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Watters S, Higgins A. Muscle dysmorphia: an under-recognised aspect of body dissatisfaction in men. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2024; 33:584-588. [PMID: 38900653 DOI: 10.12968/bjon.2023.0176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/22/2024]
Abstract
Although men and women both experience eating disorders such as anorexia nervosa and bulimia nervosa, there are differences in the way their eating disorder may present. Body dissatisfaction or body dysmorphia in men may be more related to a drive for muscularity as opposed to thinness. Muscle dysmorphic disorder (also known as muscle dysmorphia) is a form or subtype of body dysmorphia that is characterised by an extreme desire for muscularity and a preoccupation with the idea that one's physique is too small or not sufficiently muscular. It is more common in men than women and is associated with body image distortion, excessive exercise routines, muscularity-orientated disordered eating and the use of appearance- and performance-enhancing drugs such as anabolic androgenic steroids. Risk factors for muscle dysmorphic disorder include social pressure (including to conform to gender stereotypes) and low self-esteem. The condition has negative psychological, physical, relational and financial effects. Nurses can play a role in health promotion as well as in the assessment, care and referral of men with muscle dysmorphic disorder.
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Affiliation(s)
- Sarah Watters
- Registered Psychiatric Nurse, and Master's Student in Applied Social Research, School of Social Work and Social Policy Trinity College Dublin
| | - Agnes Higgins
- Professor in Mental Health, School of Nursing and Midwifery, Trinity College Dublin
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Cuadrado J, Hanne-Poujade S, Michel G. Adaptation and validation of the muscle dysmorphic disorder inventory in a population of French athletes (MDDI-Fr). L'ENCEPHALE 2024; 50:247-256. [PMID: 37604719 DOI: 10.1016/j.encep.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 05/04/2023] [Accepted: 05/05/2023] [Indexed: 08/23/2023]
Abstract
INTRODUCTION Muscle dysmorphia, a theme mainly investigated by Anglo-Saxon research, is a specific body dysmorphic disorder that characterizes individuals who think they are insufficiently muscular and lean. Understudied in francophone countries, tools translated and validated in French to measure the symptomatology of muscle dysmorphia remain rare. OBJECTIVES The aim of this study was the translation into French and the psychometric validation of a tool evaluating muscle dysmorphia, the Muscle Dysmorphic Disorder Inventory (MDDI-Fr), through 13 items divided into three dimensions: the "Drive For Size" (DFS), the "Appearance Intolerance" (AI) and the "Functional Impairment" (FI). METHODOLOGY A first translation step was conducted, followed by two cross-sectional studies conducted in France. In both of the latter studies, a sociodemographic questionnaire and the Muscle Dysmorphic Disorder Inventory - French version (MDDI-Fr) were administered. The first study included 342 university students (Mage=20.9; SDage=2.9), and 1822 athletes for the second study (Mage=23.9; SDage=5.9). Validation was performed using internal consistency measures and confirmatory factor analysis. RESULTS The correlation matrices showed good significant results between items and dimensions. The three dimensions appeared distinct from each other with significant intra-dimension correlations. The internal consistency of the tool and its three dimensions show valid Cronbach's alphas (study 1: DFS=0.79, AI=0.74, FI=0.75, MDDI=0.74; study 2: DFS=0.72, AI=0.75, FI=0.83, MDDI=0.75). In addition, the tri-factor analysis shows significant and promising scores for the tool in three dimensions and 13 items for study 1 (χ2/df=4.67, CFI=0.85, TLI=0.83, RMSEA=0.10, SRMR=0.00), as for study 2 (χ2/df=16.08, CFI=0.87, TLI=0.84, RMSEA=0.09, SRMR=.06). Gender analyses were conducted on study 2, which showed that the DFS subscale (items 1, 4, 5) and the AI subscale (items 6 and 9) presented the greatest differences in factor loadings between genders. CONCLUSION The translation, as well as the validation of the MDDI-Fr structured with 13 items and three dimensions, showed significantly satisfying results for its adaptation in French in a population of French men and women practicing weight training. However, the "Appearance Intolerance" dimension shows moderate links with the global tool, which should be investigated in future studies. Although the psychometric properties of the MDDI-Fr are promising, additional research is needed to gain a better understanding of gender differences in the results, especially for the DFS dimension.
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Affiliation(s)
- Jérôme Cuadrado
- Institut de Sciences Criminelles et de la Justice (ISCJ), Université de Bordeaux, 4, rue du Maréchal-Joffre, 33075 Bordeaux, France; Faculté de psychologie, Université de Bordeaux, 3ter, place de la Victoire, 33000 Bordeaux, France; Faculté STAPS, Équipe vie sportive, Laboratoire Cultures, éducation, sociétés (LACES, EA7437), Université de Bordeaux, 33600 Pessac, France; Cabinet de psychologie, 226, rue du Tondu, 33000 Bordeaux, France.
| | | | - Grégory Michel
- Institut de Sciences Criminelles et de la Justice (ISCJ), Université de Bordeaux, 4, rue du Maréchal-Joffre, 33075 Bordeaux, France; Faculté de psychologie, Université de Bordeaux, 3ter, place de la Victoire, 33000 Bordeaux, France; Pôle de santé Saint-Genès, 4, rue Régis, 33800 Bordeaux, France
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Devilly GJ, Wilkinson P, Allen C, Piatkowski T. Unmasking Distorted Reflections: Exploring Body Image, Alcohol, and Drug Use in Nighttime Entertainment Districts. Subst Use Misuse 2024; 59:1280-1292. [PMID: 38640402 DOI: 10.1080/10826084.2024.2320377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/21/2024]
Abstract
Background: Violence within nighttime entertainment districts (NEDs) has been blamed on problematic masculinity and has predominantly been attributed to excessive alcohol intake and steroid use in men. In this report we conducted two studies to: (1) ascertain whether researchers could act as third-party raters of body weight and muscle mass in NED patrons; and (2) to examine the relationship between body self-image, inebriation, alcohol preloading behaviors and drug use in the NEDs. Methods: Study 1 employed an observational approach to establish inter-rater reliability for ratings of muscle mass and weight. In Study 2 data (n = 2,745) were collected through breathalyzing and questionnaires to examine individuals' self-image and drinking and drug-taking behaviors. Results: Participants' self-ratings of muscle and weight significantly differed from researchers' ratings, with males perceiving themselves as less muscular and females perceiving themselves as heavier. Perceived weight and muscle size did not relate to alcohol levels, but an interaction was found for female steroid users who perceived themselves as less muscular. Conclusions: Findings indicated a distortion in participants' perceived body image, with a desire for muscularity among both males and females. These results underscore the complex interplay between self-perception, societal ideals, and drug use in young NED patrons.
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Affiliation(s)
- Grant J Devilly
- School of Applied Psychology, Griffith University, Brisbane, Queensland, Australia
- Griffith Criminology Institute, Griffith University, Brisbane, Queensland, Australia
| | - Petra Wilkinson
- School of Applied Psychology, Griffith University, Brisbane, Queensland, Australia
| | - Corey Allen
- Griffith Criminology Institute, Griffith University, Brisbane, Queensland, Australia
- Queensland Police Service, Inner West Patrol Group, Brisbane, Queensland, Australia
| | - Timothy Piatkowski
- School of Applied Psychology, Griffith University, Brisbane, Queensland, Australia
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Hudson JI, Hudson Y, Kanyama G, Schnabel J, Javaras KN, Kaufman MJ, Pope HG. Causal factors in childhood and adolescence leading to anabolic-androgenic steroid use: A machine learning approach. DRUG AND ALCOHOL DEPENDENCE REPORTS 2024; 10:100215. [PMID: 38304122 PMCID: PMC10832464 DOI: 10.1016/j.dadr.2023.100215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 11/30/2023] [Accepted: 12/26/2023] [Indexed: 02/03/2024]
Abstract
Background Prior research has demonstrated associations between anabolic-androgenic steroid (AAS) use and features from several childhood and adolescent psychosocial domains including body image concerns, antisocial traits, and low levels of parental care. However, prior approaches have been limited by their focus on individual features and lack of consideration of the relevant causal structure. Methods We re-analyzed data from a previous cross-sectional cohort study of 232 male weightlifters aged 18-40, of whom 101 had used AAS. These men completed retrospective measures of features from their childhood and early adolescence, including body image concerns, eating disorder psychopathology, antisocial traits, substance use, and family relationships. Using an approach informed by principles of causal inference, we applied four machine-learning methods - lasso regression, elastic net regression, random forests, and gradient boosting - to predict AAS use. Results The four methods yielded similar receiver operating curves, mean area under the curve (range 0.66 to 0.72), and sets of highly important features. Features related to adolescent body image concerns (especially muscle dysmorphia symptoms) were the strongest predictors. Other important features were adolescent rebellious behaviors; adolescent feelings of ineffectiveness and lack of interoceptive awareness; and low levels of paternal care. Conclusions Applying machine learning within a causally informed approach to re-analyze data from a prior study of weightlifters, we identified six factors (most prominently those related to adolescent body image concerns) as proposed causal factors for the development of AAS use. Compared with the prior analyses, this approach achieved greater methodologic rigor and yielded stronger and broader findings.
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Affiliation(s)
- James I. Hudson
- Biological Psychiatry Laboratory and Psychiatric Epidemiology Research Program, McLean Hospital, 115 Mill Street, Belmont, MA 02478, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA USA
| | - Yaakov Hudson
- Israel Center for Entrepreneurship, Jerusalem, Israel
| | - Gen Kanyama
- Biological Psychiatry Laboratory and Psychiatric Epidemiology Research Program, McLean Hospital, 115 Mill Street, Belmont, MA 02478, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA USA
| | - Jiana Schnabel
- Biological Psychiatry Laboratory and Psychiatric Epidemiology Research Program, McLean Hospital, 115 Mill Street, Belmont, MA 02478, USA
| | - Kristin N. Javaras
- Department of Psychiatry, Harvard Medical School, Boston, MA USA
- Division of Women's Mental Health, McLean Hospital, Belmont, MA, USA
| | - Marc J. Kaufman
- Department of Psychiatry, Harvard Medical School, Boston, MA USA
- McLean Imaging Center, McLean Hospital, Belmont, MA, USA
| | - Harrison G. Pope
- Biological Psychiatry Laboratory and Psychiatric Epidemiology Research Program, McLean Hospital, 115 Mill Street, Belmont, MA 02478, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA USA
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Askew AJ, Randall A, Alvarez JC, Elbe CI, Caravelli N, Gonzales M, van der Star A, Blashill AJ. Examining the association of structural stigmas with body image-related outcomes among sexual minority individuals. Body Image 2024; 48:101652. [PMID: 38141492 DOI: 10.1016/j.bodyim.2023.101652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 11/13/2023] [Accepted: 11/20/2023] [Indexed: 12/25/2023]
Abstract
Sexual minority individuals display heightened body image disturbance, which is associated with negative health outcomes. Structural stigmas are associated with negative health outcomes among sexual minority individuals, but the association between structural stigmas and body image is not understood. Using a linear regression approach, we examined how U.S. state-level structural racism and structural sexual minority stigma were associated with body image-related outcomes including eating pathology, appearance and/or performance-enhancing drug (APED) misuse, and dysmorphic concern. Participants were 942 cisgender sexual minority individuals ages 18-30, with approximately equal representation among non-Hispanic/Latinx White, Black, Asian, and Hispanic/Latinx individuals. There was not a significant main effect of state-level structural sexual minority stigma on body image-related outcomes. In states with higher structural racism, Hispanic/Latinx participants endorsed higher APED misuse, and this interaction was not significant among non-Hispanic/Latinx White individuals. This pattern was not found among Black or Asian participants, nor was it replicated for dysmorphic concern or eating pathology. Findings suggest that reducing exposure to structural racism could reduce APED misuse among Hispanic/Latinx individuals.
