roid rage
{{Short description|Side effect of anabolic steroid use}}
{{Infobox symptom
| name = Roid rage
| image =
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| symptoms = Aggression, violent tendencies, emotional dysregulation (anxiety, depression), psychosis{{Cite journal |last1=Rashid |first1=Harry |last2=Ormerod |first2=Sara |last3=Day |first3=Ed |year=2007 |title=Anabolic androgenic steroids: what the psychiatrist needs to know |url=https://www.cambridge.org/core/product/identifier/S1355514600003849/type/journal_article |journal=Advances in Psychiatric Treatment |language=en |volume=13 |issue=3 |pages=203–211 |doi=10.1192/apt.bp.105.000935 |issn=1355-5146}}
| treatment = Limiting anabolic steroid use,{{Cite journal |last1=Elliot |first1=D. |last2=Goldberg |first2=L. |date=1996 |title=Intervention and prevention of steroid use in adolescents |url=https://pubmed.ncbi.nlm.nih.gov/8947428/ |journal=The American Journal of Sports Medicine |volume=24 |issue=6 Suppl |pages=S46–47 |doi=10.1177/036354659602406S14 |issn=0363-5465 |pmid=8947428}} therapy,{{Cite journal |last=Anawalt |first=Bradley D |date=2019-07-01 |title=Diagnosis and Management of Anabolic Androgenic Steroid Use |journal=The Journal of Clinical Endocrinology and Metabolism |language=en |volume=104 |issue=7 |pages=2490–2500 |doi=10.1210/jc.2018-01882 |issn=0021-972X |pmc=6517163 |pmid=30753550}} antipsychotics{{Cite journal |last1=Romanova |first1=Zuzana |last2=Hlavacova |first2=Natasa |last3=Jezova |first3=Daniela |date=2022-01-14 |title=Psychotropic Drug Effects on Steroid Stress Hormone Release and Possible Mechanisms Involved |journal=International Journal of Molecular Sciences |language=en |volume=23 |issue=2 |pages=908 |doi=10.3390/ijms23020908 |doi-access=free |issn=1422-0067 |pmc=8779609 |pmid=35055090}}
}}
Roid rage (also known as steroid rage{{Cite journal |last1=Pope |first1=Harrison G. |last2=Katz |first2=David L. |year=1987 |title=Bodybuilder's Psychosis |url=https://linkinghub.elsevier.com/retrieve/pii/S0140673687916424 |journal=The Lancet |language=en |volume=329 |issue=8537 |pages=863 |doi=10.1016/S0140-6736(87)91642-4|pmid=2882266 |url-access=subscription }}) is a side effect of the use of anabolic steroids which is described as dramatic mood swings, increased feelings of hostility, impaired judgment, and increased levels of aggression.{{Cite journal |last=Mulube |first=M. |date=1996-09-21 |title=Personality changes due to 'roid rage' |url=https://www.bmj.com/lookup/doi/10.1136/bmj.313.7059.707 |journal=The BMJ |language=en |volume=313 |issue=7059 |pages=707 |doi=10.1136/bmj.313.7059.707 |issn=0959-8138|url-access=subscription }} The term "roid rage" became popular in the 1980s.{{Cite book |last=Lenehan |first=Patrick |title=Anabolic Steroids |date=2003 |publisher=CRC Press |isbn=978-0-415-28030-3 |location=Boca Raton |page=23}}
Cause
After supraphysiological use of anabolic-androgenic steroid which normally consists of long-term uncontrolled use of anabolic steroids (i.e. several injections over a period of time) roid rage can take place, which includes aggression{{Cite journal |last1=Chegeni |first1=Razieh |last2=Pallesen |first2=Ståle |last3=McVeigh |first3=Jim |last4=Sagoe |first4=Dominic |year=2021 |title=Anabolic-androgenic steroid administration increases self-reported aggression in healthy males: a systematic review and meta-analysis of experimental studies |journal=Psychopharmacology |language=en |volume=238 |issue=7 |pages=1911–1922 |doi=10.1007/s00213-021-05818-7 |issn=0033-3158 |pmc=8233285 |pmid=33745011}}{{Cite journal |last1=Bertozzi |first1=Giuseppe |last2=Sessa |first2=Francesco |last3=Albano |first3=Giuseppe Davide |last4=Sani |first4=Gabriele |last5=Maglietta |first5=Francesca |last6=Roshan |first6=Mohsin H. K. |last7=Volti |first7=Giovanni Li |last8=Bernardini |first8=Renato |last9=Avola |first9=Roberto |last10=Pomara |first10=Cristoforo |last11=Salerno |first11=Monica |year=2018 |title=The Role of Anabolic Androgenic Steroids in Disruption of the Physiological Function in Discrete Areas of the Central Nervous System |journal=Molecular Neurobiology |language=en |volume=55 |issue=7 |pages=5548–5556 |doi=10.1007/s12035-017-0774-1 |issn=0893-7648 |pmc=5994209 |pmid=28971285}} and emotional dysregulation which can lead to depression and paranoia.{{Cite journal |last1=Gonçalves-Pinho |first1=M. |last2=Quarenta |first2=J. |last3=Almeida |first3=A. |year=2021 |title=P.0060 From roid rage to depression - a case report |url=https://linkinghub.elsevier.com/retrieve/pii/S0924977X21008361 |journal=European Neuropsychopharmacology |language=en |volume=53 |pages=S44 |doi=10.1016/j.euroneuro.2021.10.065|url-access=subscription }} Use of steroids like corticosteroid to treat pains can cause steroid induced psychotic episodes which include racing thoughts, anger, agitation, pressured hyperverbal speech and paranoia.{{Cite journal |last1=Benyamin |first1=Ramsin M. |last2=Vallejo |first2=Ricardo |last3=Kramer |first3=Jeffery |last4=Rafeyan |first4=Roueen |date=2008 |title=Corticosteroid induced psychosis in the pain management setting |url=https://pubmed.ncbi.nlm.nih.gov/19057637/ |journal=Pain Physician |volume=11 |issue=6 |pages=917–920 |doi=10.36076/ppj.2008/11/917 |issn=1533-3159 |pmid=19057637}}
Effects
The effects of roid rage, which is not only seen in humans who take large doses of anabolic steroids but also when the same or even lower doses are administered to animals like lab rats, include the heavy increase in aggression and the fight-or-flight response. This was shown in study of lab rats where when the nucleus accumbens and medial prefrontal cortex of a group of lab rats who were administered anabolic steroids showed no difference in tyrosine hydroxylase compared to regular lab rats but the caudate putamen, a brain area important for behavioral inhibition, motor control and habit learning, showed a significant decrease in tyrosine hydroxylase due to the testosterone.{{Cite journal |last1=Wood |first1=Ruth I. |last2=Armstrong |first2=Abigail |last3=Fridkin |first3=Vlad |last4=Shah |first4=Vivek |last5=Najafi |first5=Allison |last6=Jakowec |first6=Michael |year=2013 |title='Roid rage in rats? Testosterone effects on aggressive motivation, impulsivity and tyrosine hydroxylase |journal=Physiology & Behavior |language=en |volume=110-111 |pages=6–12 |doi=10.1016/j.physbeh.2012.12.005 |pmc=3615053 |pmid=23266798}} Indecisiveness is linked to changes in the mesocorticolimbic dopamine system with anabolic steroids having an affect opamine function in mesocorticolimbic circuitry. It is not understood how this specifically affects decision making exactly. This indecisiveness is shown in lab rats which then turns into aggression, i.e. roid rage.