Body dysmorphic disorder

Samuel Fussell was a scrawny, Oxford-educated bookworm who at age 26 decided to put on some muscle as "protection" from the mean streets of New York City. Then his simple desire grew into an obsession. Four years later he found himself a 257-pound behemoth who had given up his academic ambitions for a life of constant eating, lifting, and amateur bodybuilding contests. "The inflated cartoon I became relieved me from the responsibility of being human," he recalled. "It was in the gym that I was most alive."

NOW, YOU'RE never going to hear Men's Fitness say there's anything wrong with building your muscles or spending time in the gym. In fact, since more than half of all Americans are overweight and exercise less than your average houseplant, guys who do take exceptional care of their bodies have reason to be proud.

Unfortunately, like Fussell, that health-minded bunch contains an obsessive minority who take things too far, to the point where otherwise positive activities become positively harmful. And according to Harvard psychiatrist (and weightlifter) Harrison Pope, M.D., that group--men who not only want to look and feel better but also assert a high level of control over their lives--has been growing for the past 20 years. As a result of books such as The Adonis Complex, co-written by Pope, for the first time serious attention is being paid to the male side of something that women have been warned about for decades.

What follows are some of the more dangerous traps men fall into when beneficial activities develop into unhealthy obsessions. Take the quiz to see if you're in danger of crossing that line. Or if you've crossed it already.

GROOMING

STARTS AS a way to improve appearance, self-confidence, and to reduce risk of acne, hair loss, and disease.

BECOMES a psychotic regimen focused on one or more features of the face or body, a condition known as body dysmorphic disorder. Many with BDD seek multiple cosmetic-surgery procedures (does the name Michael Jackson ring a bell?). According to Harvard psychologist Roberto Olivardia, Ph.D., nearly one out of every five who suffer from BDD attempts suicide.

SUPER-GROSS CASE STUDY Katharine Phillips, M.D., an associate professor of psychiatry and human behavior at Brown University School of Medicine, recalls a patient who became so obsessed with picking at a neck pimple with fingers and then tweezers that the carotid artery became exposed.

MF EXPERT WEIGHS IN Not all cases of BDD are so extreme, Olivardia says. "There are some people who struggle with it but they can kind of go on with their daily lives ... but it still nags on them." In other cases the symptoms can gradually increase. "They might start taking 30 minutes grooming, and a month later they're taking 35 minutes grooming, and before you know it, it's four or five hours a day."

FIXING THE PROBLEM If you avoid social situations because of how you look, most of your self-esteem is based on your appearance, or you see things wrong with your face or body that others don't see, you could have BDD. The Web site bddcentral.com has referrals to specialists.

WORKING OUT

STARTS AS a way to look good, release stress, improve strength, increase muscle size and tone, gain confidence, and lower blood pressure.

BECOMES a disorder often called "bigorexia," a sort of inverse anorexia, in which a man cannot be satisfied with the size of his physique. This can lead to steroid use and the risks of heart disease, liver failure, and erectile dysfunction that are associated with it. According to Cedric Bryant, chief exercise physiologist for the American Council on Exercise, roughly 10% of habitual exercisers can be classed as compulsive.

CASE STUDY One patient regularly did squats with a 405-pound barbell. He suspected that he had given himself a hernia but couldn't face the possibility of a break in his training, so he continued until his pain became so severe he was bedridden for five weeks.

MF EXPERT WEIGHS IN Bryant says that in most cases, exercise addiction "tends to be a gradual, progressive phenomenon." The results can be extreme: "You'll see symptoms of withdrawal or dependence. They develop a tolerance to a certain level of exercise, so they need to have more and more to try to get that same effect."

FIXING THE PROBLEM Muscle growth depends on rest between sessions, so there's no point in overworking any muscle group. Since delayed-onset muscle soreness usually occurs the day after you exercise, any pain you feel immediately after lifting could be a cause for concern. Redness or swelling also signals an injury, which means taking a few days off and consulting a doctor. If you find yourself unable to resist "working through an injury," then consider seeing a sports psychologist.

RUNNING

STARTS AS a meditative way of being alone with your thoughts, as well as a proven method to lower blood pressure, lose weight, and help prevent heart disease.

BECOMES an all-consuming obsession that is more important than work and family. While running can be a heart-healthy activity, those with weak hearts may increase their chances of a heart attack if they overdo it. Most running addicts eventually suffer bone and joint injuries that worsen over time.

