Self-Image Among Males with Eating Disorders and Those Who Use Steroids

Dissatisfaction with one’s body is common among men and women of all ages, and is a risk factor for development of an eating disorder. (See also a review of Current Findings on Males with Eating Disorders elsewhere in this issue.) For males, dissatisfaction may be tied to abuse of anabolic androgenic steroids (AAS). In a small study, researchers at the Karolinska Institute, Stockholm, Sweden, recently compared males with eating disorders and males who used AAS (Substance Abuse Treatment, Prevention, and Policy 2013;8:30.) The authors designed their study after learning that 4% of adult patients receiving specialty treatment for eating disorders in Sweden were males; only a few years earlier, this percentage was closer to 1.5%.

AAS, synthetic derivatives of endogenous testosterone, were originally used by athletes but are now used by a much wider range groups not necessarily associated with sports. The majority of AAS users are males. In Sweden, between 50,000 to 100,000 persons, or about 1% of the population, are thought to have used AAS. The primary reasons that users say they use AAs are to improve their appearance and to increase sports performance. Unfortunately, several not-so-healthy adverse emotional and behavioral effects have also increased their use, including depression, aggression, and sleep disturbances. AAs use can also be associated with “muscle dysmorphia,” a fear of not being muscular enough. Some have termed this fear “reverse anorexia,” and note that men with this disorder may have the characteristics of perfectionism, ineffectiveness, and low self-esteem.

Male adults with eating disorders (n=13) and males who recently stopped using AAS (n=29) were included in the study. In the Karolinska Institute study, men with eating disorders were participating in the Coordinated Evaluation and Research at Specialized Units for Eating Disorders project, a continuing study of 840 adult patients seeking treatment at 14 specialized eating disorders treatment centers across Sweden. None of the 13 men had a history of substance abuse. The men in the former AAS users group were consecutively selected from a doping clinic in an addiction treatment center.

The researchers used the Symptom Check List (SC-90) to measure self-reported psychiatric symptoms. The Structural Analysis of Social Behavior measure was also used; this questionnaire includes 36 positive and negative self-referential statements.

An unexpected common denominator
Males with eating disorders were significantly younger than men in the AAS group. AAS group members also had significantly higher weights and body mass index values. Overall, males in the eating disorders group had considerably more negative self images at the beginning of treatment than did men in the AAS group, but the two groups had similarly serious psychiatric symptoms. The authors concluded that the common denominators between the two groups are serious psychiatric symptoms, especially depression, interpersonal sensitivity, and obsessive-compulsive behaviors.