Body image and steroid use in male bodybuilders

Body evaluation in men: the role of body weight dissatisfaction in appearance evaluation, eating, and muscle dysmorphia psychopathology

BACKGROUND

Body image dissatisfaction is a significant concern among men, influencing appearance evaluation, eating behaviors, and muscle dysmorphia psychopathology. However, research on these correlations is notably deficient in men, largely because body image concerns are unevenly distributed between genders. Therefore, this study aims to assess the various dimensions of concerns about body image in men and explore their associations with characteristics such as sexual orientation.

METHODS

A cross-sectional study was conducted with 251 adult men from fitness centers in the Veneto Region, Italy. Participants completed self-report questionnaires, including the Eating Attitudes Test (EAT-26), the Appearance Schemas Inventory-Revised (ASI-R), and the Muscle Dysmorphic Disorder Inventory (MDDI). Body weight perception and dissatisfaction were evaluated using a Figure Rating Scale (FRS) with 12 male biometric silhouettes.

RESULTS

Participants were divided into three subgroups based on the experienced levels of body weight dissatisfaction: those who rated a smaller body (BWsmaller), those who rated a larger body (BWlarger) more highly relative to their own estimated body size, and those who reported implicit neutrality with their current weight (BWneu). BWsmaller participants reported higher levels of eating-related concern, while BWlarger participants exhibited higher levels of muscle dysmorphia. Additionally, the BWlarger group showed the highest degree of quantitative perceptual underestimation of their body weight. Sexual orientation was found to have an impact on body weight dissatisfaction, with bisexual men more likely to desire an increase in weight and gay men more likely to desire a decrease.

CONCLUSIONS

Body weight dissatisfaction significantly impacts appearance evaluation, eating behaviors, and muscle dysmorphia psychopathology in males. Tailored interventions that consider individual differences can support the well-being of men. The study provides useful insight into male body image issues, warranting further exploration to inform effective interventions and promote positive body image and mental health in this population.

Causal factors in childhood and adolescence leading to anabolic-androgenic steroid use: A machine learning approach

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.

Defining the Ideal Male Buttocks

BACKGROUND

There is no well-defined male buttock aesthetic. The authors performed a crowdsourced analysis to define the ideal male buttocks.

METHODS

A survey was deployed using the Amazon MTurk platform. Respondents rated a panel of digitally altered male buttocks from most to least attractive using three views. Respondents were asked questions pertaining to their own interest in gluteal augmentation, self-reported body type, and other demographics.

RESULTS

A total of 2095 responses were recorded; 61% were from male respondents, 52% of respondents were between the ages of 25 and 34 years, and 49% were White respondents. The preferred lateral ratio in the anteroposterior dimension was 1.18; the oblique angle between the sacrum, lateral gluteal depression, and point of maximal projection of the gluteal sulcus was 60 degrees; and the posterior ratio between the waist and maximal width of the hips was 0.66. This corresponds to moderate gluteal projection in the lateral and oblique views, with a narrower gluteal width and defined trochanteric depression in the posterior view. Loss of the trochanteric depression was associated with lower scores. Subgroup analysis revealed differences when stratified by region, race, sexual orientation, employment industry, and athletic interest. No appreciable difference was found based on respondent sex.

CONCLUSIONS

The authors' results demonstrate that there is a preferred male gluteal aesthetic. This study suggests that men and women favor a more projected male buttock with a more pronounced contour, but preferred a narrow width with defined lateral depression. These findings have the potential to guide future aesthetic gluteal contouring techniques in men.

Sources of knowledge and truth related to anabolic/androgenic steroid use among two-spirit, gay, bisexual, queer, and other men who have sex with men

OBJECTIVES

This study sought to explore how two-spirit, gay, bisexual, and queer cisgender and transgender (2SGBQ+) men engage with information related to non-prescribed anabolic/androgenic steroid (AAS) use, and how discourses of risk surrounding AASs influence their AAS use practices. Two objectives were achieved: (1) Sources of information that 2SGBQ+ men consulted when considering using AASs were identified and (2) the ways in which discourses of risk shaped 2SGBQ+ men's experiences of using AASs were revealed.

METHODS

Participants were recruited for semi-structured interviews online and through word of mouth. A critical poststructural methodology and theories of risk discourse and biopolitics were used to identify themes and interpret data.

RESULTS

Seventeen interviews were conducted with adult 2SGBQ+ cis and trans men. Three themes emerged: (1) Unauthoritative sources of knowledge and truth sought by current and prospective AAS users were inconsistent and difficult to evaluate; (2) Authoritative sources, including health care providers, reacted inconsistently; and (3) 2SGBQ+ men generated and shared lay knowledges as a form of community-led harm reduction.

CONCLUSION

The complexities of seeking and evaluating information highlight the privileged nature of trustworthy, accurate information on the topic. Risk-as a discursive regime-places 2SGBQ+ male AAS users in the position to produce lay knowledge and cultivate their own "truths" on the topic, which can lead to preventable harm. Public health needs to address these biopolitical effects by considering these lay forms of knowledge as an untapped resource and design accessible and judgement-free AAS use harm reduction programs for 2SGBQ+ AAS users.

