#085 - Dr. Katharine Phillips - The Hidden Epidemic Of Body Dysmorphia In Men

Dr. Katharine Phillips unpacks the hidden epidemic of body dysmorphic disorder, from muscle dysmorphia in young men to the mental, emotional, and spiritual toll of chasing physical perfection. We explore the dangers of anabolic steroids, distorted self-image, the illusion of control — and why real healing starts with reclaiming your identity beyond your appearance. This is a conversation about perception, pressure, and the path to wholeness.

Timestamps:
00:00 The Adonis Complex
12:55 The Path Of Dr. Phillips' Work
18:35 Body Dysmorphia As A Spectrum
23:07 Understanding Muscle Dysmorphia
26:44 The Illusion Of Control
34:20 Same Actions, Different Mindset
37:31 Body Dysmorphia & Body Positivity 
42:53 Evolutionary Desires For Getting Bigger 
47:11 Dysmorphia vs. Dysphoria 
51:08 Psychological Impact Of Steroids
57:42 Messing With Mother Nature
1:04:24 Importance Of Storytelling
1:07:08 Connect With Dr. Katharine Phillips

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Chapters

• 0:00 The Adonis Complex
• 12:55 The Path Of Dr. Phillips' Work
• 18:35 Body Dysmorphia As A Spectrum
• 23:07 Understanding Muscle Dysmorphia
• 26:44 The Illusion Of Control
• 34:20 Same Actions, Different Mindset
• 37:31 Body Dysmorphia & Body Positivity
• 42:53 Evolutionary Desires For Getting Bigger
• 47:11 Dysmorphia vs. Dysphoria
• 51:08 Psychological Impact Of Steroids
• 57:42 Messing With Mother Nature
• 1:04:24 Importance Of Storytelling
• 1:07:08 Connect With Dr. Katharine Phillips

Transcript

Dr. Katharine Phillips unpacks the hidden epidemic of body dysmorphic disorder, from muscle dysmorphia in young men to the mental, emotional, and spiritual toll of chasing physical perfection. We explore the dangers of anabolic steroids, distorted self-image, the illusion of control — and why real healing starts with reclaiming your identity beyond your appearance. This is a conversation about perception, pressure, and the path to wholeness.

Tim Doyle (00:07.988)

What is the Adonis Complex?

Katharine Phillips (00:11.248)

the Adonis Complex. yes. Well, the Adonis Complex is a term that I and my colleagues kind of invented to cover a broad range of body image concerns in men and boys. So it includes things like body dysmorphic disorder. The popular term is body dysmorphia, eating disorders in men and boys, and something called muscle dysmorphia.

which is a form of a type of body dysmorphic disorder, afflicts primarily boys and men as opposed to women or girls. people with this problem have a distorted view of how they look. They're very concerned that they're not muscular enough, that their body build isn't big enough. When in the eyes of others, they look fine or sometimes they're actually quite.

well-built and muscular, but they have a sort of a distorted view of how they look. it's troubling to people who have it. It's distressing. It often causes problems in their day-to-day life because they're so focused on how they look and so upset by how they see themselves.

Tim Doyle (01:30.998)

Do you think this Adonis complex was a slow gradual unfolding over time or through your work, is there like a point in time that you really look to where you saw like a big shift and change?

Katharine Phillips (01:48.11)

That's a great question. know, body dysmorphic disorder has been around for a very long time. It was first described in 1800s, right? So these are people who are obsessed with some perceived flaws in how they look. They think about it a lot. They, and by definition, it causes some significant emotional distress or interference in functioning, day-to-day functioning, whether it's going to school or getting to class or...

getting to meetings at work, those kinds of things. It's important to emphasize that because we don't want to call normal appearance concerns, which are so common in the general population, we don't want to give it a psychiatric name. So body dysmorphic disorder is problematic preoccupation with perceived defects in appearance. And again, distorted perception because other people can't see the defects.

that the person thinks they have. But the most common body areas of concern in body dysmorphic disorder are perceived defects of the skin, hair, and nose. Like they're going bald, but they're really not. Or they think that their nose is too large and others just don't see it that way, right? Often they're quite attractive people. So body dysmorphic disorder has been around probably forever. We know it's been described for at least 100 and, gosh, almost 150 years now.

But muscle dysmorphia is a little different. We think that's a newer form of body dysmorphic disorder. Now it's possible that it's been around for a long time and that no one ever talked about it. And we can't say for sure, but we think that a lot of the societal pressures that young boys and men experience and now in spades really came into play.

you know, some point during the night, maybe the second half of the 1900s, right? So 1960s, 70s, 80s, and those pressures on boys and men to look big and muscular might not have existed prior to that. you know, muscle dysmorphia may be a, it appears to be a newer type of manifestation of body dysmorphic disorder. So,

Katharine Phillips (04:13.858)

Now, you know, it's become quite well known. And I think the pressures on boys and men to be muscular and, you know, are sort of more powerful than ever and really creating very unrealistic and sometimes harmful, you know, what's the word I want here? You know, the images that boys and men are exposed to.

are typically, are often unrealistic and potentially harmful, the super muscular look puts a lot of pressure on boys and men, right?

Tim Doyle (04:52.16)

Do you think that, or do you know of, like has muscle dysmorphia become the most?

heightened sense of body dysmorphia. Like is that number one on the list now?

Katharine Phillips (05:05.585)

That's a great question. No one knows the answer to that question. We've had five good, well-done studies from a scientific perspective of the prevalence of BDD, body dysmorphic disorder, in the general population, showing that it currently affects maybe 2 to 3 % of people in the general population. Now, that may not sound like a lot, but it is a lot of people. It's many millions of people in the US alone.

I suspect actually that body dysmorphic disorder is now more common than those studies indicate. It's just my guess because we haven't had a good study in about 15 years actually. And I suspect with all the pressures on social media and elsewhere, the body dysmorphic disorder may be becoming more common, but we can't say for sure. Now, none of those studies looked at how the prevalence of muscle dysmorphia compares to other forms of body dysmorphic disorder.

