‘Roid Rage

Stop Press:
Discussion (and speculation) about Olympic doping including 100m/200m results
Science of Sport
Steroid Nation

I was listening on the radio just now about UK medal hopes at the Beijing Olympics. It seems we’re doing quite well. Unfortunately I have an anti-talent at sports; at primary school I would only be picked second last if my brother beat me to the wooden spoon. Many years later I lived with a girl and she would watch football on our ancient TV, whilst I sat in my room with the door shut reading ‘The Road to Wigan Pier’.

What’s more my bag is the speculation about the scale of abuse of performance enhancing drugs and their psychiatric sequelae. There are a number of substances used by athletes in order to improve performance. and of these the most common are anabolic steroids.

In the UK anabolic steroids are class C drugs and can be sold only by pharmacists with a doctor’s prescription (most often for hypogonadism). It’s legal to possess or import steroids as long as they’re for personal use, but possession or importing with intent to supply is illegal and could lead to 14 years in prison and an unlimited fine. A UK government source states that in 2003 300,000 steroid tablets were seized.

Use of anabolic steroids in the UK is suspected to be widespread and is not just the preserve of elite athletes; in a survey of 687 students at a British college the overall rate of current or previous use was 2.8% (4.4% in males, 1.0% in females) and, of these, 56% had first used anabolic steroids at the age of 15 or younger. A BMA report in 2002 found that as many as half of the members of dedicated bodybuilding gyms admitted to taking anabolic agents, and that steroid use ran as high as 13% even in some high street fitness centres.

Anabolic steroids are synthetic derivates of the hormone testosterone and allow the user to increase both the frequency and intensity of workouts, in addition to increasing muscle capacity, reducing body fat, increasing strength and endurance, and hastening recovery from injury. Users have varied aims. The majority may wish to enhance their physical appearance in order to achieve a ‘perfect body’, whilst a smaller proportion have experienced physical or sexual abuse, and are trying to increase their muscle size to protect themselves. A further group (possibly between 5 and 10%) includes people who have a form of body dysmorphic disorder (sometimes called ‘reverse anorexia nervosa’), in which they believe that they look small and weak, even if they are large and muscular (Brower et al, 1991).

The steroids are taken orally, or by intramuscular injection and according to a number of regimes – ‘stacking’, ‘cycling’ and ‘pyramiding’.

Misusers of anabolic steroids subjectively report significantly more fights, verbal aggression and violence towards their significant others during periods of use compared with periods of nonuse. Other work has suggested that adolescents who abuse anabolic steroids have nearly triple the incidence of violent behaviour. Clinical presentations include grandiose and paranoid delusional states that often occur in the context of a psychotic or manic episode. Symptoms usually resolve in a few weeks if steroid use is discontinued, although may persist for as long as a month even if adequately treated with antipsychotics.

Steroid users have been shown to have a higher prevalence of cluster B (histrionic, narcissistic, antisocial and borderline) personality traits than community controls . Self report questionnaires and informant histories have been used to retrospectively assess the personality type of anabolic steroid misusers before their first use. Such work suggests that they start out with personalities similar to those of non-using bodybuilders, but develop abnormal personality traits that could be attributed to steroid misuse.

A study involving 41 steroid-using bodybuilders used structured interviews to measure affective symptoms according to DSM–III–R criteria. They identified 5 participants (12.2%) who met the criteria for a manic episode during steroid exposure; a further 8 (19.5%) only narrowly missed the diagnosis. Significantly more participants developed a full affective syndrome during periods of steroid exposure (22%) than non-exposure (5%), and 10 were ‘stacking’ when they experienced manic symptoms.
Symptoms of steroid withdrawal include mood disorders (with suicidal depression as the most life threatening complication), apathy, feelings of anxiety, difficulty in concentrating, insomnia, anorexia, decreased libido, fatigue, headache, and muscle and joint pain. It is difficult to distinguish symptoms that may be physical in origin from those more psychological. Observing oneself to lose muscle mass, strength, performance and confidence after cessation of steroid use has a powerful negative effect on mood, and this may lead to a strong desire to take steroids again.

