Social physique anxiety, body esteem, and social anxiety in bodybuilders and self-reported anabolic steroid users

Athletes' use of analgesics is related to doping attitudes, competitive anxiety, and situational opportunity

This study aimed to investigate athletes' hypothetical use of non-steroidal anti-inflammatory drugs (NSAIDs), a behavior similar to doping, and its association with doping attitudes, competitive anxiety and situational opportunity. One hundred twenty-two sport science students completed an online survey assessing biographical information, doping attitudes, and competitive anxiety. Students' intention to use analgesics was measured via two different hypothetical situations using the vignette technique. The favorable situation included an absence of potential witnesses and presence of an attractive good whereas witnesses were present in the unfavorable situation and an attractive goal was absent. The results of two hierarchical multiple regression models showed that doping attitudes and competitive anxiety, especially worry, predicted the use of analgesics. In the situation featuring a favorable opportunity, worry was the strongest predictor, whereas in the situation of an unfavorable opportunity, doping attitudes was the strongest predictor for using NSAIDs. Results indicate that NSAID use is associated with positive attitudes toward doping and competitive anxiety, and that it is situationally dependent. Future research perspectives and practical implications are discussed.

Training Patterns and Mental Health of Bodybuilders and Fitness Athletes During the First Lockdown of the COVID-19 Pandemic—A Cross-Sectional Study

Background:

Government restrictions during the first COVID-19 lockdown, such as the closure of gyms and fitness centers, drastically limited the training opportunities of bodybuilders and fitness athletes (BoFA) who rely on indoor training facilities. This provided a unique situation to investigate the effect of training limitations on the training patterns, training adaptive strategies and mental health of BoFAs.

Objectives

The primary aim of this study was to investigate differences in the training patterns and the mental health of BoFA before and during the first COVID-19 lockdown. The secondary aim was to assess whether BoFA who exhibited features of muscle dysmorphia were affected differently from the group that did not.

Methods

A cross-sectional study was conducted with 85 BoFAs by means of an online questionnaire asking about sports activity, intensity, subjective physical performance, and economic status, including primary or secondary occupations before (from memory) and during lockdown, current physical health problems and financial fears, symptoms of depression, sleep disorders, anxiety (trait and state), muscle dysmorphia, coping mechanisms and actions during the first lockdown in Switzerland.

Results

Training patterns and mental health of BoFA were influenced by the COVID-19 pandemic and first lockdown. During lockdown, the physical activity on the BoFA dropped significantly from 2.3 ± 0.8 h per day to 1.6 ± 0.9 h per day (p < 0.001), the subjective training intensity decreased significantly from 85.7 ± 13.2% to 58.3 ± 28.3% (p < 0.001) and the subjective performance declined significantly from 83.4 ± 14.3% to 58.2 ± 27.8% (p < 0.001) of maximal performance. In comparison to those without risk for body dysmorphia, participants at risk rated their maximal performance significantly lower and scored significantly higher for depression, sleep disorders and anxiety.

Conclusion

This study showed the significant changes on the training patterns of BoFA before and during the first COVID-19 lockdown and poor mental health scores of BoFA during the lockdown itself, with those at risk of muscle dysmorphia scoring statistically worse regarding mental health than those with no risk of muscle dysmorphia. To better understand the particularities of BoFA, further investigation is needed to understand their psychology and in particular the effect of training restrictions on it.

Narcissism and Exercise Addiction: The Mediating Roles of Exercise-Related Motives

The present research examined whether the associations that narcissistic personality features had with exercise addiction were mediated by particular motives for engaging in exercise in a large Israeli community sample (N = 2629). The results revealed that each aspect of narcissism was positively associated with exercise addiction. Narcissistic admiration and narcissistic rivalry had similar positive indirect associations with exercise addiction through the interpersonal motive for exercise. However, these aspects of narcissism diverged in their indirect associations with exercise addiction through psychological motives, body-related motives, and fitness motives for exercise such that these indirect associations were positive for narcissistic admiration but negative for narcissistic rivalry. Narcissistic vulnerability had positive indirect associations with exercise addiction through body-related motives and fitness motives that were similar to those observed for narcissistic admiration. These results suggest that exercise-related motives may play important roles in the associations that narcissistic personality features have with exercise addiction. The discussion will focus on the implications of these results for understanding the complex connections between narcissism and exercise addiction.