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Affiliation(s)
- Autumn J Askew
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, 6363 Alvarado Court, Suite 103, San Diego, CA 92120, United States
| | - Alyson Randall
- Department of Psychology, San Diego State University, 5500 Campanile Drive, San Diego, CA 92182, United States
| | - Jordan C Alvarez
- Department of Psychology, Auburn University, Auburn AL, United States
| | - Connor I Elbe
- Department of Psychology, San Diego State University, 5500 Campanile Drive, San Diego, CA 92182, United States
| | - Nicolas Caravelli
- Department of Psychology, San Diego State University, 5500 Campanile Drive, San Diego, CA 92182, United States
| | - Manuel Gonzales
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, 6363 Alvarado Court, Suite 103, San Diego, CA 92120, United States
| | - Arjan van der Star
- Department of Psychology, San Diego State University, 5500 Campanile Drive, San Diego, CA 92182, United States
| | - Aaron J Blashill
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, 6363 Alvarado Court, Suite 103, San Diego, CA 92120, United States; Department of Psychology, San Diego State University, 5500 Campanile Drive, San Diego, CA 92182, United States.
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Scarth M, Westlye LT, Havnes IA, Bjørnebekk A. Investigating anabolic-androgenic steroid dependence and muscle dysmorphia with network analysis among male weightlifters. BMC Psychiatry 2023; 23:342. [PMID: 37193971 DOI: 10.1186/s12888-023-04781-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 04/13/2023] [Indexed: 05/18/2023] Open
Abstract
BACKGROUND Anabolic-androgenic steroid (AAS) dependence has numerous adverse health consequences, and may be driven in part by body image concerns, primarily muscle dysmorphia. This study aims to further understand and identify potential clinical targets using network analyses of AAS dependence and muscle dysmorphia symptoms in males who used AAS and weightlifting controls. METHODS A sample of 153 men who currently or previously used AAS and 88 weight-lifting controls were recruited through social media and relevant online forums, and via posters and flyers distributed in select gyms in Oslo, Norway. Symptoms of AAS dependence and muscle dysmorphia were assessed using clinical interviews and standardized questionnaires. Severity of muscle dysmorphia symptoms were compared between the groups using independent samples t-tests. The following symptom networks were computed using Gaussian graphical modeling or mixed graphical modeling: (1) AAS dependence symptoms among men with AAS use (2) muscle dysmorphia symptoms among men with AAS use and weight-lifting controls in two separate networks, which were compared using a network comparison test, and (3) AAS dependence and muscle dysmorphia symptoms among men with AAS use. RESULTS In a network of AAS dependence symptoms, continuing use despite physical and mental side effects, using longer than planned, tolerance, and work/life interference were the most central symptoms. When comparing symptom structures of muscle dysmorphia between those who used AAS and controls, the most central symptoms in each group were exercise dependence and size/symmetry concerns, respectively. Men with AAS use demonstrated elevated muscle dysmorphia symptoms compared to controls, indicating that both the severity and structure of symptoms differ between these groups. In a network including both AAS dependence and muscle dysmorphia symptoms, no significant connections between symptom groups were identified. CONCLUSIONS AAS dependence is complex, with correlated somatic and psychological challenges driving the symptom network, indicating that alleviating physical and mental health concerns during both AAS use and cessation is an important clinical target. Muscle dysmorphia symptoms related to taking action (diet, exercise, and supplement use) appear to cluster together more for those who use AAS than those who do not.
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Affiliation(s)
- Morgan Scarth
- Anabolic Androgenic Steroid Research Group, Section for Clinical Addiction Research, Division of Mental Health and Addiction, Oslo University Hospital, Postbox 4959, Nydalen, Oslo, 0424, Norway.
- Department of Psychology, University of Oslo, Oslo, Norway.
| | - Lars T Westlye
- Department of Psychology, University of Oslo, Oslo, Norway
- Division of Mental Health and Addiction, Institute of Clinical Medicine, NORMENT, Oslo University Hospital, University of Oslo, Oslo, Norway
- KG Jebsen Centre for Neurodevelopmental Disorders, University of Oslo, Oslo, Norway
| | - Ingrid A Havnes
- Anabolic Androgenic Steroid Research Group, Section for Clinical Addiction Research, Division of Mental Health and Addiction, Oslo University Hospital, Postbox 4959, Nydalen, Oslo, 0424, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Astrid Bjørnebekk
- Anabolic Androgenic Steroid Research Group, Section for Clinical Addiction Research, Division of Mental Health and Addiction, Oslo University Hospital, Postbox 4959, Nydalen, Oslo, 0424, Norway
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Associations between body image patterns and body image-related pathology in sexual minority individuals: A mixture-modeling approach. Body Image 2023; 45:73-85. [PMID: 36842423 DOI: 10.1016/j.bodyim.2023.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 02/05/2023] [Accepted: 02/08/2023] [Indexed: 02/27/2023]
Abstract
Body image concerns are associated with disordered eating, body dysmorphic disorder (BDD), and illicit appearance and performance enhancing drug (APED) misuse. Sexual minority individuals are a vulnerable population for body image concerns. Latent profile analyses were used to identify body image patterns in sexual minority men (n = 479) and women (n = 483) and to investigate associations between latent profiles and body image-related pathology. A 5-profile solution demonstrated best fit for men and a 4-profile solution for women. Among women, co-occurring high thinness/muscularity concerns had higher probability of vomiting and dietary restriction than the high thinness/low muscularity concerns profile. The probability of driven exercise did not differ across latent profiles for men and only differed between low thinness/low muscularity and high thinness/high muscularity concerns profiles in women. Men with low thinness/high muscularity concerns had significantly lower probability of vomiting and laxative misuse than all other profiles but did not significantly differ from co-occurring high or moderate thinness/muscularity concerns profiles in binge eating and illicit APED misuse. This study may have implications for future research, treatment, and prevention of body image-related pathology in sexual minority individuals.
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Compte EJ, Cattle CJ, Lavender JM, Brown TA, Murray SB, Capriotti MR, Flentje A, Lubensky ME, Obedin-Maliver J, Lunn MR, Nagata JM. Psychometric evaluation of the muscle dysmorphic disorder inventory (MDDI) among gender-expansive people. J Eat Disord 2022; 10:95. [PMID: 35794647 PMCID: PMC9260975 DOI: 10.1186/s40337-022-00618-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 06/24/2022] [Indexed: 11/10/2022] Open
Abstract
PURPOSE Muscle dysmorphia is generally classified as a specific form of body dysmorphic disorder characterized by a pathological drive for muscularity and the preoccupation that one is too small or not sufficiently muscular. The majority of research on the condition has been conducted in cisgender men with a paucity of literature on gender minority people, a population that is at risk for muscle dysmorphia. One of the most widely used measures of muscle dysmorphia symptoms, the Muscle Dysmorphic Disorder Inventory (MDDI), has not been psychometrically validated for use in gender minority samples, the aim of the present study. METHODS We evaluated the psychometric properties of the MDDI in a sample of 1031 gender-expansive individuals (gender minority people whose gender identity differs from that assumed for their sex assigned at birth and is not exclusively binary man or woman) aged 18-74 who were part of The PRIDE Study, a large-scale, U.S., longitudinal cohort study. RESULTS Using a two-step, split-sample exploratory and confirmatory factor analytic approach, we found support for the original three-factor structure of the measure. The subscales showed adequate internal consistency, and convergent validity was supported based on significant associations of the MDDI subscale scores with theoretically related scores on a widely used measure of disordered eating. CONCLUSIONS These findings provided novel support for adequate psychometric properties of the MDDI in a sample of gender-expansive individuals, facilitating the use of this measure in future research on muscle dysmorphia in this understudied and at-risk population.
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Affiliation(s)
- Emilio J Compte
- Eating Behavior Research Center, School of Psychology, Universidad Adolfo Ibáñez, Santiago, Chile
- Research Department, Comenzar de Nuevo Treatment Center, Monterrey, Mexico
| | - Chloe J Cattle
- Department of Pediatrics, University of California, San Francisco, 550 16th Street, 4th Floor, Box 0110, San Francisco, CA, 94158, USA
| | - Jason M Lavender
- Military Cardiovascular Outcomes Research Program (MiCOR), Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- The Metis Foundation, San Antonio, TX, USA
| | - Tiffany A Brown
- Department of Psychological Sciences, Auburn University, Auburn, AL, USA
| | - Stuart B Murray
- Department of Psychiatry and Behavioral Sciences, University of Southern California, Los Angeles, CA, USA
| | - Matthew R Capriotti
- Department of Psychology, San José State University, San Jose, CA, USA
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA, USA
| | - Annesa Flentje
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA, USA
- Department of Community Health Systems, University of California, San Francisco, San Francisco, CA, USA
- Alliance Health Project, Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Micah E Lubensky
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA, USA
- Department of Community Health Systems, University of California, San Francisco, San Francisco, CA, USA
| | - Juno Obedin-Maliver
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA, USA
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, USA
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | - Mitchell R Lunn
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA, USA
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, USA
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Jason M Nagata
- Department of Pediatrics, University of California, San Francisco, 550 16th Street, 4th Floor, Box 0110, San Francisco, CA, 94158, USA.
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Nackeeran S, Patel MS, Nallakumar DT, Ory J, Kohn T, Deibert CM, Carto C, Ramasamy R. Testosterone Therapy is Associated With Depression, Suicidality, and Intentional Self-Harm: Analysis of a National Federated Database. J Sex Med 2022; 19:933-939. [PMID: 35437187 DOI: 10.1016/j.jsxm.2022.03.611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 03/16/2022] [Accepted: 03/16/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Long-term use of testosterone can be associated with mood destabilizing effects. Most studies investigating psychiatric complications of anabolic steroids have used small samples, but a comprehensive assessment of the risk of developing mental health disorders after testosterone use has not been performed at the population level. AIM To determine whether testosterone therapy is associated with major depressive disorder or suicide attempts in men. METHODS We conducted a retrospective cohort study of 70.3 million electronic health records collected from 46 healthcare organizations encompassing flagship hospitals, satellite hospitals, and outpatient clinics since 2008 to determine whether testosterone use is associated with major depressive disorder and suicide attempts in a large population. We included men 18 or older who either used testosterone or did not, defined by reported use, insurance claim, or prescription use of testosterone documented in the electronic health record. We propensity-score matched by age, race, ethnicity, obesity, and alcohol-related disorder. Additionally, a sub-group analysis was performed in testosterone deficient (<300 ng/dL) men comparing those with TD on testosterone therapy to a control group of men with TD who are not using testosterone. OUTCOMES We determined measures of association with a new diagnosis of major depressive disorder and suicide attempt or intentional self-harm following testosterone use within 5 years. RESULTS A total of 263,579 men who used testosterone and 17,838,316 men who did not were included in the analysis. Testosterone use was independently associated with both Major Depressive Disorder (OR 1.99, 95% CI 1.94-2.04, P < .0001) and Suicide Attempt/Intentional Self-Harm (OR 1.52, 95% CI 1.40-1.65, P < .0001). Results remained significant in testosterone deficient sub-group analysis. CLINICAL IMPLICATIONS Men who use testosterone should be screened for and counseled about risks of depression and suicidality. STRENGTHS AND LIMITATIONS Strengths of this study include a large sample size, the ability to account for chronology of diagnoses, the use of propensity score matching to control for potentially confounding variables, and the consistency of results with sub-group analyses. Limitations include the potential for incorrect coding within the electronic health record, a lack of granular information regarding testosterone therapy adherence, the possibility that unrecorded testosterone or anabolic steroid use were prevalent but not captured within the control group, and a lack of data regarding testosterone withdrawal. CONCLUSION Testosterone use is independently associated with new-onset mental health disorders. Future studies are necessary to elucidate the role that androgen withdrawal plays and whether a causal relationship exists. Nackeeran S, Patel MS, Nallakumar DT, et al. Testosterone Therapy is Associated With Depression, Suicidality, and Intentional Self-Harm: Analysis of a National Federated Database. J Sex Med 2022;19:933-939.
