Association of Body Dysmorphic-Induced Anabolic-Androgenic Steroid Use With Mental Health Outcomes: A Systematic Review.

To explore the relationship between body dysmorphic disorder (BDD), anabolic-androgenic steroid use (AAS) use, and mental health outcomes and to identify potential interventions and treatments that may help mitigate these detrimental effects. PubMed, Scopus, CINAHL, Embase, and PsycINFO were searched from 1992 to 2022 with no language limits. Search terms included "AAS" AND "mental health outcomes" AND "body dysmorphia" and were expanded in PubMed to include "anabolic steroids induced depression," "anabolic steroids induced depression in athletes," "steroids," "mental health," and "performance-enhancing drugs." Forty-one articles were identified, and 37 remained after duplicates were removed. After full-text appraisal, 33 articles were included in the final review. Two reviewers independently screened studies for inclusion criteria, extracted pertinent data, and assessed the quality of evidence. Bodybuilders and fitness athletes may be more susceptible to developing muscle dysmorphia, having disordered eating habits, and using performance-enhancing drugs like AAS. The COVID-19 pandemic increased reliance on social media and online interactions, which was previously associated with disordered eating patterns and negative body image. Being a member of a sexual minority may increase one's risk of developing muscle dysmorphia and other types of BDD, as these individuals may experience additional stressors and difficulties due to stigma and discrimination, which may worsen one's sense of self and body image. The development and evaluation of interventions such as cognitive-behavioral therapy, mindfulness-based interventions, and peer support programs, should be prioritized to deter AAS use in people at risk. P.