So we don't know, you know, is it now the most common form of body dysmorphic disorder or not? Probably not, but I think it's probably becoming more common like other forms of body dysmorphic disorder. I just think that what, everyone's online now, right? And what all the unrealistic images online and all the messages to be bigger and more muscular and a fair amount of that is fake, right?

people editing their images and it's just, lot of it, and now with AI, who knows what's real and what is not real. And so I think there's just more and more pressures on people, especially young people, to attain these very unrealistic looks. And potentially very dangerous, think, especially in the case of muscle dysmorphia.

Tim Doyle (07:04.15)

Yeah. And I feel like the justification for it is it's like, okay, this is how I build up my confidence. And I'd assume that like from the ages of, I mean, it's crazy to think that it could happen in like a 10, 11, 12 year old, but I would assume from like that age to maybe mid twenties or so, maybe closer to 30, I would have to guess that muscle dysmorphia is probably the number one type of body dysmorphia.

Katharine Phillips (07:32.702)

You know, you could be right. You could be right. I think it probably is more common than those studies that I mentioned indicated. And you just look online and you just see these very unrealistic images of bulging muscles and encouragement to take potentially very dangerous drugs and supplements. And that's why I said earlier that I think muscle dysmorphia is a

particularly dangerous form of body dysmorphic disorder because if you take those drugs, you are putting your health at risk. And in many ways in which drugs, especially any anabolic steroids, anything with testosterone in them, you're very risky to take. mental health risks, you get depressed coming off of them. Occasionally people get manic on them.

you know, heightened abnormal state of agitation, euphoria, et cetera. And people may be dying young from them, some people at least, that it probably, you know, seems to increase the risk of heart disease and not good for your liver and kidneys and other kinds of things. and then, you know, if you're, some people, this is so disturbing to me actually, you know, reuse needles, share needles.

you know, there's that kind of risk as well. So, and can really harm a man's fertility. That's the other thing. You can get low libido, sexual dysfunction. And I've had seen patients who wanted to get, you know, were in a relationship, wanted to get pregnant, couldn't, and probably because of the anabolic steroids they were using. So.

Often that can come back once you stop use, but not 100 % of the time. that's muscle dysmorphia, and probably somewhere between 20 and 40 % of people with muscle dysmorphia take these, take anabolic steroids. So it's a risky, risky thing to do.

Tim Doyle (09:45.216)

I appreciate the fact that you say that like, you don't know a hundred percent because I feel like within this realm, like I feel like it brings new meaning to the phrase silent killer. Like yes, like in a literal sense, maybe it will kill you, but more so just like on an internal, like emotional level, like people don't talk about this type of stuff or like, it's just not like something that you would necessarily share. And I'd feel like just like from personal experience, like when I was younger,

Katharine Phillips (09:57.72)

Yes.

Tim Doyle (10:15.016)

Like I definitely struggled with it a little like not to like a very serious degree of like taking drugs and like being completely, you know, like overtaken by it. But like, you know, I still work out very regularly. Like I eat very healthy. But like definitely when I was younger, it definitely had like a consuming factor of my life. But it was more so just like I like I loved

Katharine Phillips (10:35.692)

Yeah.

Tim Doyle (10:43.242)

I love the work that went into it. Like I love like the discipline and the routine of like, you know, working out and obviously seeing those external positive results. But like it did become a little bit of a double edged sword at times. And I feel like I'm, you know, thankful and grateful that it kind of just like naturally, you know, evolved out of my life or like my obsession or like care for it, like has just subsided naturally.

Katharine Phillips (10:56.897)

Yes.

Katharine Phillips (11:13.282)

You're glad about that, you said? Good.

Tim Doyle (11:13.514)

What I, yeah. And like, I don't, don't think that was, I don't think that was, you know, would have necessarily happened, but like, was a point in my life where I went through like really bad chronic pain issues and it took me out of the gym and took me out of that type of lifestyle for, you know, six or seven months. So like, I was like almost unwillingly like taken out of that type of like mindset and sort of like lifestyle. and I think

long-term that that really helped me. But what I find so interesting about your work and how you got into this, because I know that this wasn't your natural intention of, I'm going to get into, you know, researching body dysmorphia. Like, what did you think the natural path of your work was going to be? And then how did you get introduced to this?

Katharine Phillips (11:46.19)

Good.

Katharine Phillips (12:06.99)

Yeah, well, when I got into this, which was quite a long time ago, no one had heard of these problems, really. Virtually no one. I don't think anyone had heard of muscle dysmorphia. body dysmorphic disorder, even though it had been described in medical journals for more than 100 years, people back in the early 90s, professionals, the general public, for the

The vast majority had never heard of this problem. But I saw some people, some patients who had it. And I remember the first person I saw, one of the very first patients I saw was a young man who was very depressed. He was suicidal as a result of it. He couldn't work because he was so obsessed about his hair. He thought he was going bald and he...

It was devastating to him. Meanwhile, he's handsome with a full head of hair, right? And he thought he had very thin hair, receding hairline. Not even slightly, right? So again, you see this distorted perception. And I saw how it was ruining his life, this obsession with his hair. And body dysmorphic disorder isn't always this severe, but he was thinking about killing himself because of it. And there is a high suicide rate in people with body dysmorphic.

disorder. And he couldn't work and he was socialized. He was very isolated. So I just thought, oh my gosh, this is a serious problem and why does no one know about it? That really motivated me. And when I went back and read about cases from, know, descriptions of patients from 1880 or 1920, there were some of them, no good studies. There's so much we didn't know about the disorder. We had no treatments. didn't

Really, I mean, we knew next to nothing about it, but none of them describe muscle dysmorphia, interestingly, and I had never heard of it. And so I think I stumbled upon it when I saw a young man who seemed to be wearing six layers of t-shirts. And a nice thing about being a psychiatrist is it's okay, you know, when you're interviewing a patient to ask about that.