Which are the Effects of Body-Objectification and Instagram-Related Practices on Male Body Esteem? A Cross-Sectional Study

OBJECTIVE

According to the objectification framework, media pressure toward body models promotes the internalization of beauty ideals that negatively influence individuals' body image and self-esteem. Historically, women have been the main target of sociocultural pressures. However, research has recently suggested that self-objectification is a male phenomenon as well, which can be inscribed in men's body experiences. Nevertheless, fewer studies have specifically focused on the male experience and general consequences of body-objectification are yet to be extensively analyzed regarding males' body image features. The current cross-sectional study explores the consequences of body-objectification on male body esteem, specifically testing the predictive role of exercising/dietary habits, body-objectification features, and SNS-related practices on male body esteem.

METHOD

A total of 238 male participants (mean age = 24.28 years, SD = 4.32) have been involved in an online survey. Three hierarchical analyses were performed to test the influence of objectified body consciousness and social networking-related experiences (i.e. Instagram intensity use, photo manipulation, selfie feedback investment) on young men's body esteem with specific reference to the weight, appearance, and attribution features of the Body Esteem Scale.

RESULTS

Findings highlighted that body shame played an interesting key role, influencing negatively all the body esteem dimensions, thus highlighting that attention needs to be deserved on this feature of OBC regarding males' experience. On the contrary, appearance control-related dimensions positively influenced body esteem. Overall, findings confirmed that objectification theory can adequately mark a pathway by which media imagery is internalized also by men and may negatively affect their body esteem.

CONCLUSIONS

Despite some limitations, this study may contribute to enlarging our knowledge on male body image and self-objectification experience and support literature shattering the stereotype that body dissatisfaction is a "female-exclusive" issue. Likewise, beyond some questioning positions, these findings also encourage further exploration of a healthier "control dimension", including body appearance-related activities and beliefs.

Positiva upplevelser av dopning: En kvalitativ studie av AAS-bruk och reflexiva kroppar [Positive experiences of doping: A qualitative study of AAS-use and reflexive bodies]

Research on doping usually has focused on social and individual problems, such as AAS-use in relations to substance abuse, criminality and health issues. The purpose of this study was to analyze the meaning of positive experiences of doping with Anabolic Androgenic Steroids (AAS), outside the traditional sports competition context. Eight respondents with own AAS-experiences were interviewed. The theoretical framework was elaborated from Giddens’ discussion on individuals’ self-reflexivity and the construction of the self-identity in the late modern age. The respondents’ narratives were analyzed in four themes: (1) To be big and strong – masculine self-identity; (2) Revenge and to become a part of a community; (3) AAS and training as an “exit” from risk behavior and substance use; (4) Euphoria generator and anxiety reducer. The themes were analyzed as different processes of the respondents’ constructions of new self-identities and lifestyles using their reflexive bodies in body regimes where weight training and use of AAS were crucial.

The Effects of Reducing Social Media Use on Body Esteem Among Transitional-Aged Youth

Introduction. Social media use (SMU) and body image concerns are highly prevalent in youth. Although several studies have shown that high SMU is crosssectionally associated with lower body esteem, experimental evidence is lacking. This pilot study experimentally evaluated the effects of reducing SMU on body esteem among transitional aged youth (TAY) with emotional distress. Methods. Thirty-eight undergraduate students presenting with elevated symptoms of anxiety/depression were randomly assigned to the intervention (n = 16), where SMU was restricted to 60 minutes/day, or to the control group (n = 22), where SMU was not restricted. SMU was monitored via screen-time trackers in participants’ smartphone submitted daily during baseline (1-week) and intervention (3-week) periods. Baseline and post-intervention measurements were taken to assess appearance and weight esteem as well as symptoms of anxiety and depression as secondary outcomes. Results. A significant group × time interaction emerged indicating that the intervention participants showed a significantly greater increase in appearance esteem over the 4 weeks compared to controls. There was no significant between-group difference on change in weight esteem. A significant group × time interaction emerge on anxiety indicating that intervention participants showed a significantly greater improvement in anxiety over the study period compared to controls. There was no significant between-group difference on change in depressive symptoms. Discussion. Reducing SMU may be a feasible and effective method of improving appearance esteem and reducing anxiety in a high-risk population of TAY with emotional distress; however, more high-quality randomized controlled trials are needed to confirm findings.

Measuring positive and negative body talk in men and women: The development and validation of the Body Talk Scale

Research suggests that positive and negative body talk are important factors in people's body image, however, the instruments designed to measure body talk are generally designed for use with a specific gender and primarily measure negative body talk. To address the shortcomings in the existing measures, the Body Talk Scale (BTS) was designed to measure both positive and negative body talk in men and women. The current study examines the development and psychometric properties of this new scale in two samples of adults, both including men and women. Study 1 focused on the development and examined the factor structure of the original scale items. Study 2 confirmed the factor structure and examined the concurrent validity, incremental validity, test-retest reliability of the scale, and also gender differences. The results indicated that the BTS is a 14-item scale that contains three subscales (Negative Fat Talk, Negative Muscle Talk, and Positive Body Talk) and demonstrates good concurrent validity, incremental validity, and test-retest reliability. Gender comparisons on all three subscales indicated that men engage in more positive body talk than women. The findings demonstrate that the BTS is a useful measure of positive and negative body talk in both men and women.

