Is What You See What You’ve Got?
I admit it – I am a Three Stooges fan. Maybe it is because they were on the television every day when I was growing up or maybe I am addicted to my own endogenous testosterone (see ). Anyway, I watch them whenever I can and particularly enjoy it when someone finds them doing something stupid and shouts “Gentlemen, Gentlemen!” In response, the stooges generally look around quizzically for any gentlemen in the vicinity, failing to realize that the comment was addressed to them.
So, what does this have to do with muscle dysmorphia (e.g., Phillips, O’Sullivan, & Pope, 1997), bigorexia nervosa or reverse anorexia (to acknowledge its similarities and differences with anorexia nervosa: Pope, Katz, & Hudson, 1993), megorexia nervosa (Kessler, 1998), machismo nervosa (Connan, 1998), or the Adonis complex (Pope, Olivardia, & Phillips, 2000)? Simply the fact that human beings are always perceiving themselves, but their evaluations are not always reliable. For instance, has someone at work, a club, or the gym ever commented on how big, cut or both you look? Maybe someone noted in casual conversation that you were the biggest person in the room. Did you smile and sincerely mumble something like “Don’t I wish” or “It must be this light?” Maybe, if the person was not into lifting, bodybuilding, or whatever you call what you do in the gym you attributed their observation to their ignorance. However, if we accept that the average weight trainer is probably stronger and/or bigger than the average or above average non-lifter then proponents would suggest that such responses might be an early sign of the Adonis complex.
In this article, I am going to discuss the Adonis Complex or more broadly, muscle dysmorphia, covering topics ranging from the methodological issues surrounding the computation and interpretation of the Fat Free Mass Index (FFMI) to logical issues and caveats of the concept. I will briefly review the research on body image in bodybuilders including some of the ideas presented by the authors of “The Adonis Complex” and suggest underlying mechanisms of the disorder.
The Fat Free Mass Index
One concept that was introduced to the general public in the Adonis Complex was the computation of the FFMI, which was the source of much angst on the Internet when the book came out. Although Pope and his colleagues had published this formula previously (e.g., Kouri, Pope, Katz, and Oliva, 1995), the book introduced the idea to the mainstream. I will not go into the details of its computation or the statistical and conceptual issues germane to the interpretation of it, deferring that discussion until later. However, several points are relevant here.
First, the FFMI could be useful as an overall measure of muscularity. The Body Mass Index (BMI; the ratio of weight to height2) is not sensitive to variations in body composition and most lifters appear obese via its computation, although it takes little time on the net to find (mis)information to the contrary (e.g.,). It could, therefore, be useful to have an enhanced means of accurately reporting physical status using a single number. Whereas the BMI uses total body mass, the FFMI takes only lean body mass into account (ratio of lean mass to height2), which could also be deceiving in cases where high levels of body fat existed. However, in conjunction with the BMI, the FFMI could prove useful for describing body composition. This, of course, does not address the height correction used for FFMI calculation in males.
However, Pope et al. (2000) went beyond such a descriptive function and suggested that “…if a man is fairly lean, has an FFMI greater than about 25, and claims that he has achieved this physical condition without the use of steroids, he is almost certainly lying (Pope Et al., 2000; pp. 35-36).” They reported that no “unequivocally” clean research participant had an FFMI above 26 and Kouri et al. (1995) found none over 25. However, this statement may be unwarranted given the method used to determine the cut-off. Later I will discuss the issue of “false positives” and why, based on the methods used (e.g., Kouri et al., 1995), the FFMI may not be suited for such a “lie detector” function.
So…What is the Adonis Complex?
So, what is the Adonis complex? First, it is technically known as muscle dysmorphia and is not a formal diagnosis, but a type of body dysmorphic disorder, or a preoccupation with slight or imagined defects in appearance. In the case of muscle dysmorphia, the preoccupation focuses on muscle size. The Adonis complex, as Pope describes it (see below), apparently encompasses an even wider range of body image concerns, specifically in men. Ultimately, the Adonis complex is a popularized idea, a name given to a syndrome (co-occurring group) of behaviors. The name probably derives from the fact that, when selling a book or an idea, non-technical terms work best. This approach to naming, of course, does not invalidate the idea, but the book would likely have received less attention if it were entitled “Muscle Dysmorphia and Beyond: Body Dysmorphia in Male Bodybuilders.” Additionally, psychiatry often turns to Greek mythology for names and metaphorical frameworks with which to express theory. No one can currently be diagnosed with the Adonis complex, although that might change when the next version of the Diagnostic and Statistical Manual (DSM: the compendium of formal psychiatric diagnoses) of the American Psychiatric Association is published. Certainly muscle dysmorphia will likely be prominently featured. But what does this syndrome look like?