Katharine Phillips (14:33.346)

So I just said, you know, I noticed you're wearing a lot of t-shirts and I wonder, you know, can you tell me a little bit about that? And it turned out he was trying to make himself look bigger. And so that led to my asking more questions and then started asking more patients about it and discovered that this seemed to be a form of body dysmorphic disorder where people were concerned, it was mostly men and boys concerned about muscle size.

thinking they were scrawny and puny and not muscular enough and they weren't. They looked normal and some looked quite muscular because they often work out a lot. And so I just felt that this was early on in my career and you know, I mean, some of my mentors discouraged me from going down this road because I think back then body dysmorphic disorder, muscle dysmorphia were confused with vanity. They are not.

They are not, this is not about vanity. This is, you know, it's a mental health problem where people have these obsessive thoughts that something's wrong with how they look. They have distorted body image. They're not seeing themselves accurately. And by definition, it's causing problems in their life or causing them a lot of distress. And I just felt I had, I wanted to try and figure it out. I wanted to just start at the beginning. What are the symptoms people have? What co-occurring disorders do they have?

How common is it for people to feel that life isn't worth living? How many have attempted suicide and how often because of these body image concerns? And then, I moved on to trying to figure out treatments, what works to help people suffer less. And we now know, I've done a lot of treatment studies over the years and now know that cognitive behavioral therapy is certain form of cognitive behavioral therapy that focuses on

Learning skills to overcome the body dysmorphic symptoms helps most people. And certain type of medication, a class of medications called serotonin reuptake inhibitors, SSRIs or SRIs, they're called both. Things like Prozac and Zoloft, Lexapro, medicines people have probably heard of because they treat a lot of different mental health conditions, like depression and obsessive-compulsive disorder. Those medicines are often really helpful.

Katharine Phillips (16:56.834)

You know, we've come a long way. Now there are a of other researchers in the field. Not so much when I started out. There are just a couple of us. But it's amazing how much we've learned through the scientific research, the studies we've been able to do, and all the people who've been willing to participate in our studies. We've learned so much about body dysmorphic disorder or muscle dysmorphia and how people can get better.

Tim Doyle (17:26.688)

feel like when it comes to dysmorphia, it's a spectrum and there's different degrees of it. And I feel like within today's day and age, mean, majority, if not all of us, I think, are on that map. They're on that spectrum.

Katharine Phillips (17:31.618)

Yes.

Katharine Phillips (17:44.782)

Yeah, I think it's probably increasing in prevalence. think most people have some what we call normal body image concerns. Most of us would change something about how we look if we could. But we may notice it, oh, I have a little pimple today. My hair isn't exactly the way I like. I don't like this haircut that much. But we let go of the thought and we move on with our day.

And you know, but that does at some point sort of morph into more, you know, as you start thinking more and more about it, if it starts bothering you, you can't just let go of the thought, then you do start moving into body dysmorphic disorder and muscle dysmorphia. And as you said, there's a range of severity. So someone with mild body dysmorphic disorder or muscle dysmorphia might think about how they look and be unhappy about it for

hour, a couple hours a day in total. They might, you know, be moderately upset about it, somewhat depressed over it, and maybe they miss an occasional social event because of it. You know, they don't want people to see them because they feel self-conscious about how they look, even though they look fine to everybody else. That's mild. You know, at the severe end of the spectrum are people who are just completely disabled by these symptoms. They are housebound. They may just be in

basement, maybe their parents basement, you know, and not dropping, they've dropped out of college, they can't work because they're so obsessed with these perceived defects and how they look. Again, they look normal. They're socially isolated. They're thinking about suicide. Some commit suicide because they're so obsessed with these perceived imperfections, flaws in how they look. So, you know, an example of

very severe muscle dysmorphia, you can see the same kind of symptoms, just very socially isolated, not wanting to be seen, because you're afraid that you look so puny and tiny, or some maybe, I remember seeing people who just exercise, mean, excessive exercise is a symptom, right? And just exercise so excessively that they damaged.

Katharine Phillips (20:08.748)

their bodies. I saw one man a long time ago who was maybe about 40 but in a wheelchair forever probably because he had exercised so excessively. He really damaged you know muscles maybe nerves you know maybe I can't remember exactly whether his spinal column had kind of collapsed because he was putting so much weight. I don't remember how exactly it happened but he just

had ruined his body by working out so much. And then there's the excessive attention to diet and eating lots of high protein, low fat meals. And sometimes that just the exercise and the attention to diet and feeling you have to gorge yourself on the foods that build muscles, that can just kind of take over someone's life. So I've seen many people who've missed social events because they have to go to the gym instead.

They felt they had to go to the gym. They'd just been there two hours before, but they had to go again, right? Because maybe they were starting to waste away. And so their girlfriend wanted to go to the gym or wanted to go out to a movie or something like, no, no, I got to get to the gym. having to go to the gym, the exercise, the attention to diet can start taking over healthier activities when it's more severe.

Tim Doyle (21:31.562)

find it really interesting.

find it really interesting that to like if somebody who's suffering from this severely, they would see it as okay, this is a physiological concrete problem that I'm dealing with. But I feel like a key word, and it's the truth of what you have to see it as it's all perception and psychological. And yeah, and when it comes to specifically muscle,

Katharine Phillips (21:58.05)

Misperception. Yeah.

Tim Doyle (22:05.386)

dysmorphia, do you have an understanding of the breakdown? Because I see like muscle dysmorphia as like two different groups. I see it as okay, there's like a group of people that like they understand how to build muscle like they know how to work out in the gym, they know how to eat to build muscle, and then they just have this unfillable hunger for more.

Like just like wanting to, okay, like I've gotten a taste of it. I've seen the results and now I just want it to the nth degree. I see that as one group. The other group that I see it as it's like, okay, they, don't know what they're doing. You know, they are looking at, you know, the next gimmick gimmick, the next quick thing, different products that will help them build muscle and nothing works. And then they just get into this like sense of hopelessness where it's like, I just like, I can't build muscle. Like, you know, I'm just withering away here.

Like, you have an understanding there between like those two groups or like, you see it that same way?

Katharine Phillips (23:08.404)

Yeah, I think there are different groups, subgroups like that, but they all, based on what you said, if they're obsessing about their body build and it all comes back to the same thing. mean, the thing is typically in muscle dysmorphia, no matter how big you get, you're not satisfied. You feel like it's never big enough and you're still too small. There's more you should.

