Etiological influences on continuity and co-occurrence of eating disorders symptoms across adolescence and emerging adulthood.

OBJECTIVE: The role of common and symptom-specific genetic and environmental influences in maintaining eating disorder symptoms across development remains unclear. This study investigates the continuity and change of etiological influences on drive for thinness, bulimia, and body dissatisfaction symptoms and their co-occurrence, across adolescence and emerging adulthood. METHOD: In total, 2,629 adolescent twins (mean age = 15.20, SD = 1.95) reported eating disorders symptoms across three waves of data collection. Biometric common pathways model was fitted to estimate genetic and environmental contributions to the continuity of each symptom over time, as well as time- and symptom-specific influences. RESULTS: Drive for thinness and body dissatisfaction symptoms showed a pattern of high continuity across development and high correlations with each other, whereas bulimia symptoms were moderately stable and less associated with the other two symptoms. Latent factors reflecting continuity of each symptom were largely under genetic influence (Al = 0.60-0.82). New genetic influences contributing to change in the developmental course of symptoms were observed in emerging adulthood. Genetic influences correlated considerably between the three symptoms. Non-shared environmental influences were largely time-and symptom-specific, but some contributed moderately to the continuity across development (El = 0.18-0.40). The etiological overlap was larger between drive for thinness and body dissatisfaction symptoms than with bulimia symptoms. DISCUSSION: The results provide preliminary evidence that stable as well as newly emerging genetic influences contribute to the co-occurrence of drive for thinness, bulimia, and body dissatisfaction symptoms across adolescence and emerging adulthood. Conversely, environmental influences were less stable and contributed to change in symptoms over time.

The Oslo University Adolescent and Young Adult Twin Project: Recruitment and Attrition.

The Oslo University Adolescent and Young Adult Twin Project started in 2006 with the first of three questionnaire data collection waves, 2 years apart. All twins from the birth cohorts 1988-1994 were invited to participate, and both the twins and their parents were asked to sign consent forms. The twins were 12-18 years old at Wave 1, at which time parents were asked to complete similar questionnaires. The parents' questionnaire enquired about the parents' ratings of their twin's traits. In addition, the parents answered questions regarding their own education, demographics and socioeconomic situation. When the twins were 18 years old, they were invited to a face-to-face interview and two new questionnaires were presented. The questionnaires for the waves included a number of personality scales, internalization and externalization traits, affective and behavioral problems, as well as measures of environment and coping. The most common DSM-IV mental disorders and all personality disorders were covered in the interview. Zygosity was established both by questionnaire and gene markers. The original sample consisted of 5374 twin families, and among these, 4668 pairs were alive and living in Norway. Of these, 2486 families (53.3%) consented to participate. Of these, again 1538 twin families (61.9%) actually participated in at least one wave and twins from 1422 pairs (57.3%) participated in the interview. Female gender, but not zygosity, predicted staying in the project. Moreover, having a planning, structured personality (being more conscientious, open to experience [i.e., curious and interested in learning], having higher resilience and better school habits) increased the chance of carrying on in the project. Interestingly, the attrition did not seem to bias the heritability estimates.

Interrater Reliability of the Structured Clinical Interview for the DSM-5 Alternative Model of Personality Disorders Module i: Level of Personality Functioning Scale.

The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) presents an alternative model for personality disorders in which severity of personality pathology is evaluated by the Level of Personality Functioning Scale (LPFS). The Structured Interview for the DSM-5 Alternative Model for Personality Disorders, Module I (SCID-5-AMPD I) is a new tool for LPFS assessment, but its interrater reliability (IRR) has not yet been tested. Here we examined the reliability of the Norwegian translation of the SCID-5-AMPD I, applying two different designs: IRR assessment based on ratings of 17 video-recorded SCID-5-AMPD I interviews by five raters; and test-retest IRR based on interviews of 33 patients administered by two different raters within a short interval. For the video-based investigation, intraclass correlation coefficient (ICC) values ranged from .77 to .94 for subdomains, .89 to .95 for domains, and .96 for total LPFS. For the test-retest investigation, ICC ranged from .24 to .72 for subdomains, .59 to .90 for domains, and .75 for total LPFS. The test-retest study revealed questionable reliability estimates for some subdomains. However, overall the level of personality functioning was measured with a sufficient degree of IRR when assessed by the SCID-5-AMPD I.

Personality disorders and Axis I comorbidity in adolescent outpatients with ADHD.

