Exercise Addiction

tired woman rests after running outside

While exercise addiction is not currently included in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5), there is a growing body of anecdotal, professional, and scientific evidence to show that it is a real and serious condition.

What is Exercise Addiction?

Exercise addiction is a compulsive disorder in which a person feels the uncontrollable need to exercise excessively. It goes beyond simple enjoyment of exercise and often results in injury or illness. Like other behavioral addictions, a person must demonstrate most of the following symptoms to be considered as suffering from exercise addiction:1

  • Loss of control: inability to control the urge to exercise or to stop exercising for a significant time, especially in the presence of an injury that requires time to heal.
  • Continuance: continuing to exercise even in the presence of injuries, physical problems, psychological issues, or interpersonal problems.
  • Intention effects: going beyond the original intended duration, frequency, or intensity of exercise without meaning to do so.
  • Time: spending a great deal of time engaging in, planning for, thinking about, or recovering from exercise.
  • Reduction in other activities: spending less time in social, occupational, or other situations as a direct result of exercise.
  • Tolerance: needing to exercise more often, for longer durations, or at higher intensity to feel the desired effect than you originally did.
  • Withdrawal: feelings of irritability, restlessness, or anxiety after a period without exercise.

Exercise addiction can occur independently or in conjunction with another disorder, such as anorexia nervosa or bulimia nervosa.2 There is some disagreement about what constitutes exercise addiction, which makes it difficult to determine how common the condition is. Some research studies equate exercise addiction with the commitment demonstrated by marathon runners. However, in more thoughtful and statistically sound research studies, excessive exercise is only considered an addiction when people report that they feel compelled to exercise and they have suffered serious physical, social, or occupational problems because of their exercise.2 These research studies agree that approximately 3% of people who exercise regularly are addicted to it; the condition is much more common in people in their late teens or early 20s.2 Other estimates have found that upward of 42% of regular gym-goers meet the criteria for exercise addiction;1 however, these are concentrated samples taken from locations with frequent or committed exercisers.

Has Your Exercise Become An Addiction?

female exercising While behavioral health and mental health tend to overlap, and many organizations substitute one term for the other, distinct differences do exist between the two. Many mental health disorders have neurological or biological causes, meaning that simply changing a person’s behavior may not cure them of that illness. Read More

How Does Exercise Addiction Develop?

There are two types of exercise addiction: primary exercise addiction and secondary exercise addiction. In each case, exercise addiction develops differently.

Primary Exercise Addiction

Primary exercise addiction is more common in males and usually develops in the response to endorphins.

Primary exercise addiction occurs as a form of behavioral addiction, but these people do not have any other psychological or behavioral conditions—exercise addiction is the main problem.2 Primary exercise addiction is more common in males and usually develops in response to the pleasurable effects of endorphins that are released during and after exercise.2 This is how exercise makes the body produce its own high, which is what primary exercise addicts become addicted to.

Secondary Exercise Addiction

Secondary exercise addiction occurs in conjunction with another disorder, most commonly eating disorders such as anorexia nervosa and bulimia nervosa.2 Secondary exercise addiction is more common in females and usually develops due to body image issues.2

Anorexia is an eating disorder involving self-starvation that leads to excessive weight loss. Even when people with this disorder are dangerously thin, they still believe they need to lose weight. Risk factors for anorexia include:3

  • A preoccupation with weight and body shape.
  • Having an anxiety disorder as a child.
  • Negative self-image.
  • Having eating problems during infancy or early childhood.
  • Holding strong or extreme social or cultural ideas about beauty, appearance, and health.
  • A preoccupation with being perfect.
  • Being overly concerned with rules.

