Episode 248: On this episode of Real Health Radio, I'm chatting with Dr. Roberto Olivardia. We speak about ADHD, both in its connection to eating disorders and more generally. We also talk about his book The Adonis Complex, covering muscle dysmorphia and eating disorders in boys and men.
Dr. Roberto Olivardia is a Clinical Psychologist, Clinical Associate at McLean Hospital and Lecturer in the Department of Psychiatry at Harvard Medical School. He maintains a private psychotherapy practice in Lexington, Massachusetts, where he specializes in the treatment of attention deficit hyperactivity disorder (ADHD), body dysmorphic disorder (BDD), and obsessive-compulsive disorder (OCD). He also specializes in the treatment of eating disorders in boys and men.
In addition to his clinical work, Dr. Olivardia is an active researcher. He is co-author of The Adonis Complex, a book which details the various manifestations of body image problems in males. He is on the Scientific Advisory Board for ADDitude Magazine, a publication serving the needs of individuals with ADHD and Learning Disabilities, as well as sits on the Professional Advisory Boards for Children and Adults with ADHD (CHADD), the Attention Deficit Disorder Association (ADDA), and is a Featured Expert for Understood. He presents at many conferences, podcasts and webinars around the country.
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Chris Sandel: Welcome to Episode 248 of Real Health Radio. You can find the show notes and the links talked about as part of this episode at www.seven-health.com/248.
Before we get started, I just want to mention that I’m currently taking on new clients. I specialise in helping clients to overcome eating disorders and disordered eating and chronic dieting, body dissatisfaction and poor body image, exercise compulsion and overexercising, and also helping clients to regain their periods. If you want help in any of these areas or you simply want to improve your relationship with food and body and exercise, then please get in contact. You can head to www.seven-health.com/help, and there you can read about how I work with clients and apply for a free initial chat. The address, again, is www.seven-health.com/help, and I’ll also include that in the show notes.
Hey, everyone. Welcome back to another episode of Real Health Radio. I’m your host, Chris Sandel. I’m a nutritionist that specialises in recovery from disordered eating and eating disorders, and really just helping anyone who has a messy relationship with food, body, and exercise.
Today’s show is a guest interview, and today’s guest is Dr Roberto Olivardia. Dr Olivardia is a clinical psychologist, a clinical associate of McLean Hospital, and a lecturer in the Department of Psychiatry at Harvard Medical School. He maintains a private psychotherapy practice in Lexington, Massachusetts, where he specialises in the treatment of attention deficit hyperactivity disorder (ADHD), body dysmorphic disorder (BDD), and obsessive-compulsive disorder (OCD). He also specialises in the treatment of eating disorders in boys and men.
In addition to his clinical work, Dr Olivardia is an active researcher. He is co-author of The Adonis Complex, a book which details the various manifestations of body image problems in males. He’s also on the scientific advisory board for Attitude magazine, a publication serving the needs of individuals with ADHD and learning disabilities, as well as sits on the Professional Advisory Board for Children and Adults with ADHD, the Attention Deficit Disorder Association, and is a featured expert for Understood. He presents at many conferences, podcasts, and webinars around the country.
I was first made aware of Roberto through Julie, a client of mine. She shared a podcast episode of him talking about eating disorders and ADD. When I looked him up, I saw that he was also the co-author of The Adonis Complex, which was a book I’d heard referenced many times over the years. So I got the book, I really enjoyed it, and I reached out to Roberto to ask him to come on the show.
I go through in the intro what we’re going to cover, which is eating disorders and ADD and also The Adonis Complex. We actually cover ADD in great detail, both with its connection to eating disorders but also more generally with how it manifests and the various symptoms. Despite ADD being one of those things that has entered into the mainstream awareness, I do think that there are many people who have this but have never received a diagnosis, or they discover it in their thirties or forties or fifties. So hopefully you can hear many of the aspects and see if it resonates with you, because as I talk about in this episode, I’ve had a number of clients discover later in life that they have ADD, and it starts to explain a lot for them.
I would also add the same with autism, where there is a much higher percentage of eating disorders with autism compared to the general population and it’s definitely something that I want to cover on a future episode.
One thing I will add connected to ADD is that it’s very much on a continuum. With each of the different aspects that can be impacted, whether we’re talking about impulse control or concentration or executive function or hyperactivity, these can look very different in different people. So while Roberto talks about his experience and the experience of his kids or different clients, know that experiences can really vary.
As part of The Adonis Complex, we talk about eating disorders in boys and men, specifically muscle dysmorphia and a little bit about anorexia, as well as talking about the media messaging and social media and how this is impacting on men and boys.
So let me stop with the intro and get on with the show. I’ll be back at the end with one recommendation, but for now, here is my conversation with Dr Roberto Olivardia.
Hey, Roberto, thanks for joining me on the show today. I’m super excited to be chatting with you.
Roberto Olivardia: Oh, it’s my pleasure, Chris. Happy to be here.
Chris Sandel: When I was doing the prep for this and trying to figure out what to talk about today, it’s been quite a challenge, and that’s because you are someone who has so much expertise in a real wide variety of areas. But what I thought would be best for today was to stick to just a couple of topics where I know there’s still a decent amount of breadth in them.
Both of these topics aren’t ones I’ve covered – either I haven’t covered at all on the show, or I’ve touched on them very briefly. The first is ADD and its comorbidity with eating disorders – something I know you have a huge amount of experience in – and then the second topic is The Adonis Complex, which is the name of the book that you co-authored over two decades ago. In this, we can then chat about the many ways that eating disorders and body obsession affect boys and men. So they’re the two main buckets that I really want to have a chat about, but this is a conversation, so let’s just see where things go naturally.
Roberto Olivardia: Sure. That sounds great.
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Chris Sandel: As a starting place, do you want to give listeners a bit of a bio of sorts? I know I’ve already made reference to your vast areas of interest and expertise, but just tell listeners your background in terms of training you’ve done, areas you work in, and how you came to be doing what you’re doing.
Roberto Olivardia: I am a clinical psychologist and lecturer in the Department of Psychiatry at Harvard Medical School in Boston, Masschusetts. I have a private practice where I specialise – I work with people of all ages, kids as young as seven and eight up to adults in their sixties – on a variety of issues.
One of my areas of specialty, as you mentioned, is I work with boys and men with eating disorders and body image disorders, like body dysmorphic disorder. I also specialise in the treatment of obsessive-compulsive disorder (OCD) as well as individuals with ADHD, attention deficit hyperactivity disorder. I also work with a lot of students who have learning disabilities and work with more socioemotional issues that can come along with that – self-esteem issues, anxiety, depression, identity issues around how to navigate through school, and work for the adults that I work with.
I also am a researcher and have done research primarily in the field of boys and men with eating disorders, and that culminated in a book. It’s funny; when you said two decades ago, I thought, oh my gosh, it has been two decades. It feels like it was yesterday. [laughs] The Adonis Complex, which I co-authored with Harrison Pope and Katharine Phillips, which came out in 2000, which blows my mind that it was that long ago. That is a book that details all the various manifestations of body image issues that we see with boys and men. Basically everything that has been researched and talked about with girls and women, things like anorexia, bulimia, binge eating disorder, body dysmorphic disorder, cosmetic surgery, we have done areas of research looking at all of those issues with boys and men.
And then I also do a lot of advocacy work. Advocacy for kids with learning disabilities. I have ADHD, and I have kids with ADHD and dyslexia, so I definitely come from a personal perspective of that as well as a professional one. And then on the side I have my family. I’m a big music lover, so if I wasn’t doing this, I’d probably be doing something in the music industry. [laughs]
Chris Sandel: Music lover and you play different instruments?
Roberto Olivardia: I used to play the drums, and actually when I was in high school, I horrified my parents by telling them, “I’m not going to go to college” – because I hated school prior to college. After college, loved it. Loved college and loved my PhD programme. But yeah, prior to that, school was just really boring and not fun, as it is for, unfortunately, a lot of people with ADD and learning issues. So I said I was going to play drums in a punk band. [laughs]
Then, thankfully, I took a psychology course my senior year of high school and that changed everything. I thought, “Oh, this I love.” Academically, it made me actually want to do all of my homework, and suddenly it shifted for me. But yeah, now everything’s on Spotify, but I have a collection of about 3,000 CDs. I’ve been to hundreds of concerts. I like all kinds of music. It’s like part of my DNA, music.
Chris Sandel: Nice. I’m a huge music fan as well. As I’ve got older, I spend less time actually at music festivals or going to venues, but my day is spent listening to music the whole time I work. Maybe once we stop recording we can have a bit of a chat about music.
Roberto Olivardia: Absolutely.
Chris Sandel: I don’t know how relevant it is for the listeners, but yeah, that’s cool to hear.
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What was it about psychology when you found it in that latter part of school? Was it then being able to understand yourself and starting to make sense of it, or more broadly than that?
Roberto Olivardia: I grew up in a family where I feel like my mom in particular, if she had the resources and privileges that I had growing up, that my parents afforded me, would’ve absolutely been a psychologist or a social worker. She grew up in Brazil in poverty, immigrated here to the States in the ’50s. But she was an incredibly empathic, very caring person. Like the kind of person where it was just so common when I was a kid, if we walked by a homeless person, she would go into the local sandwich shop the buy sandwiches for them. Literally give the coat off her back, literally, to people.
And my dad was a teacher. Very sensitive, caring person. So I always grew up with the sense of having empathy for other people and really feeling people’s perspective. And I was always that kid that all people would come to and tell their deepest secrets. I was always very trusted, and people thought I gave good advice.
But I know being a psychologist is more than just being an advice-giver to a couple friends. I think what drew me is that – I always knew that I had that part of me, but music for me was all about that, too. Music is about emotion and connection and, for me, being empathically connected. But I think with psychology, the fact that it was this academic discipline – it was like, wow, this could really help me understand people, understand myself, understand just what makes the world tick. I couldn’t get enough of it. It was the first class that I actually read more than what was assigned. [laughs] Which was already a big indicator. I got through high school, I never read a book that was assigned from cover to cover. I was the master skimmer.
But I was just enthralled. I couldn’t wait to go to class. I was just so hyper-focused, and I thought, this is taking something that is a part of who I am anyway, in terms of my values and sensibility, but putting this more academic discipline on it that could really take this to another level, and I could really do something with this and make an impact and feel good. I always wanted to be a positive force in the world. My value was always to elevate people.