BACKGROUND: Attention deficit hyperactivity disorder (ADHD) is a lifelong condition which carries great cost to society and has an extensive comorbidity. It has been assumed that ADHD is 2 to 5 times more frequent in boys than in girls. Several studies have suggested developmental trajectories that link ADHD and certain personality disorders. The present study investigated the prevalence of ADHD, common Axis I disorders, and their gender differences in a sample of adolescent outpatients. We also wanted to investigate the relationship between ADHD and personality disorders (PDs), as well as how this relationship was influenced by adjustment for Axis I disorders, age and gender. METHODS: We used a sample consisting of 153 adolescents, aged 14 to 17 years, who were referred to a non-specialized mental health outpatient clinic with a defined catchment area. ADHD, conduct disorder (CD) and other Axis I conditions were assessed using the Mini International Neuropsychiatric Interview (MINI). PDs were assessed using the Structured Interview for DSM-IV Personality (SIDP-IV). RESULTS: 13.7 % of the adolescents met diagnostic criteria for ADHD, with no significant gender difference. 21.6 % had at least one PD, 17.6 % had CD, and 4.6 % had both ADHD and a PD. There was a significantly elevated number of PD symptoms in adolescents with an ADHD diagnosis (p = 0.001), and this relationship was not significantly weakened when adjusted for age, gender and other Axis I disorders (p = 0.026). Antisocial (χ (2) = 21.18, p = 0.002) and borderline (χ (2) = 6.15, p = 0.042) PDs were significantly more frequent in girls than in boys with ADHD. CONCLUSIONS: We found no significant gender difference in the prevalence of ADHD in a sample of adolescents referred to a general mental health outpatient clinic. Adolescent girls with ADHD had more PDs than boys, with antisocial and borderline PDs significantly different. The present study suggests that ADHD in girls in a general outpatient population may be more prevalent than previously assumed. It especially highlights the importance of assessing antisocial and borderline personality pathology in adolescent girls presenting with ADHD symptoms.

Genetic and environmental influences on adolescents' smoking involvement: a multi-informant twin study.

Studying monozygotic and dizygotic adolescent twin pairs of both sexes reared together, the present study examined the extent to which the variance in smoking involvement is attributable to genetic and environmental effects, and to what extent there are sex differences in the etiology. Questionnaire data on how often the adolescent had ever smoked tobacco was collected from a population-based twin sample consisting of seven national birth cohorts (ages 12-18), their mothers, and their fathers (N = 1,394 families). The data was analyzed with multivariate genetic modeling, using a multi-informant design. The etiological structure of smoking involvement was best represented in an ACE common pathway model, with smoking defined as a latent factor loading onto all three informants' reports. Estimates could be set equal across sexes. Results showed that adolescent lifetime smoking involvement was moderately heritable (37 %). The largest influence was from the shared environment (56 %), while environmental effects unique to each twin had minimal influence (7 %).

Continuity in features of anxiety and attention deficit/hyperactivity disorder in young preschool children.

Anxiety disorders and attention deficit/hyperactivity disorder (ADHD) develop before school age, but little is known about early developmental pathways. Here we test two hypotheses: first, that early signs of anxiety and ADHD at 18 months predict symptoms of anxiety and ADHD at age 3½ years; second, that emotional dysregulation at 18 months predicts the outcome of co-occurring anxiety and ADHD at age 3½ years. The study was part of the prospective Norwegian Mother and Child Cohort Study (MoBa) at the Norwegian Institute of Public Health. The 628 participants were clinically assessed at 3½ years. Questionnaire data collected at 18 months were categorized into early behavioural scales of anxiety, ADHD, and emotional dysregulation. We investigated continuity in features of anxiety and ADHD from 18 months to 3½ years of age through logistic regression analyses. Anxiety symptoms at 3½ years were predicted by early signs of anxiety (Odds ratio (OR) = 1.41, CI = 1.15-1.73) and emotional dysregulation (OR = 1.33, CI = 1.15-1.54). ADHD symptoms at 3½ years were predicted by early signs of ADHD (OR = 1.51, CI = 1.30-1.76) and emotional dysregulation (OR = 1.31, CI = 1.13-1.51). Co-occurring anxiety and ADHD symptoms at 3½ years were predicted by early signs of anxiety (OR = 1.43, CI = 1.13-1.84), ADHD (OR = 1.30, CI = 1.11-1.54), and emotional dysregulation (OR = 1.34, CI = 1.13-1.58). We conclude that there were modest continuities in features of anxiety and ADHD through early preschool years, while emotional dysregulation at age 18 months was associated with symptoms of anxiety, ADHD, and co-occurring anxiety and ADHD at age 3½ years.