CASE STUDY A patient in Chicago ran a fast eight miles a day, seven days a week, regardless of weather, holidays, or injury. Having once run a marathon with a 101-degree fever and an ear infection, it wasn't long before the patient suffered three stress fractures--two in one foot--but continued riding a bike 15 miles a day, even in a cast.

MF EXPERT WEIGHS IN Gerald Fletcher, M.D., director of preventive cardiology at the Mayo Clinic, recommends 30-60 minutes of moderately vigorous exercise six days a week. Any more than that has "no benefit" unless you're training for specific events. "We most often see musculo-skeletal problems, with people rupturing ligaments."

FIXING THE PROBLEM See a doctor before beginning a running program, especially if you have any severe or ongoing pains--or immediately if you have chest pain. If you find yourself becoming antsy or depressed when you miss a run, seek counseling immediately.

SLIMMING DOWN

STARTS AS a way to avoid obesity, heart disease, lethargy, hypertension, diabetes, and new pants expenditures.

BECOMES an endless hell of starvation and malnutrition. Because of the stigma attached to eating disorders as a "woman's disease," no one knows how many men are afflicted. Wrestlers and others in sports where emphasis is put on weight are particularly susceptible.

CASE STUDY Harrison Pope describes a 21-year-old patient who, continually unsatisfied with his love handles, embarked upon a diet of a single piece of lettuce for breakfast, lunch, and dinner. He eventually reached 85 pounds.

MF EXPERT WEIGHS IN Most weight lost on crash diets is not fat, notes Eric Sternlicht, Ph.D., a kinesiologist and president of the exercise-and-nutrition consulting firm Simply Fit. "If you look physiologically at how much body fat you can lose per week, it's approximately 1% of body weight." Ergo, under normal conditions a 200-pound man can only lose two pounds of fat per week. Any weight loss beyond that consists of lean muscle, bone, or water.

FIXING THE PROBLEM Crash dieting, bingeing, throwing up after eating, continually losing and gaining back weight, or constantly obsessing over what you eat and how much you weigh are signs of incipient eating disorders. If you do any of these things, see a psychologist or nutritionist trained in this problem.

EATING RIGHT

STARTS AS a desire to maintain a healthful diet for mental and physical well-being and reduced risk of headaches, fatigue, and sexual dysfunction.

BECOMES an antisocial compulsion that puts diet ahead of all things. Friendships and relationships suffer, and in extreme cases a diet becomes so restrictive that balanced nutrition is impossible. This can lead to extreme weight loss, fatigue, kidney failure, and even death.

CASE STUDY Colorado physician Steven Bratman, M.D., author of the book Health Food Junkies, had an asthmatic patient who attempted to stop eating any food that could cause allergies; in the end, all that was left was sugar and lamb.

MF EXPERT WEIGHS IN Kansas State University psychologist Leon Rappoport, Ph.D., says people who adopt restrictive diets usually suffer from a psychological problem. "Their eating behaviors can become an obsessive-compulsive disorder analogous to drug addiction. The apparent health benefits simply serve as a rationalization."

FIXING THE PROBLEM While many people have legitimate allergies or dietary restrictions based on personal or religious beliefs, an overly limited diet that neglects one or more nutrients can lead to malnutrition. (Symptoms include fatigue, weakness, lethargy, increased frequency and duration of colds, and more-frequent injuries.) If you think your diet may be lacking in nutrients, or if you want to maintain a restrictive diet without negative health consequences, keep a food diary and see a nutritionist.

SEX

STARTS AS a way to share intimacy, pleasure, and mutual attention with a consenting partner, or to make babies.

BECOMES a full-blown addiction that can involve neglecting relationships, masturbating for hours, picking up prostitutes, and, in extreme cases, result in sexually transmitted diseases, rape, or child molestation. Although the exact definition of sexual addiction is sometimes disputed, experts say it affects 3% to 5% of people; the addiction often grows more severe if not treated.

CASE STUDY Sex-addiction expert Patrick Carnes, Ph.D., writes about a seemingly normal appliance repairman with a solid reputation, a wife, and three daughters. When left alone, he would go through customers' underwear drawers. This progressed to voyeurism, exhibitionism, and visiting hookers. At one point, he was forced to borrow $2,700 to cover his prostitution debts.

MF EXPERT WEIGHS IN Addiction is not the same as just having a lot of sex, says psychiatrist Margaret Jarvis, M.D., of the National Council on Sexual Addiction and Compulsivity. "This is not, by any means, having one affair. This is not doing something that's a little kinky with a willing partner. This is really something that starts intruding on other parts of your life," she explains. "Guys can talk about having affairs and one-night stands ... but for the person who really has this problem, there's a place in their heart of hearts where they begin to feel, 'I'm really out of control.'"