And music, again, was definitely in that venue. That’s what music did for me. So to me, psychology and music were not that big of a jump in my mind. Just obviously, from making a living, it’s a lot easier path to know what to do to be a psychologist and to go through grad school and everything, whereas obviously being – I mean, anyone can be a musician, but to be one – not that I ever wanted to be famous, but to have enough of a following that you can make a living from it was going to be harder. I wasn’t a great musician. [laughs] It’s not like I was this prodigy or anything. I think that’s why punk music appealed to me so much as a teenager. You didn’t really have to know how to play. [laughs]
Chris Sandel: When you started psychology or even towards the end, what did you think would be your area of specialty? What did you think you would be helping people with?
Roberto Olivardia: That’s a good question. One of the things that’s so interesting as I think back is initially I was very much drawn to trauma and the issue of trauma. I remember watching when the Oprah Winfrey Show was on the air and really big and Oprah’s experience of child sexual abuse, and I have a part of me that’s very justice-oriented – this sense that when bad things happen to good people, it really, on a molecular level, pains me. And that’s been ever since I was a kid, when I first understood what slavery was and when I learned about the Holocaust. It deeply, deeply, profoundly would upset me.
So there was something about that, saying, okay, when someone goes through something like that, like trauma, how do we help them heal from something? And I would be inspired by people. I knew people in my life who had gone through that, and that you can heal from that. And the resilience. That’s what I focused on, that wow, no matter what happens – and this is what I also got from reading Ellie Wiesel’s Night book of Holocaust survivors who go through this unspeakable trauma. How do you smile after something like that? How do you really feel gratitude towards the warmth of the sun? I would be so inspired by how people can get through that and the human spirit to really be resilient.
So that really attracted me to working with kids, particularly kids who have been abused and traumatized. So that was really, as an undergraduate, where my track was and where I was going to go. And I do work with people with trauma, but that’s not a specialty of mine.
What is so wonderful about life, and I think a field like psychology, is it can take you in different directions. It was my junior year as an undergraduate at Tufts University, where I went to college, where I took a seminar in eating disorders class. It was a three-hour block. It met once a week; it fit my schedule. It’s not like I had this profound interest in eating disorders. But it was interesting enough. I liked the idea, because I’m such a lover of popular culture and music and film and stand-up comedy and just pop culture, and eating disorders, I thought, that’s an interesting thing. Here’s a psychiatric illness that has certainly these biological perspectives, but it’s one of the few that really intersects with popular culture in terms of media imagery and body image and all of that. So I thought this would be an interesting class.
And it literally shifted the whole trajectory. I loved that class. As my final paper – now interestingly, while I was taking that class, two guys that I didn’t really know too well – but this is a common experience for me. Even people I didn’t know too well would just, in conversation, trust me. I feel very grateful that people can do that, because I’m definitely a very trustworthy person. I don’t spill any secrets. And they had disclosed to me – now, they didn’t know each other. They were just these two independent individuals who disclosed to me that they had an eating disorder. One was anorexia and one was struggling with bulimia. I thought, oh okay.
For folks who weren’t born before the internet, there was this big book called the Yellow Pages, and the Yellow Pages was this directory of businesses and services. You can look up plumbers, you can look up psychologists, you can look up whatever in the Yellow Pages. I remember going through, trying to help them find resources, and all of the resources that were for people with eating disorders were all exclusive to women. They didn’t service guys. I thought, oh, we need a space for men who have these problems, because these guys were really suffering. They were really struggling.
So I did my term paper on men and eating disorders, and that started a whole new trajectory. I thought, let’s continue with this. And I was off to the races after that.
Chris Sandel: So then as soon as you started working as a psychologist, it was from the get-go as men/boys’ eating disorders?
Roberto Olivardia: Yeah. In my PhD programme – as an undergraduate I did a senior honours thesis where I had recruited college men around the Boston area who had eating disorders, and that was the first study I did. Interestingly, I didn’t know at the time, it was the first study that had ever been done with males with eating disorders that had drawn them from a community sample. Up until that point, all of the research – and there wasn’t much, but the research that had been done on men and eating disorders were drawing from clinical samples, or men who had been hospitalised or had entered treatment, which, as we know, represents a small percentage of men at large who struggle with eating disorders because it’s still stigmatised with men.
So that was really interesting, and then throughout graduate school, continuing to do research on men with eating disorders. Then I would start to look at men who had something that at the time we didn’t have a name, so we created this name called ‘muscle dysmorphia’, which is actually now mentioned in the DSM-5, which is pretty cool. And muscle dysmorphia was men, some of whom had a history of anorexia, but now were almost – the pendulum swung in the other direction where they were just as obsessed with food and their body image, but they were obsessed with getting muscular and big.
These were guys who might be working out 5-6 hours a day, taking anabolic steroids, paying extreme attention to their diet. Unlike anorexia, they were eating, but they were incredibly obsessive-compulsive about their eating. And guys who did not like the way they looked, despite the fact that they were muscular. They feared that they looked too small, too scrawny. We called that muscle dysmorphia. So that was my master’s thesis, and then my PhD, going back to what average guys feel about their body image and what their ideals are.
And then when I started in clinical practice, I had training working with all different individuals. I trained at one of the top psychiatric hospitals here in Boston, McLane Hospital, which is affiliated with Harvard Medical School, and really worked with OCD and depression, with anxiety, individuals who were suicidal. But clinically, I thought this is a niche of individuals where there really wasn’t anyone specialising in men. So that was the majority of patients at the beginning. It’s morphed as I started taking on other things that I specialise in.
Chris Sandel: Just to get a sense of when this was, when did you do that study? When were you starting to become a psychologist? What year was that?
Roberto Olivardia: When I did that undergraduate thesis of college men with eating disorders, that was in 1993 I started that. And then that was published in the American Journal of Psychiatry in ’95. That was the first research study I did. Then Adonis Complex came out in 2000. That’s when I got my PhD, in 2000. And then after you get your PhD you have to do what’s called a postdoctoral fellowship, which I did more research on body image with men. And then in 2002 I started my practice. So it’s been 20 years, actually, this May, I’ve been in clinical practice.
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Chris Sandel: When did the focus with ADD and eating disorders come in?
Roberto Olivardia: That’s interesting. I have ADHD, and ADHD is one of those things that is still very misunderstood, and how we understand it has evolved tremendously. I’m going to be 50 this year, and when I was a kid, the only kids that were diagnosed with ADHD were kids that were burning the school down. [laughs] They were the kids who were seen as the juvenile delinquents and conduct disorder kids and kids that were at high risk of dropping out of school. Some of those kids were my friends. They were very mischievous.
Chris Sandel: You were into punk rock. It makes sense.
Roberto Olivardia: Yeah, exactly. They were fun. Who wants to be bored? But I wasn’t that kid. I didn’t have conduct disorder or whatnot. But I definitely was not a goodie two shoes, either. Now, we understand with ADHD that it’s not just that. That only represents maybe 10% of people with ADHD. It’s this issue of attention dysregulation, of impulsivity. Some people are hyperactive, but not all. It can manifest in different ways for different people. Executive functioning issues, things like time management and procrastination, organisation, decision-making, all of these things that impact people with ADHD that were difficult for me.
Although I did well enough in school that I got into a college like Tufts, which is seen as a good college to get into, literally I would write papers overnight because I would procrastinate on them. It was chaos behind the scenes. I was chronically bored in high school. I mean literally virtually narcoleptic, where I would be falling asleep. I just think if I grew up with iPhones, my friends would’ve had a field day of videos and TikToks and memes of me literally looking like I was stoned out of my mind.
I actually had a history teacher my junior year – I couldn’t keep my eyes open. I mean, drool down my face. And he kept me after class. Which I knew. I’m like, of course he is. I’m totally out of it. And he started lecturing me on the dangers of quaaludes and cannabis. [laughs] I’m thinking, where is he going with this? And then I realise, oh, he thinks I’m stoned. I said, “Oh, no, I’m not.” I didn’t have the heart to tell him “I’m just bored out of my gourd.” I just said, “I didn’t get a lot of sleep last night.” But I don’t blame him for thinking that.
I actually thanked him, because the way he was talking to me about it was so nice. If I really was on drugs, that was the nicest way to approach it, the way he was talking about it. But it was really, really hard. Even when I think of it now, seven or eight hours or however many hours you’re in school in a day was just – ugh. The social part saved me. I was a bit of a class clown, and I had funny friends. That’s probably the number one factor of who I gravitate to, funny people. I just love to laugh. So that really kept it going.
But ADHD also can play out – we think of it typically in an academic arena, but it’s really in the overall life arena that it can impact people. Because again, as I mentioned, those executive functions can play out in anything. So even though that was always an area that I kind of worked in, when I started working with a lot of men in practice, and particularly men with bulimia and binge eating disorder, it was very clear – a lot of them had already been diagnosed with ADHD; most had not been diagnosed with ADHD. It was through our work. I said, “It sounds like there’s something else here going on” and I would do a clinical evaluation, and it was very clear that there was this high comorbidity of ADHD and these issues.
Which I can personally understand. I used to joke in college, I used to say I would ‘procrastin-eat’. I if was procrastinating on writing a paper, I’m like, “Let’s put that aside and let’s order some chicken wings.” People with ADHD, basically what we know about the ADHD brain is that it’s low in a couple neurochemicals. One of them is dopamine, which is implicated in reward, and another one is GABA. GABA is implicated in inhibition. When you have an appropriate amount of GABA, you are appropriately inhibited. Well, an ADHD brain has low GABA, which means we’re less inhibited, we’re more impulsive.
I have these examples that come out in my mind of being 10 years old at a birthday party and there was all this pizza left over, and my friend’s mom saying, “Guys, eat the rest of this pizza. I don’t want to waste it.” Granted, we ate a lot. But in between, we’re playing video games and such, and one of the kids said, “Oh, no, I’m full”, and I thought, “Oh, you didn’t like this pizza?” He’s like, “No, I’m just full.” I’m thinking, I love pizza. Pizza’s my favourite food. It didn’t even occur to me – I’m like, wait a minute, if you love pizza and it’s in front of you, why wouldn’t you eat it? The idea that people would tune into their hunger cues, that’s harder for people with ADHD because we’re so externally oriented. We’re almost addicted to stimulation.
