oh, looks don’t matter. Because the truth is they kind of do, but not to the degree that the patients that I work with see it to be. And that’s where the second you say, and for therapists out there too, because I have a lot of patients that have said, Oh, I worked with a therapist who said, Oh, that’s like vanity, that doesn’t matter. And now the patient’s like, oh, okay, so I guess you think I’m vain or narcissistic, so okay, this isn’t going to work. Whereas I tell my patients, I completely understand because I know if I grew up with this, I would have been at risk for some of this. It’s just so all consuming. So I get it because we don’t want to pathologize the individual from the behaviors and those kinds of things are the things that are getting them into trouble, but it’s helpful to hear how we all kind of have these kinds of strange relationships sometimes with our bodies. And some people don’t. Some people are sort of neutral about it, but even having those conversations without necessarily pointing out things and then if there are certain behaviors for parents to share, I’ve noticed because it’s one thing to say, I think you have a problem with X, Y, and Z, especially your adolescent’s going to be like, well—they won’t hear that.
They’re not going to hear that. But if you say, I noticed you’re not going out as much as you used to with your friends and you’re a very social person, what’s up with that? If you’re sharing an observation that’s concrete, then I notice there’s these 20 supplements that you’re taking, what is all of this? And we have to make sure that this is healthy, let’s run this by your primary care physician because oftentimes the battles may be like, Oh no, you’re not going to take X, Y, and Z. And the person’s like, Well, this is healthy. And I say to parents, Just take it out of your hands and say, Well, if it’s healthy, let’s run them by your PCP. And that way it’s not this sort of parental kind of struggle as much as I just want you to be healthy.
And the truth is, and again, some of these supplements are fine. Some of them are totally ineffective and some are harmful. I wouldn’t even say young because honestly, I work with men in their 30s and 40s with this who will buy stuff and it turns out can have very harmful side effects.
Mills: Well, Dr. Olivardia, I want to thank you for joining me. I think this has been very illuminating. I hope our listeners get a lot of good information from what you’ve said. It’s very helpful.
Olivardia: Oh, thank you for having me.
Mills: You can find previous episodes of Speaking of Psychology on our website at speakingofpsychology.org or on Apple, Spotify, YouTube, or wherever you get your podcasts. And if you like what you've heard, please subscribe and leave a review. If you have comments or ideas for future episodes, you can email us at speakingofpsychology@apa.org Speaking of Psychology is produced by Lea Winerman.
Thank you for listening. For the American Psychological Association, I’m Kim Mills.
Roberto Olivardia, PhD, is a clinical psychologist at McLean Hospital in Boston and a lecturer in psychology at Harvard Medical School. He specializes in the treatment of body dysmorphic disorder and eating disorders, as well as ADHD and obsessive-compulsive disorder. He is the author of the book The Adonis Complex: The Secret Crisis of Male Body Obsession.