The relationship between personality throughout adolescence and social anxiety disorder in young adulthood. A longitudinal twin study.

This study examined the longitudinal relationship between a range of personality related variables measured throughout adolescence, and social anxiety disorder (SAD) in young adulthood. In addition, we examined to what degree the phenotypic associations between personality and SAD could be attributed to shared genetic and environmental factors, respectively. A total of 3394 twins (56% females), consisting of seven national birth cohorts from Norway, participated in the study. Personality was measured with self-report questionnaires at three times throughout adolescence, and SAD was measured with a diagnostic interview in early adulthood (M = 19.1 years, SD = 1.2). Correlation and regression analyses were performed to examine phenotypic associations between personality and SAD. We then created four composite scores of personality, in which the personality variables from four different ages throughout adolescence were weighted relative to their importance for SAD. Finally, a series of Cholesky decomposition models were used to examine the underlying genetic and environmental influences on the phenotypic associations between composite scores of personality and SAD. The results showed that especially higher neuroticism, lower extraversion, higher levels of loneliness, and lower levels of resilience, self-efficacy and sense of coherence, were associated with SAD. The phenotypic correlations between composite scores of personality and SAD increased from 0.42 when personality was measured 6-7 years prior to the assessment of SAD, to 0.52 when personality was measured shortly before the assessment of SAD. These phenotypic associations were mainly due to genetic influences, indicating that personality in adolescence predicts SAD in early adulthood due to shared genetic influences rather than having direct 'causal' effects on SAD.

The longitudinal relationship between life events and loneliness in adolescence: A twin study.

The aim of the study was to examine associations between life events and self-assessed loneliness in adolescence. We used data from a Norwegian population-based twin sample including seven birth cohorts (N = 2,879, 56% females). The participants completed self-report questionnaires three times throughout adolescence, with 2 years in between (i.e., 12-18 years old at Wave 1). By using a random intercept cross-lagged panel model (RI-CLPM), we were able to separate stable influences in the measured constructs from the within-person changes at each measurement occasion. In addition, using data from twins allowed us to examine to what degree the associations between life events and loneliness were genetic and/or environmental in nature. The results showed moderate stability of both loneliness and aggregation scores of life events throughout adolescence. The life events were assigned to clusters based on their independence (i.e., events considered dependent or independent on a person's behavior) and desirability (i.e., positive or negative). The time-stable between-person variance in all three measures, loneliness and person-dependent positive and negative life events, could almost exclusively be accounted for by genetic factors. However, as expected, also shared environmental factors influenced person-independent life events. The associations between time-stable between-person variance in loneliness and life events were small, and nearly exclusively due to shared genetic influences. Furthermore, life events do not seem to predict changes in loneliness or vice versa. In conclusion, the self-reported levels of loneliness throughout adolescence seems to be independent of life events. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Bridging temperament and the Big Five in children: A genetically informative study.

Early temperament precedes children's emerging Big Five personality, but shared models of temperament and personality are scarce. We wanted to estimate the genetic factor structure underlying both temperament and the Big Five in children, employing a genetically informed study. Within the Norwegian Mother and Child Cohort Study, we selected 26,354 twins, siblings, and cousins. Mothers rated their children's temperament three times between the ages of 1.5 and 5 years, and the children's Big Five personality at the age of 8. We analyzed the data using biometric modeling. The mean heritability of single-time temperamental traits and Big Five personality traits was .48 and .45, respectively. The mean genetic correlations of temperament across time were .80. The genetic correlations of temperament at 5 years and the Big Five at 8 years revealed two factors, the first comprising reversed Big Five Neuroticism, Agreeableness, Conscientiousness, and reversed EAS Emotionality, the second comprising Big Five Extraversion, Openness to Experience, EAS Activity, Sociability, and reversed Shyness. A confirmatory factor analysis estimated the two factors showing heritabilities of .96 and .72, respectively. The two factors mirrored the metatraits Stability and Plasticity by John M. Digman. Temperament and personality in childhood can be meaningfully bridged using just two metafactors. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Neuronal correlates of the five factor model (FFM) of human personality: Multimodal imaging in a large healthy sample.