Tim Doyle (23:20.938)

It all comes back to the same thing, yeah.

Katharine Phillips (23:36.236)

be doing. You need to join a better gym, more gyms. You need to build even more. You need to try the next new supplement. You need to take lots of supplements. You're going down the rabbit hole there, right? Because there's an endless array of stuff you can buy online. And it's not just the anabolic steroids that are potentially dangerous. It's other stuff too.

I did see someone a long time ago who went into kidney failure. That's a very serious problem. That's very, very serious if your kidneys work. It was taking about 50 to 100 supplements and people think supplements are safe and some are, know, like standard multi vitamins or something like that. But they're not regulated by, you know,

Tim Doyle (24:11.606)

from taking steroids or doing other stuff.

Katharine Phillips (24:30.818)

They're barely regulated by the FDA or anybody else. you know, that, they hard on your kidneys, hard on your liver. You never really know what's in them. I mean, a lot, a lot of them don't have in them what the labels say. They can have, some have steroid, anabolic steroids in them and that's not on the label. Some, it can be anything. You're putting stuff into your body that can, who knows what it, what it really is. So, you know, yeah.

You have to be really cautious and careful. And I think, you know, the less of that you take, the better. And we do have treatments that work. As I mentioned, the cognitive behavioral therapy and that serotonin reuptake inhibitor medications are not addicting. They're safe. you know, there are a lot of unfortunate misconceptions about them, but most people have no side effects at all, and they often can really, really help.

They can be life saving actually, especially if you're more suicidal. They can turn your life around in a good way.

Tim Doyle (25:39.1)

like in a paradoxical sense, or at least that this was like my experience to a degree when I was younger. I feel like body dysmorphia or specifically muscle dysmorphia. It can give you a

Tim Doyle (25:59.072)

perception of control or a sense of control because you you think you Know what the answer is like you think you know Okay, like when I look like that Or like when I have this type of external image or like if people see me this certain way Then like that's when I'll be good and that that sense of knowingness like gives us like some sense of like autonomy and

Katharine Phillips (26:02.36)

Yeah.

Tim Doyle (26:28.468)

We think that like, okay, everything's fine here, but it's the exact opposite where it just gets you deeper into the hole. And I feel like, I feel like the answer isn't a solution or it's like, okay, like that's, that's what's going to help me. But it's more so of a question because whether it's body dysmorphia, muscle dysmorphia, or I like just anything within our culture and society today, whether it's

Katharine Phillips (26:31.532)

Yeah, yeah.

Yeah, deeper into the world.

Tim Doyle (26:56.17)

you food, social media, all different vices. I think the solution starts with a question, which is what's the void I'm trying to fill? Like, I feel like that's what it comes down to. It's like, okay, there's some type of, whether it's consciously or unconsciously, there's a void within me that I'm trying to cover up. What are your thoughts on that? And have you seen within your work, any, like types of void that you see more than others?

Katharine Phillips (27:05.144)

Yeah.

Katharine Phillips (27:24.138)

Yeah, think to go back to the control issue, I think that there's this illusion of control actually that if you just work out a little harder, take the next great supplement, you do what the most popular influencer tells you to do, you'll get there.

you will be big enough and muscular enough. And of course, as you said, you just go deeper into the hole. No, it doesn't work that way because of that distorted body image. It's kind of like anorexia nervosa. If you're familiar with that, it mostly affects women and girls thinking, trying to get thinner and thinner and thinner, even to the point where they sometimes die from it. But it's this feeling you can never get thin enough, but you see the distorted body image there. They think they're fat, but they might be.

65 pounds and five seven, right? So muscle dysmorphia, in fact, used to be called reverse anorexia because it's kind of the opposite of that. Yeah, it can never be too big, right? But you don't get there. The treatments I mentioned will get you there, right? Because they'll help stop those obsessive thoughts and help those thoughts be less distressing and often improve

body image so you see yourself more accurately. To go back to the void, your excellent void question, you know, the cause of body dysmorphic disorder, including muscle dysmorphia, almost certainly hasn't been as well studied, is it's caused by a, like all mental health disorders, it's caused by a combination of genetic risk that you inherit from your predecessors, parents, and other blood relatives.

and so-called environmental influences. Like maybe you were teased when you were younger, maybe you were bullied. Not everyone who was bullied when they were younger gets muscle dysmorphia or body dysmorphic disorder, but it might increase the risk. So the cause of it isn't just about an internal void, right? There are these other factors that are causing the body dysmorphic disorder.

Katharine Phillips (29:40.714)

I do think that's a helpful and valid perspective to think of a void. Although it's interesting, the treatments can just take that right away. Really, it's amazing if you take a medicine that the void can fill up. It's fascinating, isn't it? But I think we find that people with body dysmorphic disorder, with muscle dysmorphia, tend to...

We work on self-esteem in our cognitive behavioral therapy. We work on self-esteem because we find that people with these disorders tend to overvalue the importance of appearance. Appearance is a big contributor to their self-esteem. I don't think that makes you vain. think it just, it came from somewhere, probably from some life experience you had. And a lot of people with this disorder don't want to be unusually attractive.

They just want to look kind of normal and fine, and not scrawny and not tiny and that kind of thing. And they often don't pay much attention or adequately value other positive aspects of themselves. They don't necessarily value

their athletic ability, their musical ability, their artistic ability, the fact that they are a good friend to others, the fact that they have whatever you consider good values, that they are helpful to others, that they, you know, they're a good student. You know, we have, we're all made up of all kinds of traits, values, personality characteristics, some positive, some negative, right? We're all mixed bag.

but people with body dysmorphic disorder and muscle dysmorphia tend to really discount and not even notice their positive traits. And so I think that's often where the void is and that they're sort of counting on their physical appearance to make them valuable or acceptable in the eyes of others. And not to say that appearance doesn't matter at all, but typically, you know,

Katharine Phillips (32:06.666)

Ask yourself, what do you value in other people? What do you value in your friends? If you have a partner, what do you value in them? Is it how big their biceps are? Is it how thick their hair is? Not typically. Usually it's because they're fun to be with. They treat you well. You have shared activities you like to do. They're a good

person, whatever, you can come up with a long list, right, of things you really value in others. And those are things that tend to keep relationships going, right? Relationships that are based on how good your hair looks or how big your calf muscles are, those relationships probably aren't gonna last very long. So in our therapy, we do work on helping people recognize and value other aspects of themselves and try and...

help them feel that void that they're feeling. They don't have to rely on their appearance to feel good about themselves and be acceptable to others.