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

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

[Exercise-risks and side effects]

Physical activity and exercise is widely connected with positive effects on human health. However, exercise may also pose as a risk factor for health under specific circumstances. Primarily, the risks connected with exercise are physical risks, but also psychological risks may appear, especially when exercise is conducted excessively. Psychological risks include eating disorders, illegal and legal substance use and exercise dependence. The aims of the present article are to focus on potential risks and side effects of exercise and physical activity and to put the risks in the context of the positive effects of exercise on health.

Towards a Sustainable Nutrition Paradigm in Physique Sport: A Narrative Review

Physique athletes strive for low body fat with high lean mass and have higher body image and eating disorder rates than the general population, and even other weightlifting populations. Whether athletes with a background or tendency to develop these issues are drawn to the sport, or whether it drives these higher incidences, is unknown. However, the biological drive of cyclical energy restriction may contribute to binge-eating behavior. Additionally, requisite monitoring, manipulation, comparison, and judgement of one's physique may contribute to body image concerns. Contest preparation necessitates manipulating body composition through energy restriction and increased expenditure, requiring dietary restraint and nutrition, exercise, and physique assessment. Thus, competitors are at mental health risk due to (1) pre-existing or predispositions to develop body image or eating disorders; (2) biological effects of energy restriction on eating psychology; and (3) dietary restraint attitudes and resultant physique, exercise, and nutrition monitoring behavior. In our narrative review we cover each factor, concluding with tentative best-practice recommendations, including dietary flexibility, slower weight loss, structured monitoring, gradual returns to offseason energy intakes, internal eating cues, appropriate offseason body compositions, and support from nutrition and mental health professionals. A mental health focus is a needed paradigm shift in bodybuilding nutrition practice and research.

Ethnicity, eating pathology, drive for muscularity, and muscle dysmorphia in college men: a descriptive study

The nature and presentation of eating pathology in ethnically diverse men are not well defined. This study examined associations among ethnicity, body image, and eating pathology in nonclinical college men (N = 343). Analysis of variance analyses indicated that markers of eating, weight, and shape concerns differed by ethnicity: Asian and Hispanic/Latino men reported more pathological levels than European and African American men. Hierarchical multiple regression analyses indicated that ethnicity moderated the relationship between drive for muscularity and body checking, which was strongest for Asian men. Results increase awareness of how ethnicity interacts with body image and eating pathology, which underscores the need for individualized, culturally sensitive treatment for ethnically diverse men.

The Association of Relationship Status and Sex-Life Satisfaction With Body Dissatisfaction and Drive for Muscularity in Male Weight-Lifters

Relationship status and sexuality are linked to body image concerns, but research on the connection to men’s drive for muscularity (DfM) is scarce. Extreme DfM can lead to a pathological preoccupation with muscularity and problematic eating/exercising behavior. This study investigated the relation of relationship status, relationship duration, and satisfaction with sex-life in weight-lifting men via an online survey (N = 270). Using cross-sectional data, we found that single weight-lifting men and those dissatisfied with their sex-life were more dissatisfied with their muscularity and showed stronger DfM than those in a relationship and satisfied men. Longer relationship duration was associated with less dissatisfaction with muscularity and less DfM while relationship satisfaction was not. Thus, being in a relationship and sexual satisfaction are related to less body dissatisfaction and DfM. Further research should use dyadic study designs to investigate both partners exercising and eating behavior in relation to each other.

Asessing the male body image: Spanish validation of two instruments

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.

Understanding the Paths to Appearance- and Performance-Enhancing Drug Use in Bodybuilding

How do gym-goers who are normally not inclined to resort to appearance- and performance-enhancing drugs (APEDs) progressively normalize their use? Based on data collected through a year and a half of participant observation in a gym and 30 semi-directive interviews with practitioners with varying profiles in French-speaking Switzerland, this article examines the evolution of practitioners’ relations with APED use by articulating various levels of analysis. Associated with social vulnerabilities, the progressive normalization of APED use is concomitant with the “conversion” to bodybuilding. Our results show the extent to which and under what conditions interactions within the layout of gyms can influence practices. From refusal to normalization, our results suggest that APEDs and the associated beliefs coincide with career stages, which we aim to bring to light here.

Is There Any Relationship Between Body Image Perception, Eating Disorders, and Muscle Dysmorphic Disorders in Male Bodybuilders?

Bodybuilding has increasingly become popular between males since male body shape has become a subject of interest in the last decades. Bodybuilders have desired to gain more muscle and paid attention to their body shape. Based on this purpose, they have string rules that include restrictive eating and excessive exercise program. Recent research has demonstrated that desiring more muscular body shape exhibits eating behavior problems and body dissatisfaction issues in bodybuilders. Limited research exists on the relationship between body dissatisfaction and eating disorders in male bodybuilders. The aim of this study was to determine the relationship between body image disturbance and eating disorders in 120 male bodybuilders. The Eating Attitude Test (EAT-40) was used to determine eating disorders, the Muscle Dysmorphia Disorder Inventory was used to determine bigorexia symptoms, and Bodybuilder Image Grid-Original (BIG O) and Scaled (BIG S) forms were used to detect the factors associated with body dissatisfaction. There was a positive relationship between Eating Attitude Test and Muscle Dysmorphia Disorder Inventory total scores. Eating Attitude Test was positively correlated with both fat and muscle dissatisfaction. Our results indicated that eating disorder psychopathology is positively related to body dissatisfaction and body dysmorphic disorders in male bodybuilders.

