Exercise Addiction 101

Exercise addiction, also known as exercise dependence, compulsive exercise, obligatory exercise and anorexia athletica isn’t always easy to recognize, especially since regular (even rigorous) physical activity is most often seen as a healthy habit and even a crucial part of recovery for other types of addiction. There’s also a fine line between competitive training and damaging, compulsive behavior. And if exercise dependence is tough to spot, it can be even harder to admit. In fact, downplaying the time spent exercising or obsessing about workouts is a common warning sign. You or someone you care about may even have several gym memberships as a way to conceal how much you’re actually exercising. That’s why it’s essential to understand the basics about this disorder, including causes, telltale symptoms and risk factors that may be involved.

When it comes to exercise addiction, you should know:

  • Exercise addiction is a repetitive behavior, or behavioral addiction, similar to gambling, sex, porn and video game addictions, among others.
  • An addiction to exercise isn’t very common: An estimated 0.3% of the total U.S. population is at risk, according to exercise addiction expert Heather A. Hausenblas, PhD.
  • There are two types of exercise addiction: primary exercise addiction, where the physical activity is the gratification in itself, and secondary exercise addiction, in which physical activity is secondary to an eating disorder and used to control and manipulate weight, according to research published in the International Journal of Environmental Research and Public Health.
  • Exercise addicts often also struggle with depression, anxiety and neuroticism.
  • Eating disorders are the most common disorder to co-occur with exercise addiction. Approximately 39% to 48% of people suffering with anorexia, bulimia or another eating disorder also suffer from secondary exercise addiction. 
  • Exercise addiction can lead to extreme weight loss, overuse injuries, exhaustion, depression, heart problems and more.
  • While there’s no formal method for treating addiction, experts have found cognitive and behavioral therapies (alone or in combination) to be effective.

Causes

If you go to the gym every day to stay fit, don’t panic: That alone doesn’t mean you’re an exercise addict. Like other addictions, there are no simple answers when it comes to how exercise addiction develops. That said, the following factors have been shown to play a crucial role in the compulsive need to exercise:

Physiological factors: For those with addictive tendencies, managing the stressors and struggles or life can seem impossible without turning to an addictive substance or behavior for solace. Exercise triggers the brain’s reward system – the same area of the brain affected by substance use – releasing dopamine, the body’s pleasure hormone, during a high-impact sweat session. This feel-good sensation is primarily what keeps an exercise addict coming back for more.

Personality: For a person with exercise addiction, physical activity becomes the primary way to cope and control negative emotions. It makes sense, then, that people with exercise addiction tend to struggle with depression, anxiety and neuroticism, according to exercise addiction specialist Heather A. Hausenblas, PhD. Generally speaking, those with these personality types are also more vulnerable to exercise addiction, according to Hausenblas:

  • Obsessive-compulsive
  • Neurotic
  • Anxious
  • Extroverts with high energy
  • Perfectionists
  • Egocentrics

Genetics: While studies haven’t found a genetic link to primary exercise addiction, when the problem is secondary to an eating disorder, DNA does count. One study, done by researchers from University of Iowa and the University of Texas Southwestern Medical Center, found that people with mutations in two different genes – ESRRA and HDAC4 – had a 90% and 85% chance of an eating disorder, respectively.

Another addiction: Having another addiction may also up a person’s risk for developing a need to over exercise. In fact, 25% of obligatory exercisers exhibit signs of other behavioral addictions – including eating, gambling, sex and shopping addictions – and 15% are also addicted to nicotine, alcohol or illicit drugs, according to a review of 83 studies examining 11 addictions.

Societal pressure: The trend of “fitspiration” (or “fitspo” or “fitbies”) is also fueling exercise addiction, according to Hausenblas. This term, short for fitness and inspiration are messages meant to inspire people to exercise and maintain a healthy weight but instead raise body image standards to a level that can only be achieved by an extremely strict diet and vigorous exercise routine, Hausenblas cautions. One example: An image of a bikini-clad woman jogging on the beach has a caption that reads: “Exercise is like an addiction. Once you’re in it, your body needs it.”

Symptoms of Exercise Addiction

So how can you distinguish between a dedicated exerciser and someone with an exercise addiction? It’s not the intensity or time spent training that matters most; in fact, there are thousands of avid gym-goers who well surpass the 30 minutes, five days-a-week minimum guidelines recommended by the U.S. Department of Health and Human Services, and the vast majority of these are by no means exercise addicts.

What counts most when determining whether someone is addicted or not, says Hausenblas, is the motivation behind exercise.