Advances in neuroimaging techniques have recently provided glimpse into the neurobiology of complex traits of human personality. Whereas some intriguing findings have connected aspects of personality to variations in brain morphology, the relations are complex and our current understanding is incomplete. Therefore, we aimed to provide a comprehensive investigation of brain-personality relations using a multimodal neuroimaging approach in a large sample comprising 265 healthy individuals. The NEO Personality Inventory was used to provide measures of core aspects of human personality, and imaging phenotypes included measures of total and regional brain volumes, regional cortical thickness and arealization, and diffusion tensor imaging indices of white matter (WM) microstructure. Neuroticism was the trait most clearly linked to brain structure. Higher neuroticism including facets reflecting anxiety, depression and vulnerability to stress was associated with smaller total brain volume, widespread decrease in WM microstructure, and smaller frontotemporal surface area. Higher scores on extraversion were associated with thinner inferior frontal gyrus, and conscientiousness was negatively associated with arealization of the temporoparietal junction. No reliable associations between brain structure and agreeableness and openness, respectively, were found. The results provide novel evidence of the associations between brain structure and variations in human personality, and corroborate previous findings of a consistent neuroanatomical basis of negative emotionality.

Fathers' mental health as a protective factor in the relationship between maternal and child depressive symptoms.

BACKGROUND: The relationship between parental and child depressive symptoms has been found to be stronger for mothers than for fathers. Does this mean that fathers' mental health is less important in the context of child depressive symptoms? The goal of the current study is to test whether the degree of fathers' depressive symptoms moderate the relationship between mothers' and children's depressive symptoms. Our knowledge about such interaction effects between mothers' and fathers' symptoms is limited. METHODS: We examined depressive symptoms in 190 children (age 7-13, 118 boys) referred to child community clinics and their parents. Mothers and fathers reported on their own and their child's depressive symptoms, whereas children only reported on their own symptoms. RESULTS: Structural equation modeling revealed significant interaction effects of mothers' and fathers' depressive symptoms on mother- and father-reported child depressive symptoms, while no effects were found for child reports. When fathers reported few depressive symptoms for themselves, no relationship between mothers' and children's depressive symptoms was observed. The more depressive symptoms in fathers, the stronger the relationship between mothers' and children's symptoms. CONCLUSIONS: Fathers' mental health may be a protective factor in the relationship between mothers' and children's depressive symptoms. Thus, researchers and practitioners would benefit from considering not only depressive symptoms in mothers, but also in fathers, when examining and working with child depressive symptoms.

Self-efficacy is mainly genetic, not learned: a multiple-rater twin study on the causal structure of general self-efficacy in young people.

Social learning theory postulates that self-efficacy is learned through the person's interaction with his/her physical and social environment. In this genetically informative, population-based, multi-informant study of 1,394 adolescent twin pairs, self-efficacy was modeled as one latent psychometric self-efficacy factor with genetic and environmental effects common to all informants, as well as for effects specific for each informant. The results showed that 75% of variation in self-efficacy was due to genetic factors. Non-shared environmental causes explained the remaining 25% of the variance in the latent factor, with no effect of common environment. Some informant-specific effects were also found. The present study challenges the theoretical assumption of learning as the dominant etiological factor behind self-efficacy in young people.

Clustering psychopathology in male anabolic-androgenic steroid users and nonusing weightlifters.

INTRODUCTION: Prior research has demonstrated that personality disorders and clinical psychiatric syndromes are common among users of anabolic-androgenic steroids (AAS). However, the prevalence, expression, and severity of psychopathology differ among AAS users and remain poorly understood. In this study, we examine the existence of potential clinically coherent psychopathology subgroups, using cluster procedures. METHODS: A sample of 118 male AAS users and 97 weightlifting nonusers was assessed using the Millon Clinical Multiaxial Inventory-III (MCMI-III), measuring personality disorders and clinical syndromes. Group differences in MCMI-III scales were assessed using Wilcoxon-Mann-Whitney tests and Fisher's exact test. Agglomerative hierarchical clustering was used to identify clusters based on MCMI-III scale scores from the whole sample. RESULTS: AAS users displayed significantly higher scores on all personality disorder (except narcissistic) and clinical syndrome scales compared to nonusing weightlifters. The clustering analysis found four separate clusters with different levels and patterns of psychopathology. The "no psychopathology" cluster was most common among nonusing weightlifters, while the three other clusters were more common among AAS users: "severe multipathology," "low multipathology," and "mild externalizing." The "severe multipathology" cluster was found almost exclusively among AAS users. AAS users also displayed the highest scores on drug and alcohol dependence syndromes. CONCLUSIONS: AAS users in our sample demonstrated greater psychopathology than the nonusing weightlifters, with many exhibiting multipathology. This may pose a significant challenge to clinical care for AAS users, particularly as there appears to be significant variation in psychopathology in this population. Individual psychiatric profiles should be taken into consideration when providing treatment to this group. SIGNIFICANT OUTCOMES: As a group, AAS users displayed markedly greater psychopathology than nonusing weightlifters. Multipathology was common among AAS users. Four different subgroups of personality profiles were identified with distinct patterns of pathology and severity. LIMITATIONS: The cross-sectional nature of the study precludes inferences about causality. The study is limited by possible selection bias, as participants choosing to be involved in research may not be entirely representative for the group as a whole. The study is vulnerable to information bias, as the results are based on self-report measures and interviews.