Muscle dysmorphia and psychopathology: Findings from an Italian sample of male bodybuilders

The aim of this study is to investigate the relationship between the risk of muscle dysmorphia and psychopathological symptoms in an Italian sample of male bodybuilders.

METHOD

The sample was recruited online (145 men with a mean age of 30.0 years) and participants were asked to fill out the Muscle Dysmorphic Disorder Inventory (MDDI), Symptom Cheklist-90-R (SCL-90-R), Dissociative Experiences Scale (DES-II), and to provide other socio-demographic data. Bodybuilders at risk of muscle dysmorphia display greater global psychopathology and present higher scores on all SCL-90-R dimensions when compared to bodybuilders not at risk of muscle dysmorphia. Furthermore, risk of muscle dysmorphia is positively associated to dissociative symptoms. The Competitiveness dimension and anabolic steroid intake were not related to muscle dysmorphia, while age appeared to be more significant. Findings are discussed based upon previous studies and directions for future research are suggested.

Physical activity and body image among men and boys: A meta-analysis

Three meta-analytic reviews have concluded that physical activity is positively related to body image. Historically, research regarding physical activity and body image has been disproportionately focused on female samples. For example, the most recent meta-analysis (2009) extracted 56 effect sizes for women and only 12 for men. The current paper provides an update to the literature regarding the relationship between physical activity and body image among men and boys across 84 individual effect sizes. The analysis also provides insight regarding moderator variables including participant age, and physical activity type and intensity. Overall, physical activity was positively related to body image among men and boys with various moderator variables warranting further investigation. Pragmatic implications are discussed as well as the limitations within existing research and need for additional research to further understand moderator and mediator variables.

Anabolic-androgenic steroid use and psychopathology in athletes. A systematic review

The use of anabolic-androgenic steroids (AASs) by professional and recreational athletes is increasing worldwide. The underlying motivations are mainly performance enhancement and body image improvement. AAS abuse and dependence, which are specifically classified and coded by the DSM-5, are not uncommon. AAS-using athletes are frequently present with psychiatric symptoms and disorders, mainly somatoform and eating, but also mood, and schizophrenia-related disorders. Some psychiatric disorders are typical of athletes, like muscle dysmorphia. This raises the issue of whether AAS use causes these disorders in athletes, by determining neuroadaptive changes in the reward neural circuit or by exacerbating stress vulnerability, or rather these are athletes with premorbid abnormal personalities or a history of psychiatric disorders who are attracted to AAS use, prompted by the desire to improve their appearance and control their weights. This may predispose to eating disorders, but AASs also show mood destabilizing effects, with longterm use inducing depression and short-term hypomania; withdrawal/discontinuation may be accompanied by depression. The effects of AASs on anxiety behavior are unclear and studies are inconsistent. AASs are also linked to psychotic behavior. The psychological characteristics that could prompt athletes to use AASs have not been elucidated.

Performance-enhancing substance misuse in sport: risk factors and considerations for success and failure in intervention programs

This article reviews identified individual "risk factors" and exogenous cultural factors and processes associated with performance-enhancing substance use and misuse and successful and unsuccessful intervention efforts.

Muscle dysmorphia in different degrees of bodybuilding activities: validation of the Italian version of Muscle Dysmorphia Disorder Inventory and Bodybuilder Image Grid

The purpose of the study was to validate two measures of muscle dysmorphia (MD) into the Italian language. The sample included three participant groups: (1) competing bodybuilders, (2) non-competing bodybuilders, and (3) non-bodybuilding controls. In general the Italian versions of the scales showed psychometric utility that is consistent with the original instruments. The severity of MD was greater for competing bodybuilders than non-competing bodybuilders and controls.

Motives for illicit use of doping substances among athletes calling a national antidoping phone-help service: an exploratory study

This study aimed to construct a hierarchy of motives linked to doping behaviors. Between 2000 and 2005, calls to a national antidoping phone-help service by 115 cyclists, 203 bodybuilders, and 40 footballers were analyzed. The results showed that the main motives were preserving health for cyclists, increasing muscular strength for bodybuilders, and personal recreation for footballers. However, in contrast to the literature, group influence was low and health preoccupations were high for cyclists; the influence of body image was relatively low for bodybuilders; and footballers cited muscular strength enhancement as a motive. The study's limitations are noted. The prevention campaigns therefore need to be specific.

