Read about upcoming changes to UnitedHealthcare coverage.
Women have long been subjected to unrealistic standards of beauty and intense pressure to attain them. But apparently, men have been experiencing similar pressures and taking extreme measures to live up to some physical ideal. It’s called “looksmaxxing”—that is, maximizing one’s appearance.
And it isn’t new. The phenomenon has to do principally with building muscle. Decades ago, there were television ads depicting a “97-pound weakling” and a bodybuilder’s remedy for that lamentable state. In the age of social media, however, the obsession with muscularity has reached a whole new level, even affecting very young boys. Increasingly, looksmaxxing has targeted other aspects of appearance as well, pressuring boys and men to take extraordinary measures to look better.
Dr. Katharine Phillips, Professor of Psychiatry, DeWitt Wallace Senior Scholar and Attending Psychiatrist at Weill Cornell Medicine, is uniquely qualified to provide insight into this worrisome trend.
Here are the main questions she’ll address below:
Is looksmaxxing a type of body dysmorphic disorder (BDD)?
In some cases, says Dr. Phillips, looksmaxxing in boys and men overlaps with BDD. To understand that overlap, she explains the telltale characteristics of BDD—a serious mental health disorder whose sufferers need mental health treatment to overcome it.
“People with BDD have a distorted body image. They worry that there’s something wrong with how they look. To other people, they look normal or even attractive, but those with BDD are preoccupied with their nonexistent or slight flaws: thinning hair, a big nose or bad skin, for instance—or their insufficient muscularity. That’s called muscle dysphoria.”
People with BDD typically obsess about these perceived flaws for at least an hour a day. On average, they spend 3 to 8 hours a day thinking about them and engaging in compulsive behaviors, such as repeatedly checking their appearance in mirrors, excessive grooming, taking lots of selfies or seeking reassurance at every opportunity.
Importantly, for a person to be diagnosed with BDD, their obsessions must cause significant emotional distress or impairment in functioning. This helps to differentiate BDD, the psychiatric disorder, from common, non-problematic concerns with appearance that so many of us experience.
“Looksmaxxing is probably a risk factor for BDD, but the precise relationship between the two hasn’t been studied,” she says.
Her conclusion, based on her clinical experience? Looksmaxxing can morph into BDD when it:
Softmaxxing vs. hardmaxxing
If looksmaxxing takes the form of working out, getting regular haircuts or eating healthy food, that’s called “softmaxxing.” By contrast, “hardmaxxing” involves extreme and dangerous behaviors, Dr. Phillips says. “These may include bonesmashing—repeatedly hitting the cheekbone or jaw with a blunt instrument in an attempt to reshape it—and using anabolic steroids and other potentially dangerous drugs to build muscle and lose fat.”
Dangerous behaviors
Bonesmashing is obviously harmful, and taking anabolic steroids can be even more so. Here’s why.
Anabolic steroids are muscle-building substances that include testosterone and their synthetic equivalents. They carry serious psychiatric and medical risks, she says. These include increased risk for:
Over the longer term, they increase a person’s risk for cognitive impairment, heart attack and, probably, stroke.
Some looksmaxxers use a steroid that’s not even intended for human use. It’s called trenbolone, and it should be avoided at all costs, she adds. As well, drug use doesn’t always stop with steroids. Boys and men may turn to other medications to build muscle and lose fat, including human growth hormone, amphetamines, diuretics, thyroid hormones and insulin. When used appropriately to treat medical conditions, these medications are often helpful, but their use is problematic and potentially harmful when used for looksmaxxing.
Why, you may well ask, would someone expose himself to such well-documented harms? Because these harms are often downplayed, Dr. Phillips says—especially online.
Looksmaxxing and the internet
Looksmaxxing has skyrocketed in recent years, fueled, at least in part, by social media and the rise of the manosphere, along with the belief that a man’s appearance is the alpha and omega of his social and romantic worth. Online dating may play a role as well, with its emphasis on photos rather than personality traits and other attributes, she hypothesizes.
“In addition, social media algorithms circulate extreme and unattainable physical ideals that hold people’s attention and can make them feel they’re not good enough. While many forms of social media are benign or even exert a positive influence, some of these platforms encourage dangerous activities such as extreme dieting and self-harm in pursuit of looksmaxxing.”
Effective treatments for BDD
There are two types of treatment that have been proven effective for BDD, including the muscle dysphoria variant of the disorder.
The first is a class of medications called serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac) and sertraline (Zoloft). High doses are often needed to treat BDD effectively.
SSRIs are usually well tolerated, and they aren’t habit-forming, Dr. Phillips says. But if an SSRI alone isn’t enough to downsize a person’s BDD, other medications, such as aripiprazole (Abilify) or buspirone, can be added to boost its effects.
Cognitive behavioral therapy (CBT) is the second treatment that has proven effective for BDD. It’s a practical form of therapy that teaches the skills people need to change the problematic thoughts and behaviors seen in the disorder.
“Medication and CBT also work very well together,” she says.
One more important point: Cosmetic treatment isn’t recommended for BDD. It almost never improves the disorder and can even make it worse.
A psychiatrist’s best advice
If looksmaxxing is a symptom of BDD, it needs to be treated accordingly. But if a boy or man at any age is engaging in looksmaxxing but doesn’t have BDD, the following advice from Dr. Phillips may help:
Make an appointment with a mental health professional by visiting Weill Cornell Medicine’s Psychiatry website or by calling (646) 962-2820.