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Affiliation(s)
- Sirpi Nackeeran
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA.
| | - Mehul S Patel
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Devi T Nallakumar
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Jesse Ory
- Department of Urology, Dalhousie University, Halifax, NS, Canada
| | - Taylor Kohn
- Department of Urology, Johns Hopkins, Baltimore, MD, USA
| | | | - Chase Carto
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Ranjith Ramasamy
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA
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Sundgot-Borgen C, Mathisen TF, Torstveit MK, Sundgot-Borgen J. Explanations for use of dietary- and muscle enhancing dietary supplements among university students: a national cross-sectional study. BMC Nutr 2022; 8:17. [PMID: 35209960 PMCID: PMC8867755 DOI: 10.1186/s40795-022-00510-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 02/14/2022] [Indexed: 11/18/2022] Open
Abstract
Background Use of dietary supplements (DS) and muscle enhancing dietary supplements (MEDS) is frequent among students despite the lack of evidence of effects and health risks related to consumption. We need to increase our understanding of students’ motivation, examine potential gender differences, and explore explanatory factors, to address preventive measures related to use. Therefore, this study aimed to explore the frequency of, and the reasons for, DS use among university students, as well as explanatory factors for use of MEDS. Method Male and female students from nine Norwegian universities participated in this cross-sectional study. Participants responded to questions about demographics, DS and MEDS use, internalization of body ideals, physical activity- and exercise level, motives for exercise, and exercise context. Independent t-test, Chi-square test, Pearson’s correlation, and logistic regression were used to investigate between group differences, associations, and explanatory factors for use, respectively. P-values ≤ 0.05 were defined as significant. Results A total of 1001 males (34%) and females, with a mean(sd) age of 24.21(4.76) years, participated. The frequency of DS use was 42% and 40% (p = .414) in males and females, respectively, in which more males than females used DS to improve physical or mental performance (p = < .001), increase muscle mass (p = < .001) and weight for health (p = .014), and improve appearance (p = < .001). In males and females, respectively, 25% and 10% used MEDS (p = < .001). In males, being a fitness center member (OR:3.80), exercising to improve muscle mass (OR:1.96), and a higher physical activity level (OR:1.09) positively explained MEDS use, while exercising to increase endurance (OR:0.49) and being an exercise science student (OR:0.47) negatively explained MEDS use. In females, internalizing the athletic body ideal (OR:1.78) and exercising to improve muscle mass (OR:1.74) positively explained MEDS use. Conclusions Our main findings indicate that a surprisingly high percentage of male and female Norwegian students use DS and MEDS, and that reasons for use, and variables explaining the variability in frequency of use, differ between genders. Longitudinal studies to investigate direction of associations are needed in future research. Supplementary Information The online version contains supplementary material available at 10.1186/s40795-022-00510-1.
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Affiliation(s)
- Christine Sundgot-Borgen
- Department of Sports Medicine, Norwegian School of Sport Sciences, Sognsveien 220, N-0806, Oslo, Norway. .,Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Postbox 4956, Nydalen, 0424, Oslo, Norway.
| | | | | | - Jorunn Sundgot-Borgen
- Department of Sports Medicine, Norwegian School of Sport Sciences, Sognsveien 220, N-0806, Oslo, Norway
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11
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Nagata JM, Peebles R, Hill KB, Gorrell S, Carlson JL. Associations between ergogenic supplement use and eating behaviors among university students. Eat Disord 2021; 29:599-615. [PMID: 32129729 PMCID: PMC7483647 DOI: 10.1080/10640266.2020.1712637] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Ergogenic supplements to improve athletic performance are commonly used among college athletes, but little is known about their association with eating disorder symptoms. The objective of this study was to examine associations between ergogenic supplement use and disordered eating attitudes and behaviors among university students, and to compare differences by sex. Undergraduate students from 10 top-ranked National College Athletics Association (NCAA) Division I colleges completed an online survey on supplement use, athletic activities, and eating attitudes and behaviors. Among 1633 university students, males (38.9%) reported higher rates of current supplement use than females (15.2%) (p < .001). In linear regression models adjusting for athletic status and body mass index, current supplement use was associated with higher Eating Disorders Examination-Questionnaire (EDE-Q) Global, Shape Concern, and Restraint scores in both males and females. Supplement use was associated with driven/compelled exercise (OR 2.00, 95% CI 1.33-2.99) in males and diuretic (OR 6.39, 95% CI 2.02-20.22) and diet pill use (OR 3.07, 95% CI 1.79-5.27) in females. Results suggest ergogenic supplement use is common in undergraduates and associated with disordered eating attitudes and behaviors. Clinicians should screen for disordered eating behaviors particularly in young adults who use ergogenic supplements.
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Affiliation(s)
- Jason M Nagata
- Department of Pediatrics, University of California, San Francisco, California, USA
| | - Rebecka Peebles
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Katherine B Hill
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, USA
| | - Sasha Gorrell
- Department of Psychiatry, University of California, San Francisco, California, USA
| | - Jennifer L Carlson
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, USA
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12
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Mullen C, Whalley BJ, Schifano F, Baker JS. Anabolic androgenic steroid abuse in the United Kingdom: An update. Br J Pharmacol 2020; 177:2180-2198. [PMID: 31989581 PMCID: PMC7174889 DOI: 10.1111/bph.14995] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 12/03/2019] [Accepted: 01/07/2020] [Indexed: 12/11/2022] Open
Abstract
Anabolic androgenic steroids (AASs) are prescribed for medical conditions related to low testosterone. Abuse of AASs has surged as they become recognised as potent image enhancement drugs. The primary goal of most abusers is to obtain a more attractive outward appearance. Abuse is complex. There are a vast range of AAS substances illegally available, the nature of their true composition is difficult to evaluate. Users follow dosing patterns which incorporate a number of different AASs, in addition to other pharmaceutical substances believed to complement the desired physical effects or manage unwanted effects. Animal work and medical case reports suggest potential to cause serious hepatotoxicity, plus possible neurotoxicity, nephrotoxicity and damage to the cardiovascular and reproductive systems. As the long-term AASs users reach maturity, further controlled experimentation, with larger sample sizes, is required. Data gathering should be directed towards the most vulnerable group of AAS users, females and adolescent boys.
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Affiliation(s)
- Carrie Mullen
- School of Computing, Engineering and Physical SciencesUniversity of the West of ScotlandPaisleyUK
| | - Benjamin J. Whalley
- School of Chemistry, Food and Nutritional Sciences, and PharmacyThe University of ReadingReadingUK
| | - Fabrizio Schifano
- School of Life and Medical SciencesUniversity of HertfordshireHatfieldUK
| | - Julien S. Baker
- Centre for Health and Exercise Science Research, Department of Sport, Physical Education and HealthHong Kong Baptist UniversityKowloon TongHong Kong
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Rubio-Aparicio M, Badenes-Ribera L, Sánchez-Meca J, Fabris MA, Longobardi C. A reliability generalization meta‐analysis of self‐report measures of muscle dysmorphia. ACTA ACUST UNITED AC 2020. [DOI: 10.1111/cpsp.12303] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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14
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Compte EJ, Nagata JM, Sepúlveda AR, Rivas A, Sbdar LS, Menga S, Rica R, Torrente F, Murray SB. Assessment and validation of a Spanish version of the Muscle Dysmorphia Disorder Inventory in Argentinian men who exercise: Inventario de Dismorfia Muscular. Body Image 2019; 31:24-34. [PMID: 31430602 DOI: 10.1016/j.bodyim.2019.08.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 08/06/2019] [Accepted: 08/06/2019] [Indexed: 12/19/2022]
Abstract
Despite an increase in body dissatisfaction and muscularity concerns among Latin American men, there is a paucity of research relating to muscle dysmorphia in this population. In this study we aimed to evaluate, for the first time in Latin America, the factor structure of the Muscle Dysmorphic Disorder Inventory (MDDI; Hildebrandt, Langenbucher, & Schlundt, 2004). A sample of 551 men who exercise completed measures of body dissatisfaction, disordered eating, and the MDDI. Exploratory factor analysis in a first split-half sample revealed a 3-factor solution similar to the original version, which was then tested through confirmatory factor analysis (CFA) in a second split-half sample. A re-specified model (allowing for error correlations between Items 10-13 and 11-13) presented adequate fit. Omega coefficients revealed adequate internal consistency (> .80) for the Drive for Size and Functional Impairment subscales. The internal consistency for the Appearance Intolerance subscale was .74 and .72 across subset samples. Associations with body dissatisfaction, disordered eating, body mass index, and frequency of training and rest days are presented as evidence of construct validity. Finally, multi-group CFA indicated that the model was invariant across type of exercise. Overall, these data suggest that the MDDI is suitable for use in Spanish-speaking Latin American male populations.
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Affiliation(s)
- Emilio J Compte
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA; School of Human and Behavioral Sciences, Favaloro University, Buenos Aires, Argentina; DBT-Eating Disorders Team, Fundación Foro, Buenos Aires, Argentina.
| | - Jason M Nagata
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of California, San Francisco, San Francisco, CA, USA
| | - Ana R Sepúlveda
- Department of Biological and Health Psychology, School of Psychology, Autonomous University of Madrid, Madrid, Spain
| | - Andrés Rivas
- School of Human and Behavioral Sciences, Favaloro University, Buenos Aires, Argentina
| | - Lara S Sbdar
- School of Human and Behavioral Sciences, Favaloro University, Buenos Aires, Argentina
| | - Sol Menga
- School of Human and Behavioral Sciences, Favaloro University, Buenos Aires, Argentina
| | - Robin Rica
- Department of Biological and Health Psychology, School of Psychology, Autonomous University of Madrid, Madrid, Spain
| | - Fernando Torrente
- Laboratory of Psychopathology Research, Institute of Cognitive and Translational Neuroscience (INCyT), INECO Foundation, Favaloro University, Buenos Aires, Argentina
| | - Stuart B Murray
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA
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Devrim A, Bilgic P. Validity and Reliability Study of Turkish Version of “Muscle Dysmorphic Disorder Inventory” and “Bodybuilder Image Grid” Scales. CURRENT NUTRITION & FOOD SCIENCE 2019. [DOI: 10.2174/1573401314666181012113904] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background:
Although bigorexia symptoms are rapidly increasing, it is mostly an underrecognized
condition in Turkish male bodybuilders. There are no validated screening tools to identify
the symptoms.
