Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-848d4c4894-75dct Total loading time: 0 Render date: 2024-05-16T20:18:43.123Z Has data issue: false hasContentIssue false

Chapter 1 - Exercise Addiction

Evolution and Challenges for Its Recognition as a Clinical Disorder

from Section 1 - From Exercise to Addiction: An Introduction to the Phenomenon

Published online by Cambridge University Press:  30 March 2023

By
Álvaro Sicilia ,
Manuel Alcaraz-Ibáñez ,
Adrian Paterna  and
Mark D. Griffiths
Edited by
Ornella Corazza  and
Artemisa Rocha Dores
Ornella Corazza
Affiliation:
University of Hertfordshire and University of Trento, Italy
Artemisa Rocha Dores
Affiliation:
Polytechnic Institute of Porto and University of Porto, Portugal
Get access

Summary

The potential negative effects of exercise addiction (EA) were first reported over 50 years ago, but it has only recently been formally recognized as a disorder in the leading clinical manuals. The inclusion of exercise behaviour as a potentially addictive behaviour will require greater consensus on how to define this disorder, with diagnostic criteria and course descriptions clearly supported by scientific evidence, and on how to categorize it in relation to other mental disorders. This chapter presents an overview of attempts to identify the defining features of EA, the development of instruments to measure it, estimates of its prevalence, and the main strategies for treating it. The diverse terminology used to describe this disorder reflects both the range of perspectives from which it has been examined, and the different manifestations of EA. The chapter concludes by recognizing that the development and validation of specific diagnostic criteria for EA pose many challenges.

Keywords

diagnostic criteriaexercise addictionmental disorderproblematic exercisetreatment
Type
Chapter
Information
The Body in the Mind
Exercise Addiction, Body Image and the Use of Enhancement Drugs
 , pp. 1 - 24
Publisher: Cambridge University Press
Print publication year: 2023