{{Cite journal |last1=Wallin |first1=Kathryn G. |last2=Alves |first2=Jasmin M. |last3=Wood |first3=Ruth I. |year=2015 |title=Anabolic–androgenic steroids and decision making: Probability and effort discounting in male rats |journal=Psychoneuroendocrinology |language=en |volume=57 |pages=84–92 |doi=10.1016/j.psyneuen.2015.03.023 |pmc=4437834 |pmid=25900595}} Heavy signs of anxiety,{{Cite journal |last1=Sanjuan |first1=Pilar M. |last2=Langenbucher |first2=James L. |last3=Hildebrandt |first3=Tom |date=2016-07-03 |title=Mood symptoms in steroid users: the unexamined role of concurrent stimulant use |journal=Journal of Substance Use |language=en |volume=21 |issue=4 |pages=395–399 |doi=10.3109/14659891.2015.1040089 |issn=1465-9891 |pmc=4979577 |pmid=27524938}} mania,{{Cite journal |last1=Cooke |first1=Robert G. |last2=Krüger |first2=Stephanie |last3=Shugar |first3=Gerald |year=1996 |title=Comparative evaluation of two self-report mania rating scales |url=https://linkinghub.elsevier.com/retrieve/pii/0006322395003924 |journal=Biological Psychiatry |language=en |volume=40 |issue=4 |pages=279–283 |doi=10.1016/0006-3223(95)00392-4|pmid=8871774 |url-access=subscription }} and paranoia were also present when "roid rage" becomes more present in the person taking in the anabolic steroids.{{Cite journal |last1=Mhillaj |first1=Emanuela |last2=Morgese |first2=Maria G. |last3=Tucci |first3=Paolo |last4=Bove |first4=Maria |last5=Schiavone |first5=Stefania |last6=Trabace |first6=Luigia |date=2015-08-26 |title=Effects of anabolic-androgens on brain reward function |journal=Frontiers in Neuroscience |volume=9 |page=295 |doi=10.3389/fnins.2015.00295 |doi-access=free |issn=1662-453X |pmc=4549565 |pmid=26379484}} Psychopathy is heavily increased if a person has underlying disorders for it when roid rage is present, where research shows the connection between substance misuse/abuse of anabolic steroids to violence, repeated imprisonment, and disrespect for authority.{{Cite journal |last1=Nelson |first1=Bryan S. |last2=Hildebrandt |first2=Tom |last3=Wallisch |first3=Pascal |date=2022-06-01 |title=Anabolic–androgenic steroid use is associated with psychopathy, risk-taking, anger, and physical problems |journal=Scientific Reports |language=en |volume=12 |issue=1 |page=9133 |doi=10.1038/s41598-022-13048-w |issn=2045-2322 |pmc=9160254 |pmid=35650220|bibcode=2022NatSR..12.9133N }}
Effects of roid rage have chances to be greatly increased in aggression and impulsiveness if the abuser of anabolic steroids has any underlying personality disorders such as borderline personality disorder.{{Cite journal |last1=Schaive |first1=Chad |last2=Tobias S. Kohler |first2=Tobias S. x |year=2016 |title=An inside perspective on anabolic steroid abuse |journal=Translational Andrology and Urology |publisher=AME |volume=5 |issue=2 |pages=220–224 |doi=10.21037/tau.2016.03.08 |doi-access=free |pmc=4837320 |pmid=27141450}} Heavy use of anabolic steroids with roid rage can cause heavy distress as well depending on how long the steroids have been abused.{{Cite journal |last1=Chegeni |first1=Razieh |last2=Notelaers |first2=Guy |last3=Pallesen |first3=Ståle |last4=Sagoe |first4=Dominic |date=2021-06-04 |title=Aggression and Psychological Distress in Male and Female Anabolic-Androgenic Steroid Users: A Multigroup Latent Class Analysis |journal=Frontiers in Psychiatry |volume=12 |doi=10.3389/fpsyt.2021.629428 |doi-access=free |issn=1664-0640 |pmc=8211877 |pmid=34149470}}
