The diagnostic dilemma of pathological appearance and performance enhancing drug use.
Appearance and performance enhancing drug (APED) use includes the use of a range of pharmacologically distinct substances and concurrent investment in outward appearance or achievement, dietary control, and frequent exercise. A number of existing reviews and conceptual papers have defined pathological forms of APED use within the APED class of anabolic-androgenic steroids (AASs) and using the framework of AAS dependence. We review published data on APED use including human studies of AAS users and identified three defining phenomenological features associated with increased health risk and pathology. These features included (1) polypharmacy or the concurrent use of several pharmacologically distinct substances used to change outward appearance or increase likelihood of personal achievement; (2) significant body image disturbance; (3) rigid practices and preoccupations with diet and exercise. Investigations into the latent structure of APED use suggest these features cluster together in a homogenous group of APED users who have the highest health risk and most psychopathology. These features are discussed in the context of AAS dependence and problems with defining classic tolerance-withdrawal symptoms among APED users. Suggestions for a resolution and outline for future research needed to determine the best system for identifying and diagnosing pathological APED use are discussed.
Eating and Weight Disorders Program, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1230, New York, NY 10029, USA. tom.hildebrandt@mssm.edu
Tom
T
Hildebrandt
Justine K
JK
Lai
James W
JW
Langenbucher
Melanie
M
Schneider
Rachel
R
Yehuda
Donald W
DW
Pfaff
D045930:Anabolic Agents / Q000009:adverse effects; D000818:Animals; D001828:Body Image; D006801:Humans; D006984:Hypertrophy / Q000139:chemically induced / Q000175:diagnosis / Q000473:pathology; D007006:Hypogonadism / Q000139:chemically induced / Q000175:diagnosis / Q000473:pathology; D058573:Performance-Enhancing Substances / Q000009:adverse effects*; D019966:Substance-Related Disorders / Q000175:diagnosis* / Q000473:pathology
D045930:Anabolic Agents; D058573:Performance-Enhancing Substances