Genetic and environmental causes of variation in trait resilience in young people.

The aim of this multi-informant twin study was to determine the relative role of genetic and environmental factors in explaining variation in trait resilience in adolescents. Participants were consenting families (N = 2,638 twins in 1,394 families), from seven national cohorts (age 12-18 years, both sexes) of monozygotic and dizygotic twins reared together. Questionnaire data on the adolescents' Ego-resilience (ER89) was collected from mothers, fathers and twins, and analysed by means of multivariate genetic modelling. Variance in trait resilience was best represented in an ADE common pathways model with sex limitation. Variance in the latent psychometric resilience factor was largely explained by additive genetic factors (77% in boys, 70% in girls), with the remaining variance (23 and 30%) attributable to non-shared environmental factors. Additive genetic sources explained more than 50% of the informant specific variation in mothers and fathers scores. In twins, additive and non-additive genetic factors together explained 40% and non-shared environmental factor the remaining 60% of variation. In the mothers' scores, the additive genetic effect was larger for boys than for girls. The non-additive genetic factor found in the twins' self ratings was larger in boys than in girls. The remaining sex differences in the specific factors were small. Trait resilience is largely genetically determined. Estimates based on several informants rather than single informants approaches are recommended.

Diagnostic efficiency of the child and parent versions of the Multidimensional Anxiety Scale for Children.

The objective of this study is to evaluate the psychometrics and clinical efficiency of the Multidimensional Anxiety Scale for Children (MASC), which measures physical symptoms, harm avoidance, social anxiety, and separation/panic. Using a sample of 190 treatment-seeking Norwegian youth (aged 7-13 years, M (age) = 10.3 years, 62.1% male), the internal stability and ability to predict to disorder were examined for child, mother, and father reports on the MASC. Moderate to strong internal reliability was exhibited across all MASC subscales. Parent-child agreement was low, but mother-father agreement was high. MASC scores successfully distinguished between children with and without anxiety disorders and identified youth with separation anxiety disorder and social phobia, but less accurately generalized anxiety disorders. The MASC has favorable psychometric properties and is a useful screening instrument for identifying youth with anxiety disorders.

Genetic and environmental causes of variation in perceived loneliness in young people.

Loneliness is prevalent in adolescence, despite the widespread expectation directed to young people to start building close relationships beyond the nuclear family. The aim of the present study was to explore the causal genetic and environmental structure behind variability in adolescents' perceived loneliness. Seven national cohorts (ages 12-18 years) of Norwegian twins reared together (1,394 twin pairs) participated. Perceived loneliness was measured with five items from the UCLA Loneliness Scale. Data were collected from mothers, fathers, and twins' self ratings by means of a posted questionnaire. Biometric analyses were applied, testing the causal architecture of loneliness within a psychometric model with one common latent factor in addition to specific genetic and environmental sources influencing the scores of each informant. The results showed a heritability (h(2)) of 75% on the latent perceived loneliness factor, and nonshared environmental effects (e(2)) explaining the remaining 25% of the latent factor variance. There were also significant rater-specific genetic and nonshared environmental effects. No shared environmental effects were found in the model, and there were no sex differences in the estimates. This study showed that variation in perceived loneliness in adolescents is highly genetic. Additional genetic and nonshared environmental etiological sources are to some extent represented in the scores of the specific rater.

Childhood trauma and borderline personality disorder traits: A discordant twin study.