So I can understand how easy it can be to fall into having access to food, not to mention all of the things around self-soothing, stress relief. And of course, when people are binging, they’re binging on typically high sugar, high fat, simple carbs, things that elevate dopamine in the brain. I don’t know people that binge on broccoli and kale. [laughs] I’ve never seen that yet.
And this is what I love about this field of psychology. I thought, we need to really get into this. I started giving more and more talks about ADHD in eating disorder communities and helping people see this comorbidity and this relationship, and started doing a lot of work in that area. I work with ADHD in a number of other – ADHD in substance abuse, ADHD in OCD, ADHD by itself. But particularly with that comorbidity because I have the specialisation in eating disorders, which most experts in ADHD don’t, and the fact that I really can understand the ADHD.
Without that understanding, ADHD has the potential to undermine the treatment of anything else that somebody might be having, particularly an eating disorder.
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Chris Sandel: When did you get your diagnosis? When you did get it, was it a real shock, or you’re like, “Oh, everything now makes sense”?
Roberto Olivardia: It was a funny evolution. Anyone who is probably over the age of 30, I would say –
Chris Sandel: I’m 40, just so you know.
Roberto Olivardia: Yeah. Anyone who’s over the age of 30 who has ADHD – it’s funny when you ask them about diagnosis. A lot of older adults were diagnosed when their kids were, because again, what we know about it is so much more now that a lot of times when I’m working with a kid or a young teen – and ADHD is highly genetic. Very, very genetic. So it’s unlikely if you have ADHD that you won’t have a biological either parent, usually, but if not a parent, sometimes an uncle, aunt, first-degree relative with ADHD. So a lot of times parents are like, “Hmm, that sounds like me” and then they start to realise, “Oh wait a minute, this is me.”
So it wasn’t a big shock. I think I officially got the diagnosis at 31. I know it was before my son was born. My son is 17 now. So I was probably in my early thirties, and honestly, I kind of went knowing. I just wanted to have somebody else hear the data, hear the information, do the evaluation. But it wasn’t a shock. If anything, it was very validating, and it was incredibly helpful because now, when I read research and I read stuff about ADHD, you realise how fundamental and foundational it is for people with ADHD. It’s more than just “I have trouble focusing.” Everything from sleep problems, sleep disorders that I’ve had – which are very common for people with ADHD. Impulsive spending. People with ADHD have quadruple the risk of any addictive behaviour. That could be drugs, alcohol, food, sex, porn, gambling, shopping. You name it. So in some ways, our job is to try to find a healthy ‘addiction’, so to speak. Music is definitely one of mine.
Even in graduate school – and this has to change – something that affects 8-10% of the population, you’d think we’d learn a lot about. And frankly, I didn’t. And that wasn’t anything reflective of just my programme. This is true when I ask colleagues of mine in psychology PhD programmes. I learned more about schizophrenia, which affects 1% of the population. And I should learn about schizophrenia, but relative to something like ADHD, which affects 8-10% of the population, I learned very little about it. And the little I learned, I thought, okay, ADHD people are likely to become addicts, drop out of school, end up in jail. They’re all the ‘bad kids’. I didn’t relate to that.
And at the same time, I loved mischief. I was a very mischievous child. I used to call them ‘shenanigans’. [laughs] I liked my shenanigans. People I think thought at times – I mean, unless people got to know me – I was a lot more innocent than I was. I always knew I had this mischievous streak. Even when I would be falling asleep in class – I consider myself bright, and I’m very strategic. I could get by. But again, even in high school, I never read a book that was assigned to me. But I would skim it. I’m just very good at getting the big picture of things.
I think that’s probably, honestly, a compensating factor, because I could not sit. My daughter is a ninth grader now and she’s reading Shakespeare. She’s like, “Dad, this is just brutal.” I’m like, “Oh yeah, you’re telling me. At least you’re reading it.” [laughs] Because I couldn’t. I would literally read a paragraph and then I’d try to predict what ended up happening in the story. And I was often pretty on point. I think this is where my psychological-mindedness really helped me, because I would just make guesses as to what characters would do. I was right enough some of the time. Sometimes I was totally off.
But it was just very difficult to relate to it, until probably on my own, after grad school, through patients that I worked with who would have ADHD – they would primarily come in maybe for depression or an eating disorder or something, and I would then delve into the books about ADHD. I thought, this is very familiar. And it wasn’t, for me, this epiphany as much as feeling almost like finding a glove and just putting it on your hand. It’s like, “Yeah, this fits. It’s good.”
But what I love about working particularly with that population is it is and can be a huge epiphany for people when they hear that and really connect the dots, and most importantly, for me, at the end of the day, part of my own personal life mission is I never want people to feel less-than. I want all of us to live our lives authentically and feeling value, whether we’re talking about ADHD, eating disorders, any mental health issue, neurodiverse condition. Just to take away any of the shame and the ‘I’m stupid’ language that can befall a lot of people with learning disabilities or ADHD, and then say, “Oh okay, this is what it is, these are strategies, and most importantly, I can be successful. I don’t have to end up in jail because of this.”
Chris Sandel: Totally. I’ve had similar experiences with clients who then discovered that they have ADD or ADHD or discovered they have autism. And this is when they’re in their thirties or forties or fifties, and they’re suddenly like, “Oh okay, now so much of this makes more sense to me.” Yes, there can be some level of shellshock with that or there can be some regret of like “Why didn’t I find this out earlier?”, but often there is a lot of gratefulness, like, “Oh, now things start to slide into perspective. This makes more sense.”
To touch on something you mentioned before in terms of schizophrenia and how small of the population it touches, I think the same thing about eating disorders. Tere’s such a big focus on, for example, diabetes in young kids. And if you look at how much that affects young kids versus eating disorders, it pales in comparison. I do just worry about where we put a lot of the focus, and then the impact that focus has.
Roberto Olivardia: Absolutely. With my kids, in their health class, I remember when they were in middle school and we got the curriculum, the outline of the things that would be covered in health class, and they did have a bullet point around body image, which I thought was great. I emailed them and said, “Are you going to be talking about eating disorders?” Body image certainly could be part of it, but just in terms of healthy eating and eating disorders.
I think sometimes schools in particular might shy away from that because – and I get it. On one hand, they don’t want to give people ideas in some ways, and at the same time, I do think it’s important – there is a way to talk about it, in the same way we talk about substance abuse. We don’t need to be giving people all the ideas of “Oh, and this drug does this awesome thing to your brain and this drug…” We don’t talk about it that way. We say, yeah, people who take this particular substance do it because it makes them feel great in the moment, but this is what it’s actually doing to their body and to their brain.
I think we have to navigate that space better. And I agree with you; I felt so grateful that my college had a whole course on eating disorders and that I had this seminar of really learning – and it was a very interdisciplinary course where we learned about the brain and what happens to the brain when we’re starving ourselves, and what happens to our oesophagus and our heart when we’re binging and purging. Then we would talk about the social elements of it, we would talk about the historical aspects of eating disorders, how there are accounts going back to the 1600s of women and restricting and anorexia, and athletes with eating disorders.
I felt very grateful because when I talk about that, people are like, “Wow, you had a whole course on it.” And I think that has to be offered more in colleges, in med school. For a lot of physicians, when I give talk to physicians about eating disorders, I hear the feedback all the time from them that they say they get very, very little to no training on eating disorders. They said, “We really should, because this is obviously something” – I mean, you’re talking about a psychiatric illness that has wide intersection in the medical landscape as well. So yeah, I couldn’t agree more.
00:41:33
Chris Sandel: I want to talk a little more in detail about ADD and eating disorders and what makes them more likely. It might be easier to split this up in terms of looking at eating disorders that might be thought about more as impulsive versus more restrictive. From hearing you on other podcasts talk about this, and from reading up on other things you’ve said, it feels like they can be slightly different, so I think it would be useful to tackle them separately.
Roberto Olivardia: Yes, and I agree. I think there is a very different psychology with people who generally are more in the compulsive, restrictive, anorexia spectrum versus the more impulsive, bulimia, binge eating. And of course there are people that can be anorexic with binging and purging symptoms, and certainly a lot of people I work with with bulimia have periods of massive restriction and fasting.
With ADHD in particular, the higher comorbidity will definitely be in the more impulsive eating disorders, so with binge eating disorder, bulimia. I have worked with people with ADHD and anorexia, which I can speak to as well.
When one understands ADHD, it completely makes sense why this could be an issue for people with ADHD. As I mentioned, just at baseline, we have an under-stimulated brain that’s low in dopamine. I think of ADHD as this orientation, really, of “I am oriented to my environment by what is going to stimulate me.” Now, keeping in mind that everything that’s pleasurable is stimulating; not everything that’s stimulating is pleasurable. That means we can be oriented towards danger, towards risk, towards conflict, towards drama, because those are all stimulating things.
I now in my life look back at my younger self and think, “Oh, okay, darn, what was I thinking?” I did some very impulsive things that were dangerous. But at the time, it’s almost like you’re not even thinking about that because what you’re seeking is the fact that you’re feeling grounded in being stimulated and being focused.
So for any parents out there that might be listening to this, if they have a kid with ADD and they think, “Oh my gosh, what were you thinking?” – understanding that this is part of the neurobiology of it. And it doesn’t mean that your kid is free to do these wild things, but at least there’s an understanding of “Oh, okay, this is what it is; now how do we work with it?”
But when I was four, I remember cutting the cord of a fan that was on because I asked my brother, “What makes the propellers in a fan work?” He said, “When you plug it in, electricity comes from the wall and it powers the motor.” I thought, “Okay.” I’m the youngest of three kids, and when you’re the youngest of three, no one’s really supervising you. [laughs] My parents were tired by the time I came around.
Chris Sandel: I have some friends who have four kids, and I definitely think of their fourth child as the forgotten child.
Roberto Olivardia: Yeah. My brother and sister are six and five years older than me, so I was definitely the baby. And no fault – I have wonderful, wonderful parents, but they were tired, and I was definitely the one that gave them the biggest run for their money. It was obvious. Even at four. So I remember my brother walked away and I’m like, “I want to see what electricity looks like. What is this thing called electricity?”