Tim Doyle (33:15.03)

Yeah, that resonates on a deep level. And I feel like for me personally, when I like I said, when I struggled with this to a degree, like it like it wasn't bad, but I was like, like I had an understanding of it. And like when I grew out of it, like I said, I still, you know, work out a lot. I eat very healthy. I eat very, you know, disciplined. But it's like the like the physical actions haven't changed. But it's just like the the it's just coming from a different consciousness.

Like it's coming from a different level of awareness and understanding of like, Hey, I'm just doing this to do this. I'm not doing this for, you know, X, Y, Z to, you know, results afterwards.

Katharine Phillips (33:57.39)

And that to feel good about yourself, you don't have to rely on having perfect hair or the biggest muscles or that sort of thing.

Tim Doyle (34:05.056)

Yeah, yeah, it comes more from a because I think it's really fascinating. I feel like wellness has become a much more popular term, and I feel like you're going to continue to see wellness become more popularized and fitness.

Katharine Phillips (34:17.343)

is.

Tim Doyle (34:27.99)

Like my hot take is like maybe in like 20 or 30 years, like wellness is a more, you know, acceptable word and fitness has become a little bit more obsolete because I think fitness is just like that one dimensional sort of, you know, physical versus like wellness, you know, involves the physical with the mental, emotional, spiritual. So it's just a more, you know, balanced way of going about things.

Katharine Phillips (34:45.324)

Okay.

Katharine Phillips (34:50.392)

Yes.

Katharine Phillips (34:53.752)

Right. And just, I agree. And I think just to follow up on something you've mentioned a few times, you know, that you work out, that you eat well, those are fantastic things to do, of course, right? So exercise is great for your brain. It's great for your mental health and physical health. And of course, eating well, we're hearing more and more about ultra processed foods, all their evils, right? So eating a healthy diet is great.

Not a lot of junk food and eating like the Mediterranean diet, but it's fantastic. with muscle dysmorphia, all those good things get carried to an extreme. So the solution isn't stop going to the gym, stop eating well. No, no. We just want to recreate a healthy amount of those things so that you're not working out so much that you're damaging your body or sacrificing your social life or missing class.

you're not eating so much that you're missing work meetings because you have to run to your blender and make a shake, you know, and you can't focus without doing that. So we're trying to help with our treatments, the medication, the therapy, get those obsessive thoughts and compulsive behaviors, get those under better, minimized, right? So that you, you know, you lead a healthy lifestyle and you don't carry.

the exercise or the diet to an unhealthy extreme.

Tim Doyle (36:26.666)

You asked the question in your book, why is the public become so fascinated with this topic? And I have an interesting hypothesis on this. And part of the reason that I wanted to have you on the show is because I recently had on a woman named Gina Bontempo. She wrote this book called fat and unhappy. And it's all about the body positivity movement and just looking at it from a very transparent

Katharine Phillips (36:35.128)

Yeah.

Tim Doyle (36:55.014)

sense of just like how that has become unhealthy as well where body positivity is gone into an extreme to an extent where it's become like fat acceptance and just like an acceptance of obesity. So just like going all the way on the other edge of things. So I wanted to have you on to kind of balance that out where it's like, okay, well, like, let's talk about what can happen on the other side of the coin.

Katharine Phillips (37:23.01)

Mm-hmm.

Tim Doyle (37:23.68)

But, but I think, and what I find fascinating, this is what my hypothesis is for like why body dysmorphia within the public and culture and media has become more apparent and people are talking about it more is because of body positivity where it's like, like, I feel like body dysmorphia in a weird way because has become like the fuel for body positivity where

Katharine Phillips (37:47.074)

Mm-hmm.

Tim Doyle (37:53.322)

you know, body positivity activists, like they will try to disown it. But I feel like it's also in a weird way become an important part of the agenda. And like they like it because it just pushes the body positivity movement even more. What are your thoughts on that?

Katharine Phillips (38:10.616)

the body dysmorphic disorder does.

Tim Doyle (38:13.686)

Yeah, sorry about yeah, I feel like body dysmorphia is kind of like a fuel or lifeblood for the body positivity movement.

Katharine Phillips (38:22.478)

That's interesting. I hadn't thought about it that way. well, appreciate your insights about that. You know, I think body positivity can mean a lot of different things, right? I think in general...

much of the time it's a helpful concept, right? Just to say though that body dysmorphic disorder, so I'm not talking about normal body image dissatisfaction, which is pretty common in the general population, but when it becomes kind of obsessive and causes problems for you, I think simply approaching it with body positivity is not.

probably not going to help you feel much better, right? I think you really, it's a mental health condition that you need one of those two treatments for that I mentioned, the serotonin reuptake inhibitor medicines or cognitive behavioral therapy that's focused specifically on BDD. So I think body positivity isn't probably not an effective treatment for body dysmorphic disorder. However, for people with more normal body image concerns, they're not as problematic, they're not as extreme.

Body positivity can be a helpful thing. think, you know, so many people grow up with shame around how they look, right? And teasing and bullying is unfortunately pretty common. And probably most of us have been teased at some point in our lives about some aspect of how we look, right? And some people really take that to heart. And...

So I think realizing that shame about how we look is not helpful. And body positivity can be a helpful thing. Now, in a helpful perspective, it's not going to treat body dysmorphic disorder for less problematic appearance concerns. But I think that body positivity too, as you imply or are stating, can be carried to bit of an extreme,

Katharine Phillips (40:30.798)

I think when it comes to obesity, we know that's not good for your health. So I think for people with obesity, body positivity can be helpful in the sense of no need to shame yourself over it. No need to denigrate yourself over it. If other people shame you over it, you don't have to accept that.