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Ashdown-Franks, G, Firth, J, Carney, R et al. Exercise as medicine for mental and substance use disorders: a meta-review of the benefits for neuropsychiatric and cognitive outcomes. Sports Med 2020; 50: 151–70.Google Scholar
Davis, C. Exercise abuse. Int J Sport Psychol 2000; 31: 278–89.Google Scholar
Szabo, A, Demetrovics, Z, Griffiths, MD. Morbid exercise behavior: addiction or psychological escape? In: Budde, H, Wegner, M, eds. The Exercise Effect on Mental Health: Neurobiological Mechanisms. Routledge, 2018: 277–311.Google Scholar
Baekeland, F. Exercise deprivation: sleep and psychological reactions. Arch Gen Psychiatry 1970; 22: 365–9.Google Scholar
Little, JC. Athletic neurosis: a deprivation crisis. Acta Psychiatr Scand 1969; 45: 187–97.Google Scholar
Morgan, WP. Negative addiction in runners. Phys Sportsmed 1979; 7: 56–70.Google Scholar
Fernandez, DP, Kuss, DJ, Griffiths, MD. Short-term abstinence effects across potential behavioral addictions: a systematic review. Clin Psychol Rev 2020; 76: 101828.CrossRefGoogle ScholarPubMed
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 5th ed. American Psychiatric Association, 2013.Google Scholar
World Health Organization. ICD-11 for Mortality and Morbidity Statistics. World Health Organization, 2019.Google Scholar
Grant, JE, Potenza, MN, Weinstein, A, Gorelick, DA. Introduction to behavioral addictions. Am J Drug Alcohol Abuse 2010; 36: 233–41.CrossRefGoogle ScholarPubMed
Griffiths, MD. Behavioural addiction: an issue for everybody? Empl Couns Today 1996; 8: 19–25.Google Scholar
Sussman, S, Sussman, AN. Considering the definition of addiction. Int J Environ Res Public Health 2011; 8: 4025–38.Google Scholar
Spada, MM. Commentary on: are we overpathologizing everyday life? A tenable blueprint for behavioral addiction research. Problems with atheoretical and confirmatory research approaches in the study of behavioral addictions. J Behav Addict 2015; 4: 124–5.CrossRefGoogle Scholar
Grant, JE, Chamberlain, SR. Expanding the definition of addiction: DSM-5 vs. ICD-11. CNS Spectr 2016; 21: 300–3.Google Scholar
Harvey, J, Beamish, R, Defrance, J. Physical exercise policy and the welfare state: a framework for comparative analysis. Int Rev Sociol Sport 1993; 28: 53–64.Google Scholar
Plymire, DC. Positive addiction: running and human potential in the 1970s. J Sport Hist 2004; 31: 297–315.Google Scholar
Maslow, AH. The Power of Self-Actualization. Sounds True, 1992.Google Scholar
Kimiecik, JC, Jackson, SA. Optimal experience in sport: a flow perspective. In: Horn, TS, ed. Advances in Sport Psychology. Human Kinetics, 2002: 501–27.Google Scholar
McInman, AD, Grove, JR. Peak moments in sport: a literature review. Quest 1991; 43: 333–51.CrossRefGoogle Scholar
Glasser, W. Positive Addiction. Harper & Row, 1976.Google Scholar
Adams, J. Understanding exercise dependence. J Contemp Psychother 2009; 39: 231–40.CrossRefGoogle Scholar
Allegre, B, Souville, M, Therme, P, Griffiths, MD. Definitions and measures of exercise dependence. Addict Res Theory 2006; 14: 631–46.Google Scholar
Estok, PJ, Rudy, EB. Physical, psychosocial, menstrual changes/risks, and addiction in the female marathon and nonmarathon runner. Health Care Women Int 1986; 7: 187–202.CrossRefGoogle Scholar
Hausenblas, HA, Symons-Downs, D. How much is too much? The development and validation of the exercise dependence scale. Psychol Health 2002; 17: 387–404.Google Scholar
Hausenblas, HA, Symons-Downs, D. Exercise dependence: a systematic review. Psychol Sport Exerc 2002; 3: 89–123.Google Scholar
Chapman, CL, De Castro, JM. Running addiction: measurement and associated psychological characteristics. J Sports Med Phys Fitness 1990; 30: 283–90.Google Scholar
Bamber, DJ, Cockerill, IM, Rodgers, S, Carroll, D. Diagnostic criteria for exercise dependence in women. Br J Sports Med 2003; 37: 393–400.CrossRefGoogle ScholarPubMed
Billieux, J, Schimmenti, A, Khazaal, Y, Maurage, P, Heeren, A. Are we overpathologizing everyday life? A tenable blueprint for behavioral addiction research. J Behav Addict 2015; 4: 119–23.Google Scholar
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th ed. American Psychiatric Association, 2000.Google Scholar