When exercise addiction is accompanied by anorexia and the primary motivation for the individual is to lose weight, this condition is called anorexia athletica.1

Another cause for secondary exercise addiction is bulimia, which is a serious eating disorder that involves a cycle of binging and purging.4 Binging refers to eating a very large amount of food in a specific period of time (typically within 2 hours), often to the point of feeling sick. To compensate for the high intake of calories, some people will exercise excessively, which, over time, can develop into exercise addiction.4 The cause of bulimia is unknown, but it is thought to be caused by a combination of genetic, psychological, and cultural factors.4

Physical Side Effects

Exercise addiction is associated with a number of physical and psychological side effects, including:5

  • Detrimental social consequences.
  • Disturbed psychological functioning.
  • Exercising despite medical contraindications.
  • Interference with relationships or work.
  • Withdrawal symptoms such as agitation, anxiety, or restlessness after not exercising for a time.

One of the most serious physical consequences of compulsive exercise is an increased risk for injury or an increased number of exercise-related injuries.2 While regular exercise strengthens the muscles and bones, too much exercise increases the risk for stress fractures. Those who have existing injuries may aggravate their injuries and lengthen the amount of time needed to recover completely. Some examples of injuries caused by excessive exercise include:5

  • Joint inflammation/ damage.
  • Loss of muscle mass.
  • Sprained ligaments.
  • Strained or torn muscles or tendons.

Another physical risk associated with exercise addiction is menstrual disturbance in women.5 Due to an unhealthy body mass, the female body stops releasing eggs and the woman misses one or multiple periods.5 This is most common in females who have secondary exercise addiction accompanied by an eating disorder, but it can happen with primary exercise addiction as well.5

Exercise addiction is also commonly associated with substance abuse. Research suggests that 15%–20% of exercise addicts are also addicted to either nicotine, alcohol, or illicit drugs.1 Not only can these substances have adverse effects on the body on their own, but if you are already weakened by excessive exercise, a substance abuse problem could pose increased risks for harm.

Social and Psychological Side Effects

stressed athletic man rests on benchDue to the amount of time that exercise-addicted people spend exercising and obsessing about exercising, many suffer from dysfunctional relationships. Family and friends often feel left out, unable to approach the person, or upset about the way the exercise-addicted person chooses to spend their time. Even when friends and family members have the best intentions, approaching someone about compulsive exercise can also create relationship conflict.

Some people with this disorder skip classes or take unpaid time off from work to exercise, which interferes with their education and reduces their income. Exercise addiction can make it difficult to carry on a satisfying social life, since people with this disorder often skip special events and activities to exercise. Even exercising with other people is difficult, since compulsive exercisers do not like to have their routines disturbed. They would rather exercise on their own so they can control the components and timing of the exercise session.

Going 6 hours without exercising may provoke anxiety for someone addicted to exercise.

Exercise addiction can cause emotional distress, especially when accompanied by negative body image or a lack of self-esteem. In particular, people suffering from exercise addiction often experience symptoms of anxiety after a period without exercise.2 The length of time between exercise sessions is subjective: though going 24–48 hours without exercising may seem normal for most people, going 6 hours without exercising may provoke anxiety for someone addicted to exercise. If the person is prevented from exercising or is forced to reduce the frequency of exercise, they will likely experience irritability, guilt, anxiousness, and sluggishness.2 These feelings may also occur when a compulsive exerciser experiences a disruption in their exercise routine.

When someone has developed a primary exercise addiction, it is common for that person to suffer depression-like symptoms when forced to stop or reduce exercising.2 For people with primary exercise addiction, exercise is often used as a coping mechanism to deal with stress, so when that coping mechanism is taken away, they don’t know how to deal with the stress of daily life. These feelings of depression are often worsened by withdrawal from the exerciser’s regular endorphin fix.2

Treatment Options for Exercise Addiction

Exercise addiction is serious, but there are treatment options available. The first step in choosing a treatment option is figuring out whether you have a primary or secondary exercise addiction. Treatment will be most effective if the root cause of the problem is addressed first. If the underlying condition is anorexia nervosa, for example, then treatment should focus on the eating disorder.

