Tommy Jackson decided he wanted to be a cop when he was six years old; a really big tough cop. Throughout childhood and adolescent Tommy stuck with his career choice. He was a formidable guy who played varsity football in high school. He worked out as often as he could and maintained a strict diet, but secretly he was always afraid that he would never be hired into law enforcement. He just wasn't as big as the officers depicted on screen.
Officer Jackson now works in a large urban area, riddled by bangers. His beat has one of the highest crime rates in the city. He has kept himself in incredible shape. He is muscular with chiseled abs and can bench 250. He continues to work out feverishly to remain in condition. Yet he can't help but notice that some of his beat partners are substantially more ripped than he is. Additionally they are more imposing on the street and more confident. He continues to obsess about his muscularity. He has to be bigger and stronger. Paradoxically, the harder he tries, the punier he feels.
Body Dysmorphic Disorder
Most people are at least somewhat self-conscious about their looks. A desire to look and feel good about appearance is a component of self-esteem. If you look in the mirror and see a flaw, there is usually a desire to correct it. Why else would Americans spend approximately $60 billion on dieting annually and an additional $15 billion for cosmetic surgery procedures? Common features that people are dissatisfied with include: facial aspects (nose or ear size), complexion (acne or wrinkles), hair (baldness), breast size, muscle size, and genitalia. It is interesting to note that 38% of men are now dissatisfied with the size of their chests compared to 34% of women who are dissatisfied with their breasts.
However, for approximately 2% of the general population, this desire can become a dangerous and disabling obsession. Body dysmorphic disorder (BDD) is a chronic mental illness in which an individual is excessively concerned about and preoccupied by a perceived defect in his or her physical features. The disorder has also been coined the imagined ugliness disorder. Essentially, people with BDD maintain an irrational, disproportionate, and negative opinion of their own bodies. In about half of the cases, these concerns reach delusional proportions. Half of individuals with BDD will undergo surgical correction to fix perceived flaw. Body dysmorphic disorder usually begins in adolescence; it can last a lifetime. Symptoms of BDD may develop gradually or very abruptly.
Individuals with BDD suffer in many ways. Over 95% have social impairment, major depression affects 60-80 percent, 2/3rd have suicide ideation, one quarter will attempt suicide, and over 1/3rd are substance abusers. Additionally, they tend to be introverted, delusional, anxious, narcissistic, display violent behavior, and have hypochondriac traits.
Male Body Dysmorphia
Body dysmorphic disorder affects both genders equally; however much more research has been done related to females. BDD in men frequently takes the special form of muscle dysmorphia, also known at the Adonis complex. A male with muscle dysmorphia becomes increasingly preoccupied that his body will never be sufficiently lean enough or muscular enough. No matter how much they work out, they continue to feel inadequate, small and frail. They obsessively lift weights for hours a day and become compulsive about their diets and supplements. These behaviors become so excessive that they may result in sacrificed careers and relationships. Some men will seek out surgical remedies such as getting pectoral and calf implants. Many experiment with androgen dietary supplements such as creatine, androstenedione, norandrostenedione, and dehydroepiandtrosterone. In other cases men with BDD will abuse anabolic steroids to become more muscular.
Anabolic Steroids
Anabolic steroids are officially known as anabolic-androgen steroids (AAS). The primary anabolic steroid hormone that the body produces is testosterone. The two main effects of testosterone on the body are anabolic (promoting muscle building) and androgen (responsible for male traits such as facial hair and a deeper voice). AAS are a class of synthetic drugs that closely mimic male sex hormones such as testosterone. They can be taken orally, applied as a patch, spread on the skin in cream or gel form, or injected. They are medically prescribed to treat growth problems in children, anemia and chronic infections like HIV. They are also prescribed to treat individuals who have low levels of testosterone. The symptoms of low testosterone include fatigue, malaise, loss of sex drive, and loss of muscle tissue. Additionally, anabolic steroids (including testosterone) are taken to enhance muscle development, strength, or endurance. They do so directly by increasing the muscles' protein synthesis. As a result, muscle fibers become larger and repair faster.
Anabolic steroids are administered multiple ways: intramuscular or subcutaneous injection, orally, onto the skin (gels or patches) or by pellet implantation under the skin. Steroids can remain in the body for a period of from two days to over a year. AAS can cause potential long-term medical problems (heart and liver damage), short-term psychiatric symptoms (mania and aggression), and depression during withdrawal.
