Journal Mobile Options
Table of Contents
Vol. 70, No. 2, 2001
Issue release date: March–April 2001
Psychother Psychosom 2001;70:61–65

‘Body Image’ Drugs: A Growing Psychosomatic Problem

Kanayama G. · Pope Jr. H.G. · Hudson J.I.
aBiological Psychiatry Laboratory, McLean Hospital, Belmont, Mass., and Department of Psychiatry, Harvard Medical School, Boston, Mass., and bDepartments of Biostatistics and Epidemiology, Harvard School of Public Health, Boston, Mass., USA

Individual Users: Register with Karger Login Information

Please create your User ID & Password

Contact Information

I have read the Karger Terms and Conditions and agree.

To view the fulltext, please log in

To view the pdf, please log in

First-Page Preview
Abstract of Editorial

Copyright / Drug Dosage

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.


  1. Pope HG Jr, Phillips KA, Olivardia R: The Adonis Complex: The Secret Crisis of Male Body Obsession. New York, Free Press, 2000.
  2. Gruber AJ, Pope HG Jr: Psychiatric and medical effects of anabolic-androgenic steroid use in women. Psychother Psychosom 2000;69:19–26.
  3. Duchaine D: Underground Steroid Handbook II. Venice, HLR Technical Books, 1989.
  4. Grunding P, Bachman M: World Anabolic Review 1996. Houston, MB Muscle Books, 1995.
  5. Duchaine D: Underground Body Opus: Militant Weight Loss and Recomposition. Carson City, XIPE Press, 1996.
  6. Llewellyn W: Anabolics 2000. Aurora, Inc, 2000.
  7. Buckley WA, Yesalis CE, Friedl KE, Anderson W, Streit A, Wright J: Estimated prevalence of anabolic steroid use among male high school seniors. JAMA 1988;260:3441–3445.
  8. Durant RH, Rickert VI, Ashworth CS, Newman C, Slavens G: Use of multiple drugs among adolescents who use anabolic steroids. N Engl J Med 1993;328:922–926.
  9. Yesalis CE, Kennedy NJ, Kopstein AN, Bahrke MS: Anabolic-androgenic steroid use in the United States. JAMA 1993;270:1217–1221.
  10. Yesalis LE, Barsukiewicz CK, Kopstein AN, Bahrke MS: Trends in anabolic-androgenic steroid use among adolescents. Arch Pediatr Adolesc Med 1997;151:1197–1206.

    External Resources

  11. Monaghan L: Challenging medicine? Bodybuilding, drugs and risk. Sociol Health Illness 1999;21:707–734.
  12. Kanayama G, Pope HG Jr, Gruber AJ, Borowiecki J: Over-the-counter drug use in gymnasiums: An underrecognized substance abuse problem? Psychother Psychosom, in press.
  13. Su T-P, Pagliaro M, Schmidt PJ, Pickar D, Wolkowitz OM, Rubinow DR: Neuropsychiatric effects of anabolic steroids in male normal volunteers. JAMA 1993;269:2760–2764.
  14. Pope HG Jr., Kouri EM, Hudson JI: The effects of supraphysiologic doses of testosterone on mood and aggression in normal men: A randomized controlled trial. Arch Gen Psychiatry 2000;57:133–140.
  15. Pope HG Jr, Brower KJ: Anabolic-androgenic steroid abuse; in Sadock BJ, Sadock VA (eds): Comprehensive Textbook of Psychiatry VII. Philadelphia, Lippincott Williams & Wilkins, 2000, pp 1085–1095.
  16. Pope HG Jr, Kouri EM, Powell KF, Campbell C, Katz DL: Anabolic-androgenic steroid use among 133 prisoners. Compr Psychiatry 1996;37:322–327.
  17. Brower KJ, Blow FC, Eliopulos GA, Beresford TP: Anabolic androgenic steroids and suicide. Am J Psychiatry 1989;146:1075.
  18. Malone DA Jr, Dimeff R, Lombardo JA, Sample BRH: Psychiatric effects and psychoactive substance use in anabolic-androgenic steroid users. Clin J Sports Med 1995;5:25–31.
  19. Kashkin KB, Kleber HD: Hooked on hormones? An anabolic steroid addiction hypothesis. JAMA 1989;262:3166–3170.
  20. Brower KJ, Blow FC, Beresford TP, Fuelling C: Anabolic-androgenic steroid dependence. J Clin Psychiatry 1989;50:31–33.
  21. McBride AJ, Williamson K, Petersen T: Three cases of nalbuphine hydrochloride dependence associated with anabolic steroid abuse. Br J Sports Med 1996;30:69–70.
  22. Wines JD Jr, Gruber AJ, Pope HG Jr, Lukas SE: Nalbuphine hydrochloride dependence in anabolic steroid users. Am J Addict 1999;8:161–164.
  23. Arvary D, Pope HG Jr: Anabolic steroids: A possible gateway to opioid dependence. N Engl J Med 2000;342:1532.
  24. Moffa HR, Wallace M, Sady S: Effects of anabolic steroids on lipoprotein profiles of female weight lifters. Phys Sportsmed 1990;18:106–110.
  25. Mewis C, Spyridopoulis I, Kuhlkamp V, Seipel L: Manifestation of severe coronary artery disease after anabolic drug abuse. Clin Cardiol 1996;19:153–155.