But it is a healthy thing to try to get your body weight back into the normal range, right? You're gonna reduce your risk of a lot of illnesses, right? And diabetes, which then increases the risk of heart disease and stroke and kidney failure and all these kinds of things. So I think it's a matter of not shaming yourself, but just saying, hey, I have this medical.

problem, obesity is a medical problem, how do I want to tackle it and work with a doctor to try to get your weight in healthier range? So don't think body positivity has to imply or it shouldn't imply that you don't want to do anything if you're very overweight. It's good for your health to do something about

Tim Doyle (41:50.464)

There's obviously a lot of societal and cultural factors at play when it comes to this conversation and people being consumed with this. But I'm also curious to know, like, is there to a degree some type of mammalian innate instinct of people who are like, all right, at the end of the day, it's my animal brain that wants to, you know, get bigger and me.

Katharine Phillips (41:58.178)

Yes. Yes.

Katharine Phillips (42:11.182)

Yeah.

Tim Doyle (42:19.808)

you know, more dominant compared to others.

Katharine Phillips (42:19.982)

Yeah. Just remember, our brains are not simply animal brains, right, of course, so that you're not a slave of an animal brain. But I think your question is great. It has probably some validity. We don't know for sure. But body disorder, muscle dysmorphia almost certainly have some sociocultural contributions, right? We've talked about that.

Tim Doyle (42:27.872)

Yeah, yeah.

Katharine Phillips (42:49.294)

boys growing up with these super muscular action figures and wanting to look like Superman and what we're seeing on social media these days and these super muscular bodies, right? Some of which are fake. They're only attainable with drugs. I mean, these influences are clearly important. And certainly for women, we've known that for a really long time, the pressure to be thin and all that. So all of this does matter, but...

There's probably an evolutionary basis as well, and more of a biological evolutionary basis. Because being big may have some evolutionary advantages, and maybe especially for males, bigger or stronger, you're going to maybe do better in a battle with the mastodon or the enemy behind the mountain next to you.

There may be an evolutionary basis for body dysmorphic disorder. We know, for example, o symmetry is a common concern of people with body dysmorphic disorder. know, my nostrils are a little asymmetrical. Well, everyone's are, by the way. But people with BDD really think that looks horrible and no one else is noticing, but they see it, right? Or my face isn't perfectly symmetrical.

It isn't for anybody really, but symmetry is a common concern and we know that in the animal world, having some moths with symmetrical wings get more mates, right? So there's something about symmetry reflecting perhaps reproductive health and fitness, know. So, you know, there probably are evolutionary roots to this disorder, but that's not going to be the only cause. You know, there's the genetic contribution.

There's these sociocultural contributions. The causes of all mental disorders is complex. There's not one thing or one factor that's the cause. And as I started out saying, even if this does have evolutionary roots, we are more evolved than that. And we don't have to accept that bigger is better. I should mention, by the way, and I and my colleagues

Katharine Phillips (45:12.994)

talked about this in our book, The Adonis Complex, that my colleague Harrison Pope, who was actually the first author on that book, The Adonis Complex, did some studies in which he found that women actually, so for heterosexual males, women don't prefer a super muscular body. They prefer a more ordinary male body, right?

And so I think sometimes men may misperceive what women find attractive. And I think we see that with women also. I think they often, that men may not prefer as skinny a body as women think they want or that the women themselves want. So I think, you know, there are all kinds of misperceptions going on here in these body image disorders.

Tim Doyle (46:08.608)

building off that conversation of gender and gender relations, something else I had a thought of was, we've been talking here strictly in terms of the language dysmorphia. Another word that I've heard used is dysphoria. Is there a difference between dysmorphia and dysphoria? Like I've only heard dysphoria used in terms of gender dysphoria.

And when I was thinking about that, like, I feel like in a way, especially when you bring, you know, steroids into the conversation, maybe it's not like as far as like, okay, that's gender dysphoria, but it feels like kind of like in the same conversation in a way where like you just like those types of people who go to that length, like don't feel good within the natural makeup of their body. Like our

Dysmorphia and dysphoria interchangeable words or no?

Katharine Phillips (47:09.998)

Not really. mean, the official term for body dysmorphic disorder is body dysmorphic disorder. It's often the term muscle dysmorphia is used a lot, which you've been using. the problem with muscle dysmorphia is it can refer to a lot of different things, I think, and there's no one agreed upon definition. So sometimes when you hear muscle dysmorphia, people are talking about, I'm sorry, body dysmorphia.

People are talking about body dysmorphic disorder, which I've defined a couple times. Sometimes they're using it to refer to body image concerns in people with an eating disorder, right? Sometimes they're referring to people with anorexia, bulimia, know, one of those disorders which involves body image concerns. And sometimes it's used to refer to more normal body image concerns, which aren't necessarily very problematic, right?

We all occasionally have a bad hair day or we're not always 100 % satisfied with everything about how we look. So the problem with the term muscle dysmorphia is sometimes it's unclear. Is it referring to normal body image concerns? We don't need mental health treatment for those. Is it referring to eating disorders or is it referring to body dysmorphic disorder? Those two things require somewhat different treatment. Body dysmorphic disorder.

does involve dysphoria, dysphoria meaning sort of an unpleasant internal state, unhappiness. It's a broad term, you know, could include some anxiety, some depressive feelings, et cetera. So, you know, from kind of an official name perspective, it's not body dysphoria, but body dysmorphic disorder does include

dysphoria, that distress, that unhappiness. It has some similarities with gender dysphoria and some differences. Both conditions involve dissatisfaction with certain aspects of how you look. But gender dysphoria is different because it really focuses on mostly, most often secondary sex characteristics, genitals, breasts, and feeling that their identity is not

Katharine Phillips (49:30.574)

congruent with their assigned gender and that their physical body is not congruent with who they really feel they are. And so, you you don't see that in body dysmorphic disorder and the treatments are quite different, you know, so, you know, they have the overlapping feature of dissatisfaction and, you know, and problematic.

you know distressing dissatisfaction with some aspect of how you look but there are some important differences between them.