I got a pair of scissors, and I didn’t shut off the fan, and I was hacking away at this cord. I snapped it, and I got an electric shock and thought, “Okay, I guess that’s what electricity is” and just put the pair of scissors down and walked away. I remember an hour or so later, my mom being like, “What” – she was apoplectic. “Who cut the cord of the fan?” I said, “Oh, I did. I just wanted to see what electricity looked like.” It was like, oh lord, here we go. And that was just the sign of things to come. [laughs]
So I think when you understand that need for stimulation – food is very stimulating. Anything that’s sensory, people with ADHD really seek sensory input. Food, you smell it, you taste it, you see it, you feel it. It just appeals so much to that. And particularly, again, foods that are high in sugar and fat and simple carbs are just really lighting up those dopamine receptors in the brain, to the degree that a lot of patients of mine with ADHD will say they feel like they’re addicted to sugar. Sometimes they’re told, “No, you can’t be addicted to sugar”, but they really feel that. They feel that without it, they’re almost going into withdrawal.
So there’s that biological piece. Then there’s the executive functioning piece. Even for healthy eating, if you think about it, healthy eating requires pretty good executive functioning. If I want to eat healthy, that means I’m probably going to have to do some amount of meal planning. If I want to eat at 5:00, I should be thinking about what I’m going to eat maybe hours before, because I might have to defrost something, I might have to foresee if I even have said ingredients in the house, I have to maybe manage and chop up vegetables and do all this planning around it. People with ADHD have a hard time with that.
We joke that there are two time zones; there’s the now and the not-now time zone. So if it’s not now, I’m not thinking about it. And then it’s 5:00 and my stomach is growling, I’m hungry, and now I’m in the ‘now’ zone, but the food isn’t presented warmly on a plate, so what do we do? We tend to be like, “We’ll just order out fast food or nitpick and snack on everything else in the household.” So there’s a lot of executive planning in that.
People with ADHD also are at higher risk for anxiety and stress. About 20-30% of people with ADHD experience significant anxiety, and some of that is because of the ADHD. ADHD can create chaos for a lot of people. And food can be a way of dealing with that, of grounding themselves, of self-soothing, bringing their body down, going to sleep every night. Sleep is a very tough issue for people with ADD. I’ve worked with patients whose binge eating actually started as a result of them binging so that they can calm their bodies down enough to almost pass out and go to sleep.
00:49:05
Chris Sandel: I’m hearing you talk about all these things, and then also knowing how common dieting is and attempts at weight loss and all of that – when that is laid on top, it then ramps up all of these things.
Roberto Olivardia: Oh, definitely.
Chris Sandel: If you’re in a place where you’ve dieted, your executive function is even worse. So it wouldn’t be surprising to me that the dieting piece and the culture we’re living in about that just really pours fuel on this.
Roberto Olivardia: Oh my gosh, absolutely. That’s the other piece. People with ADHD, we’re instant gratifiers. We are a prime candidate for those kinds of dietary illusions out there because people want the quick fix in general, but ADHD individuals are at very high risk for that. And I’ve seen that.
That’s where sometimes because of these impulsive eating habits, poor executive functioning, and self-esteem issues – again, unless somebody has had an education or some narrative about their ADHD that is positive, it’s very easy to see – well, one, everyone with ADHD that I know can tell you that at a very early age, they felt different. I definitely had these moments – I remember in second grade, we would have silent reading time where we’d pick a book from the bookcase and we’d all sit down. It was probably 20 minutes that we had to silently read. And I sat there – and I think I also had an undiagnosed dyslexia. Both of my kids are dyslexic. I always hated to read as a kid.
I remember sitting there and looking – I couldn’t even focus for five minutes. In silence? Are you kidding me? I was like, “We’ve got to get this party moving here. This is deafening to me.” Silence was literally deafening. So I remember looking around the room and thinking, “Are these people really reading, or are they pretending, the way that I’m pretending to read? Because I’m not reading this.”
Then, at that moment, there’s a narrative that starts. The narrative could be “Something must be wrong with me. Maybe I’m stupid.” Or frankly, sometimes – and maybe this was a positive defence mechanism – the narrative was, “How are they doing that? That’s so boring. Why would they want to be doing that? Why wouldn’t they want to be out in recess and whatnot?”
I think honestly, a lot of the factors that put me on a better path – not that I was free of all of those critical thoughts, but growing up, my ADHD definitely came from my mom, who was an amazing – she passed a couple years ago, but she immigrated to this country without knowing a word of English and figured it out. She was an incredibly resourceful person. I think growing up, hearing stories when she was a kid of climbing trees and putting her face near a beehive because she wanted to see what a beehive looked like and getting stung by bees [laughs] – it was so matter-of-fact. It was like, okay, that’s what we do, I guess. That’s what the Olivardias do. I don’t know.
And then because I found friends who, most of them – at the time, some of them were diagnosed with ADHD, but definitely now as adults looking back, almost all of them had ADHD. So I felt like, these are the people I really like. We’re having a lot of fun and they’re funny. So it didn’t feel weird. The parts of me that felt different, I didn’t feel less-than because of it in some ways. That’s not to say it was not frustrating at times, where I knew, “This is taking me a lot longer than it should. This is brutal. Why am I waiting for the last minute?” There was definitely a lot of that at play as well.
But I think for ADHD, because a lot of people have those self-esteem issues, food becomes their friend, and it becomes something that honestly functions like a drug. I’ve worked with many men over the years who have a history of substance abuse who have recovered from their history, whether it’s alcohol or heroin, and these are men – most of them had undiagnosed ADHD. When they became sober, they literally lapsed into an addiction to food. Food became the new venue for that kind of addictive behaviour.
It was only when we started to understand the role that ADHD plays that they thought, “Oh, wait a minute, this is kind of the same animal just playing out in a different venue.” Then they would tell me that they were also addicted to porn, addicted to gambling and things like that. They understood, “Okay, this is an impulsivity issue.”
But even with that, every patient that I’ve worked with, as much work and courage that becoming sober is, from drugs or alcohol, every patient I’ve worked with said that to recover from an eating disorder was a whole other level because you have to eat. You can’t abstain from food. In AA, Alcoholics Anonymous, they tell you, “You might not be able to hang out with your friends that were drinking anymore”, but you can’t do that with food. You can’t not hang out with people and say, “I’m not going to hang out with you because you eat.” It’s not going to work that way.
So there are so many factors that when people hear, they think, “This makes complete sense.” And I love disseminating that information to audiences, especially audiences who feel a lot of shame. Particularly people in larger bodies, in bigger bodies, that might feel and have been bullied, discriminated against, made to feel like they have no willpower – which I don’t even like that word. And then when they understand – if this is an understanding, then it’s not just “I’m a ‘pig’” – and I often say the fact is, I meet people who have never eaten a whole large pizza on their own, and that’s weird to me because I have definitely eaten a whole large pizza on my own. [laughs]
I’ve realised in my own experience, I guess that person just isn’t wired that way. It’s very easy for people who are not wired in a certain way – and this is especially true with all kinds of addiction – we moralise addiction in a way that somehow ‘bad’ people are addicts, as opposed to, I guess you’re just not wired that way. Your brain just tells you to stop better, or it doesn’t even tell you to begin. I don’t have that kind of brain. My brain is definitely wired towards this. I have to navigate and be careful, and I tell everyone, I tell my kids, with ADHD, whatever we like, we run the risk of liking too much. That’s for anything. Because dysregulation is a core feature of ADHD, whatever it is. We can be very all or nothing about things.
00:57:12
That’s going to your other question about more restrictive eating disorders. There’s nothing in the literature, but I have definitely worked with patients with ADHD who have anorexia, who have restrictive eating disorders, and for a lot of them it started because they had a binge eating problem, so they massively were overcompensating by saying – because again, we can live in that all or nothing space very easily. It’s that regulation space that people with ADHD have a harder time with. And with food, you have to regulate it. So they started restricting, and it just spiralled from there.
Or people who wanted to lose weight – again, prime candidates for these awful diet ‘programmes’ that don’t work, “Lose 20 pounds in two weeks!” They do it and then they might get the results. Granted, their body is taking a major hit for it, but they almost get addicted to the results, because we love feedback. ADHD individuals need a sense of feedback and impact in that way.
What’s interesting about that is that in treating ADHD, as far as medication – not everyone with ADHD has to take medication or is on medication, but the ones that do, stimulant medication and eating disorders, even amongst binge eating and bulimia, were seen as contraindicated because it could be an appetite suppressant. But for people with ADHD who struggle with these eating disorders, studies show actually it did not suppress it. It really regulated their appetite, so it properly connected them with their hunger cues, satiety cues.
With anorexia, it’s even more controversial because it’s like, these are people whose weight is already compromised. But when I think of a couple cases that I worked with of men who were significantly, severe anorexia and they had ADHD – I don’t prescribe medication, but the psychiatrist I collaborated with, I said, “I wonder if a little bit of a stimulant” – and we did it very carefully, and it really helped the individual. It enabled them to focus on other things other than their food and calories.
Chris Sandel: I’ve worked with someone who was anorexic and also had ADD, and what she found was that actually being in that malnourished state allowed her to focus better.
Roberto Olivardia: Yes.
Chris Sandel: It actually dampened down everything, and it was actually in recovery that she really started to notice all of the ADD stuff that had come back, and that was much more when things felt more chaotic, when she had more troubles staying on task and a lot more of the symptoms that we associate with the ADD came back online, which had been missing for her for 20 years or something along those lines, because that’s how long the eating disorder had been going on. So for her, in some senses, the restriction was the thing that suppressed a lot of the ADD.
Roberto Olivardia: I’m glad you brought that up, Chris, because that absolutely is one of the factors that definitely presented with these men that I worked with ADHD and anorexia. They said there was this function of calming the chaos. They said, “Even if I’m just thinking about food and calories, at least I’m just thinking about one thing or two things.”
And it’s true; when we think of hyperactivity with ADHD, it’s not just a physical bouncing off the walls kind of hyperactivity. One of the other misconceptions is – girls have ADHD as much as boys do, and you’ll still read it in places that say that boys outnumber girls 3:1. That’s not true. Boys may outnumber girls 3:1 in diagnosis of ADHD, but not in actuality of having ADHD. One of the things that has been conceptualised now with hyperactivity, it’s not just a physical hyperactivity but a mental hyperactivity.
