by Australia Counselling member Brad McLean

The use of performance and image enhancing drugs (PIED) is increasing along with community concerns about a link between their use, connection to violence, and criminality. Allegations about the use of PIEDs in the elite sporting world filled Australian headlines last year. But the evidence seems to be indicating that the broader picture of use is a little more prosaic. It would also seem to make sense that use of PIEDs is linked to a profound lack of self-esteem. Again, the picture is not so clear.

While concerning evidence indicates teenage males are using steroids and recently released data points to injection of steroids dramatically outstripping other illicit injectable drug use, the person using steroids is likely to be male, in their mid-20s to early 30s, professional, with a significant number, but not all, being gay or bisexual.

But what is driving men to use these drugs that bring with them a number of health risks and side effects in the long term?

Is body dysmorphia the problem?

At the most serious end of the spectrum, a small percentage of men may present with a condition known as muscle dysmorphia, one of a collection of body perception disorders where sufferers develop an obsession with the idea that they are skinny despite their above average muscularity.

People with the disorder become obsessively focused on their perceived physical flaws and hypervigilant about their imagined physical defects. Social theories say these individuals are obsessed with attaining an unrealistic cultural standard of masculinity. Some evidence also indicates that men with the disorder are at increased risk of poor quality of life, increased suicidality and abuse of illicit substances.

Therapists from different schools of therapy take different views about the genesis of muscle dysmorphia. Some link the obsessive-compulsive features to complex inner conflicts, feelings and experiences that remain unresolved. Others implicate individual factors including low self-esteem, a history of bullying, early family conflict and other unresolved vulnerabilities. It’s likely that all of these factors play a role in differing ways for differing people but it is important to remember that the condition is rare, certainly rarer than the increasing number of PIED users.

So if an individual does not have muscle dysmorphia, what motivates them to take PIEDs? There appears to be two predictable motivations: improved appearance and better physical performance.

Educated professionals lead in the use of steroids

Interestingly a US web-based survey of almost 2,000 males, which sought to comprehensively profile male PIED users, found most were highly educated professionals earning above average incomes. The majority were not involved in competitive sports.

Over 70% of respondents identified themselves as ‘perfectionists’ with many viewing life through the lens of competition. As a group, they were highly motivated, driven individuals and in the study low-self esteem was not a primary motivator for PIED use.

“Non-medical anabolic steroid use appeared to be more associated with an image of the ideal (attractive) body structure and ability as large, muscular and powerful, a view consistent with Western ideals, and not with an aversion to being small,” the researchers wrote.

Steroid use: a personal account

David, a 34 year-old insurance professional might fit the picture of a typical steroid user. He first injected a combination of two performance-enhancing drugs, a ‘stack’ over a 10-week period in his mid-twenties.

More recently he had his second ‘cycle’ at the end of 2013, which he had to stop following an unrelated injury requiring surgery. Like the first time he took anabolic steroids, he gained 20kg, significantly increasing his muscle mass and enhancing his appearance. He was motivated by a desire to be more desirable.

“It was definitely about the insecurity about my body and it definitely increased my confidence,” he says. “It had a lot to do with the Sydney gay body thing and how people in this culture notice how you look and I definitely got more attention”.

While David says he was an introvert as a young person and lacked confidence, he fits the profile where the focus is on enhancement rather than an internal battle due to a distorted perception of his appearance.

David experienced few side effects beyond snoring as a result of the weight gain. Despite concerns about the links between PIED use and aggression, David says he has never experienced rage or anger but he has heard about it among prolonged users. David’s emotional reaction was in the other direction.

“If anything I was a little emotional and maybe slightly depressed and I was definitely more sensitive and things affected me more emotionally.”

He says he is not concerned about more dramatic and serious side effects, but he would be if he were to be a prolonged user.

Some studies are now pointing to potential addiction patterns emerging with use but it is difficult to tease out whether the addiction is a chemical effect of the drug use or a psychological process. Internationally, treatment facilities are now offering withdrawal and treatment programs for steroid dependence to address the problem.

“I don’t feel like I have an addictive personality so this doesn’t concern me that much,” says David. “I tend to be able to drop things quickly if I want to. I can give things up easily.”

But that is not to say David has not observed what might be considered addictive behaviours around PDs.

“Sure, there are people you see who are never satisfied and they are always wanting to take things to the next level.”

Clearly it is important that assumptions are not made about the causes or underlying reasons why clients choose to do what they do. A PIED user may be looking to be more competitive professionally or socially rather than suffering from a particular mental health issue. Whether the drive to enhance ourselves physically in social environments speaks to a broader personal vulnerability is an individual issue that might be explored in a therapeutic relationship.

Low self-esteem may be at the heart of PIED use, but not always, and any assumptions that impulse control or issues with anger and violence are present need to be carefully assessed, ruled in or out, but never assumed. Whether any of these features are an issue for a client can only be assessed and examined though the course of a quality therapeutic relationship.

Brad McLean Sydney psychotherapistBrad McLean is a relational psychotherapist practicing in central Sydney, Australia. He can be contacted via email.




photo credits: CelebMuscle


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