[Definitie:] "An ergogenic aid is any substance or phenomenon that enhances performance." (Wilmore and Costill)

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Compulsive weight lifting and anabolic drug abuse among women rape victims

Gruber AJ, Pope HG Jr.
Compr Psychiatry. 1999 Jul-Aug;40(4):273-7.


In the course of a study of 75 female weight lifters, we encountered 10 (13%) who reported that they were raped as teenagers or adults. Nine of these women began or greatly increased their weight lifting activities after the assault to be better able to defend themselves against men. Seven began abusing anabolic steroids and/or clenbuterol to gain muscle mass. Compulsive weight lifting and anabolic substance abuse may represent another form of response to the trauma of sexual assault.


Abbreviations: Poly Dep, polysubstance dependence; GID, gender identity disorder; PTSD, posttraumatic stress disorder; AN, anorexia nervosa; BN, bulimia nervosa; MDD, major depressive disorder; Dep, dependence; OCD, obsessive-compulsive disorder; AAS, anabolic androgenic steroids.

Posttraumatic Stress Disorder

First, eight (80%) developed PTSD following the assault. In response to the SCID questions for PTSD, these eight women described feelings of helplessness; recur- rent, intrusive, and distressing thoughts about the assault; withdrawal from friends, family, and usual activities; and the belief that they would never be able to trust a man again sufficiently to marry, have children, and have a "normal" life. These women seemed to replace their earlier relationships and activities with bodybuilding activities, and new relationships formed at the gymnasium. Although several of the subjects displayed various psychiatric disorders prior to the rape, none previously displayed PTSD.

Muscle Dysmorphia

We also inquired about symptoms of "muscle dysmorphia," a form of body dysmorphic disorder that is not specifically addressed by the SCID. This syndrome, which we have described in detail previously, is characterized by preoccupation with the idea that one's body is not sufficiently lean and muscular.

Associated symptoms include long hours of weight lifting; excessive attention to diet; forgoing social, occupational, or recreational activities to maintain one's workout and diet schedule; avoidance of or intense anxiety in situations where one's body will be exposed; clinically significant distress and/or social or occupational impairment caused by the preoccupation and associated activities; and continuing bodybuilding activities despite knowledge of adverse physical or psychological consequences.

Only two of the 10 women experienced muscle dysmorphia prior to their experience of rape, but all 10 reported this syndrome afterward. Even the two subjects reporting muscle dysmorphia prior to the rape described a marked increase in these symptoms after the assault. Among the 65 women who did not report a history of rape, 56 (86%) experienced muscle dysmorphia.


Ms. A. (subject no. 4) is a 31-year-old white woman with no prior psychiatric history. She is from a high socioeconomic background and had a stable and happy childhood. She excelled in school and athletics, competing on a national level in several sports.

After graduating from a prestigious university, she started her own company, which grew rapidly and was very successful. When she could no longer participate in collegiate athletics, she joined a gymnasium, where she pursued a routine of aerobics and light weight-conditioning to maintain cardiovascular fitness and muscle tone. She was very close to her family, had good friends, and was involved in a long-term relationship with a man whom she was considering marrying.

When she was 28, she was raped and physically injured by two men on the way home from work. She described the incident as "unbearably horrible and frightening," and for over 1 year afterward, she experienced intrusive upsetting thoughts about the attack. She distanced herself from family and friends, deciding that she could never really trust or love anyone again.

In a conscious effort to gain the ability to protect herself, she abruptly sold her business and began spending almost all of her time at the gymnasium trying to become "massive and powerful," so that she could "beat the shit out of anyone" who attacked her.

She found a trainer who trained primarily male bodybuilders, and followed his training program. This program included working out a minimum of 6 hours per day, although in practice she spent much more time in the gymnasium than this because she felt safe there. In addition, she prepared high-protein meals packed in separate cartons so that she could have them available to eat every 2 hours. She also took all of the supplements and ergogenic drugs that her trainer recommended, including large doses of anabolic steroids.

Despite side effects such as acne and clitoromegaly, she continued taking the anabolic steroids in large intramuscular doses administered by her trainer. Over the next 2 years, she added 30 pounds of muscle to her 66-inch frame.

She became a personal trainer herself, and is so successful that she has a waiting list of people who want to work with her. She has completely transformed her body and her life.




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