Brian Pollack, LCSW, CEDS-C
Brian is the Founder and Clinical Director of Hilltop Behavioral Health, a boutique eating disorder specialty practice in Summit, NJ. He is one of the few male master’s-level Certified Eating Disorder Specialists in the country, with expertise in FBT, male clients, athletes, and muscle dysmorphia. He hosts the Minding Men podcast and serves as an adjunct professor at Yeshiva University.
Learn more about Brian →It is 5 a.m., and there’s a man already in the gym. He is lean. People have told him so for years. He does not believe them, and he has not believed them in a long time. (This is a composite of patterns I see in my practice, not a single patient.)
He eats what he has decided he is allowed to eat. He avoids what he has decided is dangerous. When the day breaks his rules, something has to undo it. Nobody sees any of this. What they see is discipline, strength, a man who has it together.
That gap between what the world sees and what a man carries sits at the center of the Sylvester Stallone bulimia story. Ahead of his autobiography, out this week, Stallone has reported that he pushed his body far past medically safe leanness and developed bulimia. I spoke about it on Fox News, and the interview is below. This article goes deeper into what I said and why it matters for the men reading quietly.
The Man Who Was Never Allowed to Soften
Think about what it means to be Sylvester Stallone. Rocky is not just a role. It is a body, a posture, a promise the public expects him to keep. In the interview I described this as a kind of homeostatic state. The world expects a certain man, and he has to keep delivering that man through every stage of development and aging.
Now put a nervous system under that pressure. Most of us get to change. Bodies soften, metabolisms shift, priorities move. For a man whose identity is fused to a physique, change can feel like exposure. So the body stops being a place to live and becomes something to manage.
That is not vanity. In my experience, it is a safety strategy. Holding the persona keeps him accepted. Controlling the body keeps him functional. Both are ways of finding a place in the world that feels survivable.
Sylvester Stallone Bulimia: Reading the Pattern Behind the Headlines
I have not treated Mr. Stallone, and no one can diagnose a person from a distance. What I can do is speak to the pattern he has described publicly, because it is one I recognize.
He reports pursuing extreme leanness, well beyond the thresholds that sports medicine and nutrition professionals consider medically stable. He describes wanting to be more aggressive and feral, and to measure up to Arnold Schwarzenegger. He reports turning to steroids to hold on to the body and identity he was protecting. And he reports purging.
Notice what is missing. He does not describe believing he was small or weak. That belief, a preoccupation with being insufficiently muscular, is what we call muscle dysmorphia, and it is a different presentation. What he describes is an obsession with pushing the physique, a relentless calculation that never quite closes.
When Control Over Food Becomes the Only Place That Feels Safe
Here is how it tends to go. It starts as a plan. Certain foods in, certain foods out. Timing, portions, rules. For a while the plan works, and that is the trap.
Over time the plan becomes obsessive arithmetic. Every meal is a calculation. Every deviation is a threat. The person is no longer eating to fuel a life. He is eating to keep an internal alarm quiet.
Add performance enhancing drugs to that system and the stakes rise. Steroids can push the body toward a look while the mind demands more. When food is controlled to that degree, the body often answers with a break in the pattern. And the break has to be corrected. That is where the cycle of bulimia begins.
The man inside this cycle rarely feels reckless. He feels careful. He feels like he is doing the only thing that keeps him okay. That is why it is so hard to walk away from. Who gives up the one thing that feels like safety?
Exercise Purging Is Bulimia, Even When It Looks Like Discipline
Most people hear bulimia and think of one behavior. Clinically, it is a cycle: episodes of losing control around eating, followed by efforts to compensate. Those efforts include vomiting, and they also include laxative misuse, fasting, and excessive exercise. The DSM-5 criteria recognize all of them.
In the interview I said it plainly: extreme exercise purging is a thing. It is bulimia. For men, this is often the version that hides in plain sight. One hour in the gym becomes two, then several, more than once a day. A rest day feels like a threat. Training after a meal that felt too big gets praised as commitment.
Nobody stages an intervention for the guy who never misses a workout.
Here is the question I ask men in my office: if you could not train today, what would happen inside you? The answer tells me more than any number on a scale ever could.
What the Sylvester Stallone Bulimia Story Tells Us About Men
Men are missing from most eating disorder conversations, and the research shows why that matters. A review in the Journal of Eating Disorders by Mitchison and Mond examined eating disorders and disordered eating behaviors in males and found they are far from rare, yet under-recognized. The National Institute of Mental Health also emphasizes that eating disorders affect people of all genders. And the research on muscle dysmorphia, first described by Harrison Pope and colleagues in the 1990s, shows how the drive for muscularity can carry the same obsessive, compulsive features.
Why does it stay hidden? Because the culture hands men a script. Wanting a lean, strong body gets applauded. Controlling food gets called discipline. Purging through exercise gets called dedication. By the time a man recognizes the problem, it may have been running his life for years.
If this is you, or your son, or your husband, the shame is not evidence of weakness. It is evidence of how well the pattern hid. Our page on male eating disorder treatment NJ and our eating disorder treatment for men program speak directly to this experience.
Recovery When the Body Is the Identity
Hilltop Behavioral Health treats eating disorders in men as what they are: serious, treatable, and shaped by the pressures men actually carry. Our clinicians and registered dietitians work together, because a purging cycle is never only a food problem or only a mind problem.
The work is not about taking strength away from anyone. It is about building a self that does not depend on one look to feel safe. That means addressing the obsessive calculation, the compensatory behaviors, and the medical risks that come with extreme leanness and steroid use. It also means finding out who a man is when he is not performing.
I founded Hilltop to be the place I wish more men knew existed. If you are searching for eating disorder treatment in New Jersey that understands male presentations, we are here. Stallone’s story is one man’s, told publicly. Yours does not have to be.
Reach Out Today. Contact Hilltop Behavioral Health. The first conversation is free.
