{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T05:45:27Z","timestamp":1790142327902,"version":"4.0.1"},"reference-count":90,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2025,7,22]],"date-time":"2025-07-22T00:00:00Z","timestamp":1753142400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pharmaceuticals"],"abstract":"<jats:p>Background\/Objectives: Muscle dysmorphia (MD), a subtype of body dysmorphic disorder, is prevalent among males who engage in the non-medical use of anabolic\u2013androgenic steroids (AASs) and performance-enhancing drugs (PEDs). These individuals often experience severe psychopathology, including mood instability, compulsivity, and a distorted body image. Despite its clinical severity, no randomized controlled trials (RCTs) have evaluated structured psychological treatments in this subgroup. This study aimed to assess the efficacy of a manualized cognitive behavioral therapy (CBT) protocol in reducing MD symptoms and associated psychological distress among male steroid users. Results: Participants in the CBT group showed significant reductions in MD symptoms from the baseline to post-treatment (MDDI: p &lt; 0.001, d = 1.12), with gains sustained at follow-up. Large effect sizes were also observed in secondary outcomes including depressive symptoms (PHQ-9: d = 0.98), psychological distress (K10: d = 0.93), disordered eating (EDE-Q: d = 0.74), and exercise addiction (EAI: d = 1.07). No significant changes were observed in the control group. Significant group \u00d7 time interactions were found for all outcomes (all p &lt; 0.01), indicating CBT\u2019s specific efficacy. Discussion: This study provides the first RCT evidence that CBT significantly reduces both core MD symptoms and steroid-related psychopathology in men engaged in AAS\/PED misuse. Improvements extended to mood, body image perception, and compulsive exercise behaviors. These findings support CBT\u2019s transdiagnostic applicability in addressing both the cognitive\u2013behavioral and affective dimensions of MD. Materials and Methods: In this parallel-group, open-label RCT, 59 male gym-goers with DSM-5-TR diagnoses of MD and a history of AAS\/PED use were randomized to either a 12-week CBT intervention (n = 30) or a waitlist control group (n = 29). CBT sessions were delivered weekly online and targeted distorted muscularity beliefs, compulsive behaviors, and emotional dysregulation. Primary and secondary outcomes\u2014Muscle Dysmorphic Disorder Inventory (MDDI), PHQ-9, K10, EDE-Q, EAI, and BIG\u2014were assessed at the baseline, post-treatment, and 3-month follow-up. A repeated-measures ANOVA and paired t-tests were used to analyze time \u00d7 group interactions. Conclusions: CBT offers an effective, scalable intervention for individuals with muscle dysmorphia complicated by anabolic steroid use. It promotes broad psychological improvement and may serve as a first-line treatment option in high-risk male fitness populations. Future studies should examine long-term outcomes and investigate implementation in diverse clinical and cultural contexts.<\/jats:p>","DOI":"10.3390\/ph18081081","type":"journal-article","created":{"date-parts":[[2025,7,22]],"date-time":"2025-07-22T11:44:45Z","timestamp":1753184685000},"page":"1081","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Cognitive Behavioral Therapy for Muscle Dysmorphia and Anabolic Steroid-Related Psychopathology: A Randomized Controlled Trial"],"prefix":"10.3390","volume":"18","author":[{"given":"Metin","family":"\u00c7\u0131naro\u011flu","sequence":"first","affiliation":[{"name":"Psychology Department, Faculty of Administrative and Social Sciences, \u0130stanbul Ni\u015fanta\u015f\u0131 University, 34398 \u0130stanbul, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eda","family":"Y\u0131lmazer","sequence":"additional","affiliation":[{"name":"Psychology Department, Faculty of Social Sciences, Beykoz University, 34805 \u0130stanbul, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Selami Varol","family":"\u00dclker","sequence":"additional","affiliation":[{"name":"Psychology Department, Faculty of Humanities and Social Sciences, \u00dcsk\u00fcdar University, 34662 \u0130stanbul, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2514-5682","authenticated-orcid":false,"given":"G\u00f6kben","family":"H\u0131zl\u0131 Sayar","sequence":"additional","affiliation":[{"name":"Psychiatry, Medical School, \u00dcsk\u00fcdar University, 34662 \u0130stanbul, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,7,22]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Schulte, J., Schulz, C., Wilhelm, S., and Buhlmann, U. 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