Women who read Fifty Shades of Grey are more likely to have abusive partners and eating disorders, according to academics concerned about the blockbuster novel's impact.
A study at Michigan State University found it was linked to "unhealthy behaviours" including binge drinking, unsafe sex and other risks associated with being an "abusive relationship".
Lead researcher Dr Amy Bonomi has previously argued the best-seller was "perpetuating dangerous abuse standards", romanticising a plot where the lead female character becomes "disempowered and entrapped".
Christian Grey, the main character, uses "strategies typical of abusers", including stalking, intimidation, social isolation and sexual violence, the study found.
Its affect on the character of Anastasia was "typical of abused women", the report said, causing the change in her identity, fear and feelings of helplessness.
Academics argued that the plot perpetuates violence against women and normalises it by romanticising the fictional relationship.
The latest study did not distinguish whether women experienced the negative emotional and health behaviours before or after reading Fifty Shades but Dr Bonomi said both scenarios were concerning.
"If women experienced adverse health behaviours such as disordered eating first, reading Fifty Shades might reaffirm those experiences and potentially aggravate related trauma," she said.
"Likewise, if they read Fifty Shades before experiencing the health behaviours seen in our study, it's possible the books influenced the onset of these behaviours."
The study by the university's Department of Human Development and Family Studies appeared in the Journal of Women's Health and is the first to investigate the relationship between health risks and popular fiction depicting violence against women.
Previous research has found links between watching violent television and films and real-life violence, as well as between reading glamour magazines and becoming obsessed with body image.
Out of more than 650 women between the ages of 18 and 24 questioned, those who had read the first Fifty Shades novel were 25 per cent more likely to have a partner who yelled or swore at them, 34 per cent more likely to have a partner who demonstrated stalking tendencies, and more than 75 per cent more likely to have used diet aids or fasted for more than a day.
Those who read all three books in the series were 65 per cent more likely than non-readers to binge drink and two thirds more likely to have five or more sexual partners during their lifetime.
The study also cited the Twilight novels as "normalising abuse" in relationships as well as internet pornography.
Dr Bonomi, who has a degree in health services and a master's in public health, said she supports to right of women to read what they want and make their own choices in their love lives and would not see the book banned.
She suggested parents and teachers should engage children in constructive conversations about sexuality, body image and gender roles early to help them understand the risk factors for violent and abusive relationships.
Teenagers should also be taught to consume fiction, television, movies, magazines and other media with a critical eye, Dr Bonomi said.
"We recognise that the depiction of violence against women in and of itself is not problematic, especially if the depiction attempts to shed serious light on the problem," she added.
"The problem comes when the depiction reinforces the acceptance of the status quo, rather than challenging it."
E.L James' trilogy of books have so far sold more than 100 million copies worldwide and a long-awaited film starring Dakota Johnson and Jamie Dornan is due to be released in February.