Objective:
The purpose of this study is to evaluate the validity of the Turkish version of the MDDI
and the BIG towards the diagnosis of bigorexia and to provide health care professionals with early
screening tools.
Methods:
One hundred twenty male bodybuilders, fifty-eight professional bodybuilders and sixtytwo
recreational bodybuilders, all of whom matched the research criteria, were included in this study.
MDDI and BIG forms were filled by the bodybuilders, along with an “Individual Characteristic Information
Form”, a “Nutrition-related Information Form”, and a “Bodybuilding-related Information
Form”. To evaluate the construct validity, factor analysis was conducted and resulted in a threefactor
construct.
Results:
The factor-loading values ranged from 0.542- 0.827. Calculations of Cronbach’s alpha for
the MDDI sum (α = 0.657) revealed a good internal consistency. The MDDI, BIG O, and BIG S intraclass
correlation coefficients (ICC) were found to be 0.840, 0.908, and 0.879, respectively. As a
result, MDDI had acceptable reliability and that of BIG O and BIG S was excellent.
Discussion:
Turkish MDDI, BIG-O and BIG-S forms proved to be valid and reliable scales and were
adequate for determining the symptoms of bigorexia in male bodybuilders. Using these forms, there
was a statistically significant relationship between bigorexia and eating disorders, which were significantly
positively correlated.
Conclusion:
Our results support the feasibility of using the MDDI, the BIG-O, and the BIG-S forms
to determine symptoms of bigorexia in Turkish population. Further studies are needed to confirm if
this result can be generalized to female bodybuilders.
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Affiliation(s)
- Asli Devrim
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey
| | - Pelin Bilgic
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey
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16
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Asessing the male body image: Spanish validation of two instruments. Psychiatry Res 2019; 272:483-490. [PMID: 30611968 DOI: 10.1016/j.psychres.2018.12.125] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 12/22/2018] [Accepted: 12/23/2018] [Indexed: 11/21/2022]
Abstract
Despite the literature suggesting that body dissatisfaction is increasing among males, only few measures on specific body image concerns in men have been validated in Spanish male populations. The aim of this study was to reassess the factor structure of the Spanish versions of the Muscle Dysmorphic Disorder Inventory (MMDI) and the Adonis Complex Questionnaire (ACQ). A cross-sectional study was conducted among 298 Sport Sciences male students to examine: reliability, the factorial structure, and several evidences of validity -concurrent and convergent- of both scales. The questionnaires present adequate reliability. The three-factor structure proposed for the MMDI was replicated. Nevertheless, the confirmatory factor analysis supports a second-order factor structure for the ACQ instead of the three-factor structure proposed. Moreover, the MDDI shows greater association than ACQ with the variables studied. This study represents an advance in the use of adequate and reliable scales of body image tools in the Hispanic population.
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17
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Zeeck A, Welter V, Alatas H, Hildebrandt T, Lahmann C, Hartmann A. Muscle Dysmorphic Disorder Inventory (MDDI): Validation of a German version with a focus on gender. PLoS One 2018; 13:e0207535. [PMID: 30444914 PMCID: PMC6239320 DOI: 10.1371/journal.pone.0207535] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 11/01/2018] [Indexed: 12/30/2022] Open
Abstract
Muscle dysmorphia (MD) is a condition that is characterized by body image disturbance, a drive for muscularity and excessive exercising. It leads to considerable functional impairment. Most previous studies focused on male samples. The study aimed to validate a German version of the Muscle Dysmorphic Disorder Inventory (MDDI) in order to make the instrument available in German speaking countries. We further aimed to explore for gender differences in the MDDI factors (measurement invariance) and to assess the relationship between MD and positive dimensions of body experience as well as exercise dependence. 394 participants (53% females, mean age 24.3 years) took part in an internet-based survey. The three-factor structure of the English version of the MDDI was replicated, independent of gender (multi group CFA; Base model TLI = .961; CFI = .970). Cronbach´s alpha was .81-.84 for the subscales and .75 for the MDDI total score. MD was associated with exercise dependence and negatively correlated with dimensions of positive body experience, which can be considered relevant for satisfying relationships and a positive sense of self: e.g. body contact and sexual fulfillment. Men and women showed differences in two subscales of the MDDI (appearance intolerance, drive for size). Testing for measurement invariance resulted in weak invariance: Equivalent factor structure for men and women, but significantly different loadings and coefficients. No statistically significant difference in the MDDI total score was found. The findings suggest good psychometric properties of the German version of the MDDI. Future studies should address the question of cut-off scores and norms for different samples as well as a possible overlap between MD and eating disorder psychopathology in women.
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Affiliation(s)
- Almut Zeeck
- Department of Psychosomatic Medicine and Psychotherapy, Medical Center–University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Viola Welter
- Department of Psychosomatic Medicine and Psychotherapy, Medical Center–University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Hasan Alatas
- Department of Psychosomatic Medicine and Psychotherapy, Medical Center–University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Tom Hildebrandt
- Eating and Weight Disorders Program Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Claas Lahmann
- Department of Psychosomatic Medicine and Psychotherapy, Medical Center–University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Armin Hartmann
- Department of Psychosomatic Medicine and Psychotherapy, Medical Center–University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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18
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Cuadrado J, Morin J, Hernandez P, Yubero E, Bégin C, Michel G. Psychopathologie de la dysmorphie musculaire : analyse critique de la littérature internationale. ANNALES MEDICO-PSYCHOLOGIQUES 2018. [DOI: 10.1016/j.amp.2018.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Abstract
OBJECTIVE Theoretically, legal supplement use precedes and increases the risk for illicit appearance and performance enhancing drug (APED) use-also referred to as the gateway hypothesis. Little is known about associations between the speed of progression, or gap time, from legal to illicit APED use, and psychological risk factors, such as sociocultural influence, eating disorders, body image disturbance, and impulsivity. METHOD The sample taken from two studies included 172 active steroid users (n = 143) and intense-exercising healthy controls (n = 29) between the ages of 18 and 60 (M = 34.16, SD = 10.43), the majority of whom were male (91.9%). Participants, retrospectively, reported APED use and completed measures assessing psychological and behavioral factors, including eating concern, muscle dysmorphia, and impulsivity. Participants had a gap time from initial APED use to anabolic-androgenic steroid (AAS) use that ranged from 0 to 38 years. RESULTS Continuous survival analysis indicated that interactions between self- versus other sociocultural influence on APED onset and both higher eating concern and impulsivity are associated with a shorter gap time from initial legal to illicit APED use. DISCUSSION The results indicate the potential value in developing different strategies for individuals with other sociocultural versus self-influence on illicit APED use, and among more impulsive and eating-concerned APED users. Future research is needed to assess different trajectories of APED use, such that eating-concerned and impulsive individuals who perceive less other sociocultural influence may be at greatest risk for a speedier progression to AAS use.
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20
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Griffiths S, Mitchison D, Murray SB, Mond JM. Pornography use in sexual minority males: Associations with body dissatisfaction, eating disorder symptoms, thoughts about using anabolic steroids and quality of life. Aust N Z J Psychiatry 2018; 52:339-348. [PMID: 28891676 DOI: 10.1177/0004867417728807] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE We examined two hypotheses regarding the potential association of pornography use with body image-related and eating disorder-related psychopathology among sexual minority males (i.e. non-heterosexual males). Our primary hypothesis was that pornography use would be associated with males' body dissatisfaction, eating disorder symptoms, thoughts about using anabolic steroids and quality of life impairment; our secondary hypothesis was that the type of pornography, namely, professional versus amateur pornography, which contains idealised and non-idealised (i.e. regular) bodies, respectively, would moderate these associations. METHODS A sample of 2733 sexual minority males living in Australia and New Zealand completed an online survey that contained measures of pornography use, body dissatisfaction, eating disorder symptoms, thoughts about using anabolic steroids and quality of life. RESULTS Almost all (98.2%) participants reported pornography use with a median use of 5.33 hours per month. Multivariate analyses revealed that increased pornography use was associated with greater dissatisfaction with muscularity, body fat and height; greater eating disorder symptoms; more frequent thoughts about using anabolic steroids; and lower quality of life. Effect sizes for these associations were uniformly small. Neither relationship status nor genital dissatisfaction was associated with pornography use. The association between pornography use and thoughts about using anabolic steroids was stronger for viewers of professional pornography than viewers of amateur pornography. CONCLUSION The findings suggest that the use of pornography is weakly associated with body dissatisfaction and related variables and that the type of pornography (amateur vs professional) viewed may be a moderating factor in some cases. Within the limits of a cross-sectional study design, these findings may have implications for clinicians who treat individuals with eating disorders, body dysmorphic disorder, anabolic-androgenic steroid dependence and related concerns.
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Affiliation(s)
- Scott Griffiths
- 1 Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Deborah Mitchison
- 2 Department of Psychology, Macquarie University, Sydney, NSW, Australia
| | - Stuart B Murray
- 3 Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA
| | - Jonathan M Mond
- 4 Centre for Rural Health, University of Tasmania, Launceston, TAS, Australia.,5 Centre for Health Research, Western Sydney University, Sydney, NSW, Australia
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Sandgren SS, Lavallee D. Muscle Dysmorphia Research Neglects DSM-5 Diagnostic Criteria. JOURNAL OF LOSS & TRAUMA 2018. [DOI: 10.1080/15325024.2018.1428484] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Sebastian S. Sandgren
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough Leicestershire, UK
| | - David Lavallee
- School of Social and Health Sciences, Abertay University, Dundee, UK
- Department of Physical Education and Sports Sciences, University of Limerick, Ireland
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Hildebrandt T, Heywood A, Wesley D, Schulz K. Defining the Construct of Synthetic Androgen Intoxication: An Application of General Brain Arousal. Front Psychol 2018; 9:390. [PMID: 29651261 PMCID: PMC5885244 DOI: 10.3389/fpsyg.2018.00390] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 03/08/2018] [Indexed: 01/01/2023] Open
Abstract
Synthetic androgens (i. e., anabolic-androgenic steroids) are the primary component to the majority of problematic appearance and performance enhancing drug (APED) use. Despite evidence that these substances are associated with increased risk for aggression, violence, body image disturbances, and polypharmacy and can develop a pattern of chronic use consistent with drug dependence, there are no formal definitions of androgen intoxication. Consequently, the purpose of this paper is to establish a testable theory of androgen intoxication. We present evidence and theorize that synthetic androgen intoxication can be defined by a pattern of poor self-regulation characterized by increased propensity for a range of behaviors (e.g., aggression, sex, drug seeking, exercise, etc.) via androgen mediated effects on general brain arousal. This theory posits that androgens reduce threshold for emotional reactivity, motor response, and alertness to sensory stimuli and disrupt inhibitory control over the behaviors associated with synthetic androgen use. These changes result from alteration to basic neurocircuitry that amplifies limbic activation and reduces top-down cortical control. The implications for this definition are to inform APED specific hypotheses about the behavioral and psychological effects of APED use and provide a basis for establishing clinical, legal, and public health guidelines to address the use and misuse of these substances.
