Anabolic-androgenic steroid dependence and muscle dysmorphia: an exploratory network analysis
Background: Anabolic-androgenic steroid (AAS) dependence puts users at an increased risk of adverse side effects and may be driven by several psychological and somatic factors, including muscle dysmorphia (MD), a persistent feeling of being too small and insufficiently muscular. This study aims to use network analyses of both dependence symptoms, and dependence symptoms with MD symptoms, to identify possible targets for clinical care.
Methods: We compared six symptoms of MD in weight-lifting controls (n=88) and AAS users (n=120) using independent t-tests. Next, we analyzed seven symptoms of AAS dependence using Gaussian graphical modeling. We estimated a symptom network including both dependence and MD symptoms using mixed graphical modelling, and calculated the bridge expected influence, defined as the sum of edge weights of one node (symptom) to nodes in another community (e.g. dependence to MD nodes) to evaluate if any symptoms link dependence and MD. We also calculated the correlation stability coefficients, indicating the reliability of the network.
Results: AAS users scored significantly higher on all MD measures compared to controls. In the dependence network, continuing use despite physical and mental problems, interference with work/life, using more or for longer than planned, and tolerance were the most central symptoms, while time spent was the least central. After including dependence and MD items, the two types of symptoms largely separated into two separate clusters, as bridge expected influence did not differ significantly between the nodes. The correlation stability coefficients indicated both networks appear fairly stable.
Conclusion: Similar to previous studies, MD appears more related to any AAS use than to symptoms of dependence. Symptoms related to side effects and tolerance appear to be central to AAS dependence, and thus alleviating physical discomfort when ceasing use is a relevant target for treatment. However, further studies are needed to explore psychological motivations for prolonged use.