Brown, R. Some contributions of the study of gambling to the study of other addictions. In: Eadington, WR, Cornelius, JA, eds. Gambling Behavior and Problem Gambling. University of Nevada Press, 1993: 241–72.Google Scholar
Griffiths, MD. Exercise addiction: a case study. Addict Res 1997; 5: 161–8.CrossRefGoogle Scholar
Griffiths, MD. The evolution of the ‘components model of addiction’ and the need for a confirmatory approach in conceptualizing behavioral addictions. Düşünen Adam J Psychiatry Neurol Sci 2019; 32: 179–84.Google Scholar
Griffiths, MD. A ‘components’ model of addiction within a biopsychosocial framework. J Subst Use 2005; 10: 191–7.Google Scholar
Terry, A, Szabo, A, Griffiths, MD. The Exercise Addiction Inventory: a new brief screening tool. Addict Res Theory 2004; 12: 489–99.Google Scholar
Griffiths, MD, Szabo, A, Terry, A. The Exercise Addiction Inventory: a quick and easy screening tool for health practitioners. Br J Sports Med 2005; 39: e30.Google Scholar
Meyer, C, Taranis, L, Goodwin, H, Haycraft, E. Compulsive exercise and eating disorders. Eur Eat Disord Rev 2011; 19: 174–89.Google ScholarPubMed
Taranis, L, Touyz, S, Meyer, C. Disordered eating and exercise: development and preliminary validation of the Compulsive Exercise Test (CET). Eur Eat Disord Rev 2011; 19: 256–68.Google Scholar
Yates, A, Leehey, K, Shisslak, CM. Running—an analogue of anorexia? N Engl J Med 1983; 308: 251–5.CrossRefGoogle ScholarPubMed
McCabe, MP, Vincent, MA. Development of body modification and excessive exercise scales for adolescents. Assessment 2002; 9: 131–41.CrossRefGoogle ScholarPubMed
Veale, D. Does primary exercise dependence really exist? In: Annett, J, Cripps, B, Steinberg, H, eds. Exercise Addiction: Motivation for Participation in Sport and Exercise: Proceedings of British Psychological Society, Division of Sport and Exercise Psychology. British Psychological Society, 1995: 71–75.Google Scholar
Yates, A, Leehey, K, Shisslak, CM. Running—an analogue of anorexia? N Engl J Med 1983; 308: 251–5.CrossRefGoogle ScholarPubMed
Veale, D. Exercise dependence. Br J Addict 1987; 82: 735–40.Google Scholar
Blaydon, MJ, Lindner, KJ, Kerr, JH. Metamotivational characteristics of eating-disordered and exercise-dependent triathletes: an application of reversal theory. Psychol Sport Exerc 2002; 3: 223–36.Google Scholar
Blaydon, MJ, Lindner, KJ. Eating disorders and exercise dependence in triathletes. Eat Disord 2002; 10: 49–60.Google Scholar
Johnston, O, Reilly, J, Kremer, J. Excessive exercise: from quantitative categorisation to a qualitative continuum approach. Eur Eat Disord Rev 2011; 19: 237–48.Google Scholar
Alcaraz-Ibáñez, M, Paterna, A, Sicilia, A, Griffiths, MD. Morbid exercise behaviour and eating disorders: a meta-analysis. J Behav Addict 2020; 9: 206–24.Google Scholar
Bamber, DJ, Cockerill, IM, Rodgers, S, Carroll, D. “It’s exercise or nothing”: a qualitative analysis of exercise dependence. Br J Sports Med 2000; 34: 423–30.Google Scholar
Cook, B, Hausenblas, HA. The role of exercise dependence for the relationship between exercise behavior and eating pathology: mediator or moderator? J Health Psychol 2008; 13: 495–502.Google Scholar
Trott, M, Jackson, SE, Firth, J et al. A comparative meta-analysis of the prevalence of exercise addiction in adults with and without indicated eating disorders. Eat Weight Disord 2021; 26: 37–46.Google Scholar
Shroff, H, Reba, L, Thornton, LM et al. Features associated with excessive exercise in women with eating disorders. Int J Eat Disord 2006; 39: 454–61.Google Scholar
Klein, DA, Bennett, AS, Schebendach, J et al. Exercise ‘addiction’ in anorexia nervosa: model development and pilot data. CNS Spectr 2004; 9: 531–7.CrossRefGoogle ScholarPubMed
Zmijewski, CF. Howard, MO. Exercise dependence and attitudes toward eating among young adults. Eat Behav 2003; 4: 181–95.Google Scholar
Maselli, M, Gobbi, E, Probst, M, Carraro, A. Prevalence of primary and secondary exercise dependence and its correlation with drive for thinness in practitioners of different sports and physical activities. Int J Ment Health Addict 2019; 17: 89–101.Google Scholar
Blaydon, MJ, Lindner, KJ, Kerr, JH. Metamotivational characteristics of exercise dependence and eating disorders in highly active amateur sport participants. Pers Individ Dif 2004; 36: 1419–32.Google Scholar