Muscle Dysmorphia and its Associated Psychological Features in Three Groups of Recreational Athletes

Muscle Dysmorphia (MD) is a psychological disorder characterized by the preoccupation with the idea that one's body is not lean and muscular. The current study aimed to explore MD behaviours and symptoms in three groups of recreational athletes: bodybuilders (BB; n = 42), strength athletes (SA; n = 61), and fitness practitioners (FP; n = 22). Furthermore, we assessed MD-related psychological features as well as possible psychological predictors of MD among groups. Results highlighted that the BB group reported more beliefs about being smaller and weaker than desired compared to the other groups, whereas individuals in the SA group reported setting higher standards for themselves than the FP group. Lastly, orthorexia nervosa and social anxiety symptoms emerged as predictors of MD symptoms in the BB group. Taken together, our findings suggest that individuals in the BB group are characterized by more MD general symptomatology than those in the other groups; furthermore, only orthorexia nervosa and social anxiety may play a specific role in predicting MD general symptoms in bodybuilders.

Doping Among Professional Athletes in Iran: A Test of Akers's Social Learning Theory

The use of performance-enhancing drugs (PED) is common among Iranian professional athletes. As this phenomenon is a social problem, the main purpose of this research is to explain why athletes engage in "doping" activity, using social learning theory. For this purpose, a sample of 589 professional athletes from Rasht, Iran, was used to test assumptions related to social learning theory. The results showed that there are positive and significant relationships between the components of social learning theory (differential association, differential reinforcement, imitation, and definitions) and doping behavior (past, present, and future use of PED). The structural modeling analysis indicated that the components of social learning theory accounts for 36% of the variance in past doping behavior, 35% of the variance in current doping behavior, and 32% of the variance in future use of PED.

History and epidemiology of anabolic androgens in athletes and non-athletes

The use of androgens, frequently referred to as anabolic-androgenic steroids (AAS), has grown into a worldwide substance abuse problem over the last several decades. Testosterone was isolated in the 1930s, and numerous synthetic androgens were quickly developed thereafter. Athletes soon discovered the dramatic anabolic effects of these hormones, and AAS spread rapidly through elite athletics and bodybuilding from the 1950s through the 1970s. However it was not until the 1980s that widespread AAS use emerged from the elite athletic world and into the general population. Today, the great majority of AAS users are not competitive athletes, but instead are typically young to middle-aged men who use these drugs primarily for personal appearance. AAS abuse has now become particularly prevalent in regions such as Scandinavia, the United States, Brazil, and British Commonwealth countries, but remains rare in countries such as China, Korea, and Japan - a pattern that reflects cultural differences in attitudes towards male muscularity.

Sexual (dys)functioning is related to drive for thinness, not drive for muscularity

Background Negative body image can result in sexual dysfunction for both women and men. Drive for thinness, drive for muscularity and drive for leanness have all been associated with poor body image. However, research to date has not examined which is the strongest predictor of sexual problems in each gender.

METHODS

The present study used measures of drive for muscularity and drive for thinness simultaneously to predict sexual functioning in both genders. Participants (n=519) completed measures of drive for thinness, drive for muscularity, sexual esteem, sexual assertiveness, discomfort exposing their bodies during sex and genital satisfaction. The interaction between drive for thinness and drive for muscularity was used to approximate drive for leanness.

RESULTS

Drive for thinness, not drive for muscularity (or any combination of the two), predicted men's and women's sexual problems.

CONCLUSIONS

We add to the growing body of literature on the destructive nature of excessive drive for thinness, and highlight that it may be a core factor in promoting and maintaining men's (as well as women's) sexual problems.

Biological, Psychological, and Sociocultural Factors Contributing to the Drive for Muscularity in Weight-Training Men

The drive for muscularity and associated behaviors (e.g., exercising and dieting) are of growing importance for men in Western societies. In its extreme form, it can lead to body image concerns and harmful behaviors like over-exercising and the misuse of performance-enhancing substances. Therefore, investigating factors associated with the drive for muscularity, especially in vulnerable populations like bodybuilders and weight trainers can help identify potential risk and protective factors for body image problems. Using a biopsychosocial framework, the aim of the current study was to explore different factors associated with drive for muscularity in weight-training men. To this purpose, German-speaking male weight trainers (N = 248) completed an online survey to determine the extent to which biological, psychological, and sociocultural factors contribute to drive for muscularity and its related attitudes and behaviors. Using multiple regression models, findings showed that media ideal body internalization was the strongest positive predictor for drive for muscularity, while age (M = 25.9, SD = 7.4) held the strongest negative association with drive for muscularity. Dissatisfaction with muscularity, but not with body fat, was related to drive for muscularity. The fat-free mass index, a quantification of the actual degree of muscularity of a person, significantly predicted drive for muscularity-related behavior but not attitudes. Body-related aspects of self-esteem, but not global self-esteem, were significant negative predictors of drive for muscularity. Since internalization of media body ideals presented the highest predictive value for drive for muscularity, these findings suggest that media body ideal internalizations may be a risk factor for body image concerns in men, leading, in its most extreme form to disordered eating or muscle dysmorphia. Future research should investigate the relations between drive for muscularity, age, body composition, internalization, dissatisfaction with muscularity and body-related self-esteem using longitudinal study designs. Limitations concern the cross-sectional design of the study, self-reported body composition measures and the homogeneity of the sample.