FIXING THE PROBLEM If you need to hide your sexual behavior, fail to stop a particular behavior, have a hard time getting to work or getting your work done, or frequently feel depressed after sex, go to NCSAC.org and take the Sexual Addiction Screening Test. If you are a sex addict, seek out groups that use the 12-step approach of Alcoholics Anonymous as the path to recovery.

QUIZ: ARE YOU A HEALTHOHOLIC?

Not every addiction involves drinking and drugs. Find out if you're taking the good things in your life a step too far.

WHEN GROOMING, DO YOU:

[A] SHOWER, SHAVE, COMB YOUR HAIR? MAYBE EVEN MOISTURIZE?

[B] SPEND MORE TIME GETTING GROOMED, HOPING TO LOOK EXACTLY RIGHT?

[C] KEEP PICKING AT EVERY LITTLE FLAW IN YOUR APPEARANCE AND POSSIBLY CONSIDER PLASTIC SURGERY TO ACHIEVE PERFECTION?

WHEN YOU WORK OUT, DO YOU:

[A] SPEND AN HOUR IN THE GYM THREE TO SIX TIMES A WEEK, AND IF SOMETHING HURTS, YOU LAY OFF OR SEE A DOCTOR?

[B] FEEL GUILTY IF YOU DON'T WORK OUT EVERY SINGLE DAY? DO YOU PUSH YOURSELF TOO FAR, DESPITE PAIN?

[C] START COMPARING YOURSELF TO OTHER GUYS IN THE GYM, SPENDING ALL YOUR FREE TIME WORKING OUT AND CONSIDERING STEROIDS?

WHEN RUNNING, DO YOU:

[A] PACE YOURSELF FOR 20 TO 40 MINUTES THREE TIMES A WEEK, CUTTING BACK WHENEVER YOU FEEL PAIN?

[B] PUSH YOURSELF, SLOWING DURING FITS OF PAIN, BUT REACHING YOUR GOAL?

[C] RUN THROUGH CONSIDERABLE PAIN, AND WHEN PREVENTED FROM GETTING YOUR RUN IN, TORMENT YOURSELF ABOUT IT?

WHEN ATTEMPTING TO SLIM DOWN, DO YOU:

[A] START EXERCISING MORE, CUTTING BACK ON THE SIZE OF YOUR MEALS, CUTTING OUT SIMPLE CARBS OR FAT?

[B] GO ON CRASH DIETS TO DUMP WEIGHT QUICKLY, THEN GAIN THE WEIGHT BACK SOON AFTERWARD?

[C] ALWAYS THINK OF YOURSELF AS TOO FAT, FEEL GUILTY WHEN YOU EAT, AND ALTERNATE BETWEEN BINGEING AND EATING PRACTICALLY NOTHING?

WHEN TRYING TO EAT RIGHT, DO YOU:

[A] EAT A VARIETY OF FOODS EVERY DAY? MAKE SURE TO HAVE ENJOYABLE MEALS THAT INCLUDE PROTEIN, COMPLEX CARBS, HEALTHFUL FATS, VITAMINS, MINERALS, AND FIBER?

[B] FELL SICK AND NOT JUST MALNOURISHED BUT ANXIOUS WHEN YOU STRAY SLIGHTLY FROM YOUR PATH?

[C] ELIMINATE ENTIRE FOOD GROUPS? GO ON FAD DIETS AND SUFFER NUTRITION IMBALANCES AS WELL AS MENTAL?

WHEN THINKING OF SEX, DO YOU:

[A] HAVE AN ENJOYABLE, SATISFYING SEX LIFE, WHETHER COUPLED OR ON YOUR OWN?

[B] HAVE SEXUAL FEELINGS, DESIRES, OR FANTASIES THAT YOU FEEL ASHAMED OF BUT CAN'T CONTROL?

[C] HAVE A NEED FOR ALL SEXUAL PLEASURES, RIGHT OR WRONG, NO MATTER THE FINANCIAL OR PHYSICAL COST, REGARDLESS OF WHO YOU HURT?

HOW'D YOU DO?

If you answered C to any of the questions, seek professional treatment immediately. And read this special report. Those who answered B more than once are walking, if not tap dancing, the fine line. And for every A answered, give yourself a pat on the back. You have drive and total control over your healthy habits.

COPYRIGHT 2003 Weider Publications
COPYRIGHT 2003 Gale Group