Tim Doyle (50:06.23)

Diving deeper into the steroid side of things and what I found really interesting about your work. I feel like just within the everyday nature of how we understand steroids, we just simply think of the physical. And obviously that's bound to happen because the biggest changes you see are physical on the surface. But then we only just, I feel like talk about the physical side effects really. And what I've found,

Katharine Phillips (50:35.171)

Yeah.

Tim Doyle (50:36.052)

really important and beneficial about your writing in your book, the Adonis complex is like, okay, like, yes, there are a lot of physical side effects, but that is more, you're going to see that more longterm, most likely, compared to the mental and the psychological, which can be the real danger, but I feel like that isn't talked about at all. Really. Can you just explain more of that about like the, the mental and the psychological side of steroids?

Katharine Phillips (50:56.93)

Mm-hmm.

Katharine Phillips (51:02.126)

Sure. And maybe one thing I should mention is that there are two different types of steroids. There's the kind of steroids you might take if you have an inflammatory disease or you have asthma or something like that. Those are fine, right? They're very different from the anabolic steroids, which build muscle and have the negative physical side effects I've already mentioned.

Tim Doyle (51:18.756)

Yeah.

Katharine Phillips (51:31.018)

often speeding up heart disease and can be bad for your liver, kidney, et cetera. Yeah, the mental health side effects. People have probably heard of something called roid rage. They can make people very aggressive. And I think we have some anecdotes in our book, The Adonis Complex, about guys who just usually nice guys, not aggressive, not violent. just, when they're on steroids, they'll throw a rock.

a brick through a window, know, nearly, you know, missing their girlfriends head by a hair, you know, so, or starting fights on the, you know, on the highway, you know, someone cuts them off and, you know, it's, so you can get, people can get very aggressive on these drugs. And sometimes, you if you end up harming somebody else, that's a problem, right? For them.

Tim Doyle (52:21.419)

Just diving deeper into that because I'm curious. when that happens, like what's happening on a physiological, psychological, or neurological level for that shift?

Katharine Phillips (52:32.779)

Well, I don't think we've studied roid rage quite enough to really know that, but testosterone is associated with a little bit more, not aggression, but milder versions of that, right? So I think it's just a more, it's an extreme version and most men are not violent or aggressive.

Tim Doyle (52:37.322)

Okay.

Katharine Phillips (52:59.726)

They have higher levels of testosterone than women, but they're not violent or aggressive. think just when you take it to that extreme, testosterone is known to increase the fight tendency, right? If you take too much of it. And then there's also, people can get quite depressed when they try to come off of steroids. It's good if you want to come off of, certainly it's always good to want to stop them.

And you know, primary care doctor or sometimes an endocrinologist gets involved can help with that. If you want to get, if you've lost your fertility and want to get your fertility back or you just are tired of the shrunken genitals and the hair loss and the low libido, those are all things also that are side effects of testosterone. So it's interesting. think, you know, people, we focus a lot on

the longer term potential consequences. But some of the physical side effects are potentially shorter term consequences. So I think people can get quite depressed coming off of them. An endocrinologist can be helpful with that. Sometimes a psychiatrist will get involved. Sometimes people become suicidal. So if you try to come off of them, good for you that you want to do that.

But if you find that you are getting very depressed or suicidal, you certainly want to seek professional help and try and get some help as you come off of them. Occasionally we see people get manic, which is not a good thing because it can be a state of euphoria, but sometimes there's a lot of irritability mixed in there or even depression mixed in and agitation and excessive...

like impulsivity and things like that. So, and these drugs can be addicting. I mean, you can go, you can get addicted to them. So it's just better to stay off of them and just be wary of all the supplements out there because some of them have these drugs in them and don't say they, the label doesn't indicate that. So you guys, just working out a healthy amount.

Tim Doyle (55:12.306)

It may be a little-

Tim Doyle (55:16.49)

Yeah.

Katharine Phillips (55:16.564)

eating a healthy diet, not overdoing it, and realizing that what makes you you is not just the size of your muscles, right? It's not what, you're so much more than that. And women don't even like, don't even prefer on average, you know, there may be some exceptions, but don't even prefer an excessively muscular look. Men tend to think they do and they don't.

necessarily, they often don't. And there's just so much more to you as a human than your muscle size. you really, ironically, I think there can be a feeling of wanting to be more masculine, right? That somehow muscle size can be associated with masculinity. then if your testicles start shrinking and your libido goes down the tubes and you can't get an erection, then

That's not so consistent with standard concepts of masculinity, right? So there's a bit of an irony there.

Tim Doyle (56:21.611)

Yeah.

Tim Doyle (56:27.422)

Yeah, you think you're taking these things potentially, you know, to boost your confidence. And there are so many things that can happen that just do the exact opposite. And it may be a little bit of a, you know, radical take when it comes to steroids or just like any type of.

augmentation to, you know, to your physical self. Like, I believe like, obviously, like manipulating your biology in this way can be very, very physically and, you know, neurologically dangerous. But going to what you're saying of like, hey, like you're so much more than this of like, just being your body. Like, I also see it as being very,

Katharine Phillips (57:04.814)

Yes.

Tim Doyle (57:18.888)

morally, ethically, and even spiritually dangerous in a way too. And I want to go to a few quotes in your book. You say, in the course of our research, we've done numerous statistical analyses to see if there was some particular personality variable, some biological test or some aspect of family history that would predict who would develop these bad reactions. But none of our hypotheses has worked out.

violent reactions to steroids seem to be completely idiosyncratic and unpredictable. So it's kind of like you're taking a gamble here. you're kind of just like you're taking a huge risk that you don't 100 % know. And a common theme that I also pulled from your writing and it goes to the language that you use in a few different sections, you say, what happens when you violate nature's limits?

nature made them that way. It's unhealthy to maintain a body completely different from the one that mother nature gave you. And I think that's, I think that's really important for people to understand of like this concept of this is who I am, you know, mother nature, like this is what I have, like, and it's kind of like when it gets to this, okay, you're taking the gamble. It's what you can also see it as it's like, Hey, don't test mother nature here. What do you see as

Katharine Phillips (58:19.736)

Yeah.