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Affiliation(s)
- Tom Hildebrandt
- Eating and Weight Disorders Program, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Ashley Heywood
- Eating and Weight Disorders Program, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Daniel Wesley
- Eating and Weight Disorders Program, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Kurt Schulz
- Eating and Weight Disorders Program, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States
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Griffiths S, Jacka B, Degenhardt L, Murray SB, Larance B. Physical appearance concerns are uniquely associated with the severity of steroid dependence and depression in anabolic-androgenic steroid users. Drug Alcohol Rev 2018; 37:664-670. [DOI: 10.1111/dar.12688] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 01/09/2018] [Accepted: 02/07/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Scott Griffiths
- Melbourne School of Psychological Sciences; University of Melbourne; Melbourne Australia
| | - Brendan Jacka
- National Drug and Alcohol Research Centre; University of New South Wales; Sydney Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre; University of New South Wales; Sydney Australia
| | - Stuart B. Murray
- Department of Psychiatry; University of California; San Francisco USA
| | - Briony Larance
- National Drug and Alcohol Research Centre; University of New South Wales; Sydney Australia
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Anabolic steroid use among gay and bisexual men living in Australia and New Zealand: Associations with demographics, body dissatisfaction, eating disorder psychopathology, and quality of life. Drug Alcohol Depend 2017; 181:170-176. [PMID: 29055822 DOI: 10.1016/j.drugalcdep.2017.10.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 10/10/2017] [Accepted: 10/11/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND AND AIMS Gay and bisexual men may be at heightened risk for using anabolic androgenic steroids (AAS). Few studies, however, have examined AAS use among gay and bisexual men living in countries outside the United States. In addition, few studies have explored the potential associations of AAS use with body image concerns beyond muscularity, including height and genitals, or with eating disorder symptoms and quality of life. Thus, we examined the associations of AAS use, and of thoughts about using AAS, with body image, eating disorder symptoms, and quality of life among gay and bisexual men living in Australia and New Zealand. METHODS A sample of 2733 gay and bisexual men completed an online survey promoted by paid nationwide advertisements to users of geosocial-networking smartphone applications. RESULTS The prevalence of AAS use, and of thoughts about using AAS, were 5.2% (95% confidence interval [CI]: 4.4%, 6.1%) and 25.4% (95% CI: 23.8%, 27.1%), respectively. Multivariate analyses revealed that more frequent thoughts about using AAS were associated with being older, taller, and experiencing greater dissatisfaction with muscularity and height, less dissatisfaction with body fat, greater eating disorder symptoms, and lower subjective quality of life. Actual AAS users were more likely to be older, from a non-Australian/New Zealander cultural background, experiencing less dissatisfaction with body fat, and experiencing greater eating disorder symptoms. CONCLUSIONS Psychopathology related to body image and eating disorders are associated with AAS use among gay and bisexual men living in Australia and New Zealand.
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Brennan R, Wells JSG, Van Hout MC. The injecting use of image and performance-enhancing drugs (IPED) in the general population: a systematic review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2017; 25:1459-1531. [PMID: 26806443 DOI: 10.1111/hsc.12326] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/16/2015] [Indexed: 05/25/2023]
Abstract
Injecting use of image and performance-enhancing drugs (IPED) in the general population is a public health concern. A wide and varied range of IPED are now easily accessible to all through the online market. A comprehensive literature review was undertaken according to Critical Appraisal Skills Programme (CASP) guidelines for systematic review, to identify the relevant literature. No date restrictions were placed on the database search in the case of human growth hormone melanotan I and II, and oil and cosmetic injectables. In the case of anabolic androgenic steroids search dates were restricted to January 2014-2015. Publications not in English and with a lack of specificity to the topic were excluded. The review yielded 133 relevant quantitative and qualitative papers, clinical trials, clinical case presentations and editorials/reports. Findings were examined/reviewed under emergent themes which identified/measured extent of use, user profiling, sourcing, product endorsement, risk behaviours and health outcomes in users. Motivation for IPED use may be grounded in appearance, pursuit of health and youth, and body image disturbance. IPED users can practice moderated use, with pathological use linked to high-risk behaviours, which may be normalised within IPED communities. Many IPED trajectories and pathways of use are not scientifically documented. Much of this information may be available online in IPED specific discussion forums, an underutilised setting for research, where uncensored discourse takes place among users. This review underscores the need for future internet and clinical research to investigate prevalence and patterns of injecting use, and to map health outcomes in IPED users. This paper provides community-based clinical practice and health promotion services with a detailed examination and analysis of the injecting use of IPED, highlighting the patterns of this public health issue. It serves to disseminate updated publication information to health and social policy makers and those in health service practice who are involved in harm reduction intervention.
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Affiliation(s)
- Rebekah Brennan
- School of Sport, Health and Exercise Science, Waterford Institute of Technology, Waterford, Ireland
| | - John S G Wells
- School of Sport, Health and Exercise Science, Waterford Institute of Technology, Waterford, Ireland
| | - Marie Claire Van Hout
- School of Sport, Health and Exercise Science, Waterford Institute of Technology, Waterford, Ireland
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Al OM, Elshatarat RA. Influence of knowledge and beliefs on consumption of performance enhancing agents in north-western Saudi Arabia. Ann Saudi Med 2017; 37:317-325. [PMID: 28761032 PMCID: PMC6150593 DOI: 10.5144/0256-4947.2017.317] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Consumption of performance enhancing agents (PEAs) has a wide range of negative health consequences, but knowledge of these consequences among gym users of PEAs in Saudi Arabia is not well understood. OBJECTIVES Identify the knowledge, awareness, beliefs and attitudes of gym users about negative health consequences of using PEAs, and the relationship between these factors and use of these agents. DESIGN Cross-sectional study. SETTING Five gyms in Madinah city, Saudi Arabia. SUBJECTS AND METHODS Convenience sampling was used to recruit gym users. An electronic self-administered questionnaire was used to collect data. MAIN OUTCOME MEASURE(S) Level of knowledge about the negative health consequences of PEAs among gym users. RESULTS About 70% of 316 participants had used one or more of PEAs over the last six months. Of those, about 68.4% used protein powder supplements and 48.1% used energy drinks. Participants who believed that protein powder supplements (c2=52.3, P < .01) and energy drinks (c2=35.2, P < .01) had health hazards used these agents less often than others during the six months preceding data collection. Participants who had less knowledge about the negative health consequences were more likely to use protein powder supplement (t=2.38, P=.018). On the other hand, those who were more knowledgeable about the negative health consequences of insulin, were more likely to use insulin (t=2.45, P=.015). CONCLUSION Misuse of PEAs is widespread among gym users in Saudi Arabia. Improving the level of knowledge and awareness of possible serious health consequences would hopefully lead to reduced PEA consumption. LIMITATIONS The temporal sequence of cause and effect could not be determined in a cross sectional study. Convenience sampling in a single city limited the generalizability of the findings to all regions of Saudi Arabia.
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Affiliation(s)
- Omar Mansour Al
- Dr. Omar Mansour Al Nozha, Department of Internal Medicine,, Taibah University,, PO Box 30088, Madinah 41477,, Saudi Arabia, T: 966-55534992, F: 014-8484800, , ORCID: http://orcid.org/0000-0002-9238-4683
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Marco JH, Perpiñá C, Roncero M, Botella C. Confirmatory factor analysis and psychometric properties of the Spanish version of the Multidimensional Body-Self Relations Questionnaire-Appearance Scales in early adolescents. Body Image 2017; 21:15-18. [PMID: 28229919 DOI: 10.1016/j.bodyim.2017.01.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 01/18/2017] [Accepted: 01/18/2017] [Indexed: 01/31/2023]
Abstract
The main aim of this study was to confirm the factorial structure of the Spanish version of the Multidimensional Body-Self Relations Questionnaire-Appearance Scales in early adolescents from 12 to 14 years. The sample included 355 participants, 189 girls and 166 boys, with ages ranging from 12 to 14 years old. The original MBSRQ-AS 5-factor structure was confirmed, and the model showed a good fit to the data: Appearance Evaluation, Appearance Orientation, Body Areas Satisfaction, Overweight Preoccupation, and Self-Classified Weight. The internal consistency of the test scores was adequate. Girls had higher score s than boys on Appearance Orientation, Overweight Preoccupation, and Self-Classified Weight, and lower scores on Appearance Evaluation and Body Areas Satisfaction. This study confirms the factor structure of the MBSRQ-AS.
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Affiliation(s)
- José H Marco
- Departamento de Personalidad, Evaluación e Intervención Terapéutica, Universidad Católica de Valencia "San Vicente Mártir", C/ Guillem de Castro, 175, Valencia, 46008, Spain.
| | - Conxa Perpiñá
- Departamento de Personalidad, Evaluación y Tratamientos Psicológicos, Facultad de Psicología, Universidad de Valencia, Av. Blasco Ibáñez, 21, Valencia, 46010, Spain; Ciber Fisiopatología Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Spain
| | - María Roncero
- Departamento de Personalidad, Evaluación y Tratamientos Psicológicos, Facultad de Psicología, Universidad de Valencia, Av. Blasco Ibáñez, 21, Valencia, 46010, Spain
| | - Cristina Botella
- Ciber Fisiopatología Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Spain; Departamento de Psicología Básica, Clínica y Psicobiología, Universidad Jaume I de Castellón, Avda. Sos Bainat, s/n. Castellón, Spain
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Griffiths S, Henshaw R, McKay FH, Dunn M. Post-cycle therapy for performance and image enhancing drug users: A qualitative investigation. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.peh.2016.11.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Abstract
The pressure on boys and men to engage in extensive body practices (e.g., closely monitored eating and exercise habits) and achieve ideal male bodies has grown significantly over the past 20 years. Central to the depiction of ideal male bodies and body practices are both the pursuit and achievement of lean and well-defined muscles. The labels “pitches,” “purchases,” and “performativities” were inductively derived from the literature, and used to describe the multifaceted connections between masculinities, muscularity, and idealized male body practices. “Pitches” distil how popular culture posture norms of masculinity, and manly bodies and behaviors attainable and necessary. “Purchases” refer to men’s diverse buy-in to dominant discourses about acceptable male bodies and practices. “Performativities” chronicle how men embody and navigate gender norms as they evaluate their own bodies, behaviors, and eating habits and those of their peers. Based on findings from the current scoping review, future research could benefit from fully linking masculinities with the drive for muscularity to address health and social risks associated with the pursuit of the idealized male body. In highlighting the plurality of masculinities and the complexity of men’s diverse identities, health care providers can better reach and support men. Focusing on, and celebrating, a wider range of male bodies could help recenter dominant discourses about how and whose bodies and experiences are idealized. The current scoping review article offers an overview of how masculinities and muscularity have been linked to male body practices, and recommendations to advance this emergent field.
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Affiliation(s)
- Maya Lefkowich
- 1 University of British Columbia, Vancouver, British Columbia, Canada
| | - John L Oliffe
- 1 University of British Columbia, Vancouver, British Columbia, Canada
| | - Laura Hurd Clarke
- 1 University of British Columbia, Vancouver, British Columbia, Canada
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García-Rodríguez J, Alvarez-Rayón G, Camacho-Ruíz J, Amaya-Hernández A, Mancilla-Díaz JM. [Muscle Dysmorphia and Use of Ergogenics Substances. A Systematic Review]. ACTA ACUST UNITED AC 2016; 46:168-177. [PMID: 28728801 DOI: 10.1016/j.rcp.2016.06.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 06/03/2016] [Accepted: 06/29/2016] [Indexed: 10/21/2022]
Abstract
The use of ergogenic substances (UES) is not restricted to achieving a better athletic performance, but also it is a behavior for body changing through muscle development; however, little is known about the relationship between muscle dysmorphia (MD) and UES. Therefore, it was conducted a systematic review of those empirical papers that have studied this relationship over the last decade (2004-2014). First it is highlighted that of the 22 articles analyzed, only 13 explicitly aimed this interest. Besides, although the documented data outlined some relevant aspects such as the existence of a high co-occurrence (60-90%) between MD and UES. In general, the evidence is still incipient and uncertain, mainly because of the large disparity between the methodologies of the studies, particularly in terms of indicators, parameters and measures utilized to assess UES within the context of MD.
