Considering anabolic androgenic steroid use in relation to non-substance related diagnostic categories with special emphasis on eating disorders: a systematic review

Abstract

Background: Anabolic androgenic steroids (AAS) mimic the effects of naturally occurring testosterone. The media pressures men to have slender but muscular bodies in Western societies promoting larger muscularity, paralleling a growth in AAS use. It seems impossible to estimate prevalence as studies have shown variation across different populations. Steroid use is more likely to be motivated by aesthetic rather than performance reasons. The DSM-5 allows for body dysmorphic disorder (300.7; F45.22) to be defined by a specifier for muscle dysmorphia (MD) without mentioning AAS. Literature describes similar behaviours in MD as in anorexia nervosa (AN), such as pathologised eating patterns, excessive exercise and substance abuse, including diuretics. Aim: Conduct a systematic review of current literature considering how best to diagnose and conceptualise AAS. Methods: Electronic databases from EBSCO Host (PsycARTICLES, PsycEXTRA, PsycINFO) were used. Results: Fourteen papers were finally selected based on inclusion criteria. Conclusions: Results reflect a multi-factorial understanding of AAS, although a more simplistic addiction model prevails. However, there is on-going academic debate encouraging alternative diagnostic conceptualisation of AAS use, as either an eating disorder or specific type of obsessive-compulsive disorder (OCD).

• Addiction
• diagnostic conceptualisation
• steroids

Declaration of interest

This paper was partially funded by the South London and Maudsley NHS Foundation Trust as part of a larger post-graduate research project. Neither author has any links with the tobacco or alcohol industry. Neither is to gain financially from this work being published. No other conflict of interest exists for either author.

This article has not been published or being considered elsewhere.

Notes

¹ Ethnopharmacology is the scientific study of ethnic groups and their use of drugs. Monoghan uses this term here to explain how there is a particular understanding of AAS use within the community which uses it, including the prohibition of abuse of such drugs, although abuse would be differently understood within the community. Ethnopharmacological prescriptions here may thus include using alternative substances, reducing the dosage or any other means acceptable by the community, rather than those outside of the community, to manage such a problem.