The use of Image and Performance-Enhancing Drugs (IPED) in behavioural addictions

Background and aims: Digitalisation and rapid technological advancements have intensified socio-cultural pressures surrounding body ideals and performance, contributing to the increased use of Image and Performance Enhancing Drugs (IPED). Body dissatisfaction, muscularity-oriented concerns, and distorted self-perception represent key drivers of this phenomenon and are further amplified by digital media, which increasingly promote IPED use. Although IPED use has been consistently associated with body image disturbances and eating-related psychopathology, its relationship with behavioural addictions remains largely underexplored. This represents a critical knowledge gap, given that IPEDs are often used to shape the body, regulate mood, sustain productivity, sharpen cognition, and intensify sexual experiences, all of which may contribute to compulsive patterns of behaviour. Methods: This narrative review synthesises existing literature examining IPED use in relation to behavioural addictions, including exercise addiction, eating disorders, work addiction, gaming disorder, gambling disorder, and compulsive sexual behaviour disorder. Results: Moving beyond traditional doping frameworks, it examines how IPED use is shaped by appearance-related disorders, compulsive behaviours, and social validation pressures. Particular attention is given to the role of digital environments and online fora in facilitating access to IPEDs, normalising their use, and interacting with reinforcement processes in these conditions. By integrating previously fragmented lines of research, the review proposes a novel framework that conceptualises IPED use as recurring across diverse behavioural addictions rather than an isolated phenomenon confined to sport. Discussion and conclusions: Understanding the mechanisms linking IPED use, behavioural addictions, and digital contexts is crucial for informing targeted public health strategies and the development of effective prevention and intervention approaches.