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Affiliation(s)
- Jaime García-Rodríguez
- Facultad de Estudios Profesionales Iztacala, Universidad Nacional Autónoma de México, México
| | - Georgina Alvarez-Rayón
- Facultad de Estudios Profesionales Iztacala, Universidad Nacional Autónoma de México, México.
| | - Jaime Camacho-Ruíz
- Unidad Académica Profesional Nezahualcóyotl, Universidad Autónoma del Estado de México, México
| | - Adriana Amaya-Hernández
- Facultad de Estudios Profesionales Iztacala, Universidad Nacional Autónoma de México, México
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Santos Filho CAD, Tirico PP, Stefano SC, Touyz SW, Claudino AM. Systematic review of the diagnostic category muscle dysmorphia. Aust N Z J Psychiatry 2016; 50:322-33. [PMID: 26553217 DOI: 10.1177/0004867415614106] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES (1) To collect, analyze and synthetize the evidence on muscle dysmorphia diagnosis as defined by Pope et al. and (2) To discuss its appropriate nosology and inclusion as a specific category in psychiatric classificatory systems. METHOD A systematic search in the MEDLINE, the PsycNET, the LILACS and SciELO databases and in the International Journal of Eating Disorders was conducted looking for articles published between January 1997 and October 2014 and in EMBASE database between January 1997 and August 2013. Only epidemiological and analytical studies were considered for selection. The methodological quality of included studies was assessed according to the Evidence-Based Mental Health and the National Health and Medical Research Council's guidelines. The support for inclusion of muscle dysmorphia in psychiatric classificatory systems was examined against Blashfield et al.'s criteria. RESULTS Thirty-four articles were considered eligible out of 5136. Most of the studies were cross-sectional and enrolled small, non-clinical samples. The methodological quality of all selected papers was graded at the lowest hierarchical level due to studies' designs. Forty-one percent of the publications considered the available evidence insufficient to support the inclusion of muscle dysmorphia in any existing category of psychiatric disorders. The current literature does not fulfill Blashfield et al.'s criteria for the inclusion of muscle dysmorphia as a specific entity in psychiatric diagnostic manuals. CONCLUSION The current evidence does not ensure the validity, clinical utility, nosological classification and inclusion of muscle dysmorphia as a new disorder in classificatory systems of mental disorders.
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Affiliation(s)
| | | | | | - Stephen W Touyz
- School of Psychology, The University of Sydney, Sydney, Australia
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ANGOORANI H, HALABCHI F. The Misuse of Anabolic-Androgenic Steroids among Iranian Recreational Male Body-Builders and Their Related Psycho-Socio-Demographic factors. IRANIAN JOURNAL OF PUBLIC HEALTH 2015; 44:1662-9. [PMID: 26811817 PMCID: PMC4724739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The high prevalence and potential side effects of anabolic-androgenic steroids (AAS) misuse by athletes has made it a major public health concern. Epidemiological studies on the abuse of such drugs are mandatory for developing effective preventive drug control programs in sports community. This study aimed to investigate the prevalence of AAS abuse and their association with some psycho-socio-demographic factors in Iranian male recreational body-builders. METHODS Between March and October 2011; 906 recreational male body-builders from 103 randomly selected bodybuilding clubs in Tehran, Iran were participated in this study. Some psycho-socio- demographic factors including age, job, average family income, family size, sport experience (months), weekly duration of the sporting activity (h), purpose of participation in sporting activity, mental health as well as body image (via General Health Questionnaire and Multidimensional Body-Self Relations Questionnaire, respectively), and history of AAS use were obtained by interviews using questionnaires. RESULTS Participants were all recreational male body-builders [mean age (SD): 25.7 (7.1), ranging 14-56 yr]. Self-report of AAS abuse was registered in 150 body-builders (16.6%). Among different psycho-socio-demographic factors, only family income and sport experience were inversely associated with AAS abuse. CONCLUSION Lifetime prevalence of AAS abuse is relatively high among recreational body-builders based on their self-report. Some psycho-socio-demographic factors including family income and sport experience may influence the prevalence of AAS abuse.
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Affiliation(s)
- Hooman ANGOORANI
- Dept. of Sports and Exercise Medicine, Hazrat Rasool-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Farzin HALABCHI
- Sports Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran,Dept. of Sports and Exercise Medicine, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran,Corresponding Author:
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Healthcare professionals' stigmatization of men with anabolic androgenic steroid use and eating disorders. Body Image 2015; 15:49-53. [PMID: 26125091 DOI: 10.1016/j.bodyim.2015.06.001] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Revised: 05/13/2015] [Accepted: 06/01/2015] [Indexed: 12/20/2022]
Abstract
Building upon previous research on the stigmatization of individuals with eating disorders (EDs), the present study sought to evaluate healthcare providers' attitudes toward male anabolic androgenic steroid (AAS) users. Healthcare providers (N=148) were first randomly assigned to read one of four vignettes describing a male AAS user, ED patient, cocaine user, or healthy control. Each provider then rated, on a scale of -3 to +3, how strongly either word in one of 22 word-pairs described his or her feelings toward the person described in the vignette. Results indicated that providers perceived the ED and AAS use patients less favorably than the cocaine user or healthy adult, suggesting that the two groups may be stigmatized by health providers. Given the psychiatric and medical risks associated with AAS use and EDs, reducing bias may help reduce the personal suffering and public health burden related to these behaviors.
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Confirmatory factor analysis and psychometric properties of the Spanish version of the Multidimensional Body-Self Relations Questionnaire-Appearance Scales. Body Image 2015; 14:47-53. [PMID: 25867527 DOI: 10.1016/j.bodyim.2015.03.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Revised: 03/11/2015] [Accepted: 03/13/2015] [Indexed: 12/28/2022]
Abstract
The Multidimensional Body-Self Relations Questionnaire (MBSRQ) is the most comprehensive instrument to assess body image. The MBSRQ-Appearance Scales (MBSRQ-AS) is a reduced version that has been validated in other languages. The main aim of the present study was to confirm the factor structure of the Spanish version of the MBSRQ-AS and analyze its psychometric properties in 1041 nonclinical individuals. Confirmatory factor analysis showed excellent goodness of fit indices for the five-factor structure (Appearance Evaluation, Appearance Orientation, Body Areas Satisfaction, Overweight Preoccupation, and Self-Classified Weight). Factors possessed adequate scale score reliability indices. Some of the factors showed significant associations with the Eating Attitudes Test. Significant differences were found between boys/men and girls/women, and among age groups. The Spanish version of the MBSRQ-AS is a valid instrument for use in nonclinical population settings in people from 15 to 46 years old.
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Pomara C, Neri M, Bello S, Fiore C, Riezzo I, Turillazzi E. Neurotoxicity by synthetic androgen steroids: oxidative stress, apoptosis, and neuropathology: A review. Curr Neuropharmacol 2015; 13:132-45. [PMID: 26074748 PMCID: PMC4462038 DOI: 10.2174/1570159x13666141210221434] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Revised: 09/30/2014] [Accepted: 10/25/2014] [Indexed: 12/25/2022] Open
Abstract
Anabolic-androgenic steroids (AAS) are synthetic substances derived from testosterone that are largely employed due to their trophic effect on muscle tissue of athletes at all levels. Since a great number of organs and systems are a target of AAS, their adverse effects are primarily on the following systems: reproductive, hepatic, musculoskeletal, endocrine, renal, immunological, infectious, cardiovascular, cerebrovascular, and hematological. Neuropsychiatric and behavioral effects as a result of AAS abuse are well known and described in the literature. Mounting evidence exists suggesting that in addition to psychiatric and behavioral effects, non-medical use of AAS carries neurodegenerative potential. Although, the nature of this association remains largely unexplored, recent animal studies have shown the recurrence of this AAS effect, ranging from neurotrophin unbalance to increased neuronal susceptibility to apoptotic stimuli. Experimental and animal studies strongly suggest that apoptotic mechanisms are at least in part involved in AAS-induced neurotoxicity. Furthermore, a great body of evidence is emerging suggesting that increased susceptibility to cellular oxidative stress could play a pivotal role in the pathogenesis of many neurodegenerative disorders and cognitive impairment. As in other drug-evoked encephalopathies, the key mechanisms involved in AAS - induced neuropathology could represent a target for future neuroprotective strategies. Progress in the understanding of these mechanisms will provide important insights into the complex pathophysiology of AAS-induced neurodegeneration, and will pave the way for forthcoming studies. Supplementary to abandoning the drug abuse that represents the first step in reducing the possibility of irreversible brain damage in AAS abusers, neuroprotective strategies have to be developed and implemented in future.
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Affiliation(s)
- Cristoforo Pomara
- Institute of Legal Medicine, Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
- Department of Anatomy, University of Malta. Msida, Malta
| | - Margherita Neri
- Institute of Legal Medicine, Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Stefania Bello
- Institute of Legal Medicine, Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Carmela Fiore
- Institute of Legal Medicine, Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Irene Riezzo
- Institute of Legal Medicine, Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Emanuela Turillazzi
- Institute of Legal Medicine, Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
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Stapleton P, McIntyre T, Bannatyne A. Body Image Avoidance, Body Dissatisfaction, and Eating Pathology: Is There a Difference Between Male Gym Users and Non-Gym Users? Am J Mens Health 2014; 10:100-9. [PMID: 25389214 DOI: 10.1177/1557988314556673] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
With research highlighting the increasing prevalence and severity of body image and eating disturbances in males, particularly athletes and regular gymnasium users, the current study examined body image and eating disturbances in a sample of male gym users and non-gym users (N = 180). Based on previous research, it was predicted that male gym users would report greater body image disturbance (e.g., body image avoidance and body dissatisfaction) and eating pathology, compared with non-gym users. Results of the study partially supported hypotheses, revealing body dissatisfaction and eating pathology were significantly increased in male gym users. However, no significant differences were observed in body image avoidance behaviors, though this is likely because of methodological limitations associated with psychometric measures selected. The study provides preliminary evidence that male gym users do experience subclinical eating and body image concerns, with some also experiencing clinically significant symptoms that could be precursors to the later development of an eating disorder. Results of the current study highlight the importance of educating key stakeholders within health and fitness centers, through community-based interventions, to increase awareness regarding male body image and eating disturbances.
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Eli Joubert H, Melluish S. Considering anabolic androgenic steroid use in relation to non-substance related diagnostic categories with special emphasis on eating disorders: a systematic review. JOURNAL OF SUBSTANCE USE 2014. [DOI: 10.3109/14659891.2014.977974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Kimergård A, McVeigh J. Variability and dilemmas in harm reduction for anabolic steroid users in the UK: a multi-area interview study. Harm Reduct J 2014; 11:19. [PMID: 24986546 PMCID: PMC4098923 DOI: 10.1186/1477-7517-11-19] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Accepted: 06/19/2014] [Indexed: 11/22/2022] Open
Abstract
Background The UK continues to experience a rise in the number of anabolic steroid-using clients attending harm reduction services such as needle and syringe programmes. Methods The present study uses interviews conducted with harm reduction service providers as well as illicit users of anabolic steroids from different areas of England and Wales to explore harm reduction for this group of drug users, focussing on needle distribution policies and harm reduction interventions developed specifically for this population of drug users. Results The article addresses the complexity of harm reduction service delivery, highlighting different models of needle distribution, such as peer-led distribution networks, as well as interventions available in steroid clinics, including liver function testing of anabolic steroid users. Aside from providing insights into the function of interventions available to steroid users, along with principles adopted by service providers, the study found significant tensions and dilemmas in policy implementation due to differing perspectives between service providers and service users relating to practices, risks and effective interventions. Conclusion The overarching finding of the study was the tremendous variability across harm reduction delivery sites in terms of available measures and mode of operation. Further research into the effectiveness of different policies directed towards people who use anabolic steroids is critical to the development of harm reduction.