Personal and psychosocial predictors of doping use in physical activity settings: a meta-analysis

BACKGROUND

There is a growing body of empirical evidence on demographic and psychosocial predictors of doping intentions and behaviors utilizing a variety of variables and conceptual models. However, to date there has been no attempt to quantitatively synthesize the available evidence and identify the strongest predictors of doping.

OBJECTIVES

Using meta-analysis, we aimed to (i) determine effect sizes of psychological (e.g. attitudes) and social-contextual factors (e.g. social norms), and demographic (e.g. sex and age) variables on doping intentions and use; (ii) examine variables that moderate such effect sizes; and (iii) test a path analysis model, using the meta-analyzed effect sizes, based on variables from the theory of planned behavior (TPB).

DATA SOURCES

Articles were identified from online databases, by contacting experts in the field, and searching the World Anti-Doping Agency website.

STUDY ELIGIBILITY CRITERIA AND PARTICIPANTS

Studies that measured doping behaviors and/or doping intentions, and at least one other demographic, psychological, or social-contextual variable were included. We identified 63 independent datasets.

STUDY APPRAISAL AND SYNTHESIS METHOD

Study information was extracted by using predefined data fields and taking into account study quality indicators. A random effects meta-analysis was carried out, correcting for sampling and measurement error, and identifying moderator variables. Path analysis was conducted on a subset of studies that utilized the TPB.

RESULTS

Use of legal supplements, perceived social norms, and positive attitudes towards doping were the strongest positive correlates of doping intentions and behaviors. In contrast, morality and self-efficacy to refrain from doping had the strongest negative association with doping intentions and behaviors. Furthermore, path analysis suggested that attitudes, perceived norms, and self-efficacy to refrain from doping predicted intentions to dope and, indirectly, doping behaviors.

LIMITATIONS

Various meta-analyzed effect sizes were based on a small number of studies, which were correlational in nature. This is a limitation of the extant literature.

CONCLUSIONS

This review identifies a number of important correlates of doping intention and behavior, many of which were measured via self-reports and were drawn from an extended TPB framework. Future research might benefit from embracing other conceptual models of doping behavior and adopting experimental methodologies that will test some of the identified correlates in an effort to develop targeted anti-doping policies and programs.

Comparisons of Body Image Perceptions of a Sample of Black and White Women with Rheumatoid Arthritis and Fibromyalgia in the US

OBJECTIVE

To explore the disease-related, body image (BI) perceptions of women diagnosed with, rheumatoid arthritis (RA) and fibromyalgia (FM).

METHODS

A purposive sample of twenty-seven females participated in individual semi-structured phone interviews to elicit BI perceptions relative to pain, activity limitations and coping measures. Sessions were digitally recorded, transcribed verbatim, and content analyzed.

RESULTS

Body image perceptions relative to 5 major themes emerged in the analysis. They focused on Pain, Disease Impact on Physical and Mental Function, Weight, Diseased-Induced Fears and, Coping measures. Pain was a common experience of all participants. Other troubling factors verbalized by participants included dislike and shame of visibly affected body parts, and disease-induced social, psychological and physical limitations. RA participants thought that manifested joint changes, such as swelling and redness, undergirded their prompt diagnosis and receipt of health care. Contrarily, women with fibromyalgia perceived that the lack of visible, disease-related, physical signs led to a discounting of their disease, which led to delayed health care and subsequent frustrations and anger. All but one participant used prayer and meditation as a coping measure.

CONCLUSION

The body image perceptions evidenced by the majority of participants were generally negative and included specific focus on their disease-affected body parts (e.g. joints), mental function, self-identity, health care experiences, activity limitations and overall quality of life. Given the global effect of RA and FM, assessment and integration of findings about the BI perceptions of individuals with FM and RA may help define suitable interdisciplinary strategies for managing these conditions and improving participants' quality of life.

Aggression and body image concerns among anabolic androgenic steroid users, contemplators, and controls in Norway

AAS users and contemplators were investigated for differences in aggression and body image concern. Prevalence rates were sought as a secondary aim. 396 male adolescents at Norwegian high schools completed a questionnaire battery during school hours. Prevalence of AAS use showed 4.0%; AAS contemplation showed 5.1%. No significant differences between the AAS users and contemplators were found on levels of aggression and body image concern. AAS users and contemplators reported significantly higher levels of aggression and body image concern compared nonusing controls. AAS contemplators enhance understanding of AAS use by representing psychosocial factors contributing to increased aggression, and AAS use or risk thereof indicative of an aggressive personality profile. Body image concerns for AAS users and contemplators may indicate that AAS use does not diminish body image concern, and that body image concern is a risk factor for AAS use. This is supportive of previous research.

