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

Abstract Background 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 males who used AAS and weightlifting controls. Methods A sample of 153 men who had used AAS and 88 weight-lifting controls were recruited through social media and relevant online forums, and via posters and flyers distributed in select gyms in Oslo, Norway. Symptoms of AAS dependence and muscle dysmorphia were assessed using clinical interviews and standardized questionnaires. Severity of muscle dysmorphia symptoms were compared between the groups using independent samples t-tests. The following symptom networks were computed using Gaussian graphical modeling or mixed graphical modeling: 1) AAS dependence symptoms among men who has used AAS 2) muscle dysmorphia symptoms among men who had used AAS and weight-lifting controls in two separate networks, which were compared using a network comparison test, and 3) AAS dependence and muscle dysmorphia symptoms among men who had used AAS. Results In a network of AAS dependence symptoms, 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 those who used AAS and controls, the most central symptoms in each group were exercise dependence and size/symmetry concerns, respectively. Men who had used AAS 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 men who had used, no significant connections between symptom groups were identified. Conclusions 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.