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Affiliation(s)
- Andreas Kimergård
- Addictions Department, National Addiction Centre, Institute of Psychiatry, King's College London, 4 Windsor Walk, London SE5 8BB, UK.
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Waldorf M, Cordes M, Vocks S, McCreary D. „Ich wünschte, ich wäre muskulöser”: Eine teststatistische Überprüfung der deutschsprachigen Fassung der Drive for Muscularity Scale (DMS). DIAGNOSTICA 2014. [DOI: 10.1026/0012-1924/a000106] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Die Drive for Muscularity Scale (DMS) ist der am häufigsten verwendete Fragebogen zur Erfassung des Muskulositätsstrebens. Ziel der Studie war die psychometrische Überprüfung der deutschsprachigen Version der DMS. 601 Männer aus muskel- und kraftorientierten Sportarten wurden am Computer oder mit der Papierversion der DMS und mit weiteren Skalen befragt. Interne Konsistenz und Retest-Reliabilität der DMS liegen im sehr guten Bereich (>.88), ebenso die Korrelation mit einem Alternativtest (Male Body Attitudes Scale: .81). Muskulositäts- und Schlankheitsstreben lassen sich eindeutig differenzieren (Eating Disorder Inventory-2-DT: .11). Die durchgeführten Faktorenanalysen stützen die Einteilung in eine kognitive und eine korrelierte behaviorale Subskala. Es zeigten sich Zusammenhänge mit körperbezogenem Selbstwert und körperdysmorphen Sorgen. Die deutschsprachige DMS ist ein reliables und valides Instrument zur Erfassung des Muskulositätsstrebens in Forschung und klinischer Einzelfallanwendung.
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Reilly EE, Anderson LM, Schaumberg K, Anderson DA. Gender-based differential item functioning in common measures of body dissatisfaction. Body Image 2014; 11:206-9. [PMID: 24958654 DOI: 10.1016/j.bodyim.2014.02.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Revised: 01/27/2014] [Accepted: 02/10/2014] [Indexed: 11/28/2022]
Abstract
Many widely used measures of body image were developed using all-female samples and thus may not adequately capture the male experience of body dissatisfaction. The current study examined differential item functioning (DIF) in three commonly-used measures of body image: The Body Shape Questionnaire (N=590, 39.7% male), the Body Dissatisfaction subscale of the Eating Disorders Inventory (N=529, 44.6% male), and the Shape and Weight Concern subscales of the Eating Disorders Examination Questionnaire (N=1116, 43.5% male). Participants completed a series of measures evaluating body image and eating pathology. Results evidenced statistically significant DIF in several of the items; one item met criteria for clinically significant DIF. While most items did not evidence clinically elevated levels of DIF, additional evaluation is necessary in order to determine overall quality of the measures in terms of capturing the experience of male body image concerns.
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Affiliation(s)
- Erin E Reilly
- Department of Psychology, University at Albany, State University of New York, Albany, NY, United States.
| | - Lisa M Anderson
- Department of Psychology, University at Albany, State University of New York, Albany, NY, United States.
| | - Katherine Schaumberg
- Department of Psychology, University at Albany, State University of New York, Albany, NY, United States.
| | - Drew A Anderson
- Department of Psychology, University at Albany, State University of New York, Albany, NY, United States.
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Hildebrandt T, Shope S, Varangis E, Klein D, Pfaff DW, Yehuda R. Exercise reinforcement, stress, and β-endorphins: an initial examination of exercise in anabolic-androgenic steroid dependence. Drug Alcohol Depend 2014; 139:86-92. [PMID: 24690349 PMCID: PMC4039319 DOI: 10.1016/j.drugalcdep.2014.03.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Revised: 03/06/2014] [Accepted: 03/06/2014] [Indexed: 12/14/2022]
Abstract
BACKGROUND Anabolic-androgenic steroids (AASs) are abused primarily in the context of intense exercise and for the purposes of increasing muscle mass as opposed to drug-induced euphoria. AASs also modulate the HPA axis and may increase the reinforcing value of exercise through changes to stress hormone and endorphin release. To test this hypothesis, 26 adult males drawn from a larger study on AAS use completed a progressive ratio task designed to examine the reinforcing value of exercise relative to financial reinforcer. METHOD Sixteen experienced and current users (8 on-cycle, 8 off-cycle) and 10 controls matched on quantity×frequency of exercise, age, and education abstained from exercise for 24 h prior to testing and provided 24-h cortisol, plasma cortisol, ACTH, β-endorphin samples, and measures of mood, compulsive exercise, and body image. RESULTS Between group differences indicated that on-cycle AAS users had the highest β-endorphin levels, lowest cortisol levels, higher ACTH levels than controls. Conversely, off-cycle AAS users had the highest cortisol and ACTH levels, but the lowest β-endorphin levels. Exercise value was positively correlated with β-endorphin and symptoms of AAS dependence. CONCLUSION The HPA response to AASs may explain why AASs are reinforcing in humans and exercise may play a key role in the development of AAS dependence.
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Affiliation(s)
- Tom Hildebrandt
- Department of Psychiatry, Ichan School of School of Medicine at Mount Sinai, New York, NY, USA.
| | - Sydney Shope
- Department of Psychiatry, Ichan School of School of Medicine at Mount Sinai, New York, NY
| | - Eleanna Varangis
- Department of Psychiatry, Ichan School of School of Medicine at Mount Sinai, New York, NY
| | - Diane Klein
- Department of Psychiatry, New York University, New York, NY
| | | | - Rachel Yehuda
- Department of Psychiatry, Ichan School of School of Medicine at Mount Sinai, New York, NY,James J. Peters Veterans Affairs Medical Center, Bronx, New York
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Pope HG, Wood RI, Rogol A, Nyberg F, Bowers L, Bhasin S. Adverse health consequences of performance-enhancing drugs: an Endocrine Society scientific statement. Endocr Rev 2014; 35:341-75. [PMID: 24423981 PMCID: PMC4026349 DOI: 10.1210/er.2013-1058] [Citation(s) in RCA: 339] [Impact Index Per Article: 33.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Despite the high prevalence of performance-enhancing drug (PED) use, media attention has focused almost entirely on PED use by elite athletes to illicitly gain a competitive advantage in sports, and not on the health risks of PEDs. There is a widespread misperception that PED use is safe or that adverse effects are manageable. In reality, the vast majority of PED users are not athletes but rather nonathlete weightlifters, and the adverse health effects of PED use are greatly underappreciated. This scientific statement synthesizes available information on the medical consequences of PED use, identifies gaps in knowledge, and aims to focus the attention of the medical community and policymakers on PED use as an important public health problem. PED users frequently consume highly supraphysiologic doses of PEDs, combine them with other PEDs and/or other classical drugs of abuse, and display additional associated risk factors. PED use has been linked to an increased risk of death and a wide variety of cardiovascular, psychiatric, metabolic, endocrine, neurologic, infectious, hepatic, renal, and musculoskeletal disorders. Because randomized trials cannot ethically duplicate the large doses of PEDs and the many factors associated with PED use, we need observational studies to collect valid outcome data on the health risks associated with PEDs. In addition, we need studies regarding the prevalence of PED use, the mechanisms by which PEDs exert their adverse health effects, and the interactive effects of PEDs with sports injuries and other high-risk behaviors. We also need randomized trials to assess therapeutic interventions for treating the adverse effects of PEDs, such as the anabolic-androgen steroid withdrawal syndrome. Finally, we need to raise public awareness of the serious health consequences of PEDs.
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Affiliation(s)
- Harrison G Pope
- McLean Hospital (H.G.P.), Harvard Medical School, Belmont, Massachusetts 02478; University of Southern California (R.I.W.), Los Angeles, California 90089; University of Virginia (A.R.), Charlottesville, Virginia 22904; Department of Pharmaceutical Biosciences, (F.N.), Upsala University, SE-751 24, Upsala, Sweden; United States Anti-Doping Agency (L.B.), Colorado Springs, Colorado 80919; and Brigham and Women's Hospital (S.B.), Harvard Medical School, Boston, Massachusetts 02115
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Hildebrandt T, Langenbucher JW, Flores A, Harty S, Berlin HA, Berlin H. The influence of age of onset and acute anabolic steroid exposure on cognitive performance, impulsivity, and aggression in men. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2014; 28:1096-104. [PMID: 24841181 DOI: 10.1037/a0036482] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The name of author Heather Berlin omitted a middle initial in the byline and author note and should appear as Heather A. Berlin.] A growing translational literature suggests that adolescent exposure to anabolic-androgenic steroids (AASs) leads to increased aggression and impulsivity. However, little is known about the cognitive effects of AASs among AAS users or the differences between adolescent- and adult-onset users. This study provides a test of the effects of acute naturalistic AAS use and age of onset (adolescent vs. adult) on measures of inhibitory control, planning and attention, and decision making. Seventy-one active adult male AAS users completed self-report measures of impulsivity and aggression, and a subsample (11 adolescent onset vs. 11 adult onset) matched on current age were administered 4 computerized tests from the Cambridge Neuropsychological Test Automated Battery (CANTAB) (Cambridge Cognition, 2002) and the Iowa Gambling Task (Stanton, Liening, & Schultheiss, 2011). Multiple regression analyses and a series of 2 (adolescent vs. adult) × 2 (on-cycle vs. off-cycle) analyses of variance (ANOVAs) were used to examine the differential effects of age of onset and acute drug use on cognition and behavior. Regression analyses revealed larger on-cycle effects for adolescent users than adult users. Subsample analyses indicated that on-cycle users performed less well on cognitive measures of inhibitory control and attention, but not on tests of planning or decision making. Adolescent onset was associated with greater impulsivity and more acute sensitivity to AAS effects on attention. These preliminary findings suggest the possibility that acute AAS use is associated with some differences in inhibitory control and impulsivity and to a lesser degree, aggression. These effects may be more potent for those initiating AAS use in adolescence.
