Dissatisfaction with the body is very common in the population, in females in all ages  as well as among males . Studies on female and male body image show the role of the media in defining and perpetuating body ideals , e.g., a muscular ideal male body type , or a thin female ideal . A meta-analysis of the effects of the media on male body image concerns, yielded similar effect sizes as those found with women . As a result of internalization of cultural norms, females become dissatisfied with the lower part of their bodies from the waist down and try to lose weight while males primarily want to change the shape of upper part of their bodies (stomach and chest) and are more likely to desire an increase in weight . Body dissatisfaction has been reported as a risk factor, and one of the strongest predictors for onset of an eating disorder (ED) [8–10] and is also associated with low self-esteem and depression [8, 11]. Dissatisfaction with the body seems to be the common and prominent denominator, not only between the sexes, but also between males with ED  and males using anabolic androgenic steroids (AAS) . Both ED and the use of AAS may seriously affect physical health and the psychological and social wellbeing of those who suffer from those problems [14, 15].
ED among males
ED is a long-lasting mental disorder, characterized with disturbed eating or weight controlling behavior . Studies have shown that ED are most common among young women, and that only about 10 per cent of patients with ED seen in mental health care are males . Some have found that only 16 per cent of males with ED in fact seek treatment . The proportion of males, 18 years or older in specialist treatment for ED in Sweden has been lower (1.5%) , than expected from prevalence studies . A report from Swedish Quality registry on ED indicates an increase in the amount of males seeking treatment, since 4% of the adult patients in specialist ED-treatment in Sweden last year were males .
Earlier research studies on ED often excluded males and our knowledge about males with eating disorders is therefore still sparse [12, 20]. However, research has begun focusing on males with ED and similarities between genders have been found, such as multi-factorial causes of ED, the core symptoms of ED, and suggestions that the course of illness, treatment response and long-term prognoses are comparable, which means that ED among males are also associated with an increased risk of mortality [21–24]. Differences between genders have however also been reported [25, 26]. A history of premorbid overweight is more common among males with ED , and they report significantly lower scores on drive for thinness than females with ED, since they rather strive for a lean muscularity [27–29]. Males often use exercise as a compensatory method, while females vomit to control their body weight. Males are also more likely to binge eat than females [12, 30–32]. Stanford and Lemberg  conclude that ED symptoms in males especially differ from females with ED in the construct of body dissatisfaction and the compensatory behavior associated with bulimia. Some results also indicate prognosis and outcome to be more favorable for males with shorter time to recovery and higher proportion of males reaching recovery .
AAS among males
AAS, synthetic derivatives of the male endogenous sex hormone testosterone, were originally used by athletes but are now used by a far wider range of groups outside of sports and athletics [34, 35]. The majority of AAS users are males [36–38]. In Sweden, between 50 000 – 100 000 people are thought to have used AAS, about 1% of the population of 9 million . Lifetime prevalence of AAS use among males in USA is estimated to 0.9% and to 0.1% among females in the general population, while the prevalence of AAS use in Poland is 6% among males and 3% among females . In Western countries life time prevalence of AAS in males ranges from 1% to 5%, and among females the prevalence is estimated to 0.1% . The users reason for using AAS is to improve their appearance as well as performance [39, 42]. Serious physical (i.e. cardiovascular, reproduction and endocrine system), psychiatric (i.e. depression, aggression and sleeping problems)  and social side effects (i.e. abuse of other drugs, battering of spouses and other criminality)  of AAS misuse have been reported. Heightened levels of violent behaviors are also reported among AAS-users .
Comparisons between males with ED, male bodybuilders and normal controls revealed that bodybuilders more closely resembled the ED group than normal controls regarding body dissatisfaction and loss of sexual desire . Few studies have so far investigated why some of the body dissatisfied males become oriented towards thinness and why others become focused on muscularity. One study indicates that the groups may differ regarding body ideals .
Are there other differences or similarities?
AAS use can be associated with body image disorders as “Muscle Dysmorphia” [46, 47], sometimes also called “reverse anorexia nervosa”, which is defined as a fear of being too small . The authors discuss the possibility that this “reverse anorexia nervosa” in males may be a similar disorder to anorexia nervosa in females and account for the lower prevalence rates of anorexia nervosa in males.
Other similarities found between males with ED and body-builders including AAS users were characteristics such as perfectionism, ineffectiveness and low self-esteem . An essential question is whether more similarities can be found between males with ED and AAS users or if these groups differ in some essential respects. It is for example unclear whether there is a distinction between males with ED and males using AAS regarding the occurrence of underlying interpersonal profiles like negative self-image and the severity of psychiatric symptoms. Based on earlier studies showing several similarities between these groups, we anticipated that negative self-image and psychiatric symptoms would be similar between males with eating disorders and males who recently used AAS.
The aim of this study was to compare two clinical samples of males, one of males with ED and one of males who used AAS, regarding self-image and psychiatric symptoms.