During puberty (in adolescent males) the intake of anabolic steroids can alter mood and personality causing a heavier roid rage that can impact them for a long-term time range.{{Cite journal |last1=Lumia |first1=Augustus R. |last2=McGinnis |first2=Marilyn Y. |year=2010 |title=Impact of anabolic androgenic steroids on adolescent males |url=https://linkinghub.elsevier.com/retrieve/pii/S003193841000020X |journal=Physiology & Behavior |language=en |volume=100 |issue=3 |pages=199–204 |doi=10.1016/j.physbeh.2010.01.007 |pmid=20096713|url-access=subscription }} Due to puberty being a sensitive time period with hormones, anabolic steroids can cause a shift on testosterone production and induce unprovoked aggression whether the person may or may not still be using anabolic steroids.{{Cite journal |last=Cunningham |first=Rebecca L. |last2=Lumia |first2=Augustus R. |last3=McGinnis |first3=Marilyn Y. |date=2013-07-26 |title=Androgenic anabolic steroid exposure during adolescence: Ramifications for brain development and behavior |url=https://linkinghub.elsevier.com/retrieve/pii/S0018506X1200308X |journal=Hormones and Behavior |language=en |volume=64 |issue=2 |pages=350–356 |doi=10.1016/j.yhbeh.2012.12.009 |pmc=3633688 |pmid=23274699}} This may lead to extreme violent tendencies even after a year of drug absence, which is more present in adolescents and young adults, anabolic steroids are linked directly to the heightened factor of violent tendencies.{{Cite journal |last1=Beaver |first1=Kevin M. |last2=Vaughn |first2=Michael G. |last3=DeLisi |first3=Matt |last4=Wright |first4=John Paul |date=2011-09-20 |title=Anabolic-Androgenic Steroid Use and Involvement in Violent Behavior in a Nationally Representative Sample of Young Adult Males in the United States |journal=American Journal of Public Health |language=en |volume=98 |issue=12 |pages=2185–2187 |doi=10.2105/AJPH.2008.137018 |issn=0090-0036 |pmc=2636528 |pmid=18923108}}
After tests were done comparing the use of methyltestosterone and stanozolol (both compounds of anabolic steroids) on castrated lab rats, both showed levels of heightened aggression, which shows that if males had a vasectomy it can still affect the levels of aggression they would have.{{Cite journal |last1=Clark |first1=Ann S. |last2=Barber |first2=Diana M. |year=1994 |title=Anabolic-androgenic steroids and aggression in castrated male rats |url=https://linkinghub.elsevier.com/retrieve/pii/0031938494903514 |journal=Physiology & Behavior |language=en |volume=56 |issue=5 |pages=1107–1113 |doi=10.1016/0031-9384(94)90351-4 |pmid=7824579|doi-access=free }}
= Violence =
When a person is experiencing roid rage and increased levels of aggression, they may become easily provokable and be prone to commit violent assaults.{{Cite journal |last1=Piacentino |first1=Daria |last2=Kotzalidis |first2=Georgios |last3=Casale |first3=Antonio |last4=Aromatario |first4=Maria |last5=Pomara |first5=Cristoforo |last6=Girardi |first6=Paolo |last7=Sani |first7=Gabriele |date=2015-04-13 |title=Anabolic-androgenic Steroid use and Psychopathology in Athletes. A Systematic Review |url=https://www.eurekaselect.com/article/63923 |journal=Current Neuropharmacology |volume=13 |issue=1 |pages=101–121 |doi=10.2174/1570159x13666141210222725 |issn=1570-159X |pmc=4462035 |pmid=26074746}} Many times when a person has abused anabolic steroids and commits violent crimes, they do not maintain the same levels of judgement to their actions, which may lead to aggravated murders.{{Cite journal |last1=Pope |first1=Harrison G. |last2=Kanayama |first2=Gen |last3=Hudson |first3=James I. |last4=Kaufman |first4=Marc J. |year=2021 |title=Review Article: Anabolic-Androgenic Steroids, Violence, and Crime: Two Cases and Literature Review |journal=The American Journal on Addictions |language=en |volume=30 |issue=5 |pages=423–432 |doi=10.1111/ajad.13157 |issn=1055-0496 |pmc=8995103 |pmid=33870584}} The abuse of other drugs can lead to a worsening effects of aggression and violence that a person may commit.