A discordant twin design was utilized to examine the potentially causal effects of childhood trauma (CT; i.e., emotional abuse, physical abuse, sexual abuse, and witnessing violence) on borderline personality disorder traits (BPD traits) in early adulthood. The participants were 2,808 twins between 17 and 23 years from the Oslo University Adolescent and Young Adult Twin Project. BPD traits were assessed by the Structured Interview for DSM-IV Personality (SIDP-IV), and CT was assessed using the Childhood Trauma Interview (CTI). BPD traits (h² = .50) and CT (h² = .33-.69) were both found to be moderately heritable. Small but statistically significant associations between CT and BPD traits were found in the total sample. After controlling for shared environmental and genetic factors in the discordant twin pairs, the analyses showed little to no evidence for causal effects of CT on BPD traits. The results indicated that the associations between CT and BPD traits stem from common genetic influences. These findings are inconsistent with the widely held assumption that CT causes the development of BPD. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The role of sense of coherence and loneliness in borderline personality disorder traits: a longitudinal twin study.

BACKGROUND: Borderline personality disorder (BPD) implies having problems with identity and relations with other people. However, not much is known about whether these indications of BPD are present in adolescence, i.e., before personality disorders usually are diagnosed. In this study, we examined the prediction of an aspect of identity (i.e., sense of coherence [SOC]) and social relations (i.e., perceived loneliness) throughout adolescence on BPD traits in young adulthood. In addition, we examined to what degree the predictive ability could be attributed to genetic and environmental factors. We also examined whether life events in adolescence were related to BPD traits. METHODS: Three thousand three hundred ninety-one twins, consisting of seven national birth cohorts from Norway, participated in the study. SOC, loneliness and life events were measured three times throughout adolescence with self-report questionnaires, with 2 years in between measurements. BPD traits were measured at the end of adolescence around the age of 19 with a structured interview. Regression analyses were performed to examine the prediction of SOC, loneliness and life events on BPD traits. Cholesky decomposition models were then used to determine to what degree the associations were due to genetic and environmental influences. RESULTS: The prediction of SOC and loneliness on BPD traits increased from R = .25 (when measured 6 years prior to the assessment of BPD traits) to R = .45 (when measured shortly before the assessment of BPD traits). In addition, negative life events considered dependent on a person's behavior were related to BPD traits. Negative independent and positive dependent life events did not contribute to the prediction of BPD traits. Cholesky decomposition models showed that SOC and loneliness were associated with BPD traits mainly due to shared genetic influences (i.e., the proportion due to genetic influences ranged from 71 to 86%). Adding negative dependent life events to the prediction of BPD traits did not change these percentages. CONCLUSIONS: These findings indicate that the weaker SOC, the stronger feelings of loneliness, and the negative life events associated with BPD traits are mainly consequences of the genetic aspects of BPD traits, rather than having direct effects on levels of BPD symptoms.

Psychopathology among anabolic-androgenic steroid using and non-using female athletes in Norway.

Anabolic-androgenic steroids (AAS) are primarily used to improve physical appearance and increase lean muscle mass. Due to their masculinizing properties, the majority of people using AAS are men; however, AAS use among females may increase with changing body ideals trending towards a more muscular appearance. AAS use among males have been associated with risk-taking behavior, and increased prevalence of personality disorders and psychopathology. As a result of low perceived prevalence and stigma among females who use AAS, the relationship between AAS use and psychopathology in this population is not well-known. AAS using women (n = 16) and weight-lifting controls (WLC) (n = 16) completed questionnaires regarding AAS use, health and training information. Psychopathology was evaluated using the Millon Clinical Multiaxial Inventory-III (MCMI-III). Group differences on demographic variables and scores on MCMI-III scales were evaluated with Mann-Whitney U tests. The clinical cut-off was then applied to all MCMI-III scales and groups were compared using Fisher's exact test. AAS consumers demonstrated significantly greater psychopathology than WLC on several scales. Externalizing personality disorder scales were elevated among those who use AAS relative to controls, such as borderline (p < 0.001), antisocial (p = 0.007) and sadistic (p = 0.002), and in addition depressive (p = 0.012), negativistic (p = 0.001) and masochistic (p = 0.029) personality disorders scales. Furthermore, all clinical syndromes were elevated among AAS consumers. AAS consumers thus demonstrated multi-pathology, and 56% (n = 9) of the group met the clinical criteria for six or more disorders. Females who use AAS experience in general increased levels of psychopathology compared to WLC. Clinicians should be aware of these traits and the challenges they present in providing care to this population.