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

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

Competitive Bodybuilding: Positive Deviance, Body Image Pathology, or Modern Day Competitive Sport?

The sport of competitive bodybuilding is strongly associated with muscle dysmorphia, a body-image-related psychological disorder. This theoretical article draws on existing concepts, namely stereotyping, prejudice, and positive deviance in sport, to explicate the notion that competitive bodybuilding and body-image disturbance may be mistakenly conflated. The perspective offered here goes beyond the countercultural physique to argue that a negative social perception of competitive bodybuilders obscures the pragmatic necessity to develop a hypermesomorphic physique. Competitive bodybuilders (CBs) and athletes in mainstream competitive sport exhibit congruent psychobehavioral tendencies. In a competitive-sport context, behavior among CBs perceived as pathological may primarily represent a response to the ideological sporting ethic of “win at all costs,” not extreme body-image disturbance. Analyzing the psychobehavioral characteristics of CBs within a sporting rather than a pathological framework, allows for a contextual assessment of behaviors to then determine the clinical significance relative to the research population under investigation.

Development and validation of the Male Body Talk Scale: a psychometric investigation

This paper details the development of the Male Body Talk (MBT) scale and five studies supporting the psychometric soundness of scores on this new measure. Participants were 18-65-year-old men recruited via Amazon's Mechanical Turk, introductory psychology courses, and snowball sampling. The MBT scale assesses the frequency with which men engage in negatively valenced body-related conversations with others. Two subscales were identified through a combination of exploratory and confirmatory factor analysis. The Muscle Talk subscale assesses men's tendency to express concerns regarding degree of muscularity and being too small. The Fat Talk subscale assesses men's tendency to express concerns regarding level of body fat and being overweight. Scores on the MBT scale demonstrated strong internal consistency and moderate test-retest reliability. Evidence of convergent, discriminant, and incremental validity of scores on the MBT scale is presented. This new measure is a useful tool for examining how often men engage in negative body talk.

The global epidemiology of anabolic-androgenic steroid use: a meta-analysis and meta-regression analysis

PURPOSE

To estimate the global lifetime prevalence rate of anabolic-androgenic steroid (AAS) use and investigate moderators of the prevalence rate.

METHODS

A meta-analysis and meta-regression analysis was performed using studies gathered from searches in PsycINFO, PubMed, ISI Web of Science, and Google Scholar among others. Included were 187 studies that provided original data on 271 lifetime prevalence rates. Studies were coded for publication year, region, sample type, age range, sample size, assessment method, and sampling method. Heterogeneity was assessed by the I(2) index and the Q-statistic. Random effect-size modeling was used. Subgroup comparisons were conducted using Bonferroni correction.

RESULTS

The global lifetime prevalence rate obtained was 3.3% (95% confidence interval [CI], 2.8-3.8; I(2) = 99.7, P < .001). The prevalence rate for males, 6.4% (95% CI, 5.3-7.7, I(2) = 99.2, P < .001), was significantly higher (Qbet = 100.1, P < .001) than the rate for females, 1.6% (95% CI, 1.3-1.9, I(2) = 96.8, P < .001). Sample type (athletes), assessment method (interviews only and interviews and questionnaires), sampling method, and male sample percentage were significant predictors of AAS use prevalence. There was no indication of publication bias.

CONCLUSION

Nonmedical AAS use is a serious widespread public health problem.

Exercise dependence and muscle dysmorphia in novice and experienced female bodybuilders

BACKGROUND AND AIMS

Extensive research has shown that male bodybuilders are at high risk for exercise dependence, but few studies have measured these variables in female bodybuilders. Prior research has postulated that muscular dysmorphia was more prevalent in men than women, but several qualitative studies of female bodybuilders have indicated that female bodybuilders show the same body image concerns. Only one study has compared female bodybuilders with control recreational female lifters on eating behaviors, body image, shape pre-occupation, body dissatisfaction, and steroid use. The purpose of this study was to compare exercise dependence and muscle dysmorphia measures between groups of female weight lifters.

METHODS

Seventy-four female lifters were classified into three lifting types (26 expert bodybuilders, 10 or more competitions; 29 novice bodybuilders, 3 or less competitions; and 19 fitness lifters, at least 6 months prior lifting) who each completed a demographic questionnaire, the Exercise Dependence Scale (EDS), the Drive for Thinness scale (DFT) of the Eating Disorder Inventory-2, the Bodybuilding Dependence Scale (BDS), and the Muscle Dysmorphia Inventory (MDI).

RESULTS

Female bodybuilders scored higher than fitness lifters for EDS Total, BDS Training and Social Dependence, and on Supplement Use, Dietary Behavior, Exercise Dependence, and Size Symmetry scales of the MDI.

DISCUSSION AND CONCLUSIONS

Female bodybuilders seem to be more at risk for exercise dependence and muscle dysmorphia symptoms than female recreational weight lifters.