Anabolic-androgenic steroid dependence: an emerging disorder

AIMS

Anabolic-androgenic steroids (AAS) are widely used illicitly to gain muscle and lose body fat. Here we review the accumulating human and animal evidence showing that AAS may cause a distinct dependence syndrome, often associated with adverse psychiatric and medical effects.

METHOD

We present an illustrative case of AAS dependence, followed by a summary of the human and animal literature on this topic, based on publications known to us or obtained by searching the PubMed database.

RESULTS

About 30% of AAS users appear to develop a dependence syndrome, characterized by chronic AAS use despite adverse effects on physical, psychosocial or occupational functioning. AAS dependence shares many features with classical drug dependence. For example, hamsters will self-administer AAS, even to the point of death, and both humans and animals exhibit a well-documented AAS withdrawal syndrome, mediated by neuroendocrine and cortical neurotransmitter systems. AAS dependence may particularly involve opioidergic mechanisms. However, AAS differ from classical drugs in that they produce little immediate reward of acute intoxication, but instead a delayed effect of muscle gains. Thus standard diagnostic criteria for substance dependence, usually crafted for acutely intoxicating drugs, must be adapted slightly for cumulatively acting drugs such as AAS.

CONCLUSIONS

AAS dependence is a valid diagnostic entity, and probably a growing public health problem. AAS dependence may share brain mechanisms with other forms of substance dependence, especially opioid dependence. Future studies are needed to characterize AAS dependence more clearly, identify risk factors for this syndrome and develop treatment strategies.

The anabolic steroids testosterone propionate and nandrolone, but not 17alpha-methyltestosterone, induce conditioned place preference in adult mice

Anabolic androgenic steroids (AAS) are often misused by adolescents and athletes. Their effects vary according to chemical structure and metabolism, route of administration, and AAS regimen. In this study, adult C57Bl/6 male mice were systemically exposed to testosterone propionate (TP), nandrolone or 17alpha-methyltestosterone (17alpha-meT), type I, type II and type III AAS, respectively, in order to determine the hedonic or aversive properties of each drug. For this purpose, the conditioned place preference (CPP) test was employed at three different AAS doses (0.075, 0.75 and 7.5 mg/kg). Other behavioral domains monitored were light-dark transitions (side changes) and general activity. TP shifted place preference at all doses tested, and nandrolone shifted place preference at 0.75 and 7.5 mg/kg, but not at 0.075 mg/kg, the lower dose tested. Conversely, mice receiving 17alpha-meT did not show alteration in the preference score. The lower dose of nandrolone did modify exploratory-based anxiety showing a decrease in light-dark transitions if compared to vehicle-treated animals, while mice treated with TP or 17alpha-meT were not affected. Our data suggest that when studying hedonic and rewarding properties of synthetic androgens, distinction has to be made based on type of AAS and metabolism.

Daily exercise and anabolic steroids use in adolescents: a cross-national European study

AIM

The aim of this paper is to investigate the association between anabolic steroid (AS) use and intensive physical exercise among adolescents.

DESIGN/SETTING

The 1999 cross-sectional European School Survey Project on Alcohol and Other Drugs (ESPAD). Data collection by standardized methodology using anonymous self-administered questionnaires completed in the classroom.

PARTICIPANTS

National probability samples of a total of 18,430 16-year-old high school students from six European countries (Bulgaria, Croatia, Cyprus, Greece, the Slovak Republic, and the U.K.)

MEASUREMENTS

Besides AS use and physical exercise, questionnaire items selected for this study included tobacco, alcohol, and illicit drug use, indicators of other deviant behavior (self-harming thoughts and behavior, truancy, aggressive behavior), friends' use of AS, and perceived availability. Backward elimination with likelihood ratio tests was used to select the variables to be retained in a mutlifactorial model. Interactions of other independent variables with country were checked.

FINDINGS

Logistic regression analysis of lifetime AS users compared to nonusers showed that the odds of lifetime AS use are 1.4 times higher for students who exercise almost daily and 1.8 times higher for boys compared to girls. Significant associations of AS use were also found with current frequent alcohol use, lifetime use of tranquilizers/sedatives and cannabis, and with the perceptions of friends' use of AS and of easy availability of the substance.

