Clustering psychopathology in male anabolic–androgenic steroid users and nonusing weightlifters

Abstract

Introduction Prior research has demonstrated that personality disorders and clinical psychiatric syndromes are common among users of anabolic–androgenic steroids (AAS). However, the prevalence, expression, and severity of psychopathology differ among AAS users and remain poorly understood. In this study, we examine the existence of potential clinically coherent psychopathology subgroups, using cluster procedures. Methods A sample of 118 male AAS users and 97 weightlifting nonusers was assessed using the Millon Clinical Multiaxial Inventory‐III (MCMI‐III), measuring personality disorders and clinical syndromes. Group differences in MCMI‐III scales were assessed using Wilcoxon‐Mann–Whitney tests and Fisher's exact test. Agglomerative hierarchical clustering was used to identify clusters based on MCMI‐III scale scores from the whole sample. Results AAS users displayed significantly higher scores on all personality disorder (except narcissistic) and clinical syndrome scales compared to nonusing weightlifters. The clustering analysis found four separate clusters with different levels and patterns of psychopathology. The “no psychopathology” cluster was most common among nonusing weightlifters, while the three other clusters were more common among AAS users: “severe multipathology,” “low multipathology,” and “mild externalizing.” The “severe multipathology” cluster was found almost exclusively among AAS users. AAS users also displayed the highest scores on drug and alcohol dependence syndromes. Conclusions AAS users in our sample demonstrated greater psychopathology than the nonusing weightlifters, with many exhibiting multipathology. This may pose a significant challenge to clinical care for AAS users, particularly as there appears to be significant variation in psychopathology in this population. Individual psychiatric profiles should be taken into consideration when providing treatment to this group. Significant Outcomes As a group, AAS users displayed markedly greater psychopathology than nonusing weightlifters. Multipathology was common among AAS users. Four different subgroups of personality profiles were identified with distinct patterns of pathology and severity. Limitations The cross‐sectional nature of the study precludes inferences about causality. The study is limited by possible selection bias, as participants choosing to be involved in research may not be entirely representative for the group as a whole. The study is vulnerable to information bias, as the results are based on self‐report measures and interviews.

Off-label use of clomiphene citrate to treat anabolic androgenic steroid induced hypogonadism upon cessation among men (CloTASH) – A pilot study protocol

“…The first AAS case control study from our research group [ 27 , 28 ] found significant effects between the groups for measures of psychopathology with effect sizes ex =0.27. With a power of 80 % and a wish to detect effects of moderate level (Cohen's d = 0.4), a total sample of 52 participants is needed.…”

Off-label use of Clomiphene citrate to Treat Anabolic-androgenic Steroid induced Hypogonadism upon cessation among men (CloTASH) - a pilot study protocol

“…The rst AAS case control study from our research group [52][53][54] found signi cant effects between the groups for measures of psychopathology with effect sizes ex = .27. With a power of 80% and a wish to detect effects of moderate level (Cohen's d = 0.4), a total sample of 52 participants is needed.…”

Psychological traits associated with anabolic androgenic steroid use and dependence among female athletes

“…As the majority of research on AAS use has focused on males, there is a lack of knowledge around risk factors and consequences of AAS use in females, particularly regarding the effects of AAS on the brain. Among males, studies have identified associations between AAS use and a number of cognitive, neurobiological, and psychiatric challenges including decreased executive function, cortical thinning, accelerated brain aging, and increased internalizing and externalizing psychopathology (Bjørnebekk et al, 2021;Bjørnebekk et al, 2017;Hauger et al, 2020;Jørstad et al, 2023;Kanayama et al, 2013;Scarth, Havnes, et al, 2022). Similarly, there is likely an increased prevalence of psychiatric disorders among females who use AAS , in addition to potential social cognitive challenges (Vaskinn et al, 2020).…”