A quote from Pope during an ABC News chat should be illuminating – “Let me define the Adonis Complex in more detail. It refers to all types of body image preoccupations in boys and men. Some boys and men worry that they aren’t muscular enough; others worry that they aren’t lean enough and still others worry that they have some unattractive feature, such as hair, facial features, etc. All of these worries represent different forms of the Adonis Complex” (). So, if you are male and worry that you are too small, too fat, or unattractive, in almost any way, then you might have the Adonis complex.
Unfortunately, this quote provides little illumination and the ambiguity of the answer further clouds the issue. The wider the range of symptoms one tries to fit into a category, the less meaningful and useful the category becomes for defining behavior and this seems a problem for both the book and the disorder. On the other hand, the application of broader criteria increases the number of people who might fit the category, which is useful when selling an idea. Consistent with the above quote, the Adonis complex, although often considered synonymous with muscle dysmorphia, is actually a sub-category of that syndrome – the complex exclusively addresses male appearance preoccupations, while muscle dysmorphia has also been noted in female bodybuilders (Gruber & Pope, 2000). Female bodybuilders also show similar behavioral characteristics (e.g., nutritional patterns) as their male counterparts (Anderson, Bartlett, Morgan, & Brownell, 1995; Anderson, Brownell, Morgan, & Bartlett, 1998).
What Might Muscle Dysmorphia Look Like?
Have you ever refused to go out to dinner or attend a social function because the food would not fit with your current diet? Did you ever refuse, even on hot days, to walk around in a tank top or wear a swimsuit at the beach for fear that others would find you too small or too fat? Do you continuously and obsessively look at yourself in mirrors, checking out your reflection in shop or car windows you pass by? Do you become frustrated, depressed, or angry (not just irritable) if you are forced to miss a scheduled workout? Would you sooner give up your girlfriend or wife than your regular training? Would you give up a high-paying job to spend your days at the gym even if it meant a significant loss of income? Males with muscle dysmorphia may show obsessive working out and dieting, withdrawal from social contact, loss of friends and relationships, and ultimate injury and disability (Phillips et al., 1997). These behaviors suggest that one might have the Adonis complex. Similar behaviors and concerns may predispose individuals to anabolic-androgenic steroid use (Blouin & Goldfield, 1995). A major question to be dealt with is the differentiation between dissatisfaction as a necessary component of motivation to change and dissatisfaction as an indicator of psychopathology.
Most people who have spent a few years in gyms can classify the people there into several types. Some want to get healthy [e.g., lose (“loose”) weight/fat, get fit, get “toned”) and, although frequently misinformed, they have accepted that weight training is important. Others want to get stronger. Some want to gain muscle for reasons of health or competition. And some would like to get bigger and stronger. There are also those who want to make friends or establish a social life. And, of course, some want to be associated with people doing all of the above for other reasons not discussed here. It is an interesting observation, given the bodybuilding subculture, that the more dedicated trainers are also being cast as potentially the most pathological among these groups (Klein, 1995). For instance, bodybuilders appear to share many features with eating disordered individuals (Mangweth, Pope, Kemmler, Ebenbichler. Hausman, De Col, Kreutner, Klinzl, & Biebl, 2001). Although, one must note that the outcomes may be different.
This series focuses on those who want to become bigger, as did the “The Adonis Complex”. In fact, there was controversy about whether these findings related to weightlifters or bodybuilders, a distinction the authors did not clearly make. However, those who want to get stronger also fit this picture. For instance, competitive power lifters score more highly on a measure of exercise dependence than do endurance athletes (Pierce & Morris, 1998) and weightlifters are also more prone to eating disorders than are casual exercisers (Brooks, Taylor, Hardy, & Lase, 2000). Both of these factors might be part of the Adonis complex picture – but that is another article.