CONCLUSION

Findings indicate that daily exercising appears to increase the risk of anabolic steroid use in adolescents. However, a more general pattern of closely interlinked deviant types of behavior, such as other drug use and aggressive behavior, is prominent. Preventive interventions are needed targeted towards adolescents involved in intensive exercise and sport. These should take into account both the idiosyncrasy and setting of the sporting culture and the special characteristics of this group.

Long-term psychiatric and medical consequences of anabolic-androgenic steroid abuse: a looming public health concern?

BACKGROUND

The problem of anabolic-androgenic steroid (AAS) abuse has recently generated widespread public and media attention. Most AAS abusers, however, are not elite athletes like those portrayed in the media, and many are not competitive athletes at all. This larger but less visible population of ordinary AAS users began to emerge in about 1980. The senior members of this population are now entering middle age; they represent the leading wave of a new type of aging former substance abusers, with specific medical and psychiatric risks.

METHODS

We reviewed the evolving literature on long-term psychiatric and medical consequences of AAS abuse.

RESULTS

Long-term use of supraphysiologic doses of AAS may cause irreversible cardiovascular toxicity, especially atherosclerotic effects and cardiomyopathy. In other organ systems, evidence of persistent toxicity is more modest, and interestingly, there is little evidence for an increased risk of prostate cancer. High concentrations of AAS, comparable to those likely sustained by many AAS abusers, produce apoptotic effects on various cell types, including neuronal cells--raising the specter of possibly irreversible neuropsychiatric toxicity. Finally, AAS abuse appears to be associated with a range of potentially prolonged psychiatric effects, including dependence syndromes, mood syndromes, and progression to other forms of substance abuse. However, the prevalence and severity of these various effects remains poorly understood.

CONCLUSIONS

As the first large wave of former AAS users now moves into middle age, it will be important to obtain more systematic data on the long-term psychiatric and medical consequences of this form of substance abuse.

A league of their own: demographics, motivations and patterns of use of 1,955 male adult non-medical anabolic steroid users in the United States

Background

Rule violations among elite-level sports competitors and tragedies among adolescents have largely defined the issue of non-medical anabolic-androgenic steroid (NMAAS) use for the public and policy makers. However, the predominant and oft-ignored segment of the NMAAS community exists in the general population that is neither participating in competitive sports nor adolescent. A clearer profile of NMAAS users within the general population is an initial step in developing a full understanding of NMAAS use and devising appropriate policy and interventions. This survey sought to provide a more comprehensive profile of NMAAS users by accessing a large sample of user respondents from around the United States.

Methods

U.S.-based male NMAAS users (n = 1955) were recruited from various Internet websites dedicated to resistance training activities and use of ergogenic substances, mass emails, and print media to participate in a 291-item web-based survey. The Internet was utilized to provide a large and geographically diverse sample with the greatest degree of anonymity to facilitate participation.

Results

The majority of respondents did not initiate AAS use during adolescence and their NMAAS use was not motivated by athletics. The typical user was a Caucasian, highly-educated, gainfully employed professional approximately 30 years of age, who was earning an above-average income, was not active in organized sports, and whose use was motivated by increases in skeletal muscle mass, strength, and physical attractiveness. These findings question commonly held views of the typical NMAAS user and the associated underlying motivations.

Conclusion

The focus on "cheating" athletes and at risk youth has led to ineffective policy as it relates to the predominant group of NMAAS users. Effective policy, prevention or intervention should address the target population(s) and their reasons for use while utilizing their desire for responsible use and education.

Central effects of the anabolic steroid 17alpha methyltestosterone in female anxiety

The androgen 17alpha-methyltestosterone (17alpha-meT) is one of the most commonly abused anabolic androgenic steroids (AAS). We assessed the impact of 17alpha-meT after bilateral infusion into the dorsomedial hypothalamus (DMH) in female anxiety. A paradoxical effect in Vogel conflict test (VCT) behavior was noted: while AAS infusion induced an increase in the latency to display the appetitive reaction of the task, it also increased the number of punished responses. No changes in elevated plus maze (EPM) behavior were noted. However, AAS infusion induced an increase in social interactions. Changes in social interactions were mimicked by muscimol infusion and counteracted by co-infusion of AAS plus the GABAA receptor (GABAA-R) antagonist GABAzine. A reduction of systolic blood pressure was registered after AAS infusion in the DMH. No changes in fluid intake or locomotor behaviors were noted. We conclude that the AAS 17alpha-meT modulates distinct anxiety domains in females through a fast-acting mechanism.