    External Resources

  26. Palfi S, Ungurean A, Vecsei L: Basilar artery occlusion associated with anabolic steroid abuse in a 17-year-old bodybuilder. Eur Neurol 1997;37:190–191.

    External Resources

  27. King DS, Sharp RL, Vukovich MD, Brown GA, Reifenrath TA, Parsons KA, King DS: Effect of oral androstenedione on serum testosterone and adaptations to resistance training in young men: A randomized controlled trial. JAMA 1999;281:2020–2028.
  28. Kachhi PN; Henderson SO: Priapism after androstenedione intake for athletic performance enhancement. Ann Emerg Med 2000;35:391–393.
  29. Yesalis CE: Medical, legal, and societal implications of androstenedione use. JAMA 1999;281:2043–2044.
  30. Whitehouse AM, Duncan JM: Ephedrine psychosis rediscovered. Br J Psychiatry 1987;150:258–261.

    External Resources

  31. Vahedi K, Domigo V, Amarenco P, Bousser M-G: Ischaemic stroke in a sportsman who consumed MaHuang extract and creatine monohydrate for bodybuilding. J Neurol Neurosurg Psychiatry 2000;68:112–113.

    External Resources

  32. Capwell RR: Ephedrine-induced mania from an herbal diet supplement. Am J Psychiatry 1995;152:647.
  33. Centers for Disease Control and Prevention: Adverse events associated with ephedrine-containing products – Texas, December 1993–September 1995. Morb Mortal Wkly Rep 1996;45:689–693.
  34. Food and Drug Administration: Dietary Supplements Containing Ephedrine Alkaloids. Document No 21 CFR Part III. Washington, United States Department of Health and Human Services, June 4, 1997.
  35. Gruber AJ, Pope HG Jr: Ephedrine abuse among 36 female weightlifters. Am J Addict 1998;7:256–261.
  36. Croyle P, Place R, Hilgenberg A: Massive pulmonary embolism in a high school wrestler. JAMA 1979;241:827–828.
  37. Appleby M, Fisher M, Martin M: Myocardial infarction, hyperkalemia and ventricular tachycardia in a young male bodybuilder. Int J Cardiol 1994;44:171–174.
  38. Al-Zaki T, Talbot-Stern J: A bodybuilder with diuretic abuse presenting with symptomatic hypotension and hyperkalemia. Am J Emerg Med 1996;14:96–98.

    External Resources

  39. Garfinkel PE: Eating disorders; in Kaplan HI, Sadock BK (eds): Comprehensive Textbook of Psychiatry, ed 6. Baltimore, Williams & Wilkins, 1995, pp 1361–1371.
  40. Delbeke FT, Desmet N, Debackere M: The abuse of doping agents in competing body builders in Flanders (1988–1993). Int J Sports Med 1995;16:66–70.
  41. Prather ID, Brown DE, North P. Wilson JR: Clenbuterol: A substitute for anabolic steroids? Med Sci Sports Exerc 1995;27:1118–1121.
  42. Goldstein DR, Dobbs T, Krull B, Plumb VJ: Clenbuterol and anabolic steroids: A previously unreported cause of myocardial infarction with normal coronary arteriograms. South Med J 1998;91:780–784.

    External Resources

  43. Wadler GI, Hainline B: Drugs and the Athlete. Philadelphia, Davis, 1989.
  44. Spalding BJ: Black-market biotechnology: Athletes abuse EPO and HGH. Biotechnology 1991;9:1050–1053.
  45. Adamson JW, Vapnek D: Recombinant erythropoietin to improve athletic performance. N Engl J Med 1991;324:698–699.
  46. Brownell KD, Napolitano MA: Distorting reality for children: Body size proportions of Barbie and Ken dolls. Int J Eat Disord 1995;18:295–298.
  47. Norton KI, Olds TS, Olive S, Dank S: Ken and Barbie at life size. Sex Roles 1996;34:287–294.
  48. Pope HG Jr, Olivardia R, Gruber A, Borowiecki J: Evolving ideals of male body image as seen through action toys. Int J Eat Disord 1999;26:65–72.
  49. Garner DM, Garfinkel PE, Schwartz D, Thompson M: Cultural expectations of thinness in women. Psychol Rep 1980;47:483–491.