So even the kid that looks like they’re spacing out, I know for me, when I was a kid, I could look like I was a zombie looking out the window, but I have a very active imagination. I have a whole inner world playing in my head. Again, I don’t know what’s the chicken and what’s the egg, but I know it very much helped me through a lot of boring situations in which I needed to entertain – if I couldn’t be the class clown, which is disruptive to a class, although my friends would laugh – but if I couldn’t do that – and my intention at that time wasn’t “I’m going to self-stimulate because of ADHD.” I didn’t understand it. All I knew is “I feel like I’m literally fading away, and I need to do something to get me plugged into this”, so I’d blurt something out, say something funny, and find the right moment. I have such a love for stand-up comedy. Even as a kid I used to watch a lot of that, and I appreciated the art of what could make somebody laugh.
But if I couldn’t do that, and I learned at times it’s not always appropriate to that, I had to escape somewhere. I remember in college sitting with a friend – he did not have ADHD, and we were at a bus stop waiting for the bus. There’s this moment of silence and I said, “What are you thinking about?” He’s like, “Nothing.” I’m like, “No, really, what were you thinking?” He’s like, “Nothing.” I was like, “Really? You really had nothing? Nothing? Blank slate?” He’s like, “Yeah, just nothing.”
I have never, Chris, in the 50 years of my life, never, ever had that experience of thinking of nothing. I have multiple things that my head is going through at any given moment. And I always feel like it’s just – to me, it’s as if you’re watching a 3D movie. What’s the thing that’s going to pop out? That’s the thing I’m attending to, but I’m not fooling myself; in the background is other stuff.
And part of that I like. I always want to emphasize, ADHD is not a mental illness. It’s more a neurodiverse condition. I always tell, especially young people, think of it like a coin. There’s the heads and the tails. There are parts of ADHD that obviously we want to treat because it could be frustrating. It can really get in the way of your life. It could wreck your life if it’s not treated, for some people, because it can get them into very dangerous situations. People with ADHD are more likely to suffer from financial issues. They’re more likely to get a divorce. They’re more likely to be addicted to something. You hear all these grim statistics.
And at the same time, I always want to preface on the other side that you see the entrepreneurial field is filled with people with ADHD. Filled with them. A lot of musicians and a lot of creative individuals. I love my brain. My brain is very strategic. I’m a problem-solver. I consider myself very creative. I can attune to people interpersonally. That’s how my ADHD works; not everyone’s ADHD works the same way in that way. So I wouldn’t trade it.
To me, it’s almost like we just have to accept this brain. We want to work at the things that are challenges and don’t come easy, but also understand that that same brain can lend itself – the fact that we’re kind of out-of-the-box as a general rule, well, out-of-the-box thinking is where a lot of the movers and shakers are. Out-of-the-box thinking is what leads to invention and innovation.
However, you need to have that ADHD managed in order to then really connect to those strengths, and that’s the key. A lot of times it’s like, “ADHD is a gift.” Well, it’s a gift only if it’s managed. If it’s not managed, it is not a gift. It can really get in the way of people’s lives.
But all that noise, absolutely, when someone’s in a restrictive mode, they’re quieting all of that down, and that absolutely could be a function.
01:06:29
Chris Sandel: I’m not someone who knows very much about ADD; it’s a fairly new topic to me. I did recently read Gabor Maté’s book Scattered Minds. Is that something you’ve read?
Roberto Olivardia: I haven’t read that book, but I’ve heard good things about it.
Chris Sandel: What he posits is that the thing with ADD, there’s two things that make it likely or make it happen. One, a genetic predisposition for someone who is more sensitive or highly attuned. And when I hear your story, that’s definitely something I’m picking up on.
And then he says there is some failure of attachment with parents at some point in normally early development. He points out repeatedly that this isn’t about blame and that parents and caregivers are doing their absolute best, but the child didn’t receive the attachment that they needed. So a lot of the recommendations as part of that book are focusing on how to repair attachment. So I’m just wondering, is that something that you think about or talk about, or a way that you conceptualise this?
Roberto Olivardia: I would disagree with the second part. Definitely genetic, 100%. If you have ADHD, probably a 70% chance that you’ll have a child with ADHD. It’s as genetic as height and intelligence, which are very, very highly genetic factors. Identical twins, it’s like a 98-99% concordance rate, so if one twin has it, it’s pretty much inevitable that the other twin will have it.
As far as the attachment thing, I disagree with that. One, I disagree with the notion that that causes ADHD. I mean, there are symptoms and behaviours that can look like ADHD. You have kids that let’s say might have problems with attention that could be related to trauma, that could be related to anxiety, that could be related to a sleep disorder, that could be related to a learning disability – none of which is the same as ADHD.
And I think in a lot of ways, ADHD falls victim to everyone looking at these behaviours and thinking, excessive video games can cause ADHD. It’s like, no, it’s the other way around. If you have ADHD, those are the kids that are going to be playing video games for 14 hours straight. Those are the kids that are attracted to those things. It’s not that playing video games causes you to have ADHD.
Now, at the same time, culturally, we are seeing people basically who are – we live in a culture that is more instantly gratifying, and kids don’t have the same attention span as they did generations ago. So in a way, yes, our culture has this ‘ADD-ness’ to it. But that’s different than ADHD.
I think it falls into sometimes that popular like “Oh, I’m so ADD, I forgot my keys.” It’s like, if you forget your keys once, that’s not ADD. That’s you forgot your keys. [laughs] It’s as simple as that. Versus someone with ADHD, that could be a daily occurrence of forgetting their keys and these mishaps that happen all of the time.
I think with the attachment thing, however, what’s important is for parents, if you have a child with ADHD, and particularly – I do agree with the notion that an ADHD individual has a sensitive nervous system. So people with ADHD are at higher risk for allergies. My first 10 years of my life were riddled by horrific ear infections, like really bad, like three surgeries. My ear doctor, Dr Klein, I literally thought was a member of my family because I was seeing him every single week. Like an icepick in my head. It was brutal. Had hearing loss at one point. For a music lover, that did not go over well. And then thankfully, that last surgeon hit. But because of that, I still don’t know how to swim properly because I couldn’t go underwater because my ear infections were so bad that it would’ve set off really bad ear infections.
But ear infections, allergies, sensitivity to temperature, to sound, to those kinds of thing. I refer to it as almost – again, how diagnostic is this? In third grade we had to write a paragraph of a fictional character we related to, and a lot of the boys wrote The Hulk and Spider-Man, and I’m thinking, you don’t relate to them. Maybe you want to be them, but how are you relating to The Hulk? [laughs] But I interestingly wrote Goldilocks from ‘The Three Bears’. Of course, people are like, “Goldilocks? What?” I said, “This bed was too hard and this bed was too soft, but this was the bed that was just right, that enabled her to fall asleep.”
Having ADD is a lot like that. You feel like Goldilocks. It’s a narrower zone to feel grounded, to basically be connected and grounded. So it can look very picky. Kids with ADHD can be picky eaters. They’re the kids that do not fall asleep. Both of my kids did not fall asleep through the night until they were over 14 months old, which to my wife, who does not have ADHD, was harrowing. It was very, very difficult because she was a solid 9-hour sleeper. And it helped that I have ADHD, so I got up with them at 2:00, 3:00. Sometimes I was up already just because I didn’t go to bed early at that time. [laughs]
That’s so important as far as that sensitivity, and then emotional sensitivity. Again, there’s the coin. On one hand, we are more highly prone to emotional dysregulation. We are more susceptible to mood disorders, to depression, anxiety, those things. Rejection sensitivity is very big for people with ADHD. But the flipside is that people with ADHD can be highly empathic and very interpersonally sensitive in ways that really help them, and help other people. That’s why even as a kid, in my experience – and I think especially for boys and men, who, although we’ve come a long way, we still have a long way to go, are still shamed for crying and being ‘emotional’, ‘like a girl’, which is also sexist, that there’s something so wrong about being like a girl. But these gendered notions of emotion we still have to dismantle.
Thankfully, because I think of the household I was raised in and my love of music, I looked at being emotional as a good thing. I’m like, to be a musician, these are emotional people, because to write songs, you’ve got to tap into your emotions. So I thankfully never shamed myself for crying, for feeling – I was a feeler. I felt my emotions strongly as a kid. Very strongly. It was something that I do remember thinking to myself, “I don’t want to block this out, but I need a filter.” I didn’t use that word when I was a kid because I didn’t know what a filter was, but “I need something that makes it go through in a more even way”, because I felt like I would be flooded by those emotions.
So you have all this sensitivity. Now, oftentimes you’re going to have a parent that probably has ADHD themselves, and depending on how they managed it, how they’re reacting to their child – and then the parent without ADHD, if you don’t have the knowledge and understanding of ADHD, it can be very challenging to be like, “Why is my kid not sitting still at circle time like the other kids are?” And especially for a firstborn, parents are very sensitive. The worst thing, the thing that would just slay me in terms of me feeling not good about myself, is if my kids ever thought I was not a good parent, a bad parent. Thankfully I have two wonderful teenagers that I’ve been blessed with.
But as a new parent, when your kid is the one that’s running off of circle time, you feel like “Oh my gosh, people are going to think I’m a bad mom or a bad dad.” How you handle that, frankly, sometimes parents get frustrated. And I don’t blame the parents. Sometimes they can be like, “Sit still!” Sometimes they resort to physical punishment, thinking that’s going to get them in line and not understanding that this is not a fault of bad parenting. And this isn’t your kid being bad, either. They’re curious.
I remember when my son was in gymnastics at three, four years old. I thought it was a good way to get him attuned to his body and more mindful, and they’d have circle time. I was in this room because the parents would be there with them, and he would run off to the trampoline. In my head, I’m thinking, of course. Who wants to sit here in a circle when a trampoline is literally two arm’s lengths away? I want to be jumping on that trampoline, and I was an adult at the time. I used to say to him, “I totally understand why you want to be jumping on the trampoline. Of course it’s more fun. But right now, Miss Jill, the teacher, wants to make sure she talks to all of you and you all listen before we go on the trampoline.”