Misperception: A Two-Sided Coin
There is another and equally interesting side to muscle dysmorphia that was not entertained in the Adonis Complex. Body image distortion can go both ways; one can see themselves as smaller or more unattractive than they truly are or they might see themselves as larger and more attractive. The Three Stooges (at least their film personae) probably were not gentlemen by any accepted definition and had they believed they were, they would have been mistaken. Pope et al. (2000) likely fail to address this for at least two reasons. First, they recruited “male weightlifters ‘aged 18-30 who can bench press their own body weight at least 10 times but are still sometimes concerned that [they] look too small’ (p. 1292; Olivardia, Pope, & Hudson, 2000).” This will not attract people who think they are big enough. Secondly, those who see themselves as bigger than they are tend to appear more disturbing than disturbed and intrapsychic disturbance is much more the focus of mental health research. Generally those who are disturbing in their perception that they possess perfect physiques are merely a mild annoyance to the rest of us. Think of it similarly to the common view “self-esteem.” Although people with overblown self-esteem can be annoying, too much self-esteem is hardly ever looked at as a problem, but too little is purported to be behind almost every ill of society. This may be an inaccurate perception, but it is an accepted one.
Anyway, that is the quick overview of some the issues related to the Adonis Complex (both the book and the “disorder”) that deserve a closer look. I will, over the next few articles in this series, try to provide some insight into the concept and try to highlight where it may have gone right and where it possibly went wrong, as well.
Anderson, R.E., Bartlett, S.J., Morgan, G.D., & Brownell, K.D. (1995). Weight loss, psychological, and nutritional patterns in competitive male bodybuilders. International Journal of Eating Disorders, 18, 49-57.
Anderson, R.E., Brownell, K.D., Morgan, G.D., & Bartlett, S.J. (1998). Weight loss, psychological, and nutritional patterns in competitive female bodybuilders. Eating disorders: The journal of treatment and prevention, 6, 159-168.
Blouin, A.G., & Goldfield, G.S. (1995). Body image and steroid use in male bodybuilders. International journal of eating disorders, 18, 159-165.
Brooks, C. Taylor, R.D., Hardy, C.A., & Lass, T. (2000). Proneness to eating disorders: Weightlifters compared to exercisers. Perceptual and Motor Skills, 90, 906.
Connan, F. (1998). Machismo nervosa: An ominous variant of bulimia nervosa. European Eating Disorders Review, 6, 154-159.
Gruber, A.J., & Pope, H.G. (2000). Psychiatric and medical effects of anabolic- androgenic steroid use in women. Psychotherapy & Psychosomatics, 69, 19-26.
Kessler, D.N. (2000). Megorexia nervosa: Using eating disorders as a model for obligatory bodybuilding. Dissertation Abstracts International: Section B: The Sciences & Engineering, 58, 4454.
Klien, A.M. (1995). Life’s too short to die small: Steroid use among male bodybuilders (pp. 105-120). In Sabo, Donald F., Ed; Gordon, David Frederick (Eds.), Men’s health and illness: Gender, power, and the body. Thousand Oaks, CA; Sage Publications, Inc,
Kouri, E.M., Pope, H.G., Katz, D.L., & Oliva, P. (1995). Fat-free mass index in users and non-users of anabolic-androgenic steroids. Clinical Journal of Sport Medicine, 5, 223-228.
Mangweth, B., Pope, H.G., Kemmler, G., Ebenbichler. C., Hausman, A., De Col, C., Kreutner, B., Klinzl, J., & Biebl, W. (2001). Body image and psychopathology in male bodybuilders. Psychotherapy and Psychosomatics, 70, 38-43.
Olivardia, R., Pope, H.G., & Hudson, J.I. (2000). Muscle dysmorphia in male weightlifters: A case-controlled study. American Journal of Psychiatry, 157, 1291-1296.
Phillips, K.A., O’Sullivan, R.L., & Pope, H.G. (1997). Muscle dysmorphia. Journal of Clinical Psychiatry, 58, 361.
Pierce, E.F., & Morris, J.T. (2000). Exercise dependence among competitive power lifters. Perceptual and Motor Skills, 86, 1097-1098.
Pope, H.G., Katz, D.L., & Hudson, J.I. (1993). Anorexia nervosa and “reverse anorexia” among 108 male bodybuilders. Comprehensive Psychiatry, 34, 406-409.
Pope, H.G., Phillips, K.A. & Olivardia, R. (2000). . New York, NY; Free Press
Klein, Alan M.
Affiliation: Northeastern U, Boston, MA, US
Title: Life’s too short to die small: Steroid use among male bodybuilders.
FOUND IN: Sabo, Donald F., Ed; Gordon, David Frederick, Ed Men’s health and illness: Gender, power, and the body. Research on men and masculinities series, Vol. 8. Sage Publications, Inc, Thousand Oaks, CA, US; Sage Publications, Inc, Thousand Oaks, CA, US 1995, p 105-120