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Is competitive body-building pathological? Survey of 984 male strength trainers
  1. Ian Steele1,2,
  2. Harrison Pope2,3,
  3. Eric J Ip4,5,
  4. Mitchell J Barnett4,6,
  5. Gen Kanayama2,3
  1. 1Consultation-Liason Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts, USA
  2. 2Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
  3. 3Biological Psychiatry Laboratory, McLean Hospital, Belmont, Massachusetts, USA
  4. 4Clinical Sciences/College of Pharmacy, Touro University California, Vallejo, California, USA
  5. 5Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
  6. 6Iowa Board of Pharmacy, Iowa Department of Public Health, Des Moines, Iowa, USA
  1. Correspondence to Dr Harrison Pope; hpope{at}


Objectives Hundreds of thousands, if not millions, of individuals worldwide engage in competitive body-building. Body-building often attracts derogatory characterisations such as as ‘bizarre’ or ‘narcissistic,’ or a ‘freak show’, seemingly implying that it is associated with pathology. Few studies have compared psychological features in competitive bodybuilders versus recreational strength trainers.

Methods Using logistic regression with adjustment for age and race, we compared 96 competitive bodybuilders (‘competitors’) with 888 recreational strength trainers (‘recreationals’), assessed in a prior internet survey, regarding demographics; body image; use of anabolic–androgenic steroids (AAS), other appearance-enhancing and performance-enhancing drugs (APEDs), and classical drugs of abuse; history of psychiatric diagnoses; and history of childhood physical/sexual abuse.

Results Competitors reported a higher lifetime prevalence of AAS (61 (63.5%) vs 356 (10.1%), p<0.001) and other APED use than recreationals but showed very few significant differences on other survey measures. AAS-using competitors were more likely than AAS-using recreationals to have disclosed their AAS use to a physician (31 (50.8%) vs 107 (30.0%), p=0.003). Both groups reported high levels of body image concerns but did not differ from one another (eg, ‘preoccupation with appearance’ caused significant reported distress or impairment in important areas of functioning for 18 (18.8%) competitors vs 132 (15.4%) recreationals, p=0.78). No significant differences were found on the prevalence of reported childhood physical abuse (9 (9.4%) vs 77 (8.8%), p=0.80) or sexual abuse (4 (4.2%) vs 39 (4.5%), p=0.83). Competitors reported a lower lifetime prevalence of marijuana use than recreationals (38 (39.6%) vs 514 (57.9%), p=0.001).

Conclusion Aside from their APED use, competitive bodybuilders show few psychological differences from recreational strength trainers.

  • body-building
  • body image
  • anabolic steroids
  • psychiatry

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  • Contributors Contributors EJI and MJB designed and conducted the original internet study that provided data for the present publication. They also assisted in data analysis in the present study and in revising the work for important intellectual content. IS, HP and GK designed the present study, performed data analysis and interpretation, and drafted the report of the work. All authors provided final approval for the manuscript. HP is the corresponding author and guarantor of the results.

  • Funding This study was conducted without external or internal funding.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval This study was determined to be exempted by the Touro University Institutional Review Board because it did not involve 'interaction or intervention with individuals', and the information obtained was not 'individually identifiable' or 'readily ascertained by the investigator are associated with the information'.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data will be made available upon reasonable request.

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