Investigating anabolic-androgenic steroid dependence and muscle dysmorphia with network analysis

Anabolic-androgenic steroid (AAS) dependence has numerous adverse health consequences, and may be driven in part by body image concerns, primarily muscle dysmorphia. This study aims to further understanding and identify potential clinical targets using network analyses of AAS dependence and muscle dysmorphia symptoms in male AAS users and weightlifting controls. Symptoms of AAS dependence and muscle dysmorphia were assessed using clinical interviews and standardized questionnaires. In a network of AAS dependence symptoms among users, continuing use despite physical and mental problems, using longer than planned, tolerance, and work/life interference were the most central symptoms. When comparing symptom structures of muscle dysmorphia between AAS users and controls, the most central symptoms in each group were exercise dependence and size/symmetry concerns, respectively. AAS users demonstrated elevated muscle dysmorphia symptoms compared to controls, indicating that both the severity and structure of symptoms differ between these groups. In a network including both AAS dependence and muscle dysmorphia symptoms among users, no significant connections between symptom groups were identified. AAS dependence is complex, with correlated somatic and psychological challenges driving the symptom network, indicating that alleviating physical and mental health concerns during both AAS use and cessation is an important clinical target.