Tod, D, Edwards, C. A meta-analysis of the drive for muscularity’s relationships with exercise behaviour, disordered eating, supplement consumption, and exercise dependence. Int Rev Sport Exerc Psychol 2015; 8: 185–203.Google Scholar
Tod, D, Edwards, C, Hall, G. Drive for leanness and health-related behavior within a social/cultural perspective. Body Image 2013; 10: 640–3.Google Scholar
Corazza, O, Simonato, P, Demetrovics, Z et al. The emergence of exercise addiction, body dysmorphic disorder, and other image-related psychopathological correlates in fitness settings: a cross sectional study. PLoS ONE 2019; 14: e0213060.Google Scholar
Foster, AC, Shorter, GW, Griffiths, MD. Muscle dysmorphia: could it be classified as an addiction to body image? J Behav Addict 2015; 4: 1–5.Google Scholar
Oberle, CD, Watkins, RS, Burkot, AJ. Orthorexic eating behaviors related to exercise addiction and internal motivations in a sample of university students. Eat Weight Disord 2018; 23: 67–74.Google Scholar
Cena, H, Barthels, F, Cuzzolaro, M et al. Definition and diagnostic criteria for orthorexia nervosa: a narrative review of the literature. Eat Weight Disord 2019; 24: 209–46.CrossRefGoogle ScholarPubMed
Di Nicola, M, Tedeschi, D, Mazza, M et al. Behavioural addictions in bipolar disorder patients: role of impulsivity and personality dimensions. J Affect Disord 2010; 125: 82–8.Google Scholar
Di Nicola, M, Martinotti, G, Mazza, M et al. Quetiapine as add-on treatment for bipolar I disorder with comorbid compulsive buying and physical exercise addiction. Prog Neuropsychopharmacol Biol Psychiatry 2010; 34: 713–14.CrossRefGoogle ScholarPubMed
Carmack, MA, Martens, R. Measuring commitment to running: a survey of runners’ attitudes and mental states. J Sport Psychol 1979; 1: 25–42.Google Scholar
Corbin, CB, Nielsen, AB, Borsdorf, LL, Laurie, DR. Commitment to physical activity. Int J Sport Psychol 1987; 18: 215–22.Google Scholar
Blumenthal, JA, Toole, LCO, Jonathan, L. Is running an analogue of anorexia nervosa? An empirical study of obligatory running and anorexia nervosa. JAMA 1984; 27: 520–3.Google Scholar
Pasman, LN, Thompson, JK. Body image and eating disturbance in obligatory runners, obligatory weightlifters, and sedentary individuals. Int J Eat Disord 1988; 7: 759–69.3.0.CO;2-G>CrossRefGoogle Scholar
Hailey, BJ, Bailey, LA. Negative addiction in runners: a quantitative approach. J Sport Behav 1982; 5: 150–4.Google Scholar
Freimuth, M, Moniz, S, Kim, SR. Clarifying exercise addiction: differential diagnosis, co-occurring disorders, and phases of addiction. Int J Environ Res Public Health 2011; 8: 4069–81.CrossRefGoogle ScholarPubMed
Davis, C, Brewer, H, Ratusny, D. Behavioral frequency and psychological commitment: necessary concepts in the study of excessive exercising. J Behav Med 1993; 16: 611–28.Google Scholar
Ogden, J, Veale, D, Summers, Z. The development and validation of the Exercise Dependence Questionnaire. Addict Res 1997; 5: 343–56.Google Scholar
Colledge, F, Buchner, U, Schmidt, A, Walter, M. Does exercise addiction exist? A brief review on current measurement tools and future directions. Ment Health Addict Res 2019; 4: 1–4.Google Scholar
Marques, A, Peralta, M, Sarmento, H et al. Prevalence of risk for exercise dependence: a systematic review. Sports Med 2019; 49: 319–30.Google Scholar
Symons-Downs, D, Hausenblas, HA, Nigg, CR. Factorial validity and psychometric examination of the Exercise Dependence Scale-Revised. Meas Phys Educ Exerc Sci 2004; 8: 183–201.Google Scholar
Lindwall, M, Palmeira, A. Factorial validity and invariance testing of the Exercise Dependence Scale-Revised in Swedish and Portuguese exercisers. Meas Phys Educ Exerc Sci 2009; 13: 166–79.Google Scholar
Sicilia, A, González-Cutre, D. Dependence and physical exercise: Spanish validation of the Exercise Dependence Scale-Revised (EDS-R). Span J Psychol 2011; 14: 421–31.Google Scholar
Müller, A, Claes, L, Smits, D et al. Validation of the German version of the Exercise Dependence Scale. Eur J Psychol Assess 2013; 29: 213–19.Google Scholar
Costa, S. Psychometric examination and factorial validity of the Exercise Dependence Scale-Revised in Italian exercisers. J Behav Addict 2012; 1: 186–90.Google Scholar
