Abstract
Appearance- and performance-enhancing drugs (APEDs) are commonly used by adolescents and young adults in an effort to improve not only athletic performance but also physical and mental efficiency and sexual appearance. The rationale for using these drugs is grounded in the perceived importance of external appearance, the quest for health and youth, and the urge to boost one's sexual performances. Although APED users tend to be quite moderate overall, some specific subpopulations can display pathological use associated with high-risk behaviors. A wide and diverse range of APEDs is now easily accessible to almost anyone through backdoor online avenues. Common APEDs include anabolic–androgenic steroids, non-steroidal anabolics, anorectics, diuretics and ergo/thermogenics, nootropics or “cognition enhancers,” licit and illicit psychostimulants, and finally, sexual enhancers. The use of APEDs appears linked to several psychopathological disorders of unclear prevalence, e.g., body image disorders and eating disorders, perfectionism, but also depression and loneliness. The role of personality traits related to APED use has been investigated in adolescents and young adults, in elite and amateur athletes, and in chemsexers and associated with the above-reported personality traits. The studies herein analyzed show that APED consumption in the general population is quickly growing into a public health concern. It is therefore essential to launch prevention and intervention projects aimed at promoting safe instrumental use of the body, not only in sports disciplines but also among the general population, and to promote psychological aid procedures for people with substance use issues, depression and anxiety, and body image disorders.
Highlights
Anabolic–androgenic steroids promoting bone strength and feelings of well-being, with consequent testosteronesupplementation therapy being used for mood and sexual performance problems associated with male aging [1,2,3];
As summarized for the above-reported subpopulation of APED users, the mechanisms underlying this behavior involve escape from stressful circumstances, anxiety, depression, body image disorders, dysfunctional diet and exercise patterns, and personality traits attributable to the “dark triad” of personality—Machiavellianism, narcissism, and psychopathy— and perfectionism
It is worth bearing in mind that while Machiavellianism refers to interpersonal strategies aimed at furthering self-interest, deception, and manipulation, narcissism defines a pathological form of self-love, and lastly, psychopathy reflects superficial charm and remorselessness, selfishness, callousness, lack of interpersonal affection, and antisocial lifestyle and behaviors
Summary
The definition “appearance- and performance-enhancing drugs (APEDs)” started to be applied to drugs and supplements used to improve athletic appearance and performance and cognitive and sexual performance. Parental and coach pressure toward perfectionism in young athletes generally entails a higher tendency to resort to performance-enhancing drugs, whereas perfectionistic efforts showed an inverse correlation [33] For this reason, it is safe to assume that perfectionism can represent both a risk and protective factor against doping use, while self-control was demonstrated to be negatively associated with doping attitudes [61]. To complete all the above-reported concepts, qualitative data from a systematic review suggest that the personality traits promoting chemsex-related behaviors are as follows: coping with stressful events and painful emotions, risk trivializing sexualized drug use, giving into interpersonal pressure or fulfilling one’s desire for community belonging, increasing intimacy, and lessening interpersonal and sexual inhibitions in terms of enhancing sexual performance and functioning [71]. The use of sexual performance-enhancing drugs, such as the ones reported above among chemsexers, emerges from some fundamental traits such as an individual’s desire to disengage from the cognitive burden generated by dissonant feelings; the knowledge that certain environments or pharmacologically active drugs will facilitate this disengagement; escaping from stress, anxiety, and depression; and attributing to substance use positive emotional and sexual experiences
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