Katharine Phillips (58:44.13)

Great way to put it.

Tim Doyle (58:45.366)

Yeah, what do you see as Mother Nature and especially like getting it? I feel like there is a spiritual component to this conversation and how people can. That's where I was also getting into, you know, filling the void. I feel like a lot of the time that could potentially be like, hey, some type of spiritual or just like deeper knowing of like who you are as a person and getting more in touch with like your soul rather than simply just your physical body.

Katharine Phillips (59:13.304)

Yes. I agree. agree. And again, not to blame people with this problem, not to shame them, not, and again, it's not body dysmorphic disorder and muscle dysmorphia are not vanity, right? It's their mental health conditions, right? But

Tim Doyle (59:20.18)

Yeah, of course not, of course.

Katharine Phillips (59:38.23)

I absolutely agree with your perspective and it is one of the things we do in our therapy, which is trying to get...

Broaden your sense of who you are and pay attention to the different components of yourself, what other people value in you. It's easy to discount all of that. If you have any inclination to go down a spiritual road, however you define that, that's wonderful.

to meaning, to value aspects of yourself you may have been ignoring or even devaluing. So yes, I agree, so much of this is about

not putting all of your eggs in that appearance basket. Your body's going to change, it's going to age, it's just going to happen, right? And it's not primarily what other people value in you. It's not going to make a relationship work over the longer term. It's, yeah, expand your view, value your strengths.

things other people appreciate about you, the good things you do in the world, your purpose, and your spiritual journey if you're on one. I think these are all incredibly, incredibly important things to try to encompass and focus on. And the treatments I mentioned will help people get there, definitely, because they're not

Katharine Phillips (01:01:30.126)

bombarded by these obsessive thoughts and these compulsions to go to the gym and work out a little bit more. But that broadening perspective, just realize you're so much more than the size of your calf muscles. You are a full human being and everything that comes along with that, right? And also, just also say realize that a lot of what you see online is fake when it comes to muscle dysmorphia, especially, you know.

I'm not saying in general, although that's going to become more of a problem, right? But a lot of what you're seeing online with the hypertrophy, massive muscles, you know, it's a product of drugs. It's not necessarily a product of working out or being healthy. And now, you know, with AI and I think we're moving beyond Photoshopping, but even with that, a lot of what you're seeing isn't real. So don't feel you have to attain that.

It makes no sense actually, as you said, as we said in our book, know, Mother Nature didn't intend that. If you're a heterosexual male, women don't tend to like that either. I've seen quite many men, know, some were not in a relationship because they felt so ashamed of their bodies, right? And, and, but some were, and I can say the partners almost always, if they were, if, if the guy was using a lot of supplements, was using antibiotics, the women were

the partners were pleading with them to stop. Just stop. They could see the negative effects. for the sake of your relationships, for your own sake, it's best to get treatment if you think you have muscle dysmorphia or body dysmorphic disorder more broadly, other body image concerns that are problematic, because we have really good treatments.

Tim Doyle (01:03:22.1)

The last thing that I want to finish up with, and I think it's the most impactful part of your work and especially your writing is that it seems like it's largely coming at it from the lens of storytelling and understanding body dysmorphia on a macro level by really getting deep into the micro and the anecdotal experiences of it. And one of your

One of my favorite lines from the book is a couple of stories from our patients better than any statistics tell of this pain. What do you think or what would you like to see the future of this story? So to speak to be.

Katharine Phillips (01:04:07.928)

Well, we need both. We need the scientific research studies and we need the stories also. I didn't know what research studies to do until I had heard from many people with body dysmorphic disorder and the muscle dysmorphia form. I'm so grateful to all the people I've ever treated, all my patients who've opened up and have been willing to trust me with their stories because there's so much shame that these conditions cause.

embarrassment. so listening to stories is so important and I think is a wonderful way to help others understand what the condition is like and especially sharing improvement, right, with the treatments we've talked about. The scientific studies are also critically important because that's really the only way you know what treatments really work.

and what don't. So I've done both in my career. But started off telling the stories, you know, back in 1996 when I wrote my first book, The Broken Mirror on Body Dysmorphic Disorder, and then subsequently in the Yedonis Complex. So I think the stories are very important. You know, I think we have a lot of reason to be hopeful about the future. Hopefully the word is getting out that we have good treatments for

for body dysmorphic disorder and muscle dysmorphia. Hopefully more good treatment studies will be done. We are learning a lot more about what's going on in the brain of people with these conditions, why they misperceive what they see, and that may lead to more treatments that may be helpful in addition to the ones we already have. So, you know, I think we have a lot of reason to be hopeful, hopeful for the future.

Tim Doyle (01:06:06.582)

Dr. Phillips, it's been great speaking with you today. Is there anywhere that you'd wanna send people or if people wanna learn more about you and your work, anywhere that they should go?

Katharine Phillips (01:06:16.622)

Oh, sure. Yeah, I mean, I've written a lot of books. So The Broken Mirror and then an updated version Understanding Body Dysmorphic Disorder, sort of a textbook that's more for professionals. In 2017, I have a website. People want to come check out my website. It's Katherine, K-A-T-H-A-R-I-N-E, Phillips, two L's.

MD at.

MD.com. Yes, I should know the address of my website. I've published a lot in scientific journals also. Check out the Merck manual. It's free online. And you can read about body dysmorphic disorder and other related conditions. So yeah, there's a lot, lot I've written that's out there, other interviews with people like you on YouTube and other places. So

And thank you for doing this interview because it really helps to get the word out that this is a common and treatable problem. So I appreciate that.

Tim Doyle (01:07:27.424)

Awesome, yeah, it's been great speaking with you today and I really enjoyed the conversation.

Katharine Phillips (01:07:31.864)

Thank you.