Szabo, A, Pinto, A, Griffiths, MD, Kovácsik, R, Demetrovics, Z. The psychometric evaluation of the Revised Exercise Addiction Inventory: improved psychometric properties by changing item response rating. J Behav Addict 2019; 8: 157–61.Google Scholar
Meyer, C, Plateau, CR, Taranis, L et al. The Compulsive Exercise Test: confirmatory factor analysis and links with eating psychopathology among women with clinical eating disorders. J Eat Disord 2016; 4: 1–9.Google Scholar
Plateau, CR, Shanmugam, V, Duckham, RL et al. Use of the Compulsive Exercise Test with athletes: norms and links with eating psychopathology. J Appl Sport Psychol 2014; 26: 287–301.CrossRefGoogle Scholar
Griffiths, MD, Urbán, R, Demetrovics, Z et al. A cross-cultural re-evaluation of the Exercise Addiction Inventory (EAI) in five countries. Sports Med Open 2015; 1: 1–7.Google Scholar
Mónok, K, Berczik, K, Urbán, R et al. Psychometric properties and concurrent validity of two exercise addiction measures: a population wide study. Psychol Sport Exerc 2012; 13: 739–46.CrossRefGoogle Scholar
Lejoyeux, M, Avril, M, Richoux, C, Embouazza, H, Nivoli, F. Prevalence of exercise dependence and other behavioral addictions among clients of a Parisian fitness room. Compr Psychiatry 2008; 49: 353–8.CrossRefGoogle ScholarPubMed
Serier, KN, Smith, JE, Lash, DN et al. Obligatory exercise and coping in treatment-seeking women with poor body image. Eat Weight Disord 2018; 23: 331–8.Google Scholar
Sicilia, A, Paterna, A, Alcaraz-Ibáñez, M, Griffiths, MD. Theoretical conceptualizations of problematic exercise in psychometric assessment instruments: a systematic review. J Behav Addict 2021; 10: 4–20.Google Scholar
Szabo, A, Frenkl, R, Caputo, A. Relationship between addiction to running, commitment to running, and deprivation from running: a study on the Internet. In: European Yearbook of Sport Psychology, Vol. 1. European Federation of Sport Psychology, 1997: 130–47.Google Scholar
Weik, M, Hale, BD. Contrasting gender differences on two measures of exercise dependence. Br J Sports Med 2009; 43: 204–7.Google Scholar
Hausenblas, HA, Giacobbi, PR. Relationship between exercise dependence symptoms and personality. Pers Individ Dif 2004; 36: 1265–73.CrossRefGoogle Scholar
Szabo, A, Griffiths, MD, de La Vega, R, Mervó, B, Demetrovics, Z. Methodological and conceptual limitations in exercise addiction research. Yale J Biol Med 2015; 88: 303–8.Google Scholar
Chamberlain, SR, Grant, JE. Is problematic exercise really problematic? A dimensional approach. CNS Spectr 2020; 25: 64–70.Google Scholar
Adams, J, Kirkby, R. Exercise dependence: a problem for sports physiotherapists. Aust J Physiother 1997; 43: 53–8.Google Scholar
Weinstein, AA, Koehmstedt, C, Kop, WJ. Mental health consequences of exercise withdrawal: a systematic review. Gen Hosp Psychiatry 2017; 49: 11–18.CrossRefGoogle ScholarPubMed
Colledge, F, Cody, R, Pühse, U, Gerber, M. Responses of fitness center employees to cases of suspected eating disorders or excessive exercise. J Eat Disord 2020; 8: 1–9.Google Scholar
Prochaska, JO, Redding, CA, Evers, KE. The transtheoretical model and stages of change. In: Glanz, K, Rimer, BK, Viswanath, K, eds. Health Behavior. Theory, Research, and Practice. Jossey-Bass, 2015: 125–48.Google Scholar
Petry, NM. Pathological Gambling: Etiology, Comorbidity, and Treatment. American Psychological Association, 2005.Google Scholar
Corazza, O, Simonato, P, Demetrovics, Z et al. The emergence of exercise addiction, body dysmorphic disorder, and other image-related psychopathological correlates in fitness settings: a cross sectional study. PLoS ONE 2019; 14: 1–17.Google Scholar
Shaffer, HJ, LaPlante, DA, LaBrie, RA et al. Toward a syndrome model of addiction: multiple expressions, common etiology. Harv Rev Psychiatry 2004; 12: 367–74.Google Scholar
Egorov, AY, Szabo, A. The exercise paradox: an interactional model for a clearer conceptualization of exercise addiction. J Behav Addict 2013; 2: 199–208.Google Scholar
Kardefelt-Winther, D, Heeren, A, Schimmenti, A et al. How can we conceptualize behavioural addiction without pathologizing common behaviours? Addiction 2017; 112: 1709–15.Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×