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Harm Reduction In Male Patients Actively Using Anabolic Androgenic Steroids AAS And Performance-Enhancing Drugs PEDs: A Review

Clinical and Scientific Implications of the 2023 Journal of Clinical Medicine Review

"Clinical and Scientific Implications of Eating Disorders: A Focus on Patients with Anorexia Nervosa" (Sperlich et al., 2024)




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1. Background & Key Findings



Aspect What the review shows


Pathophysiology Severe caloric restriction in AN triggers a cascade of neuro‑hormonal adaptations: ↑ ghrelin, ↓ leptin, altered dopamine transmission, and changes in corticotropin‑release factor (CRF) signaling.


Neurocognitive profile Patients exhibit impaired executive function (set‑shifting, inhibition), but intact or even enhanced verbal memory—consistent with a "learning bias" toward body‑image related cues.


Biomarker potential Elevated CRP and IL‑6 correlate with symptom severity; ghrelin/leptin ratios may reflect metabolic adaptation stages.


These findings underscore the importance of multi‑modal assessment: endocrine, inflammatory, neuropsychological, and imaging measures.



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2. The Clinical Trial Landscape



2.1 Current Interventions



Category Intervention Evidence Level


Pharmacologic SSRIs (e.g., fluoxetine) Moderate—some efficacy on mood/anxiety but variable effect on weight/shape concerns.


Bupropion + Naltrexone (Contrave®) Limited data in eating disorders; primarily used for obesity.


Topiramate Small RCTs show modest reduction in binge frequency, but side‑effects and weight loss may confound results.


Psychotherapy CBT‑E (standardized protocol) Strong evidence—multiple RCTs demonstrate significant reductions in binge episodes.


Interoceptive Exposure (within CBT) Effective for reducing avoidance of bodily sensations; improves interoceptive awareness.


Mindfulness‑Based Interventions (e.g., MB-EAT) Emerging evidence—reduces emotional eating and improves body acceptance.


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4. How These Findings Shape the Treatment Plan




Evidence‑based First Line: CBT‑E


Why: It is specifically designed to target binge eating behaviors, has a solid evidence base in adolescents, and can be delivered in an individual format that respects her privacy.
Implementation: Begin with 12–16 weekly sessions, each ~60 min, focusing on the principles of exposure to internal cues (anxiety, cravings) while preventing the behavioral response.





Incorporate Exposure & Response Prevention


Why: The therapist’s experience with ERP suggests she can handle structured exposures and will benefit from gradual, repeated practice in a controlled environment.
How: Use the "Binge‑Avoidance Plan" to set up exposure tasks (e.g., sitting with a snack for 5 min) followed by monitoring of thoughts/emotions without acting on them.





Use CBT Techniques


Why: CBT can help reframe distorted beliefs about food and body image, reduce anxiety, and improve coping skills.
How: Teach thought‑record sheets, behavioral experiments to test catastrophic predictions (e.g., "If I eat this snack, will I lose control?"), and relaxation training.





Monitor Progress


Why: Tracking sessions, binge frequency, and mood helps adjust the plan and provides evidence of improvement.
How: Keep a simple log or use an app; review weekly during therapy.





Prepare for Relapse


Why: Relapses are common in eating‑disorder recovery; having strategies reduces shame and facilitates return to treatment.
How: Identify high‑risk situations, practice coping responses (e.g., grounding exercises), and schedule follow‑up sessions promptly after a relapse.



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Summary




Diagnostic criteria for binge‑type EDs involve recurrent binge episodes with loss of control and significant distress or impairment.


Treatment centers on CBT/EFT (CBT‑ED, MBCT, IPT, DBT‑PSR) combined with medical monitoring and psychoeducation.


Key intervention points: early identification of binge patterns, comprehensive assessment, stabilization of physical health, initiation of psychotherapy, relapse prevention, and long‑term support.



By following this structured approach, clinicians can effectively diagnose, treat, and monitor patients presenting with binge eating behaviors and related psychopathology.

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