An exercise addict needs physical activity to feel normal and can suffer withdrawal symptoms like anxiety and irritability if he or she skips even a single workout session. It’s also common for someone with exercise addiction to work out (and go full throttle) despite illness or injury; he or she may feel unable to stop and allow time for rest and recovery. Similarly, the need to exercise begins to interfere with work/school, personal relationships and other ways to have fun or be social. It’s common, for example, for a person who’s compulsive about exercise to spend more than hour in motion (even if the intent was 30 minutes), or much more than that, and, as a result, miss or arrive late to an important work event or social obligation, explains Hausenblas.

Because the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), the handbook of psychiatric disorders used by mental health professionals, has yet to recognize exercise addiction as a disorder, there are no widely agreed-on diagnostic criteria either. One tool used to measure whether a person’s exercise patterns share similarities to an addiction, however, is “The Exercise Dependence Scale,” created by psychologists Hausenblas and Danielle Symons Downs, PhD, associate professor of kinesiology and obstetrics and gynecology at Penn State. The 21-item screening scale, based on indicators for substance abuse and behavioral addictions like gambling, sex, porn and video game addictions, includes seven subscales that assess:

  • Tolerance: more and more physical activity over time to chase a feeling, whether a ”buzz,” sense of accomplishment or calmness
  • Withdrawal: symptoms such as anxiety, irritability, restlessness and sleep problems in the absence of exercise
  • Continuance: continuing to workout in spite of negative consequences, such as missed responsibilities, interpersonal problems, physical injuries or mental health issues
  • Lack of control: an inability to reduce or stop exercising for a certain period of time
  • Reduction in other activities: choosing exercise over work/school and time spent with friends and family
  • Time: an excessive amount of time working out and thinking about, planning for and recovering from workouts
  • Intention: unable to stick to one’s intended routine as evidenced by exceeding the amount of time devoted to exercise or consistently going beyond the intended amount

Another measure of exercise addiction is the “Exercise Addiction Inventory” (EAI), developed by psychologist Mark Griffiths, PhD, which includes a six-item questionnaire. Answers are rated on a five-point scale, including strongly disagree (1) disagree (2) uncertain (3) agree (4) strongly agree (5). Those most at risk of exercise addiction would score 24 or more out of 30; those with a score of 13 to 23 are at potential risk; and those with a score of 0 to 12 are very unlikely to an addiction to exercise.

The six questions for the EAI are:

  1. Exercise is the most important thing in my life.
  2. Conflicts have arisen between me and my partner about the amount of exercise I do.
  3. I use exercise as a way of changing my mood (e.g., to get a buzz/to escape).
  4. Over time I have increased the amount of exercise I do in a day.
  5. If I have to miss an exercise session I feel moody and irritable.
  6. If I cut down the amount of exercise I do and then start again, I always end up exercising as often as I did before.

Since overtraining is a big part of exercise addiction, it’s also important to be able to recognize in yourself or your loved one the physical and mental signs of overtraining, which are defined by the American Council of Exercise as:

  • Decreased performance
  • Loss of coordination
  • Prolonged recovery
  • Elevated morning heart rate
  • Elevated resting blood pressure
  • Headaches
  • Loss of appetite
  • Muscle soreness/tenderness
  • Gastrointestinal disturbances
  • Decreased ability to ward off infection
  • Increased incidence of musculoskeletal injuries
  • Disturbed sleep patterns
  • Depression
  • Apathy
  • Difficulty concentrating
  • Emotional sensitivity
  • Reduced self-esteem

Risk Factors

The more you know about exercise addiction, the better your chances of preventing a problem before it starts or stopping it from getting worse. Here are several red flags that raise risk:

Gender: Men are most prone to primary exercise addiction; though when exercise is secondary to an eating disorder, it’s women who are at an increased risk. (Only about 5% to 15% of people with anorexia or bulimia are male, according to the National Association of Anorexia Nervosa & Associated Disorders.)

Age: The peak time for developing exercise addiction is between the age of 18 and 24, with rates at their lowest after age 45, when more adults start working out less often.

Eating disorders: While anyone can fall into problematic exercise behavior, it’s very common for people with an eating disorder like anorexia or bulimia to cope using obsessive exercise. Nearly 50% of people with one of these problems also experience secondary exercise addiction, using workouts as a way to control weight and/or purge “excess” calories.

Environment: Training and participating in triathlons, marathons and other highly demanding endurance events definitely doesn’t make you an exercise addict, but those with compulsive tendencies do tend to gravitate toward these types of activities, often in an attempt to mask their addiction. After all, in these circles, it’s socially accepted to exercise a great deal, for very long periods of time, says Hausenblas. Not surprisingly, those with an addiction also tend to choose professions in the fitness industry. 

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