title: Anabolic-androgenic steroid use and psychopathology in athletes. A systematic review.
abstract: The use of anabolic-androgenic steroids (AASs) by professional and recreational athletes is increasing worldwide. The underlying motivations are mainly performance enhancement and body image improvement. AAS abuse and dependence, which are specifically classified and coded by the DSM-5, are not uncommon. AAS-using athletes are frequently present with psychiatric symptoms and disorders, mainly somatoform and eating, but also mood, and schizophrenia-related disorders. Some psychiatric disorders are typical of athletes, like muscle dysmorphia. This raises the issue of whether AAS use causes these disorders in athletes, by determining neuroadaptive changes in the reward neural circuit or by exacerbating stress vulnerability, or rather these are athletes with premorbid abnormal personalities or a history of psychiatric disorders who are attracted to AAS use, prompted by the desire to improve their appearance and control their weights. This may predispose to eating disorders, but AASs also show mood destabilizing effects, with longterm use inducing depression and short-term hypomania; withdrawal/discontinuation may be accompanied by depression. The effects of AASs on anxiety behavior are unclear and studies are inconsistent. AASs are also linked to psychotic behavior. The psychological characteristics that could prompt athletes to use AASs have not been elucidated.
authors.affiliation: NESMOS (Neurosciences, Mental Health, and Sensory Organs) Department, School of Medicine and Psychology, Sapienza University-Rome, Italy; UOC Psychiatry, Sant'Andrea Hospital, Rome, Italy;
authors.forename: Daria
authors.initials: D
authors.lastname: Piacentino
authors.affiliation: NESMOS (Neurosciences, Mental Health, and Sensory Organs) Department, School of Medicine and Psychology, Sapienza University-Rome, Italy; UOC Psychiatry, Sant'Andrea Hospital, Rome, Italy;
authors.forename: Georgios D
authors.initials: GD
authors.lastname: Kotzalidis
authors.affiliation: NESMOS (Neurosciences, Mental Health, and Sensory Organs) Department, School of Medicine and Psychology, Sapienza University-Rome, Italy; UOC Psychiatry, Sant'Andrea Hospital, Rome, Italy; ; Department of Psychiatric Rehabilitation, P. Alberto Mileno Onlus Foundation, San Francesco Institute, Vasto, Italy;
authors.forename: Antonio
authors.initials: A
authors.lastname: Del Casale
authors.affiliation: Department of Anatomical, Histological, Forensic Medicine, And Orthopedic Sciences. Sapienza University-Rome, Italy;
authors.forename: Maria Rosaria
authors.initials: MR
authors.lastname: Aromatario
authors.affiliation: Department of Forensic Pathology, University of Foggia; Ospedale Colonnello D'Avanzo, Foggia, Italy;
authors.forename: Cristoforo
authors.initials: C
authors.lastname: Pomara
authors.affiliation: NESMOS (Neurosciences, Mental Health, and Sensory Organs) Department, School of Medicine and Psychology, Sapienza University-Rome, Italy; UOC Psychiatry, Sant'Andrea Hospital, Rome, Italy; ; Centro Lucio Bini, Rome, Italy;
authors.forename: Paolo
authors.initials: P
authors.lastname: Girardi
authors.affiliation: NESMOS (Neurosciences, Mental Health, and Sensory Organs) Department, School of Medicine and Psychology, Sapienza University-Rome, Italy; UOC Psychiatry, Sant'Andrea Hospital, Rome, Italy; ; Centro Lucio Bini, Rome, Italy; ; IRCCS Santa Lucia Foundation, Department of Clinical and Behavioral Neurology, Neuropsychiatry Laboratory, Rome, Italy;;
authors.forename: Gabriele
authors.initials: G
authors.lastname: Sani
mesh_terms: D045930:Anabolic Agents / Q000009:adverse effects; D000987:Antisocial Personality Disorder / Q000523:psychology*; D056352:Athletes / Q000523:psychology*; D054874:Athletic Performance / Q000523:psychology; D006801:Humans; D001523:Mental Disorders / Q000139:chemically induced / Q000523:psychology; D011599:Psychopathology; D013256:Steroids / Q000009:adverse effects; D019966:Substance-Related Disorders / Q000453:epidemiology; D045165:Testosterone Congeners / Q000009:adverse effects
chemical_list: D045930:Anabolic Agents; D013256:Steroids; D045165:Testosterone Congeners
keywords: Anabolic-androgenic steroids; doping; mood disorders; psychopathology; psychosis