The difference between that and pulling a kid and saying, “Sit down!” and not validating them – and again, I want to always preface that 99% of parents really have the best intentions, and this is why it’s so important, and I’m glad you and I are talking about this. We need to disseminate this information, because you don’t know what you don’t know as a parent. If you are thinking – kids with ADHD, for example, as infants are more likely to be colicky, meaning they’re crying and they have a harder time soothing and self-soothing. It can make you cuckoo if your kid is screaming and you’re singing to them and you’re putting them in the swing and you’re breastfeeding them and they’re not soothing. It can be like, “Oh my gosh.” And you’re sleep deprived yourself.
So a lot of times there are these attachment issues, but I always want to be clear, it’s not that it’s causing the ADHD; it’s more that those attachment issues could be a result of this intersection and this interaction effect of the parent and child. I do a lot of work particularly with kids and with teenagers where sometimes the parents feel like there’s only one way to do something – and a lot of the work I’ll do is with the parents that say, “He shouldn’t need music while he’s studying. That’s just wrong and I will not allow it.” I have to, in a sense, advocate on behalf of the child to say, “Actually, it could help them.” It varies.
I was the kid – I need music with everything except reading. When I’m writing a paper, you’d better believe I have music. When I wrote my dissertation, I literally in the acknowledgments page of my dissertation – people thank their family, which I did, and my mentors, but I also thanked The Go-Gos, Billy Idol, Green Day, Joan Jett, Nirvana, and Hole because that was the music I was listening to while writing the dissertation. [laughs] And The Ramones. That pop punk, those riffs and everything just got a momentum for me to write this almost 200-page dissertation.
So I tell parents, having ADHD, what we want to teach the child, and sometimes it’s teaching the parents too, is you’re going to be your own researcher to determine what is going to work and what doesn’t.
My older brother, his ADHD, he needed complete silence. Complete silence. We shared a room, which was very difficult because I like sound. We’re very close but very different personalities. He wanted more silence, and even when I had my headphones on, because I played my music really loud, he could hear it through the headphones. He goes, “I cannot concentrate with that.” And I would get really upset, like, “What do you mean, you can’t concentrate?” We now look back and we laugh at that, but really, neither of us could understand – I couldn’t understand how he could function and operate in total silence. I’d be so distracted. He couldn’t understand how I’m really getting work done while blasting the music I was listening to at the time.
But for parents, there is this flexibility, and sometimes you see these, unfortunately, negative relationship patterns because sometimes parents have a hard time bending to what might work for them or what they think is the ‘right’ way. And then there are times that a child will insist that “Oh, no, having Netflix on is helping me” when it’s really not helping them, it’s distracting them. So I tell the kids, the proof is in the pudding. We have to actually test it out, but if you are watching Netflix and in an hour of time, you only got 10 minutes of your work done, this isn’t working. You are being distracted by it, and your mom or dad is right about that.
So there’s a lot of battles that can happen around going to sleep, around curfews, around rules. People with ADHD – I almost feel like we’re born into the world a little oppositional, frankly. I don’t know. I used to say growing up – again, wonderful parents. They weren’t particularly strict with me. I just had this rebellious spirit in me. I don’t know if it’s because you feel a little against the grain in some way and are wired that way, that you operate in that way. I certainly had moments like that with my parents where I pushed hard. Of my siblings, I was definitely the one that would challenge. My brother would say I was a little litigator. I was definitely not someone that someone could steamroll over. If I wanted something, I was going to do it and say it and argue with it.
I appreciate my parents – they’re both gone now, but they lived amazing lives. But even in my adult life, I would say, “Gosh, you guys really handled that well, because it can be very frustrating.” [laughs]
So that part I would agree with, absolutely. And not just with parental relationships. With marriages. Really important for the non-ADHD spouse to understand what ADHD is. So important. And for the person with ADHD to also – just because we have ADHD, I always tell people, it’s not an excuse. It’s an understanding. We are responsible and accountable for working. It’s not like, “Oh, I have ADHD so I’m just not going to pay the bills.” That’s not how it works.
But at the same time, it is helpful in couples as well – I remember very early on in my relationship with my wife, we’d have these talks and I’d be doing stuff while we were talking. She’s like, “You’re not paying attention to me.” The truth was, I actually was paying attention better because I was doing the dishes or folding laundry or doing miniscule stuff. So she needed to know that I wasn’t being disrespectful, that my intention, actually, of getting up and doing those things is so I can pay better attention than just sitting there.
At the same time, I needed to learn, I can understand for her, just because that’s helping me, she needs me to be present and in that physical space and having eye contact while having that. So I have to work at that. So we need to meet a little bit on this. It’s not just – but it makes a huge difference if she at least knows my intention is to hear her, because once you think “This person is being rude”, then the sparks start flying. And that’s true for parents, too. I guess just to underscore how important that is.
But those attachments issues are not the cause of ADHD. And then I work with people whose families thankfully know ADHD, maybe they were diagnosed and very open about it and have very easy relationships because there’s that education. I mean, knowledge is power.
Chris Sandel: Yeah. I mean, Gabor has ADHD. Either two or three of his kids do. So it’s an issue he knows personally. And even when you’re saying you don’t think it’s causative, a lot of what you’re talking about in terms of parenting and how to be with a child and all of that is a lot of what he’s chatting about.
Roberto Olivardia: Yeah, that I would agree with.
Chris Sandel: I think there’s a lot where you’re on the same page, and I still would be very interested to hear your thoughts if you do check it out. But yeah, I found it very useful to read, and it resonated with me quite a lot. I’ve got a four-year-old child and we’ve been having a lot of challenges with him, and implementing some of the stuff that Gabor talked about, we noticed some real changes.
Roberto Olivardia: That’s great.
Chris Sandel: We don’t have any official diagnosis for our son; there’s potentially other things going on as well. But at least it resonated in terms of my personal experience. And this is n=1, but yeah. [laughs]
Roberto Olivardia: That’s great. I will definitely check it out. And I’m sure from that, it sounds like it’s probably speaking to a lot of the similar things. It’s not even directed necessarily to his book as much as just some of those myths of the past with ADHD would be bad parenting, too much TV watching, these things.
Chris Sandel: He’s talking about it much more from the subtleness of it and the high sensitivity. Like his daughter would be saying, “Stop shouting at me” and he’s like, “I’m not shouting.” Just realising how sensitive they were. So when I say poor attachment – I thought I was giving my son the most amazing attachment, but when I look at some of the subtleties and his sensitivities, I see it in a different light.
Roberto Olivardia: Yeah, with that frame of understanding it, that’s absolutely true. These dots are not connecting in the way people are thinking they’re connecting, definitely.
Chris Sandel: Yes. It’s not mis-attachment in the way a lot of people would think about it. He goes into the subtleties of attunement and how those things can be missing. For a regular kid, they wouldn’t even notice it, but for someone with that sensitivity they do, and that’s how it can get started.
Roberto Olivardia: Yes, that’s absolutely true. Definitely true. I always say as advice, when you’re expecting, it’s always good to know your own genetics. Whatever it is. If you’re someone who’s on the anxious side – again, most of these things are genetically oriented. But being aware of how you’re managing that for yourself and these interactions in that way.
And again, sometimes it’s the parent with ADHD that is more attuned to the kid with ADHD; sometimes, though, it’s the parent with ADHD who almost is more frustrated than the non-ADHD parent because maybe for them, it might have been different. Sometimes I’ll hear from ADHD parents, “I got through – why is it so hard for him? Why can’t he just do it?” I have to tell them, “You didn’t do it in 2022.” I very much appreciate what it would be like today.
If I’d had an iPhone and Netflix, forget about it, Chris. Forget about it. There’s no way I would’ve even – because as it was – this was so smart on my parents’ side. They didn’t get cable. My parents got cable television the day I went to college. [laughs] They couldn’t even wait 24 hours. I called and my mom said, “The cable guy…” I’m like, “What do you mean, cable?” Granted, I’m a child of the ’80s. I wanted my MTV badly, and nope, there was no cable. I said, “Really? Now you’re getting cable?”
We had one television. It was in the living room, which was right off of my parents’ bedroom. I grew up in a middle-class family. We could’ve afforded a colour TV. Nope. I think I was in high school when we got a colour TV. We had a black-and-white television that had, at that time, three channels on it because there was no cable. So literally there wasn’t much to do past 10:00 when I was in elementary and middle school. I’d listen to music, but then I’d get tired and go to bed.
If I’d had basically a television in my room, which is what a phone is, mobile device – I wasn’t a big video game person, but now the video games are so much more sophisticated – I wouldn’t have gone to sleep. There’s so much more to have to screen out in terms of distractions. My kids only have Snapchat. They don’t have any other social media. And I tell them, and I’ve had a lot of conversations – the fact is, I know if I had all of that, I wouldn’t have been able to regulate it very well. I just know it. And I don’t even want to introduce that. They’re very good students. They have a lot going on. I’m like, Snapchat is good to connect with your friends. You don’t need TikTok, you don’t need Facebook, you don’t need Instagram. You don’t need it. It’s just more.
So sometimes it’s the ADHD parent that has a harder time being attuned, but I know in my case – I could’ve diagnosed my son prenatally with ADHD. I’m not kidding, because he was active in the womb. Every time we got an ultrasound, every single time, the technician would be like, “Whoa, you’ve got an active one here!” He literally couldn’t sit still even in utero. [laughs] His birth was dramatic. I mean, he was nine pounds. You could just see it. I thought, okay. I feel it’s a privilege that I had a full understanding of ADHD in my own life as a psychologist, and trying to educate my wife along the process of everything from sleep issues and things like that, because it can be hard. And same with learning disabilities, which also run through my family.
But yeah, we’re not just talking about ADHD. If you’re an anxious person, it’s important to know that you can start to see those traits in your kids. So when your kid is shy, as opposed to having the approach of throwing them in the deep end of the pool, understand that there might be anxiety there. They might need a little more work. And at the same time, you don’t want to overaccommodate the anxiety, either. Or the ADHD. Because that happens, too. Sometimes parents might be like, “Because they have ADHD, I’m going to do everything for them.” I’m like, “That’s not actually going to be helpful, because they need to learn those skills.”
01:32:20
Chris Sandel: Definitely. I know we don’t have a huge amount of time left, so I want to spend the rest of this time focusing on the Adonis Complex. Just to start with, how do you define the Adonis Complex?