Predicting intentions for long-term anabolic-androgenic steroid use among men: A covariance structure model

Long-term use of anabolic-androgenic steroids (AASs) is associated with both positive and negative effects. The authors examined possible mechanisms by which these effects contribute to AAS satisfaction and predict intentions for future AAS use. Five hundred male AAS users completed an interactive Web-based instrument assessing the psychological and physical effects of AAS use. Covariance structure modeling was used to evaluate both direct and indirect effects of AAS consequences on satisfaction with AASs and intentions for future AAS use. Results suggest that gain in muscle mass and psychological benefits from AAS use uniquely contributed to both AAS satisfaction and intentions for future use. Side effects from AAS use also uniquely contributed to AAS satisfaction, but ancillary drug use was found to partially mediate this relationship, suggesting that the satisfaction of experienced AAS users is enhanced by their mastery of side effects through the use of ancillary drugs. The final model explained 29% of the variance in intentions for future AAS use. Mechanisms for sustained AAS use and implications for intervention and prevention strategies are discussed.

Men, muscles, and body image: comparisons of competitive bodybuilders, weight trainers, and athletically active controls

OBJECTIVES

To investigate body image and psychosocial adjustment among competitive bodybuilders, non-competitive weight trainers, and athletically active men.

METHODS

Participants were 40 men in each of the three groups who were assessed on body composition and multiple facets of body image evaluation, investment and anxiety, eating attitudes, and social self esteem.

RESULTS

Relative to the other two groups, competitive bodybuilders had greater body mass due to fat-free body mass. Although groups did not differ in their situational body image discomfort, competitive bodybuilders and weight trainers had a more positive global appearance evaluation and were more psychologically invested in their physical appearance. Compared with active controls, men in both weightlifting groups were more satisfied with their upper torso and muscle tone. Competitive bodybuilders reported more mid torso satisfaction than the other two groups. Competitive bodybuilders also wished to be significantly heavier than controls did and reported higher social self esteem but greater eating disturbance.

CONCLUSIONS

The findings suggest that competitive bodybuilders as a group are not more "muscle dysmorphic" than either non-competitive weight trainers or physically active men who do not train with weights.

Modulation of affect after chronic exposure to the anabolic steroid 17alpha-methyltestosterone in adult mice

A battery of behavioral tasks in C57BL/6J mice was used to assess changes in affective components of behavior after systemic exposure to the anabolic-androgenic steroid (AAS) 17alpha-methyltestosterone (7.5 mg/kg). Gonadal weight in both sexes was reduced after 16 days of AAS exposure. Changes in discrete components of social behaviors were observed. No changes were recorded in the elevated plus-maze, the light-dark transition, and defensive behavior tests on exposure to 17alpha-methyltestosterone. When compared with controls, AAS-exposed females received a greater number of shocks, and AAS-exposed males displayed a shorter recovery time to consume water after a negative reinforcer in the modified Vogel conflict test. Results show that systemic exposure to a single AAS modified social behaviors, whereas minimal effects on anxiety-related behaviors were observed according to sex.

Muscularity concerns among men: development of attitudinal and perceptual measures

The current study reports the development and psychometrics of a figure rating scale with leanness and muscularity dimensions and a 13-item questionnaire assessing symptoms associated with muscle dysmorphia (MD). Three separate samples of men and women completed the muscle dysmorphic disorder inventory (MDDI), the bodybuilder image grid (BIG) or both to measure 1-week test-retest reliability, internal consistency, convergent and divergent validity and valid placement of BIG figures along interval scales of body fat and lean muscle mass. The MDDI and MDDI subscales (drive for size, appearance intolerance, and functional impairment) had good reliability, internal consistency, convergent and divergent validity. The BIG had good to excellent test-retest reliability, good convergent and divergent validity and validity as an interval scale. Implications for characterizing body image disturbance in men and benefits and limitations of the measures are discussed.