    External Resources

  50. Wiseman CV, Gray JJ, Mosimann JE, Ahrens AH: Cultural expectations of thinness in women: An update. Int J Eat Disord 1992;11:85–89.
  51. Leit RA, Pope HG Jr, Gray JJ: Cultural expectations of muscularity in men: The evolution of Playgirl centerfolds. Int J Eat Disord 2001;29:90–93.
  52. Pope HG Jr, Olivardia R, Cohane G, Borowiecki J: The growing relative value of the male body as seen through advertisements in women’s magazines. Psychother Psychosom, in press.
  53. Berscheid E, Walster E, Bohrnstedt G: The happy American body: A survey report. Psychol Today 1973;7:119–131.
  54. Garner DM: Body image survey. Psychol Today 1997;30:30–84.
  55. Pope HG Jr, Gruber AJ, Mangweth B, Bureau B, deCol C, Jouvent R, Hudson JI: Body image perception among men in three countries. Am J Psychiatry 2000;157:1297–1301.
  56. Jäger B, Ruggiero GM, Edlund B, Gomez-Perretta C, Lang F, Mohammadkhani P, Sahleen-Veasey C, Schomer H, Lamprecht F: Status and functional interactions of risk factors for bulimia nervosa in 12 countries. Psychother Psychosom, in press.
  57. Kaneko K, Kiriike N, Ikenaga K, Miyawaki D, Yamagami S: Weight and shape concerns and dieting behaviors among pre-adolescents and adolescents in Japan. Psychiatry Clin Neurosci 1999;53:365–371.
  58. Sarver DB, Wadden TA, Foster GD: Assessment of body image dissatisfaction in obese women: Specificity, severity, and clinical significance. J Consult Clin Psychol 1998;66:651–654.
  59. Buddeberg-Fischer B, Klaghofer R, Reed V: Associations between body weight, psychiatric disorders and body image in female adolescents. Psychother Psychosom 1999;68:325–332.
  60. Erickson SJ, Robinson TN, Haydel KF, Killen JD: Are overweight children unhappy? Body mass index, depressive symptoms, and overweight concerns in elementary school children. Arch Pediatr Adolesc Med 2000;154:931–935.

    External Resources

  61. Chen W, Swalm RL: Chinese and American college students’ body-image: Perceived body shape and body affect. Percept Mot Skills 1998;87:395–403.
  62. Russell GFM: Bulimia nervosa: An ominous variant of anorexia nervosa. Psychol Med 1979;9:429–448.
  63. Olivardia R, Pope HG Jr, Mangweth B, Hudson JI: Eating disorders in college men. Am J Psychiatry 1995;152:1279–1285.
  64. Mangweth B, Pope HG Jr, Hudson JI, Olivardia R, Kinzl J, Biebl W: Eating disorders in Austrian men: An intra-cultural and cross-cultural comparison study. Psychother Psychosom 1997;66:214–221.
  65. Fava GA: Morselli’s legacy: Dysmorphophobia. Psychother Psychosom 1992:58:117–118.

    External Resources

  66. Phillips KA, McElroy SL, Keck PE Jr, Pope HG Jr, Hudson JI: Body dysmorphic disorder: 30 cases of imagined ugliness. Am J Psychiatry 1993;150:302–308.
  67. Phillips KA: The Broken Mirror: Understanding and Treating Body Dysmorphic Disorder. New York, Oxford University Press, 1996.
  68. Snaith P: Body image disorders. Psychother Psychosom 1992;58:119–124.

    External Resources

  69. Pope HG Jr, Katz DL, Hudson JI: Anorexia nervosa and ‘reverse anorexia’ among 108 male bodybuilders. Compr Psychiatry 1993;34:406–409.
  70. Pope HG Jr, Gruber AJ, Choi PY, Olivardia R, Phillips KA: Muscle dysmorphia: An underrecognized form of body dysmorphic disorder. Psychosomatics 1997;38:548–557.
  71. Olivardia R, Pope HG Jr, Hudson JI: ‘Muscle dysmorphia’ in male weightlifters: A case-control study. Am J Psychiatry 2000;157:1291–1296.
  72. Mangweth B, Pope HG Jr, Kemmler G, Ebenbichler C, Hausmann A, DeCol C, Kinzl J, Biebl W: Body image and psychopathology in male bodybuilders. Psychother Psychosom 2001;70:38–43.
  73. Ung EK, Fones CSL, Ang AWK: Muscle dysmorphia in a young Chinese male. Ann Acad Med Singapore 2000;29:135–137.
  74. Smith E: Bodybuilders face ‘flip side’ of anorexia. USA Today, November 24, 1997, p 1.
  75. Anonymous: Obsessive body-building is male counterpart to anorexia. Deutsche Presse-Agentur, December 8, 1997.
  76. Anonymous: Could this be a body that’s out of shape? Singapore Straits Times, November 24, 1997.
  77. Adolescent body image and attitudes to anabolic steroid use. Am J Dis Children 1992;146:823–828.
  78. Blouin AG, Goldfield GS: Body image and steroid use in male bodybuilders. Int J Eat Disord 1995;18:159–165.
  79. Brower KJ, Blow FC, Young JP, Hill EM: Symptoms and correlates of anabolic-androgenic steroid dependence. Br J Addict 1991;86:759–768.
  80. Brower KJ, Blow FC, Hill EM: Risk factors for anabolic-androgenic steroid use in men. J Psychiatr Res 1994;28:369–380.

Pay-per-View Options
Direct payment This item at the regular price: USD 38.00
Payment from account With a Karger Pay-per-View account (down payment USD 150) you profit from a special rate for this and other single items.
This item at the discounted price: USD 26.50