Prevalence of use of performance enhancing drugs by fitness centre members

Studies on the use of performance enhancing drugs (PED) in fitness centres rely predominately on conventional survey methods using direct questioning. However, research indicates that direct questioning of sensitive information is characterized by under-reporting. The aim of the present study was to contrast direct questioning of different types of PED use by Dutch fitness centre members with results obtained with the Randomized Response Technique (RRT). Questionnaires were conducted among members of fitness centres. PED were classified into the following categories: anabolic steroids, prohormones, substances to counteract side-effects, growth hormone and/or insulin, stimulants (to reduce weight), and miscellaneous substances. A total of 718 athletes from 92 fitness centres completed the questionnaire. The conventional method resulted in prevalences varying between 0% and 0.4% for the different types of PED with an overall prevalence of 0.4%. RRT resulted in prevalences varying between 0.8% and 4.8% for the different types of PED with an overall prevalence of 8.2%. The overall prevalence of the two survey methods differed significantly. The current study showed that the conventional survey method using direct questioning led to an underestimation of the prevalence. Based on the RRT results, the percentage of users of PED among members of fitness centres is approximately 8.2%. Stimulants to lose weight had the highest prevalence, even higher than anabolic steroids. The key task for future preventive health work is to not only focus on anabolic steroid use, but also include interventions focusing on the use of stimulants to lose weight.

Eating disorders and anabolic androgenic steroids in males--similarities and differences in self-image and psychiatric symptoms

Background

Body dissatisfaction is common among both females and males. Dissatisfaction with the body is a risk factor both for onset of eating disorders and for abuse of anabolic androgenic steroids (AAS). Few studies have however investigated if there are other similarities in respect to self-image or psychiatric symptoms between clinical samples of eating disordered males and males in treatment for negative effects of AAS use.

Aim

The aim of this study was to compare two clinical samples, one of males with ED and one of males who used AAS, regarding self-image and psychiatric symptoms.

Methods

This study compared males with eating disorders (n = 13) and males who recently stopped AAS use (n = 29) on self-image and psychiatric symptoms, using The Structural Analysis of Social Behavior self-questionnaire and a shortened version of The Symptom Check List.

Results

The eating disorder group reported significantly lower scores for Self-emancipation and Active self-love and higher scores for Self-blame and Self-hate. Both groups reported serious psychiatric symptoms. The common denominator between groups was serious psychiatric symptomatology rather than negative self-image.

Conclusions

The negative self-image profile, especially self-hate, found among males with Eating Disorders may indicate that the studied groups differ in aetiology of the underlying problems. The serious psychiatric symptoms in both groups call staff to pay attention to any thoughts of suicide due to severe depressive symptoms where by specialized psychiatric treatment may be needed.

Body talk among college men: content, correlates, and effects

Though researchers are beginning to examine body-related talk in women (often referred to as fat talk), little work has examined how men talk about their bodies with peers. The two studies presented in this article explore body talk among U.S. college men. First, an online survey examined the frequency with which college men engage in negative body talk, the content of these conversations, and the body image variables associated with engaging in this type of talk. Negative body talk in men was associated with drive for muscularity, eating disordered behavior, and appearance investment. Study 2 experimentally examined the effects of hearing male peers engage in negative body talk. Hearing muscle talk or fat talk caused decreased state appearance self-esteem and increased state body dissatisfaction. The correlates and consequences of negative body talk among men appear no less troubling than those identified among women.

A comparison of eating, exercise, shape, and weight related symptomatology in males with muscle dysmorphia and anorexia nervosa

In the context of the lack of nosological clarity surrounding muscle dysmorphia, this paper aims to compare the symptomatic profile of muscle dysmorphia and anorexia nervosa in males whilst using measures sensitive to indexing male body image concerns. Twenty-one male muscle dysmorphia patients, 24 male anorexia nervosa patients, and 15 male gym-using controls completed the Eating Disorder Examination-Questionnaire, the Muscle Dysmorphia Disorder Inventory, the Compulsive Exercise Test, and a measure of appearance-enhancing substance use. Men with muscle dysmorphia and anorexia nervosa demonstrated widespread symptomatic similarities spanning the domains of disturbed body image, disordered eating, and exercise behaviour, whilst differences were consistent with the opposing physiques pursued in each condition. Furthermore, correlational analyses revealed significant associations between scores on muscle dysmorphia and eating disorder measures. The present findings provide moderate support for the notion that muscle dysmorphia may be nosologically similar to anorexia nervosa.

Risk factors for illicit anabolic-androgenic steroid use in male weightlifters: a cross-sectional cohort study

BACKGROUND

Illicit anabolic-androgenic steroid (AAS) abuse, though an important public health problem, remains inadequately studied. Almost all AAS abusers are male and lift weights, but the risk factors for AAS use among male weightlifters remain poorly understood.

METHODS

We recruited 233 experienced male weightlifters, of whom 102 (44%) reported lifetime AAS use, and assessed their childhood and adolescent attributes retrospectively, using structured clinical interviews and computerized questionnaires. This cross-sectional cohort approach-a design that we have formally presented in the recent methodological literature-utilizes a study cohort, not selected for outcomes of interest, and assesses exposures and outcomes retrospectively. We hypothesized that conduct disorder and body-image concerns would be major risk factors for subsequent AAS use among male weightlifters.