Effects of Androgenic-Anabolic Steroids in Athletes

Androgenic-anabolic steroids (AAS) are synthetic derivatives of the male hormone testosterone. They can exert strong effects on the human body that may be beneficial for athletic performance. A review of the literature revealed that most laboratory studies did not investigate the actual doses of AAS currently abused in the field. Therefore, those studies may not reflect the actual (adverse) effects of steroids. The available scientific literature describes that short-term administration of these drugs by athletes can increase strength and bodyweight. Strength gains of about 5-20% of the initial strength and increments of 2-5 kg bodyweight, that may be attributed to an increase of the lean body mass, have been observed. A reduction of fat mass does not seem to occur. Although AAS administration may affect erythropoiesis and blood haemoglobin concentrations, no effect on endurance performance was observed. Little data about the effects of AAS on metabolic responses during exercise training and recovery are available and, therefore, do not allow firm conclusions. The main untoward effects of short- and long-term AAS abuse that male athletes most often self-report are an increase in sexual drive, the occurrence of acne vulgaris, increased body hair and increment of aggressive behaviour. AAS administration will disturb the regular endogenous production of testosterone and gonadotrophins that may persist for months after drug withdrawal. Cardiovascular risk factors may undergo deleterious alterations, including elevation of blood pressure and depression of serum high-density lipoprotein (HDL)-, HDL2- and HDL3-cholesterol levels. In echocardiographic studies in male athletes, AAS did not seem to affect cardiac structure and function, although in animal studies these drugs have been observed to exert hazardous effects on heart structure and function. In studies of athletes, AAS were not found to damage the liver. Psyche and behaviour seem to be strongly affected by AAS. Generally, AAS seem to induce increments of aggression and hostility. Mood disturbances (e.g. depression, [hypo-]mania, psychotic features) are likely to be dose and drug dependent. AAS dependence or withdrawal effects (such as depression) seem to occur only in a small number of AAS users. Dissatisfaction with the body and low self-esteem may lead to the so-called 'reverse anorexia syndrome' that predisposes to the start of AAS use. Many other adverse effects have been associated with AAS misuse, including disturbance of endocrine and immune function, alterations of sebaceous system and skin, changes of haemostatic system and urogenital tract. One has to keep in mind that the scientific data may underestimate the actual untoward effects because of the relatively low doses administered in those studies, since they do not approximate doses used by illicit steroid users. The mechanism of action of AAS may differ between compounds because of variations in the steroid molecule and affinity to androgen receptors. Several pathways of action have been recognised. The enzyme 5-alpha-reductase seems to play an important role by converting AAS into dihydrotestosterone (androstanolone) that acts in the cell nucleus of target organs, such as male accessory glands, skin and prostate. Other mechanisms comprises mediation by the enzyme aromatase that converts AAS in female sex hormones (estradiol and estrone), antagonistic action to estrogens and a competitive antagonism to the glucocorticoid receptors. Furthermore, AAS stimulate erythropoietin synthesis and red cell production as well as bone formation but counteract bone breakdown. The effects on the cardiovascular system are proposed to be mediated by the occurrence of AAS-induced atherosclerosis (due to unfavourable influence on serum lipids and lipoproteins), thrombosis, vasospasm or direct injury to vessel walls, or may be ascribed to a combination of the different mechanisms. AAS-induced increment of muscle tissue can be attributed to hypertrophy and the formation of new muscle fibres, in which key roles are played by satellite cell number and ultrastructure, androgen receptors and myonuclei.

A preliminary investigation into the relationship between anabolic-androgenic steroid use and the symptoms of reverse anorexia in both current and ex-users

RATIONALE

To establish whether the symptoms of reverse anorexia continue with the cessation of anabolic-androgenic steroid (AAS) use in male body builders.

OBJECTIVE

To determine whether current and ex-AAS-using body builders score higher on the modified (for reverse anorexia) eating disorders inventory (EDI) than both non-AAS-using body builders and regular aerobic exercisers.

METHODS

A random sample of regular aerobic exercisers, current, ex-, and non-AAS-using body builders were recruited from four local gyms and a syringe exchange in the Merseyside area. A total of 137 male subjects with an average age of 29 years (range 17-49 years) were recruited. Fifty subjects were classed as aerobic exercisers, 39 subjects were classed as non-AAS-using body builders, 29 subjects were current AAS users and 19 subjects were ex-AAS users. All subjects undertook an anonymous questionnaire consisting of the modified EDI, the severity of dependence scale (SDS) for both exercising and AAS use, and questions about body weight, dieting, and substance use.

