Behind the bulk: one young man's story of steroid addiction, body obsession, and getting clean. (Close-up: Steroids).

Every time he passed a mirror, Craig Costa flexed, his muscles. He wanted to look "insanely big--like an action figure."

"When I walked into a room, I wanted heads to turn," he says. People did notice Craig's 225-pound, 5-foot 9-inch frame. But what they didn't see was the physical damage and psychological turmoil going on inside. The story behind the bulk was five years of steroid abuse and a struggle with muscle dysmorphia, a condition in which a person has a distorted image of his or her body (see sidebar). Men with this condition think that they look small and weak, even if they are large and muscular.

ILLEGAL AND GRIM

It all started when Craig was 18. Before a trip to Walt Disney World in Orlando, Fla., he was feeling overweight. He wanted to look good with his shirt off so he resolved to get fit. A student at Bristol Community College, in Fall River, Mass.. he started going to a nearby gym. Running on the treadmill, he slimmed down fast, losing 20 pounds in a month.

But lean wasn't Craig's ideal. "My whole priority was, I wanted people to say, 'That guy's huge."

He lifted weights and experimented with steroidal supplements, also called dietary supplements. These drugs promise to build muscles. Despite potential risks and unclear effectiveness, they can be bought legally over the counter at many stores.

But what Craig was looking for couldn't be bought in a store. So he turned to anabolic steroids, drugs derived from the male sex hormone testosterone.

Under a doctor's supervision, anabolic steroids have some legitimate medical uses, as do corticosteroids, a different type of steroid used to reduce swelling. But to use steroids as Craig did, for muscle-building in a healthy body, is illegal. This didn't stop him. Neither did the many grim potential side effects (see sidebar, left).

Craig thought he knew exactly what he was getting into. And like 4 percent of high school seniors (according to a 2002 NIDA-funded study) and an estimated hundreds of thousands of adults, he took steroids anyway.

HEART PROBLEMS

Craig's appearance was that important to him. "The scale was my enemy. Every pound meant so much to me' he says.

Craig constantly compared himself to others. He drove his friends and family crazy asking, "Is that guy bigger than me? What about that guy?"

He never had complete satisfaction. "Some days, I'd be arrogant; wearing shorts to show off my quads. Other days, I'd be a disaster. On a non-lifting day, I'd have to wear big, baggy clothes."

Craig's steroid use escalated over time. He had begun by taking oral steroids (pills) exclusively. But when he heard that injectable steroids were more effective, he overcame a fear of needles. At his worst, he was injecting three to four times a day and taking 10 pills on top of that.

The drugs took their toll. Craig's hair fell out; acne popped up all over his back; his face swelled. Then, something even more serious happened: He started having chest pains.

Craig was having heart problems of the emotional sort, too. "I don't even remember how much of a jerk I was," he says.

NEW PRIORITIES

There was a lot of screaming and yelling at home, and ultimately, the end of his marriage and a custody battle over his 1-year-old son, Jake. Craig's wife said that Craig, then 25, couldn't see their child until he passed a drug test. That was the moment when everything changed for Craig. He knew he had to quit.

On Father's Day, 2001, Craig went cold turkey. He knew he needed help, so his parents found him a psychiatrist, who treated him through the better part of a year.

Today, Craig's priorities have changed. He still wants to be a head-turner, but for a different reason. "Now I'd rather be walking into a room with my son [who is now 2] and have people thinking, 'Wow, he's the greatest dad in the world."

RELATED ARTICLE: ROID RAGE 

Steroids can mess with your head. They can even make you violent. Dr. Harrison Pope said, "I have consulted on several cases where previously non-violent individuals committed murders when under the influence of steroids."

In 2000, Dr. Pope conducted a NIDA-supported study which showed that, along with violent behavior, high doses of steroids can cause extreme fluctuations in emotions, from euphoria (bliss) to rage.

These psychiatric symptoms may be a result of steroids' effect on the brain. Steroids act on the limbic system, which is involved in mood, memory, and learning. There, the drug disrupts the normal functioning of neurons--hence, the overly aggressive behavior and mood swings.

LOOKS CAN BE DECEIVING

Steroids unquestionably work extremely well--no denying it," says Dr. Harrison Pope of McLean Hospital in Belmont, Mass. "But they will probably shorten your life expectancy. By how much, we still don't know."

On the outside, steroid abusers look big and strong, but on the inside, they're weak. Their organs take a beating, and their bodies turn on them in all kinds of ways. Here's some of the tough stuff that anabolic steroid users may encounter.

MOOD SWINGS

Steroids disrupt the functioning of the brain's limbic system, which influences mood

CONFUSED HORMONES

Steroids confuse the hypothalamus, the part of the brain that controls sex hormones. Boys can develop breasts; girls can get deep voices and facial hair. Both sexes risk reproductive problems, including infertility.

STUNTED GROWTH

Steroids can trick the brain into signaling the bones to stop growing. Teens who--steroids may never reach their full adult height.

INFECTION

Monsterile injection techniques and sharing needles put abusers at risk for life-threatening diseases, including HIV and hepatitis B and C.

More Than a Bad Hair Day

Ever had a bad hair day or a pimple and felt that you couldn't focus on anything else? Imagine if a small flaw (real or imagined) took over your life. That's what it's like for an estimated one to two percent of Americans with body dysmorphic disorder, or BDD.

Like anorexia nervosa, the eating disorder that causes people to see themselves as fat even as they starve their bodies into dangerous thinness, BDD involves a distortion in body image. In extreme cases, people with HOD can spend hours glued to a mirror or even become suicidal. As you've read, the disorder can also lead to steroid abuse.

We talked to Dr. Roberto Olivardia, the psychiatrist who treated Craig and Dr. Pope's co-author, to find out more.

What is BDD?

A: It's when you're very, very bothered by a part of your appearance. Craig focused on his muscularity, but BDD can be a preoccupation with any body part--your hair, skin, nose.

Q: What causes BDD?

A: We live in a culture that praises a perfect appearance. But that's only part of the picture. There are also deeper psychological roots.

Q: How do I know if I have BDD?

A: Ask yourself: How much of my self-esteem is wrapped up in how I look? Does it prevent me from going to school? Am I still hanging out with friends?

Q: How can I get help for BDD?

A: The best treatment for the disorder is psychotherapy (counseling).

Check your local PBS listings or inthemix.org for a program on steroids, airing May 3-10.