Psychopathology among anabolic-androgenic steroid users and non-using female athletes in Norway

Abstract

Background: Anabolic-androgenic steroids (AAS) comprise testosterone and synthetic derivatives, primarily used in the bodybuilding and fitness communities to increase lean muscle mass. However, AAS can lead to several somatic and psychiatric side-effects. As a result of low perceived prevalence and stigma among female users, the relationship between AAS use and psychopathology in this population is not well-known.Methods: AAS using women (n=16) and weight-lifting controls (WLC) (n=16) completed questionnaires regarding AAS use, health and training information. Psychopathology was evaluated using the Millon Clinical Multiaxial Inventory-III (MCMI-III). Group differences on demographic variables and scores on MCMI-III scales were evaluated with Mann-Whitney U tests. The clinical cut-off was then applied to all MCMI-III scales and groups were compared using Fisher’s exact test. Results: AAS users demonstrated significantly greater psychopathology than WLC on several scales. Externalizing personality disorder scales were elevated among users relative to controls, such as borderline (p<0.001), antisocial (p=0.007) and sadistic (p=0.002), and in addition depressive (p=0.012), negativistic (p=0.001) and masochistic (p=0.029) personality disorders scales. Furthermore, all clinical syndromes were elevated among AAS users. AAS users thus demonstrated multi-pathology, and 56% (n=9) of the group met the clinical criteria for six or more disorders. Conclusion: Female AAS users experience in general increased levels of psychopathology compared to WLC. Clinicians should be aware of these traits and the challenges they present in providing care to female AAS users.