RESULTS

AAS-using bodybuilders were striving towards an exaggerated mesomorphic physique. Both current and ex-AAS users had higher scores on all sections of the EDI than both groups of non-AAS users. There was a significant positive correlation between the SDS scores for AAS and scores on the EDI for current AAS users.

CONCLUSIONS

AAS use, but not body building per se, was associated with increased symptoms of reverse anorexia, and this symptomatology was higher in those who had higher scores on the SDS for AAS. It remains to be determined whether symptoms of reverse anorexia are either a cause or an effect of AAS use.

Dismorfia muscular

Preocupações mórbidas com a imagem corporal eram tidas até recentemente como problemas eminentemente femininos. Atualmente estas preocupações também têm sido encontradas no sexo masculino. A dismorfia muscular é um subtipo do transtorno dismórfico corporal que ocorre principalmente em homens que, apesar da grande hipertrofia muscular, consideram-se pequenos e fracos. Além de estar associada a prejuízos sociais, ocupacionais, recreativos e em outras áreas do funcionamento do indivíduo, a dismorfia muscular é também um fator de risco para o abuso de esteróides anabolizantes. Este artigo aborda aspectos epidemiológicos, etiológicos e padrões clínicos da dismorfia muscular, além de tecer comentários sobre estratégias de tratamento para este transtorno.

Adult psychopathology: issues and controversies

This review discusses issues and controversies with respect to the construct of a mental disorder, models of etiology and pathology, and domains of psychopathology. Fundamental to the science of psychopathology is a conceptualization of mental disorder, yet inadequate attention is being given to the differentiation of normal and abnormal psychological functioning in current research. The boundaries between mental and physical disorders are equally problematic. Neurophysiological models are receiving particular emphasis in large part because of the substantial progress being made in documenting and clarifying the important role of neurophysiological structures and mechanisms in etiology and pathology. However, this attention might be at the expense of the recognition of equally valid psychological models. Problematic diagnostic boundaries are also considered, including those within and between different classes of disorder. Dimensional models may offer a more precise and comprehensive classification of psychopathology.

Building culturally sensitive substance use prevention and treatment programs for transgendered populations

Studies show that transgendered individuals are at high risk for substance use problems. It is important to identify the unique needs and concerns of these individuals and culturally sensitive programs that will be successful in recruiting and retaining these individuals in drug abuse treatment services. This involves incorporating the needs of services from the perspectives of both the transgendered community and health-care professionals. It is the purpose of this article to discuss transgenderism as well as the substance use problems and difficulties within substance use treatment that transgendered men and women may face. This article presents guidelines for the design and evaluation of health-care services to transgendered populations.

A psychological comparison of females with anorexia nervosa and competitive male bodybuilders: body shape ideals in the extreme

There is accumulating evidence that young men have become as concerned with their physical appearance as young women. However, different from women who want to achieve an ultra-slender body shape, most men want to increase their muscle mass and body size. Women with anorexia nervosa (AN) and competitive male bodybuilders are those who have taken the cultural standards of bodily perfection to the extreme, and both use unhealthy behaviours such as severe food restriction, excessive exercise, and steroids in pursuit of their goals. Findings of this study confirmed our prediction that the psychological profile of bodybuilders would be very similar to that found in women with AN. Both groups were significantly more obsessional, perfectionistic, anhedonic, and pathologically narcissistic than the general population. However, the bodybuilders reported very positive perceptions of their self-worth while the AN patients had very negative perceptions. Results are interpreted in the framework of a speculative developmental model of AN and bodybuilding, which focuses on the role of personality in the initiation and maintenance of excessive behaviours.

Rare mononeuropathies of the upper limb in bodybuilders

Clinical and electrophysiological findings of mononeuropathies of thoracodorsal, dorsoscapular, terminal branch of suprascapular, and medial pectoral nerves are reported in 4 bodybuilders. All athletes used anabolic steroids. After about 1 year partial improvement of symptoms was evident in 2 cases and complete recovery in the other 2. The data are discussed in the light of the few other existing reports and possible pathogenetic mechanisms.