So, you’re all asking yourself, what’s FP’s advice? Listen to Noam Chomsky:

‘Take, say, sports — that’s another crucial example of the indoctrination system, in my view. For one thing because it … offers people something to pay attention to that’s of no importance; that keeps them from worrying about things that matter to their lives that they might have some idea of doing something about. And in fact it’s striking to see the intelligence that’s used by ordinary people in [discussions of] sports [as opposed to political and social issues

***

Sources for this posting:

General

I have leant very heavily on Anabolic androgenic steroids: what the psychiatrist needs to know

This BBC Ethics page has a concise summary of the arguments for and against use of performance enhancing drugs in sport

The talk to Frank site anabolic steroids page

News reports:

Steroids a dangerous new trend BBC February 2 2004

BBC 8 June 2006 Body builder misuse alarm

BBC 11 April 2002 Steroid misuse widespread

Radio programmes (I can’t get these to work, but perhaps you can…)

BBC Radio 4 Diet and Drugs 24 April 2002

BBC Radio 4 The Long View 14 October 2003

Woman’s hour East German doping 7 November 2005

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7 Responses to “‘Roid Rage”

  1. NorthernIrelandExile says:

    FP,

    Are there psychiatric effects of blood doping? I understand that this is harder to detect but fairly effective, and allegedly with little chance of side effects?

  2. I used to do a fair bit of weightlifting (all natural – the only bodybuilding class you’d see me in would be the ‘fat, lazy office-worker’ one) and spent time on on-line lifting forums.

    There are a lot of people out there taking steroids who are nowhere near competing in international competitions. I think one of the reasons this happens is that in bodybuilding and weightlifting, most of your gains are going to occur in the first 3 years of training. Once you get there, to add even 5kg to your total can take YEARS of effort. This is why I was glued to the lifting in the Olympics – believe me, the UK team, for example, are tested about 10 times a year – BWLA are super-strict as this is a sport with the highest amount of carry-over from steroid use – and you can be pretty sure the Olympic athletes are clean – anyway the determination and dedication it takes to make that tiny improvement takes a certain type of person. I admire these lifters greatly.

    So you get a lot of amateurs who are sick of not improving after some years who then take steroids. Some are fully educated on the physical and mental dangers and choose to take the risk, and do not compete in drug-tested competition thereafter. Others, shall we say, ‘cheat’, or rush in with realising how much damage they can do themselves.

    I’ve seen people posting to bodybuilding boards (men) after taking the fertility drug Clomid (as part of some kind of steroid cycle) about how they are experiencing suicidal depression and asking for support for the 14 days or so they want to take it. “Roid Rage” and how to avoid it was also discussed quite frequently. I think that in the bodybuilding community the mental health risks of steroid use are well known. It’s just, I guess, that people don’t realise how much it can suck until it happens to them, or think it won’t affect them.

    Please note: I have never taken any performance-enhancing drugs. I lurked on these sites as the same people who knew all about steroids also knew all about technique, good execution of lifts and how to put training routines together. They were friendly to “natural” athletes.

  3. Frontier Psychiatrist says:

    NIE – re: blood doping – no psychiatric problems from the increase in RBC in itself, but if a blood clot caused a stroke this could cause all sorts of problems…

    DDR – thanks for your long and interesting comment. If you could share a web address of any body building boards with people talking about their psychiatric problems with steroids I’d be keen to take a look!

  4. Here’s a bodybuilding and weightlifting site I used to be a member of a few years back:
    http://www.elitefitness.com

    It has a very overt steroid focus, with a large number of forums dedicated solely to the discussion of same.

    I have never taken any steroids, ephedrine, or other performance enhancing substance (um, I’d be slimmer and fitter than I am for starters if I had!). Since when signing up for BWLA membership I sign an attestation along those lines, I feel the need to point this out.

    The board does have a lot of very good general training advice forums. If you post in these asking for advice, you need to specify that you aren’t taking any steroids, as apparently when people are taking steroids they do completely insane (yeah, yeah) routines to promote muscle growth, which is just going to rip the regular person’s body apart.

    It’s quite a macho environment on there (lots of frat boys), so you will probably need to dig to find mental health-related information, but I’m sure it’s there. Some of them used to joke about the mental effects of some of the substances in the other forums when taking the mick out of one another, for example.

    ps weightlifting is a lot of fun.

  5. Paul says:

    Congratulations – you’re one of the top psychiatry blogs according to this website:

    http://www.universityreviewsonline.com/2005/10/top-100-mental.html

    Well deserved!

    Cheers Paul

  6. Frontier Psychiatrist says:

    Thanks for that tip – that’s very exciting.

    I’m ten months into my first year of blogging. As an anniversary treat I’ll be writing a piece which will seek to blow the lid off the secret world of mental health blogging(!)

  7. Just stumbled across this article now, and knowing alittle about the subject wanted to commend you on your article.
    not only is it well written, but its accurate, informative and uptodate!
    thanks for sharing it.
    Diana

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