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Skemp KM, Mikat RP, Schenck KP, Kramer NA. Muscle dysmorphia: risk may be influenced by goals of the weightlifter. J Strength Cond Res 2014; 27:2427-32. [PMID: 23302755 DOI: 10.1519/jsc.0b013e3182825474] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Athletes with muscle dysmorphia suffer from constant dissatisfaction with body size and shape because they perceive themselves as smaller and less muscular than they actually are. There may be discrepancies among the various subgroups within the weightlifting community in regards to vulnerability and susceptibility to the development of MD. The purpose of this study, therefore, was to examine and compare MD symptomology between male and female, competitive and noncompetitive, and appearance-related and performance-related weightlifters. The MD assessments were made with the muscle dysmorphia inventory (MDI). The participants included 85 competitive (55 men and 30 women) and 48 noncompetitive (24 men and 24 women) weight training athletes. Each group included athletes with a primary focus on appearance enhancement or performance enhancement. Factorial analyses of variance were used to measure differences between each group on all MDI subscales. The results showed that men scored significantly higher than did women on the supplement (p = 0.006), physique protection (p = 0.039), and body size and symmetry subscales (p < 0.001). Competitive athletes scored significantly higher than noncompetitive athletes did on diet (p < 0.001), supplement (p < 0.001), exercise dependence (p < 0.001), and body size and symmetry (p = 0.002) subscales. Finally, the athletes focused on appearance enhancement scored significantly higher than athletes focused on performance enhancement on all 6 subscales (p < 0.01). Coaches and health and fitness professionals should understand that the goals of athletes in regard to weight training can influence susceptibility to development of MD symptoms. Knowing that athletes who engage in weight training to enhance appearance may exhibit greater behavioral characteristics than those athletes who do not may be helpful so they may be able to identify, prevent, and reverse MD in the athletes they serve.
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Affiliation(s)
- Karen M Skemp
- Department of Health Education and Health Promotion, University of Wisconsin-La Crosse, La Crosse, Wisconsin, USA.
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Ip EJ, Trinh K, Tenerowicz MJ, Pal J, Lindfelt TA, Perry PJ. Characteristics and Behaviors of Older Male Anabolic Steroid Users. J Pharm Pract 2014; 28:450-6. [PMID: 24643452 DOI: 10.1177/0897190014527319] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To compare and contrast the characteristics of 2 groups of men ≥40 years old: reported anabolic-androgenic steroid (AAS) users and nonusers. DESIGN Cross-sectional survey. SETTING Thirty-eight online fitness, weight lifting, bodybuilding, and steroid Web sites. PARTICIPANTS A total of 67 male AAS users and 76 male nonusers ≥40 years old. MAIN OUTCOMES MEASURED Demographics, utilization of AAS and other performance-enhancing agents (PEAs), exercise patterns, history of illicit drugs and alcohol use, and psychiatric traits/diagnoses. RESULTS The majority of AAS users ≥40 years old were caucasian (92.5%), heterosexual (97.0%), and classified themselves as recreational exercisers (79.1%). AAS users took more PEAs (11.5 ± 5.6 vs 4.6 ± 2.7; P < .001), were more likely to binge drink (47.8% vs 29.0%; P = .025), report heavy alcohol use (21.0% vs 7.9%; P = .031), meet criteria for substance dependence disorder (27.4% vs 4.0%; P < .001), and report an anxiety disorder diagnosis (12.0% vs 2.6%; P = .046) than nonusers. CONCLUSIONS AAS misuse is prevalent among older men and is associated with polypharmacy, more aggressive alcohol use, and a higher incidence of substance dependence and anxiety disorders compared to nonusers. This information may help clinicians and researchers identify and develop appropriate intervention strategies for AAS abuse among older men.
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Affiliation(s)
- Eric J Ip
- Department of Pharmacy Practice, Touro University California College of Pharmacy, Vallejo, CA, USA
| | - Karen Trinh
- Department of Pharmacy Practice, Touro University California College of Pharmacy, Vallejo, CA, USA
| | - Michael J Tenerowicz
- Department of Pharmacy Practice, Touro University California College of Pharmacy, Vallejo, CA, USA
| | - Jai Pal
- Department of Pharmacy Practice, Touro University California College of Pharmacy, Vallejo, CA, USA
| | - Tristan A Lindfelt
- Department of Pharmacy Practice, Touro University California College of Pharmacy, Vallejo, CA, USA
| | - Paul J Perry
- Department of Pharmacy Practice, Touro University California College of Pharmacy, Vallejo, CA, USA
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Brennan BP, Kanayama G, Pope HG. Performance-enhancing drugs on the web: a growing public-health issue. Am J Addict 2013; 22:158-61. [PMID: 23414502 DOI: 10.1111/j.1521-0391.2013.00311.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2012] [Revised: 03/10/2012] [Accepted: 03/23/2012] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Today's Internet provides extensive "underground" guidelines for obtaining and using illicit substances, including especially anabolic-androgenic steroids (AAS) and other appearance- and performance-enhancing drugs (APEDs). We attempted to qualitatively characterize APED-related Internet sites. METHODS We used relevant Internet search terms (eg, "steroids bodybuilding" and "buy steroids online") to assess (i) the numbers of site visitors; (ii) offers of drugs for sale; and (iii) the quality of online medical information. We also chose the examples of (iv) "site-enhancing oils" and (v) "cattle implants" to illustrate the volume of available Internet information as compared with that in the medical literature. RESULTS We found thousands of sites involving AAS and other APEDs. Most sites presented an unabashedly pro-drug position, often openly questioning the qualifications and motivations of mainstream medical practitioners. Offers of AAS and other APEDs for sale, together with medical advice of varying legitimacy, was widespread across sites. Importantly, many sites provided detailed guidelines for exotic forms of APED use, some likely associated with serious health risks, which are probably unknown to most practicing clinicians. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE It seems important for practitioners to be aware of the extent of this "underground literature," which may strongly influence their patients' decisions about use and abuse of APEDs.
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Affiliation(s)
- Brian P Brennan
- Biological Psychiatry Laboratory, McLean Hospital, Belmont, MA 02478, USA.
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Cain AS, Epler AJ, Steinley D, Sher KJ. Concerns related to eating, weight, and shape: typologies and transitions in men during the college years. Int J Eat Disord 2012; 45:768-75. [PMID: 21744376 PMCID: PMC3193855 DOI: 10.1002/eat.20945] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/14/2011] [Indexed: 11/06/2022]
Abstract
OBJECTIVE How to best classify concerns related to eating, weight, and shape (CREWS) in men remains an open question. Research on men considering CREWS during different developmental periods could be particularly informative. METHOD Focusing on one potentially dynamic developmental period, this study charts the course of CREWS in men over the college years. Latent class/latent transition analysis identified typologies of weight- and shape-influenced self judgment, limiting attempts, fasting, overeating, binge eating, self-induced vomiting, and laxative or diuretic abuse for 1,025 men over the four traditional college years. RESULTS Three classes emerged: (1) no obvious pathological eating-related concerns (61-65%); (2) a high likelihood of limiting attempts and a moderately high likelihood of overeating (31-34%); (3) pervasive bulimic-like concerns (4-6%). Class membership was highly stable across assessment occasions. DISCUSSION The results contribute to the growing literature on empirically derived classifications of CREWS and indicate that for many men CREWS are a chronic presence during the college years.
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Affiliation(s)
- Angela S. Cain
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, Mississippi
| | - Amee J. Epler
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, Mississippi,G.V (Sonny) Montgomery Veterans Affairs Medical Center, Jackson, Mississippi
| | - Douglas Steinley
- The Midwest Alcoholism Research Center and the Department of Psychological Sciences, University of Missouri, Columbia, Missouri
| | - Kenneth J. Sher
- The Midwest Alcoholism Research Center and the Department of Psychological Sciences, University of Missouri, Columbia, Missouri
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Abstract
PURPOSE OF REVIEW To summarize recent advances in studies of illicit use of androgens and other hormones. RECENT FINDINGS Androgens and other appearance-enhancing and performance-enhancing substances are widely abused worldwide. Three notable clusters of findings have emerged in this field in recent years. First, studies almost unanimously find that androgen users engage in polypharmacy, often ingesting other hormones (e.g., human growth hormone, thyroid hormones, and insulin), ergo/thermogenic drugs (e.g., caffeine, ephedrine, and clenbuterol), and classical drugs of abuse (e.g., cannabis, opiates, and cocaine). Second, reports of long-term psychiatric and medical adverse effects of androgens continue to accumulate. In cardiovascular research particularly, controlled studies have begun to supersede anecdotal evidence, strengthening the case that androgens (possibly acting synergistically with other abused drugs) may cause significant morbidity and even mortality. Third, it is increasingly recognized that androgen use may lead to a dependence syndrome with both psychological and physiological origins. Androgen dependence likely affects some millions of individuals worldwide, and arguably represents the least studied major class of illicit drug dependence. SUMMARY Given mounting evidence of the adverse effects of androgens and associated polypharmacy, this topic will likely represent an expanding area of research and an issue of growing public health concern.
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Affiliation(s)
- Gen Kanayama
- Biological Psychiatry Laboratory, McLean Hospital, Belmont, Massachusetts 02478, USA
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Hildebrandt T, Harty S, Langenbucher JW. Fitness supplements as a gateway substance for anabolic-androgenic steroid use. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2012; 26:955-62. [PMID: 22486333 DOI: 10.1037/a0027877] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Approximately 3.0% of young Americans have used anabolic-androgenic steroids (AAS). A traditional model of adolescent substance use, the gateway hypothesis, suggests that drug use follows a chronological, causal sequence, whereby initial use of a specific drug leads to an increased likelihood of future drug use. Therefore, the use of illicit appearance and performance enhancing drugs (APED), such as AASs, also follows an analogous progression, whereby legal APEDs, (e.g., nutritional supplements) precedes illicit APED use. We examined the relationship between nutritional supplement use, beliefs about APEDs, and APED use in 201 male (n = 100) and female (n = 101) undergraduates. Participants completed measures of muscle dysmorphia (MDDI), body checking (BCQ, MBCQ), eating disorder symptoms (EDE-Q), perfectionism (FMPS), positive beliefs about the efficacy-safety of AAS use and APED use patterns. A series of covariance structure models (CSM) showed body image disturbance, compulsive exercise, illicit drug use, and perfectionism, independent of gender, were significant predictors of positive beliefs about AAS. Those who used both fat burning and muscle building supplements reported the strongest beliefs in AAS efficacy-safety, which was associated with higher likelihood of current illicit APED use. There was evidence of significant indirect relationships between supplement use and illicit APED use through contact with other AAS users and beliefs about AAS. The potential role for nutritional supplement use in the initiation of illegal APED use is discussed. Future prevention efforts may benefit from targeting legal APED users in youth.
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Affiliation(s)
- Tom Hildebrandt
- Eating and Weight Disorders Program, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 120, New York, NY 10029, USA.
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Lavender JM, Gratz KL, Anderson DA. Mindfulness, body image, and drive for muscularity in men. Body Image 2012; 9:289-92. [PMID: 22230801 DOI: 10.1016/j.bodyim.2011.12.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2011] [Revised: 11/30/2011] [Accepted: 12/08/2011] [Indexed: 11/18/2022]
Abstract
Studies have shown that dispositional mindfulness, a construct characterized by awareness and attention to present moment experiences, is associated with body image constructs in women. However, little is known about the relationship between dispositional mindfulness and body image among men. Therefore, this study examined the unique associations between dispositional mindfulness and three body image variables in men: overall appearance evaluation, satisfaction with distinct body areas, and drive for muscularity. Undergraduate men (N=296) completed the Multidimensional Body Self-Relations Questionnaire-Appearance Scales, the Drive for Muscularity Scale, the Mindful Attention Awareness Scale, and the Positive and Negative Affect Schedule. A series of hierarchical regression analyses revealed that mindfulness was uniquely associated with all three body image variables after accounting for body mass index and negative affect. Results are discussed with regard to the potential role of dispositional mindfulness in body dissatisfaction among men.
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Affiliation(s)
- Jason M Lavender
- Department of Psychology, University at Albany, State University of New York, Albany, NY, USA.
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