RESULTS

Within our study population, many attributes showed little association with AAS use, but conduct disorder and body-image concerns showed strong associations. For individuals with prior conduct disorder versus those without, the hazard ratio (95% confidence interval) for subsequent AAS use was 2.2 (1.5, 3.4). For individuals in the middle versus lowest tertile of scores on a retrospective adolescent muscle-dysmorphia scale, the hazard ratio was 1.5 (.84, 2.6); for the highest versus lowest tertile, the hazard ratio was 3.3 (2.0, 5.3); and for the linear trend of hazard ratios, p < .001.

CONCLUSIONS

Conduct disorder and body-image concerns represent important risk factors for AAS use among male weightlifters. Thus, assessment of these attributes may help to identify individuals most likely to require interventions to discourage this form of substance abuse.

Eating disorders in men: underdiagnosed, undertreated, and misunderstood

This article provides a survey of eating disorders in men, highlights the dramatic rise in eating disorders, identifies issues specific to males, and suggests areas for research and intervention. This survey concludes that men with eating disorders are currently under-diagnosed, undertreated, and misunderstood by many clinicians who encounter them. Ongoing research addressing these issues is expected to result in assessment tools and treatment interventions that will advance positive outcomes for men with eating disorders.

Development and validation of the appearance and performance enhancing drug use schedule

Appearance-and-performance enhancing drug (APED) use is a form of drug use that includes use of a wide range of substances such as anabolic-androgenic steroids (AASs) and associated behaviors including intense exercise and dietary control. To date, there are no reliable or valid measures of the core features of APED use. The present study describes the development and psychometric evaluation of the Appearance and Performance Enhancing Drug Use Schedule (APEDUS) which is a semi-structured interview designed to assess the spectrum of drug use and related features of APED use. Eighty-five current APED using men and women (having used an illicit APED in the past year and planning to use an illicit APED in the future) completed the APEDUS and measures of convergent and divergent validity. Inter-rater agreement, scale reliability, one-week test-retest reliability, convergent and divergent validity, and construct validity were evaluated for each of the APEDUS scales. The APEDUS is a modular interview with 10 sections designed to assess the core drug and non-drug phenomena associated with APED use. All scales and individual items demonstrated high inter-rater agreement and reliability. Individual scales significantly correlated with convergent measures (DSM-IV diagnoses, aggression, impulsivity, eating disorder pathology) and were uncorrelated with a measure of social desirability. APEDUS subscale scores were also accurate measures of AAS dependence. The APEDUS is a reliable and valid measure of APED phenomena and an accurate measure of the core pathology associated with APED use. Issues with assessing APED use are considered and future research is considered.

The diagnostic dilemma of pathological appearance and performance enhancing drug use

Appearance and performance enhancing drug (APED) use includes the use of a range of pharmacologically distinct substances and concurrent investment in outward appearance or achievement, dietary control, and frequent exercise. A number of existing reviews and conceptual papers have defined pathological forms of APED use within the APED class of anabolic-androgenic steroids (AASs) and using the framework of AAS dependence. We review published data on APED use including human studies of AAS users and identified three defining phenomenological features associated with increased health risk and pathology. These features included (1) polypharmacy or the concurrent use of several pharmacologically distinct substances used to change outward appearance or increase likelihood of personal achievement; (2) significant body image disturbance; (3) rigid practices and preoccupations with diet and exercise. Investigations into the latent structure of APED use suggest these features cluster together in a homogenous group of APED users who have the highest health risk and most psychopathology. These features are discussed in the context of AAS dependence and problems with defining classic tolerance-withdrawal symptoms among APED users. Suggestions for a resolution and outline for future research needed to determine the best system for identifying and diagnosing pathological APED use are discussed.

Muscle dysmorphia and the DSM-V conundrum: where does it belong? A review paper

OBJECTIVE

Muscle dysmorphia is a relatively recently identified psychological condition that, since its inception, has been variously conceptualized as an eating disorder and subsequently as a type of body dysmorphic disorder within the somatoform disorders. This review aims to inform and encourage ongoing debate surrounding the diagnostic placement of this disorder.

METHOD

We present a review and synthesis of the extant literature with a view to informing future decisions regarding the conceptualization of muscle dysmorphia.

RESULTS

The validity of muscle dysmorphia as a clinical entity has been empirically demonstrated. While the condition bears little semblance to somatization as currently conceptualized, the research suggests a strong conceptual similarity with anorexia nervosa. However, future research needs to utilize more appropriate measures of male eating disorder pathology. Muscle dysmorphia is also inclusive of obsessive compulsive features that are typical to those seen in eating disorder presentations.

DISCUSSION

We suggest that muscle dysmorphia be reanalyzed through the lens of an eating disorder spectrum. Recognition of muscle dysmorphia as an eating disorder may offer more clinical utility in recognizing the male experience of eating disorder pathology and also help reduce the number of current male cases falling into the EDNOS category.