Muscle dysmorphia and anxiety

Many studies found a relationship between MD, general anxiety, and anxiety disorders (Cafri et al., 2008; Chandler et al., 2009; McFarland & Kaminski, 2009; Olivardia et al., 2000; Wolke & Sapouna, 2008). Our study results correspond with previous research findings as MD was associated with higher levels of anxiety. However, the source of anxiety in men with MD is not clear, as it may relate to several different factors, such as body appearance, obsessive thoughts, body comparison, low self-esteem, or feelings of not being muscular or masculine enough. Furthermore, we still do not know whether the onset of anxiety occurs before or after the development of MD. Olivardia et al. (2000) suggested that compulsive weightlifting might serve as a coping strategy to deal with the comorbid conditions, such as feelings of anxiety. Wolke and Sapouna (2008) found that higher levels of MD symptoms partially mediated the relationship between childhood victimization and global psychopathology, including anxiety. Despite of these study findings, the relationship between MD and anxiety is still understudied.

Future studies for the clarification of the sources of anxiety experienced in MD, should investigate the mediator and moderator factors between MD and anxiety.

5.3.5 Prevalence of anabolic-androgenic steroid use among Hungarian male weightlifters

Although research evidence indicates that the use of AAS is prevalent among male weightlifters, the AAS use in this high risk population is still understudied in Hungary.

Therefore, the study also aimed to examine the prevalence rate of AAS use among Hungarian male weightlifters. Results indicated that the lifetime prevalence of AAS use in our study sample of Hungarian male weightlifters was 27.6%. Moreover, past and current steroid use was also differentiated in the study. According to the results, 17.4%

of the weightlifters reported past steroid use and 10.2% reported current steroid use.

In a previous comparable Hungarian study, 9.3% (n = 13) of the male weightlifters reported current steroid use (Túry et al., 2001), which was similar to the prevalence of

current steroid use in the present study, χ²(1) = .290, p = .590. Pope et al. (2012) found 44% (n = 102) prevalence of lifetime AAS use among male weightlifters. The prevalence rate of lifetime steroid use in the current study was significantly lower comparing to results of the above mentioned study, χ²(1) = 33.056, p < .001. Pope et al.

(1993) found 51% (n = 47) and Kanayama et al. (2003) also revealed same (50%, n = 48) prevalence rate of lifetime AAS use among male weightlifters. These rates were also significantly higher compared to the prevalence rate in our study sample, χ²(1) = 66.430, p < .001 and χ²(1) = 60.842, p < .001, respectively. However, the prevalence rate of lifetime AAS use in the current study is lower compared to the international data, the current study results indicate that lifetime AAS use among Hungarian male weightlifters is also prevalent. As it was suggested in previous studies (e.g., Thiblin &

Petersson, 2005), the weightlifter population is considered as a high risk population for AAS use. Further national studies would be needed to confirm this hypothesis and also to replicate our research findings.

5.3.6 Characteristics of anabolic-androgenic steroid users

Since AAS use is a growing public health problem, many studies investigated the association between AAS use and various psychological correlates to find out the risk factors of AAS use. Therefore, we also aimed to examine the general and psychological characteristics of AAS users that may predispose weightlifters to AAS use. In the present study current and past AAS users were distinguished, since the psychological correlates may be different in these two groups.

Results indicated that current steroid users had higher BMI than past steroid users and non-users. Because of the anabolic effect of AAS, the higher level of BMI in the current steroid users is not surprising, as the use of AAS improve fat-free mass, muscle size, and strength (Bhasin, et al., 1996; Kouri et al., 1995). Additionally, in the previous study of Hungarian male weightlifters, the body weight, BMI, and desired body weight of steroid users were significantly higher compared to steroid non-users (Túry et al., 2001).

Our study results confirm previous research findings, as current steroid use was strongly associated with the symptoms of MD. Although at a lesser extent, this association was present in past steroid users as well. Therefore, our study results are in line with previous study results suggesting that AAS users display marked symptoms of MD (Cole et al., 2003; Kanayama et al., 2003; Kanayama et al., 2006; Pope et al., 1997;

Rohman, 2009). The association between AAS use and MD had been discussed earlier.

Results also indicated higher levels of exercise dependence in lifetime steroid users comparing to the non-users. Since muscle hypertrophy usually occurs through physical activity, it is expected that AAS use is related to excessive exercise. Furthermore, the prevalence rate of exercise dependence was significantly higher in lifetime steroid users (14.3%, n = 12) compared to steroid non-users (7.3%, n = 16). However, it should be also noted that excessive exercise may impede muscle growth since the muscles need proper rest and recovery after a hard workout in order to hypertrophy. Excessive amount of exercise and short recovery periods may interfere with muscle gain (Eichner, 1995).

Results also revealed that current steroid users had the lowest level of self-efficacy comparing to past steroid users and non-users. Self-efficacy reflects to the belief that one’s action are responsible for successful outcomes; in other words, it refers to the beliefs that a person can achieve something on their own, based on his own power (Bandura, 1994). People with low self-efficacy believe that they need help from outside to achieve their goals. Based on this, those weightlifters who would like to build muscles and increase their strength with low self-efficacy may start using AAS. Usually these people believe that they can not achieve their body ideals without AAS and other muscle-enhancing supplements. Therefore, intervention and prevention programs should also focus on and include self-efficacy as it may play an important role in the development of AAS use.

Finally, current steroid users displayed the highest level of interpersonal distrust relative to the past steroid users and non-users. This result is in line with previous study results, suggesting an increased level of interpersonal distrust among AAS users (Cole et al., 2003; Goldfield & Woodside, 2009; Kanayama et al., 2006). Steroids may induce

changes in the personality and behaviour, which can have an adverse effect on the interpersonal relationships as well. On the other hand, the phenomenology of MD and exercise dependence, which are strongly associated with AAS use, may also have an effect on personality and interpersonal relationships.

We were unable to confirm previous study results, emphasizing the relationship between low self-esteem and AAS use (Brower et al., 1994; Cafri et al., 2005; Blouin &

Goldfield, 1995). This negative result suggests that AAS use may not be strictly related to low self-esteem (as it was also argued by Kanayama et al., 2006), but rather to the feelings of ineffectiveness and the desire toward weight gain.