Roberto Olivardia: Adonis Complex is not a clinical term. We use that as almost like a pop culture term to encapsulate all of the different manifestations of body image and eating issues that we see with men. Adonis was a Greek mythological character; he was half-man, half-god, and he represented the ideal in masculine beauty. He was strong, he was good-looking, he was a warrior. All the men wanted to be him, all the women wanted to be with him. So we thought that was a fitting name to encapsulate.
In that book, we talk about anorexia, bulimia, body dysmorphic disorder, anabolic steroid use, compulsive weight-lifting, and media imagery that’s directed to boys and men, which I think for a lot of people that part in particular was of interest. Unlike with women, it hasn’t been historical. It’s not like it’s been throughout time that men and boys have felt the media impact. But beginning in the ’80s, we started to see more of that. It wasn’t the covered-up Marlboro Man cowboy. It became guys with their shirts off and six-pack abs and things like that, and understanding that boys are impacted by that.
I work with young boys who see themselves as too big and are fearful of being overweight, and I also work with boys who have a lot of body image issues because they see themselves as looking too skinny and too underweight. Gendered notions of masculinity are that you can’t be weak. Even with the boys and young men I work with with anorexia, the majority of them do not want to be skinny. What they say to me is that they want to be lean, but they want to have muscle mass. And of course, to get muscle mass, you need to have a certain amount of body fat. What they’re stuck in is this prison – a lot of times patients will say to me, “If I knew that everything I ate would convert to muscle and not fat, then I’m fine with eating.” A lot of the guys I work with say, “I don’t care if I’m overweight in terms of a number on a scale. I don’t want to be overfat.”
That’s where it’s a little bit of a different construct than what you would see with women. With women, often overweight/overfat become one and the same construct, this number. But most bodybuilders are technically overweight, but they have very low body fat. So a lot of the boys I work with, I have worked with boys who get bullied for being too skinny, for being too weak-looking. It can go in that direction.
Chris Sandel: That was definitely my experience. I haven’t had an eating disorder. You talked about just there with the ADHD that if you were living at this point as a child or a teenager, how bad it would be because of the Netflix and social media, etc. And I feel the exact same way. If I was a teenager at this point, knowing how small I was – I have school photos where it looks like I was in the wrong year picture because I’m just that much smaller than everyone else.
It’s interesting when I think back on that how much it affected me in terms of being really self-conscious and wishing that something was different, but I think the difference was I was never shown that there could be an alternative. I never got the idea that “Oh cool, you can go and do steroids” or “If you spend time in the gym or if you do these things with your diet” – none of that stuff was ever on my radar, so it didn’t get internalised as “Wow, this is something that is in your control and you can change.” There can still be the disappointment aspect of it, but it felt like something like “this is the way it is”, so it never went down that route.
And maybe I don’t have the right genetic predisposition anyway, but I know if I was a teenager of today growing up in the body I grew up in, I don’t know what would’ve happened.
Roberto Olivardia: Yeah. Absolutely. And even just what is possible. If we look at something like steroids – I met the wrestler Hulk Hogan when I think I was 13 or 14. He was signing autographs at a local gym. I used to watch the World Wrestling Federation, as it was called at the time, and he was enormous. It’s almost like TV dwarfs him. His arm – I just remember his bicep was the size of my head, it was so big.
I knew that there were these things called steroids. I didn’t really totally understand, but I knew that people could take drugs to make themselves bigger, and I thought, “He’s got to be doing something. How can you possibly be that big?” He had denied it at the time, and years later he admitted that he was in fact using steroids all of that time.
And then I remember at 17, I was at the gym – because I was also a shorter – in some ways, I wish I had the metabolism now that I had when I was a kid, but I could eat everything under the sky and I didn’t gain weight. Similarly, especially in early puberty, it was just awkward being in that body. I wanted some kind of muscle. I never needed to be ripped or anything like that, but I definitely did not like the skinny body either. So I can relate to that.
But I remember seeing guys actually do steroids, like injecting them in their butt at the locker room of this gym, which tended to attract, I think, a lot of more hardcore gym users, and thinking, “Hmm.” Thankfully, I thought, “That can’t be good for you.” First of all, I don’t like needles, but that really can’t be good for you. It’s almost like that little part of you that’s like, wow, that would be appealing – and again, the ADD part of me can see, anything that’s that quick and easy to do, and you can work out with the same amount of effort – like, ooh, I can see how easy it is. In the same way with women with diet pills and things like that. Like, “Here, take this pill.” It’s the same mentality as diet culture.
But nowadays it’s so mainstream. It’s not like this fringe thing. I’ve worked with boys as young as 14 who are using anabolic steroids, or using these thermogenic supplement fat burner blah, blah, blah, these products that are not regulated by the FDA, that are not even under the guise that they’re healthy. It’s a lot. I don’t know. I’m almost seeing it through my kids’ eyes, and I profoundly appreciate how they navigate through all this. We are a family and we talk very openly about all of these things, but yeah, I think that all the time, Chris, all the time. If I was a teenager now, it could’ve been a very different story.
01:40:50
Chris Sandel: Yeah. In the book, when you talk about the muscle dysmorphia and how this affects the men’s lives, it was heartbreaking hearing how it affects them. And from an outsider looking in, you wouldn’t suspect it in the least, in the same way that this can be the case for someone who fits into the stereotypical female body and people are like, “Oh wow, they struggle with body image?” Men who are ginormous in lots of ways and yet they feel tiny, and they’re unable to take off any of their clothes in any public arena; they throw in their job as an accountant or at a law firm so they can be a personal trainer.
I know when you were originally thinking about this concept, you talked about it as being like reverse anorexia. And in a lot of ways there is so much overlap between the two in terms of how much it skews someone’s perception of their own body, and also how it skews someone’s perception of what is most important and valuable.
Roberto Olivardia: Definitely. With muscle dysmorphia, there is this body image distortion where, despite being fit and muscular – sometimes really muscular – these men often feel scrawny, or they’re at this utter fear that they’re going to lose the muscle. It’s very similar to the mentality of anorexia, the utter fear that one is going to gain body fat.
Actually, I conducted a study where I compared men with muscle dysmorphia to men with anorexia, and we found that they scored similarly in all indexes, including the drive for thinness, which is interesting. Because with muscle dysmorphia, what these eating disorder surveys also can pick up on is a drive for leanness. So these men were very similar. Their mentality, their psychology was very similar. The only difference was, of course, that the men with muscle dysmorphia were getting some nutrition. They were getting nutrition. Granted, very compulsive.
When I say compulsive, as an example, I remember somebody in one of my early research studies that had to research all the various toothpastes that were out there because he could not have a toothpaste that had a certain percentage of sodium in it because that would offset his water absorption, which would offset his muscle mass. I mean, it was that compulsive. I remember this guy who said during certain times he can’t kiss his wife because he was afraid she’d transmit calories through her saliva. He goes, “Then I don’t know, I’m not as certain of how many calories I’m taking in. It’s going to mess that up.”
And these are not the guys that you would see at Venice Beach, California, with their shirts off, proudly, almost sometimes narcissistically showing their bodies. These are not those guys. The men that I treat, despite people objectively saying, “Wow, that guy has a really fit body”, they can wear long-sleeved sheets on 90-degree days and feel really uncomfortable. If someone is looking at them – they might be looked at because they have what’s seen as a good, fit body, but they think, “Oh my gosh, they’re looking at me because I must look scrawny or skinny or ugly.” So they have problems in intimate relationships. It just becomes all-consuming.
Probably the strongest example was actually a young man in the very first research study I did of this. I will never forget him. He actually would send me a yearly Christmas card for years after that study. He was in his mid-twenties. He was an attorney, and as you mentioned, some of these individuals get so consumed that it gets in the way of their work, of everything. So he gave up his career in law; he went to work at a gym so he could just get workouts in in between personal training. He was 24. He was on many different anabolic steroids, like stacking them, they call it, when you’re using multiple ones. He had bulimia and periods of restriction. He would do things like go into a sauna, dehydrate, vomit, wear a mylar suit, do a thousand jumping jacks, to literally sweat out any amount of water out of his body.
But because of the steroids, he suffered a lot of the side effects that sometimes can happen with steroids – testicular shrinkage, cystic acne, impotence. He’s at the gym six, seven hours a day. He got addicted to painkillers because when you work out six to seven hours a day, your body’s going to be in pain.
I asked him – he was this really nice guy, very sweet guy – and I said, “What do you feel this is all for? At the end of the day, what is this?” He said, “To get chicks. I want to be seen as attractive. I want to be seen as appealing. And not just to get laid, but also to find love and be with a person.” So it wasn’t just to be promiscuous, necessarily, but also, he felt “If I have the perfect body, that’s going to get me the perfect relationship and that’s what’s going to make me happy.”
What stands out is that I learned so much in this conversation with him that summed it all up for me as to what this is about. I said, “But you realise, right now your life is so limited. The only girls you’re going to meet are at the gym”, because after the gym he was in so much pain he didn’t go out anywhere. His body was physically breaking down. He was only 24 years old. I said, “Also, you’re telling me you have all these effects of steroids, including impotence. Even if you were to meet someone and you were to be sexually intimate, you can’t be because of these biological adverse effects of the steroids. You feel like you can’t even take your shirt off in front of somebody. How would you ever sustain a relationship? It’s almost like your relationship is with the gym and muscle dysmorphia.” At the time – this was the first study we did, so I think at that point we were calling it reverse anorexia.
He looked at me – and this was a very bright guy – with this perplexed look and said, “Wow, you know what? I never thought of that.” I thought, “Really? What?” But this is one of those moments. I was in grad school at the time, but as a future psychologist, I thought, wow, this is how it can be. This is how a disorder can work. Really, when you hear about with substance abuse – and I had friends who had struggled with that – I understand how someone can be in denial of something, and yet there’s almost this part that’s like, are they really, though? How could they – and this was a very intelligent guy. I thought, wow, he really never thought of that. Because he was so in it. He was so in it that he could not pull away to see the bigger picture of it.
