Use of image and performance-enhancing drugs surged during Covid-19 restrictions

By The University of Hertfordshire

Figure of a woman in a red bathing suit inside a plastic rectangle on top of a fabric cloth.
Image: Zenza Flarini/Shutterstock

28% of people have used image and performance-enhancing drugs (IPEDs) during the Covid-19 pandemic, rising to 32% in the UK, an international study led by the University of Hertfordshire has found. Researchers say this trend is being worsened by ‘fitspirational’ posts on social media pressuring people to achieve the ‘perfect body’.

Published today in Frontiers in Psychiatry, researchers asked more than 3,000 people from 7 different countries, including the UK, about their exercise habits, use of IPEDs and the feelings they have towards their appearance.


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They found that 32% of the UK have used IPEDs during the pandemic – 6% for the first time ever – with 43% of those buying IPEDs from the internet, likely without medical supervision or professional advice. The study also found that men were significantly more likely to use IPEDs than women, with 28% of men reporting to have used IPEDs during lockdown compared to 16% of women.

IPEDs is a broad term used to capture the range of products available that can alter a person’s appearance, physical or mental performance. IPEDs can include anything from legal products such as proteins, multivitamins, Viagra and laxatives, to illegal drugs like anabolic steroids and amphetamines (also known as Speed). 

Researchers also found that 4% of the respondents were at risk of problematic or excessive exercising. This was highest in the UK at 11% – more than double that of Spain (5%), the country with the second highest figure.

Exercising can become excessive or problematic if it gets in the way of important activities, if you become distressed when you cannot exercise, or if you continue to exercise despite a serious injury, illness or medical condition. Problematic or excessive exercise can cause both physical and psychological problems leading to injury, fatigue and depression.

A significant number of the participants across the sample were anxious about their appearance. 18% of people in Italy scored high on the anxiety scale, the most among the participating countries (13% in the UK).

Scoring highly could indicate symptoms of body dysmorphic disorder (BDD), an often under-recognized mental condition where a person experiences extreme dissatisfaction with their perceived flaws. Usually, those living with BDD will have an urge to act on these flaws and ‘fix’ them.

Pressure to achieve the ‘perfect body’

Dr Ornella Corazza, reader in substance addictions and behaviors at the University of Hertfordshire and the lead on this study, says: “There’s a lot of pressure, particularly in western societies, to have the ‘perfect body’ and the rise of social media has certainly deepened this trend.

“As countries around the world have introduced lockdown restrictions, people have had greater access to social media, where they are bombarded with ‘fitspirational’ posts or motivational messages encouraging exercise.”

“For many people, the lockdown restrictions have also worsened their mental health and any pre-existing conditions they may have had. Some have started exercising excessively or turned to IPEDs in order to cope.”

She continued: “Our research has not only shown an increase in IPED use during lockdown, but it has also identified a strong link between high appearance anxiety, physical activity and the likelihood of using IPEDs. It is hoped these findings will be used by the participating countries to inform any future lockdown restrictions they impose, whilst considering the particular vulnerabilities of certain groups and cultural differences.”

Kitty Wallace, head of operations at the Body Dysmorphic Disorder Foundation, adds: “The findings of this international study are significant and shocking; however, they are sadly unsurprising to us at the Body Dysmorphic Disorder Foundation. We know that the pandemic has had a catastrophic effect on people’s mental health and we are trying to manage a deluge of individuals who are making contact with us for more support. Excessive exercise due to appearance anxiety can be a symptom of BDD, muscle dysmorphia or an eating disorder, and must be taken more seriously. For anyone affected, we encourage you to seek help and reach out for support. Information on BDD and how to get help is on our website.”

The research team is now exploring further how people have been using the internet as a coping mechanism during the pandemic – looking at areas such as pornography use, gambling and online shopping habits.

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