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Roid Rage - The Benoit Legacy on Steroids

Roid Rage After the death of Chris Benoit and his family, the world was shocked and dismayed that anabolic steroids were harmful. The word Roid Rage was released into the public domain as if everyone taking anabolic steroids was a roving maniac. Since the development of steroids, it has always been known that these drugs had potent central nervous system effects. For decades it has been known that steroids can have a variety of effects on the brain. Just ask any female who goes through menopause. The problem is that most athletes have always been concerned about the peripheral effects of steroids and have completely neglected the brain effects.

For individuals who are taking steroids of any type, there is very little risk of developing roid rage. Corticosteroids have a lot of side effects but roid rage is very rarely reported. Infact, until the Chris Benoit fiasco, Roid rage was not a common medical entity.

The major complaint todate by people who take steroids on a regular basis is more of depression, anxiety or lack of sleep. Eliciting anger episodes is rare.

Roid rage is just one symptom in an entire spectrum of side effects of steroids. The majority of individuals who take anabolic steroids are worried about gynecomastia, acne, decreased libido, hair loss, and so on. No one really cared about the emotions induced by these drugs. Furthermore, not every athlete who takes anabolic steroids is prone to the central nervous system side effects. Why some individuals become aggressive and violent while taking steroids is not fully understood.

Roid rage is not a continuous symptom like depression but is a sudden loss of impulse control. What provokes this loss of control can be the mildest of arguments or emotional conflicts. The loss of impulse control is not prolonged but can last anywhere from a few minutes to a few hours. The loss of impulse control is generally associated with an explosive anger or rage.

Because roid rage does not occur in everyone, it has been difficult to understand the condition. The majority of individuals who have an episode of roid rage are away from health care professionals and so the circumstances surrounding the rage have never been properly analyzed.

In the majority of cases, roid rage results in violence towards others, in some cases, the violence is towards friends or family members.

Personality and Rage

Roid rage may also have a strong association with personality. The majority of athletes who take these drugs are motivated. An “A” type personality, achievers, those who want to succeed may be more prone to developing Roid Rage. These same individuals already have a tendency to get upset over minor things. And when this is combined with steroids, there is bound to be loss of control.


Incidence of steroid psychosis is not really known but from the medical literature is thought to be anywhere from 10%-50%. The majority of episodes are mild and full blown psychosis is very rare. The incidence of an acute psychotic episode appears to be less than 5%.

Steroid psychosis is more likely in men but this is most likely related to dosage. Females generally take much lower doses.

Types of psychiatric disorder
  There is a whole range of psychiatric manifestation in individuals who take steroids. The majority develop depression, 25% develop mania, 15% develop agitated schizophreniform or paranoid psychosis. A few individuals develop acute delirium. Depression & Anabolic Steroids  

Most researchers believe that there is a relationship between steroid psychosis and dosage. With increasing dosage the chances of developing psychiatric manifestations also increase. However, one should note that the absence or presence of a psychotic episode during a steroid treatment does not mean that the subsequent steroid treatment will have the same effect.

Even though patients with psychiatric history may be more prone to psychotic episodes, this is not a reliable predictor of future episodes.

Duration of symptoms

The onset of acute psychotic episodes is of very short duration. The majority can occur within the first 4-8 hours after administration of intramuscular injection, or within 4-6 days after a large oral dose. From the few isolated cases which have been studied, the most frequent initial presentation of acute psychosis is one of extreme cerebral excitation. The individual may be irritable, anxious, the mood may be labile, one may develop audio or visual hallucinations. Some even have slight impairment of speech and difficulty with proper thought. These symptoms progress over a period of 72-96 hours and can make the individual confused and have no semblance of reality.

  Roid Rage Treatment The treatment of roid rage is supportive care. If someone has become angry and violent then urgent hospital care is necessary. There are medications which can be used to sedate a violent individual. Sudden withdrawal of anabolic steroids is not recommended. The majority of these individuals need treatment from a psychiatrist.  

The treatment of steroid induced psychiatric manifestations is with the use of anti-psychotics. In the days before the availability of such drugs, most steroid induced psychotic episodes lasted anywhere from 2 weeks to several months after stopping the steroids. With drug treatment, the majority of individuals will recover within 6 weeks. Delirium is usually the first symptom to disappear but a full blow psychotic episode needs hospital admission and aggressive treatment.

After a diagnosis of steroid psychosis has been made, the majority make a complete recovery. Unfortunately, a few individuals have been known to commit suicide. At least 5%-7% of these individuals will continue with the diagnosis of a psychiatric condition. Asides from anti-psychotics, some individuals have also required ECT therapy for treatment of resistant depression.

Individuals who develop depression generally have a poor and prolonged recovery. Exacerbation and relapse of symptoms is common and some individuals may need long term anti depressant therapy.

How steroids alter the brain is not well understood but there is evidence that they may alter the synthesis of certain neurotransmitters in the brain.


For the last 50 years, thousands of individuals have taken anabolic steroids and countless other individuals have received anabolic steroids in a hospital. Yet the media hype makes it sound like there is an epidemic of roid rage. Other than a few wrestlers who have been angry or upset, there are very few reports of roid rage. Every time there is an argument on the baseball pitch or on the gym does not mean someone is on steroids. There are some individuals who are just plain mean and bad. Roid rage will occur in the future but it is hard to predict who and when. In general, individuals who take high doses and those who already have a labile mood are most prone to these rages.

Steroid induced psychoses is not a new disorder but have been well known since the inception of steroids into medicine. While there are ways to treat it, the only way to prevent this disorder is not to take the steroids in the first place.

Bottom line: Benoit may have killed his family because of anabolic steroids, but anyone who watched him all these years could see that he had a personality problem also. To blame anabolic steroids for all the rage in this world is myopic. We have more people dying from car accidents, gun shooting and random violence. It is time the media put things into perspective- and do not forget, Benoit had a lot of other drugs in his body besides testosterone.


Breuer ME, McGinnis MY, Lumia AR, Possidente BP. Aggression in male rats receiving anabolic androgenic steroids: effects of social and environmental provocation. Horm Behav. 2001 Nov;40(3):409-18.

Hall RCW, Popkin M, Stickney S, et al: Presentation of “steroid psychosis”. J Nerv Ment Dis 167:229-236, 1979

Hall RCW, Popkin M, Kirkpatrick B: Tricyclic exacerbation of steroid psychosis. J Nerv Ment Dis 166(10)738-742, 1978

Hall RCW, Beresford TP: Psychiatric manifestations of physical illness, in Michels R, Cavenar JO, Brodie HKH et al(eds): Psychiatry, Vol 2, 1989, Philadelphia, J.B. Lippincott Co, chapter 88, p 9

Hall RCW(ed): Psychiatric Presentations of Medical Illness: Somatopsychic Disorders. New York, Spectrum Publications, 1980

Lewis DA, Smith RE: Steroid-induced psychiatric syndromes: A report of 14 cases and a review of the literature. J Affect Dis 5:319-332, 1983

McGinnis MY. Anabolic androgenic steroids and aggression: studies using animal models. Ann N Y Acad Sci. 2004 Dec;1036:399-415. Review.

McGinnis MY, Lumia AR, Breuer ME, Possidente B. Physical provocation potentiates aggression in male rats receiving anabolic androgenic steroids. Horm Behav. 2002 Feb;41(1):101-10.

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