As I’m sure you’ve seen, Chris, all the time, we see that all the time with eating disorders – people who are so in it that when I ask them that question, “What is this all for?” – because with eating disorders, it’s not about the body. It’s people maybe wanting to feel in control, people wanting to think that a perfect body will bring them more happiness, will bring them more friends. It’s a currency. Our body is like a currency for something else. It might even start off with, “I want to be healthier and that’s why I started doing that.” It’s like an orthorexia, and then it spirals and it’s like, now it’s not fulfilling that value of health.
But it was an epiphany for him, to the degree that – it was just a three-hour research study that he was a part of, and for a decade after that, he literally would send me a Christmas card every year to thank me because he got off steroids. The last I heard from him, he had got off steroids, went back to practicing law. But he said it was hard. He went through a pretty significant depression not working out seven hours a day anymore. It’s like sobriety in a lot of ways. He then got off painkillers and became sober. But it was powerful.
Those are the kinds of stories that – they get consumed with it. And I think because even with the general public, when you see a woman let’s say who’s 80 pounds and emaciated, it’s very clear that she’s sick. It’s very clear there’s illness there and this person needs help. But it’s harder to see that sometimes with a guy who is muscular and looks like he sometimes could be the role model of fitness.
And frankly, people are not as sympathetic to men with that condition. A lot of times, people think “Oh please, he’s just looking for attention and whatnot.” It’s harder to see, I think, with men in general. I remember 20 years ago, with eating disorders sometimes I would get that kind of feedback when I would do interviews with people that just didn’t sound as sympathetic to men having eating disorders. And not just from men, but from women as well who sometimes were like, “Oh please, it’s not as hard as it is for women.”
And I’ve never said that. To me, it’s not an issue of whose trauma or whose pain is worse. Pain is pain, as far as I’m concerned. But with muscle dysmorphia, it’s even less of that because people are like – and frankly, in the same way that women who might be models or might have what women might see as an ideal body could feel the same way if they’re struggling with an eating disorder, saying, “Please, how could they possibly think that they’re ugly?” or whatever. As opposed to looking at it from a more compassionate view of like, imagine how tormenting that must be. People end up projecting, often, their own body image stuff on that.
01:52:10
Chris Sandel: Totally. That’s a really heartwarming story of your interaction with that guy. I’ve had similar situations where I have a conversation and there is some kind of real ‘aha’ moment in that conversation, and that then starts to change the trajectory of someone being able to change certain behaviours, etc., and it feels like that was a real turning point. I’ve had many of those conversations, and then by the next time we talk, that awareness is just gone. I think this is the problem with eating disorders.
And whether it be muscle dysmorphia or anorexia, the way that the brain is affected by being in that depleted state and the anosognosia means it’s not so much about denial as there’s a brain impairment that stops someone being able to see that. That’s the real challenge with this, because it’s not about denial; it is about how the brain starts to warp the perception of what is going on. That’s what I find can often be such a challenging thing, but I’m so pleased to hear how it worked out for that guy.
Roberto Olivardia: Absolutely. Especially with restrictive eating disorders, people have to recognise that the brain is not getting nourishment and nutrition. And for people with bulimia, when people are eating and then purging out a lot of the essential vitamins and minerals and food, that’s dysregulating. Your brain is just not thinking straight.
I think that’s also what I find. To me, with eating disorders, here you have this disorder that really we have to look at in a biological, psychological, sociocultural lens. It really intersects all of these different lenses. And then here we’re talking about men and women, but in different ethnicities, in minority groups, in LGBT communities, the meaning of the body and the pressures and expectations, it varies depending on whatever community or category people see themselves, or that society sees that person in.
That to me is also what, from an academic sense, fascinates me about eating disorders. It is this evolving concept, and because sociocultural images – I absolutely have seen such a difference with the advent of social media in terms of the kids I work with who are younger dealing with body image issues, who are just – studies have shown this correlation of Instagram usage and negative body image.
But even with cosmetic surgeons, I’ve read interviews where they’ve said many years ago, someone would come in with a picture of Jennifer Lopez or some other celebrity and say, “I want to look like this” and now they’re coming in with a picture of themselves that has been photoshopped, filtered, shaped in exactly the way they want, saying, “I want to look like this” with the expectation that they can.
And a lot of adolescents I work with put these filters, especially with the pandemic and Zoom, where now they feel like “This is how people see me, so in public I have to put on lots of makeup or do this, this, this because I’ve altered my image so much on a virtual landscape. Now I need the real landscape to match that.” Just the pressures of that. It’s tough. And I think we have to continue that conversation and understand what kids are being exposed to in regard to body image.
01:56:39
Chris Sandel: Totally. I think it’s going to get worse, unfortunately. It just looks like the way that things are heading, we’re only seeing the early emergence of this kind of stuff. Yeah, it is incredibly worrying. I also think the statistics you’ve talked about as well in places where it’s like something like 10% of people with eating disorders seek treatment.
Roberto Olivardia: That’s right. Only 10%. Imagine that. I mean, the mortality rate of eating disorders is anywhere from 10-15%, some might say higher. And that’s for not just restrictive eating disorders, but also with bulimia. There are cardiovascular incidents and events, and you’re at higher risk for heart attacks.
But also to emphasize that a lot of those mortality rates are also due to suicide. There is a very high rate of suicide amongst people with anorexia nervosa, bulimia nervosa, that speaks to the torment and the suffering that individuals go through with this disorder. But yeah, to know that only 10% of people are seeking treatment. And I work with men – it’s even far, far less of men who have eating disorders.
But we need to do something about that. We need to continue to get services and talk about it in health class. We need to make sure college campuses have adequate resources. We need to educate doctors and med school dentists, guidance counsellors, anyone who could be a gatekeeper to spotting some of these signs – I’ve worked with coaches, and some of them are great. Some of them are not so great in terms of seeing these signs in their athletes. Because that’s, to me, an abysmal statistic. 10% of something that could kill people. It’s just not acceptable to me.
Chris Sandel: I agree. Look, Roberto, this has been a wonderful conversation. I’m looking at my notes and I think we’ve barely scratched the surface on so much of this. I could talk to you for hours.
Roberto Olivardia: Yeah, same here.
Chris Sandel: Where can people go if they want to be finding out more information about you?
Roberto Olivardia: Going back to the social media, I don’t have any social media. I don’t have a website, no Twitter, no Facebook, none of that. Frankly, that’s me managing my ADD of not getting mired in all of that.
So I have a good old-fashioned email address, which I honestly welcome people to shoot me an email. I always love hearing what people get out of these conversations, what things stuck with people, what questions they have that I can maybe better answer at another podcast or webinar I do. My email is roberto_olivardia@hms.harvard.edu. It’s a long email. My name’s long. [laughs] But feel free to email me.
And I can send people, if they’re looking for resources on ADHD, on men and eating disorders, on muscle dysmorphia – papers, websites, therapists that might be in their area. I’ll do the best I can to try to connect people to resources.
Chris Sandel: Perfect. I will put that email address in the show notes. I like your style of no social media. I did it for a while, and I have come off all social media in the last year or so, and it is one of the best decisions I’ve ever made. So yes, I have a website, but no social media is a really good thing.
Roberto Olivardia: Yeah. I think eventually – everyone’s like, “Roberto, just get a website.” My son is like, “Dad, I can put it together.” I’ll probably at some point do that, just to have these links to all these great conversations and webinars and things like that as a resource for people. So that I might end up doing.
But this has been great, Chris. I really appreciated you selecting this as a topic, because it’s not talked about enough.
Chris Sandel: Thank you. You are someone in the know with this stuff, so thanks for coming on the show and chatting about it.
Roberto Olivardia: My pleasure.
Chris Sandel: So that was my conversation with Dr Roberto Olivardia. I really enjoyed chatting with him, and I hope you found it both informative and helpful.
02:01:37
I have one recommendation for you today. In keeping with the love of music that Roberto talked about early on in the conversation, I want to share something that I’ve been loving lately. It is Arcade Fire’s most recent album, called ‘We’.
I’ve been a huge fan of Arcade Fire since their first release called ‘Funeral’, which came out back in 2004. It’s incredible to think it was that long ago. I’ve seen them live a number of times, and they’re incredible live. One of the first dates that I went on with Ali was to an Arcade Fire gig. This is their sixth album and is probably my favourite, or one of my favourites. I enjoyed their previous two albums, but they felt a little unfinished in parts, and it was more a case of me liking many of the songs on them but less liking them as an album as a whole, whereas this is much more of a return to their earlier albums where I love it from start to finish.
As a band, they’re hard to describe because they’re rather different. There are seven members in the band, but when they tour and play live, there are much more people than this. So there’s always this stage that’s filled with people. I’ve seen it written that they, between them all, play 16 instruments. So apart from the usual stuff you would associate with a rock band, they also play violin and viola and cello and double bass and xylophone and glockenspiel and French horn and harp and mandolin. It’s lots and lots of different instruments.
With this most recent album, it’s produced by Nigel Godrich, and he’s often referred to as the sixth member of Radiohead, as he’s produced all their albums since ‘OK Computer’. I can definitely hear his influence on their sound. But there’s also a lot of nods and influences of loads of other people and bands that have influenced Arcade Fire – David Bowie, John Lennon, The Beatles, Bruce Springsteen, ABBA, New Order, Peter Gabriel, Neil Young. This album also has more of an electronic music influence, which was apparent a little bit on the last album as well.
But despite all of these different influences that I can hear in different tracks, it’s still very much Arcade Fire. I was recently listening to an interview with Jonny Greenwood, who is one f the guitarists for Radiohead; he’s also gone on to compose classical music and has done loads of film scores, particularly with Paul Thomas Anderson. In the interview, he talked about music as being about building tension and then releasing it and then building tension and releasing it. When I listen to ‘We’, this is exactly what it does.
It’s an album I’ve had on repeat basically since it came out a few weeks ago, and know that it will be one of my favourite albums of the year. So I highly recommend checking it out. It’s called ‘We’ by Arcade Fire.
So that is it for this week’s episode. As I mentioned at the top, I’m taking on new clients. If you want help with an eating disorder or disordered eating, chronic dieting, poor body image, exercise compulsion, getting your period back, or any of the topics that I cover as part of the show, then please reach out. You can head to www.seven-health.com/help for more information.
I will be back next week with another episode. Take care, and I’ll catch you then.
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This was a fantastic and incredibly informative episode. Thank you- very useful information I’ll be sharing with colleagues.