{{Cite journal |last1=Klötz |first1=Fia |last2=Petersson |first2=Anna |last3=Isacson |first3=Dag |last4=Thiblin |first4=Ingemar |year=2007 |title=Violent crime and substance abuse: A medico-legal comparison between deceased users of anabolic androgenic steroids and abusers of illicit drugs |url=https://linkinghub.elsevier.com/retrieve/pii/S0379073807000606 |journal=Forensic Science International |language=en |volume=173 |issue=1 |pages=57–63 |doi=10.1016/j.forsciint.2007.01.026 |pmid=17337333|url-access=subscription }}
According to anecdotal reports, wives and girlfriends of athletes who take anabolic steroids face violence when the users of anabolic steroids continue to use them; this includes verbal abuse and physical domestic abuse.{{Cite journal |last1=Choi |first1=Precilla |last2=Pope |first2=Harrison |date=1994-03-01 |title=Violence Toward Women and Illicit Androgenic-Anabolic Steroid Use |url=http://www.informaworld.com/openurl?genre=article&doi=10.3109/10401239409148835&magic=crossref||D404A21C5BB053405B1A640AFFD44AE3 |journal=Annals of Clinical Psychiatry |language=en |volume=6 |issue=1 |pages=21–25 |doi=10.3109/10401239409148835 |issn=1040-1237 |pmid=7951641|url-access=subscription }}
Treatment
Certain drugs that minimise the amount of oestrogen created as the anabolic steroids break down could help lessen the aggression.{{Cite magazine |last=Hamzelou |first=Jessica |date=2011-04-09 |title=Should steroid users be given drugs to treat 'roid rage'? |url=https://linkinghub.elsevier.com/retrieve/pii/S026240791160777X |magazine=New Scientist |language=en |volume=210 |issue=2807 |pages=12 |doi=10.1016/S0262-4079(11)60777-X|bibcode=2011NewSc.210...12H }} Anabolic steroid users can go into a psychosis when roid rage is induced, and even start experiencing suicidal ideation, some antipsychotic medications, such as haloperidol, have been used extensively to treat the psychosis induced roid rage, evidence also exists to support second-generation antipsychotics, lithium, selective serotonin reuptake inhibitors, tricyclic antidepressants (TCAs), and select antiepileptic drugs, including carbamazepine as well as valproic acid and its derivatives.{{Cite journal |last1=Huynh |first1=Grace |last2=Reinert |first2=Justin P. |year=2021 |title=Pharmacological Management of Steroid-Induced Psychosis: A Review of Patient Cases |journal=Journal of Pharmacy Technology |language=en |volume=37 |issue=2 |pages=120–126 |doi=10.1177/8755122520978534 |issn=8755-1225 |pmc=7953074 |pmid=34752563}}
In popular culture
In a season 8 episode of South Park, "Up the Down Steroid", the character Jimmy goes into a roid rage after use of anabolic steroids.{{cite web |last=Schorn |first=Peter |date=August 26, 2006 |title=South Park: The Complete Eighth Season DVD Review |url=http://www.ign.com/articles/2006/08/29/south-park-the-complete-eighth-season |access-date=April 25, 2017 |website=IGN}}
In a season 7 episode of Family Guy, "Stew-Roids", the character Stewie Griffin develops roid rage after his father Peter Griffin gives him steroids in order to make him stronger at the gym.{{cite web |title=Family Guy – Stew-Roids |url=https://tv.yahoo.com/family-guy/show/stew-roids/episode/205378 |access-date=September 29, 2012 |website=Yahoo! TV}}