The diagnostic dilemma of pathological appearance and performance enhancing drug use

The diagnostic dilemma of pathological appearance and performance enhancing drug use / Tom Hildebrandt, Justine K. Lai, James W. Langenbucher, Melanie Schneider, Rachel Yehuda, Donald W. Pfaff. - (Drug and Alcohol Dependence 114 (2011) 1 (1 March); p. 1-11)

  • PMID: 21115306
  • PMCID: PMC3039045
  • DOI: 10.1016/j.drugalcdep.2010.09.018


Appearance and performance enhancing drug (APED) use includes the use of a range of pharmacologically distinct substances and concurrent investment in outward appearance or achievement, dietary control, and frequent exercise. A number of existing reviews and conceptual papers have defined pathological forms of APED use within the APED class of anabolic-androgenic steroids (AASs) and using the framework of AAS dependence. We review published data on APED use including human studies of AAS users and identified three defining phenomenological features associated with increased health risk and pathology. These features included (1) polypharmacy or the concurrent use of several pharmacologically distinct substances used to change outward appearance or increase likelihood of personal achievement; (2) significant body image disturbance; (3) rigid practices and preoccupations with diet and exercise. Investigations into the latent structure of APED use suggest these features cluster together in a homogenous group of APED users who have the highest health risk and most psychopathology. These features are discussed in the context of AAS dependence and problems with defining classic tolerance-withdrawal symptoms among APED users. Suggestions for a resolution and outline for future research needed to determine the best system for identifying and diagnosing pathological APED use are discussed.

Original document


5 November 2010
Hildebrandt, Tom
Lai, Justin K.
Langenbucher, James W.
Pfaff, Donald W.
Schneider, Melanie
Yehuda, Rachel
United States of America
Other organisations
Icahn School of Medicine at Mount Sinai (ISMMS)
James J. Peters VA Medical Center
Rockefeller University
Rutgers University
Doping classes
S1. Anabolic Agents
Medical terms
Body image
Health effects
Muscle dysmorphia
Substance use research
Document category
Scientific article
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Pdf file
Date generated
15 October 2020
Date of last modification
20 October 2020
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