Katherine Schreiber once exercised up to four hours a day, picked her job in New York City because it was next to a gym, canceled dates in order to work out and couldn’t sleep if she hadn’t done her time on a treadmill. Something healthy and enjoyable had veered into damaging and compulsive behavior. When Schreiber tried to learn more about what was behind what she was thinking and doing, though, she came up short. That led her to co-write The Truth About Exercise Addiction: Understanding the Dark Side of Thinspiration.
Schreiber teamed with Heather A. Hausenblas, PhD, a career researcher on exercise dependence and an associate professor at Jacksonville University, in Jacksonville, Florida. Hausenblas’s research was among the little that Schreiber found when searching for science to support her conclusion that exercise addiction is real and not simply too much of a good thing. “I have been researching ED for about 20 years,” Hausenblas says, referring to exercise disorder, which is not included in the Diagnostic and Statistical Manual of Mental Disorders (DSM-V). “The goal is to have [ED] recognized as a behavioral addiction in the next DSM. The worst cases I’ve seen are people who can’t stop exercising despite severe pain from overuse injuries, [or even when their need to exercises causes] relationships and jobs to fail.”
Hausenblas, who has co-authored five other scientific books, developed a scale as a means for health professionals and patients to determine when extreme exercising has crossed into something addictive and potentially harmful. The Exercise Dependence Scale has been translated into 11 languages and is part of the new book. To develop the screening scale Hausenblas and a fellow researcher applied guidelines based on indicators for substance abuse and behavioral addictions such as gambling. If someone has three or more of the following indicators, says Hausenblas, there’s cause for concern:
- Tolerance: increasing the amount of exercise to chase a feeling, “buzz” or sense of satisfaction;
- Withdrawal: when the person isn’t exercising they feel anxious, irritable, restless, have trouble sleeping or experience other negative consequences;
- Lack of control: an inability to reduce or stop exercising;
- Intention effect: The individual cannot stay within planned limits on time or amount of exercise intended;
- Time: Preparing for, participating in and recovering from exercise engulfs a large amount of time;
- Reductions in other activities: time shrinks or stops for work, social relationships and other recreational activities to allow more time for exercising;
- Continuance: continuing to exercise despite knowing that the activity is causing or worsening physical, psychological and/or interpersonal problems.
The Truth About Exercise Addiction also includes first-person stories about what it’s like to live with ED. “I think it helps to read about other people like yourself going through something like this, so you don’t feel so alone,” says Schreiber, 26, a blogger now working on her master’s in creative non-fiction. “I know that was a real comfort to me.” Exercise addiction is new enough that sufferers seldom seek treatment for it directly, Schreiber says. It is often discovered after the person seeks help for something else. Maybe they injure themselves by exercising on strained tendons, or suffer anxiety or depression when not able to exercise. But nearly half of those with eating disorders also suffer ED, Schreiber says. Compulsive exercisers may be suffering from a primary addiction, a secondary addiction, in this case almost always meaning the compulsive exercise is in service to an eating disorder, or what’s called a “transfer addiction,” in which someone essentially trades one addiction in for another. For example, some patients who got lap band surgery to treat morbid obesity began compulsively shopping or gambling when they were unable to feed their eating disorder after having surgery.
Schreiber thinks her condition falls under this last category. As a child, Schreiber was traumatized after her father moved out and her parents divorced. She started smoking marijuana at age 12, then soon began drinking, and was eventually put into a two-week rehab for substance abuse and self-harming behavior. An Idaho “scared straight” boot camp followed. After seven months in rehab treatment for anorexia, her body weight had normalized, Schreiber says, but she lacked a way to get the rush she craved. “I would sneak off to my room obsessively do push-ups and jump squats,” she remembers. The eating disorder came and went over the years; at one point the 5-foot-6-inch Schreiber weighed less than 100 pounds. Once she graduated from college, the exercise addiction consumed her, she says. “People say, ‘Oh, gee, I wish I had that addiction,’ but that’s part of the whole ‘thinspiration’ problem, this widespread view of extremism about body weight,” Schreiber says. Studies show that exercise dependence strikes about 3% of the general population, including gym-goers. However, as many as 52% of triathletes suffer from ED.
There are no protocols yet for treating ED, but approaches may include antidepressants and cognitive behavioral therapy, along with other types of talk therapy. Since physical activity is part of a healthy lifestyle, abstinence is not the goal, but rather re-learning a healthy, balanced approach to exercise. Some people have found it helpful to hire a personal trainer who sets limits on reasonable amounts of activity. Schreiber says that she still struggles with ED, and though she has become more flexible about scheduling her time, she admits, “I haven’t missed a day working out in three years.”