Objective: The authors sought to expand on previous observations suggesting that body-image pathology is associated with illicit use of anabolic-androgenic steroids (AAS). In particular, the authors compared current versus past AAS users and short-term versus long-term users in this respect.
Method: The authors assessed 89 heterosexual men who lifted weights regularly-48 AAS users and 41 nonusers-on measures of self-esteem, attitudes toward male roles, body image, eating-related attitudes and behaviors, and muscle dysmorphia ("reverse anorexia nervosa").
Results: AAS users as a whole showed few differences from nonusers on most measures but showed greater symptoms of muscle dysmorphia (e.g., not allowing their bodies to be seen in public, giving up pleasurable activities because of body-appearance concerns). The current and past AAS users each differed only modestly from nonusers on most measures. Short-term AAS "experimenters" were also largely indistinguishable from nonusers, but the long-term AAS users showed striking and significant differences from nonusers on many measures, including marked symptoms of muscle dysmorphia and stronger endorsement of conventional male roles.
Conclusions: Both body-image pathology and narrow stereotypic views of masculinity appear to be prominent among men with long-term AAS use. Although our cross-sectional observations cannot confirm that these factors help to cause or perpetuate AAS use, a causal hypothesis is certainly plausible and deserving of further testing in longitudinal studies. If these factors are indeed causal, then AAS users might respond to cognitive behavior approaches that simultaneously take aim at both types of maladaptive beliefs.