Anabolic-Androgenic Steroid Abuse
Anabolic-androgenic steroid abuse is not confined to individuals with body dysmorphic disorder. Traditionally anabolic steroids have primarily been abused by bodybuilders and athletes to gain competitive advantage and/or improve their physical performance. Additionally, individuals who work in careers requiring enhanced physical strength, such as law enforcement, have been known to take these drugs.
Steroid abusers sometimes take up to 100 times the normal therapeutic doses of AAS. This frequently involves taking two or more steroids at a time; this practice is called stacking. Abusers will also alternate time periods for using high, low, or no doses of steroids; this practice is called cycling.
Extreme mood swings can occur as a result of taking AAS. This leads to irritability, rage, delusions, impaired judgment, suicide, aggression and violence.
Legal Ramifications
In 1990 the Anabolic Steroids Control Act placed anabolic steroids into Schedule III of the Controlled Substances Act. Under this legislation, anabolic steroids are defined as any drug or hormonal substance chemically and pharmacologically related to testosterone (other than estrogens, progestins, and corticosteroids) that promotes muscle growth. Other Schedule III drugs include: morphine, codeine, and barbiturates. The possession of anabolic steroids without a valid prescription is illegal. Simple possession can be either a misdemeanor or felony (depending on the state). The sale of steroids is a felony in every state.
AAS Abuse in Law Enforcement
Law enforcement officers face ongoing mentally and physically challenging situations. They also have excellent reasons to be concerned about the safety and lives, not only their own, but their partners and the people they are sworn to protect. While violent crime rates are reported to be falling, the bad guys have become increasingly more dangerous. For an officer, physical fitness is essential.
There are certainly officers in law enforcement who abuse anabolic-androgen steroids. Most of these officers do so for what they perceive as all the right reasons; to provide them a physical and psychological advantage while performing their jobs. These drugs allow the officer to increase muscle strength and size quickly and easily while increasing physical endurance.
Remember Officer Jackson? He eventually got caught up in the cycle of AAS abuse; he still maintains he was forced into using steroids. It happened after a suspect on meth fought Jackson and another officer to the ground and attempted to grab the officers' handguns. After talking to other cops and researching the subject, Jackson ultimately began injecting himself daily with a cocktail of Depo-Testosterone, Sustanon, Deca-Durabolin, and Anadrol. Within weeks he could bench an additional 100 pounds. He gained 30 pounds. He looked chiseled, ripped, formidable and imposing and walked around his beat with a definite command presence. His confidence grew, he felt more self-assured.
Jackson, like other officers who abuse AAS, eventually faced the end of his career and more due to his steroid abuse. One night Jackson jumped into a high speed pursuit across town. A family of four was killed when Jackson took unnecessary risks and hit their van. There had already been several reports of excessive use of force, including one complaint from an officer in a neighboring jurisdiction. Jackson was tested for AAS usage, fired, arrested, charged with felony possession, and is now awaiting his trial. Whether or not Jackson had suffered with body dysmorphic disorder or not was finally a moot point. The department settled out of court.
The number of officers who abuse anabolic-androgen steroids is unknown, many professionals have provided guestimates. However, it is widespread enough that the DEA has published a pamphlet called Steroid Abuse by Law Enforcement Personnel.
Treatment for Male Body Dysmorphic Disorder
Bona fide body dysmorphia in men requires professional treatment. This treatment includes both medication and therapy. Currently the medications of choice are SSRI antidepressants (Celexa, Paxil, Prozac, Lexapro, Zoloft). Cognitive behavior therapy (CBT) helps the individual confront and challenge his mistaken beliefs about perceived physical defects. CBT also assists the man in changing his underlying negative thoughts and beliefs.
Conclusion
From early childhood, boys are bombarded with thousands of images of Herculean bodies. The not so subtle message is that this is how an ideal man should look. Growing boys, as well as men, need to recognize that muscularity is not the defining sign of masculinity; and self-esteem should not be built on six pack abs. Anabolic-androgen steroids have shattered the equilibrium of nature. They allow men to be more muscular and leaner than their bodies were designed to be. They have also shattered countless lives.
Pamela Kulbarsh
Pamela Kulbarsh, RN, BSW has been a psychiatric nurse for over 25 years. She has worked with law enforcement in crisis intervention for the past ten years. She has worked in patrol with officers and deputies as a member of San Diego's Psychiatric Emergency Response Team (PERT) and at the Pima County Detention Center in Tucson. Pam has been a frequent guest speaker related to psychiatric emergencies and has published articles in both law enforcement and nursing magazines.