Exercise addiction is challenging to treat because exercise is a healthy habit that should be incorporated into each person’s daily life.

Once the root problem is identified, the next step is to determine if another condition needs to be addressed first for health or safety reasons. For example, though exercise addiction can be extremely harmful, a co-occurring substance abuse problem may be more immediately threatening. In such cases, the substance abuse problem may need to be addressed first. It is important to consult with a medical professional and a mental health professional when seeking treatment for exercise addiction because the condition affects the physical body as much as your mental condition.

With the problems properly identified and prioritized, a behavioral health professional can help you begin treatment. Right now, there are no prescription drugs available for exercise addiction treatment, but research continues to discover if certain drugs can help you control your impulses to engage in harmful behaviors. A medical or mental health professional may prescribe medication to address symptoms that result from exercise addiction and exercise withdrawal, such as anxiety or depression. A medical professional may also prescribe medications to help with any physical injuries caused by excessive exercise.

Exercise addiction is challenging to treat because exercise is a healthy habit that should be incorporated into each person’s daily life. Also, what may seem like a challenging workout for one person may be easier for someone in better shape. So it becomes difficult to define what is within the bounds of normal, healthy exercise and what is harmful.

Exercise addiction treatment is further complicated by the fact that abstinence is not usually an option. While some people suffering from exercise addiction may need to take time off from exercise to recover from existing injuries, eventually exercise should be reincorporated into a daily routine.

Recognize dysfunctional thought patterns that lead to excessive exercise.

To get a better understanding of your specific case of exercise addiction, behavioral health professionals may use an assessment tool called the Exercise Dependence Scale.1 This tool is used to determine how severe your reliance on exercise is on an emotional and psychological level. As treatment progresses, a counselor or therapist may ask you to complete the assessment again to determine what progress you’ve made.

With primary exercise addiction, it is likely that you do not have any other coping skills for dealing with stress. In this case, treatment focuses on building healthy coping skills and using cognitive behavioral therapy to recognize dysfunctional thought patterns that lead to excessive exercise.1

In cases of secondary exercise addiction, the therapist focuses on self-esteem issues and distorted body image. Medications such as anti-depressants, anti-psychotics, and mood stabilizers are commonly prescribed in the early stages of eating disorder treatment.6 Other therapies include individual therapy, group therapy, nutritional counseling, and medical monitoring.1

As many as 35% of people with an eating disorder will relapse, and while exercise addiction further complicates the treatment process, recovery is possible.7 It is often a lifelong battle to establish healthy habits and boundaries that prevent normal eating and exercise patterns from reverting to excessive or overly controlled, but with the right treatment and continued support, you can go on to live a healthy life.

Sources

  1. Freimuth, M., Moniz, S., & Kim, S. R. (2011). Clarifying Exercise Addiction: Differential Diagnosis, Co-occurring Disorders, and Phases of Addiction. International Journal of Environmental Research & Public Health, 8(10), 4069–4081.
  2. Berczik, K., Szabo, A., Griffiths, M. D, Kurimay, T., Kun, B., Urban, R., & Demetrovics, Z. (2012). Exercise addiction: Symptoms, diagnosis, epidemiology, and etiology. Substance Use & Misuse, 47, 403–417.
  3. United States National Library of Medicine. (2016). Anorexia.
  4. United States National Library of Medicine. (2016). Bulimia.
  5. Pinheiro, A. P., Thornton, L. M., Plotonicov, K. H. P., Tozzi, F., Klump, K. L., Berrettini, et al. (2007). Patterns of Menstrual Disturbance in Eating Disorders. International Journal of Eating Disorders, 40, 424–434.
  6. National Institute of Mental Health. (2016). Eating Disorders.
  7. Carter, J. C., Blackmore, E., Sutandar-Pinnock, K., & Woodside, D. B. (2004). Relapse in anorexia nervosa: A survival analysis. Psychological Medicine, 34(4), 671–9.
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