Clarifying Exercise Addiction: Differential Diagnosis, Co-occurring Disorders, and Phases of Addiction
1. Introduction: Exercise as an Addiction
Defining Exercise Addiction
- Tolerance: increasing the amount of exercise in order to feel the desired effect, be it a” buzz” or sense of accomplishment;
- Withdrawal: in the absence of exercise the person experiences negative effects such as anxiety, irritability, restlessness, and sleep problems ;
- Lack of control: unsuccessful at attempts to reduce exercise level or cease exercising for a certain period of time;
- Intention effects: 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;
- Time: a great deal of time is spent preparing for, engaging in, and recovering from exercise;
- Reduction in other activities: as a direct result of exercise social, occupational, and/or recreational activities occur less often or are stopped;
- Continuance: continuing to exercise despite knowing that this activity is creating or exacerbating physical, psychological, and/or interpersonal problems.
2. Results and Discussion
2.1. Distinguishing Exercise Addiction from Other Disorders
2.2. Exercise Addiction, Exercise Compulsion, or Impulse Control Disorder?
2.3. Addictions that Co-Occur with Exercise Addiction
2.4. When is Frequent Exercise Not an Addiction?
Sally makes a New Year’s Resolution to “get in shape.” She begins going to the gym every morning before work. She enjoys how exercise has improved her strength and appearance but enjoys running the most because it helps her forget her worries and leaves her feeling relaxed. She begins running longer distances on the treadmill. As her endurance increases, she decides to train for a five-mile race with a group of other runners. She follows this program to the letter. After successfully completing the race, she feels wonderful and decides to continue the training regimen on her own, gradually increasing her distance. One day, while running on the treadmill, Sally twists her ankle. She has a severe sprain and her doctor recommends she stop running for the next few weeks. On the first day of refraining from exercise, Sally feels a little irritable. Over the next few days, she just doesn’t seem herself; she misses running and wonders if she is depressed. She begins to think the doctor over-reacted and decides to go to the gym just to lift some weights. She does this for two days but on the third day she cannot resist the urge to get on the treadmill; she runs until her ankle gives out.
2.4.1. Phase One: Recreational Exercise
2.4.2. Phase Two: At-Risk Exercise
- The Thermogenic Hypothesis: exercise increases body temperature, thereby reducing somatic anxiety. This decrease in anxiety is related to an increased temperature in certain brain regions ;
- The Catecholamine Hypothesis: exercise releases catecholamines, which are strongly implicated in control of mood, attention, and movement as well as endocrine and cardiovascular responses linked to stress ;
- The Endorphin Hypothesis: exercise releases endorphins, which are opiates that occur naturally in the body. This pleasurable experience of exercise may have unplanned consequences. With regular intense aerobic exercise, the increased endorphin production results in the brain down-regulating endorphin production. If this happens, the person will need to continue the exercise in order to maintain the natural balance in the brain .
2.4.3. Phase Three: Problematic Exercise
2.4.4. Phase Four: Exercise Addiction
3. Implications and Conclusions
3.1. Assessment and Treatment Implications
- American Psychiatric Association. DSM 5 Development. 2010. Available online: http://www.dsm5.org/Pages/Default.aspx accessed on 30 September 2011.
- Freimuth, M. Addicted? Recognizing Destructive Behavior before It’s too Late; Rowman & Littlefield Publishers, Inc: Lanham, MD, USA, 2008. [Google Scholar]
- Hausenblas, HA; Downs, DS. How much is too much? The development and validation of the Exercise Addiction scale. Psychology and Health 2002, 17, 387–404. [Google Scholar]
- Downs, DS; 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]
- American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders (Text Revision), 4th ed.; American Psychiatric Association: Washington, DC, USA, 2000.
- Aidman, EV; Woollard, S. The influence of self-reported exercise addiction on acute emotional and physiological responses to brief exercise deprivation. Psychol. Sport Exerc 2003, 4, 225–236. [Google Scholar]
- Allegre, B; Souville, M; Therme, P; Griffiths, M. Definitions and measures of exercise dependence. Addict. Res. Theory 2006, 14, 631–646. [Google Scholar]
- Allegre, B; Therme, P; Griffiths, M. Individual factors and the context of physical activity in exercise dependence: A prospective study of “ultra-marathoners”. Int. J. Ment. Health Addict 2007, 5, 233–243. [Google Scholar]
- De Coverley Veale, DM. Exercise addiction. Br. J. Addict 1987, 82, 735–740. [Google Scholar]
- Terry, A; Szabo, A; Griffiths, M. The exercise addiction inventory: A new brief screening tool. Addict. Res. Theory 2004, 12, 489–499. [Google Scholar]
- Zmijewski, CF; Howard, MO. Exercise Addiction and attitudes toward eating among young adults. Eat. Behav 2003, 4, 181–195. [Google Scholar]
- Sussman, S; Lisha, N; Griffiths, M. Prevalence of the addictions: A problem of the majority or the minority? Eval. Health Prof 2011, 34, 3–56. [Google Scholar]
- Lejoyeux, M; Avril, M; Richoux, C; Embouazza, H; Nivoli, F. Prevalence of exercise addiction and other behavioral addictions among clients of a Parisian fitness room. Comprehensive Psychiatry 2008, 49, 353–358. [Google Scholar]
- Meyer, C; Taranis, L; Goodwin, H; Haycraft, E. Compulsive exercise and eating disorders. Eur. Eat. Disord. Rev 2011, 19, 174–189. [Google Scholar][Green Version]
- Brewer, JA; Potenza, MN. The neurobiology and genetics of impulse control disorders: relationships to drug addictions. Biochem. Pharmacol 2008, 75, 63–75. [Google Scholar]
- Grant, JE; Potenza, MN. Compulsive aspects of impulse-control disorders. Psychiatr. Clin. North Am 2006, 29, 539–549. [Google Scholar]
- Cook, B; Hausenblas, H; Tuccitto, D; Giacobbi, PR, Jr. Eating disorders and exercise: A structural equation modeling: Analysis of a conceptual model. Eur. Eat. Disord. Rev 2011, 19, 216–225. [Google Scholar]
- Cox, R; Orford, J. A qualitative study of the meaning of exercise for people who could be labelled as “addicted” to exercise—can “addiction” be applied to high frequency exercising? Addict. Res. Theory 2004, 12, 167–188. [Google Scholar]
- Iannos, M; Tiggemann, M. Personality of the excessive exerciser. Pers. Indiv. Differ 1997, 22, 775–778. [Google Scholar]
- Yates, A. Compulsive Exercise and Eating Disorders; Brunner/Mazel: New York, NY, USA, 1991. [Google Scholar]
- Rosa, DA; De Mello, MT; Negrao, AB; De Souza-Formigoni, MLO. Mood changes after maximal exercise testing in subjects with symptoms of exercise dependence. Percept. Mot. Skills 2004, 99, 341–353. [Google Scholar]
- Scully, D; Kremer, J; Meade, MM; Graham, R; Dudgeon, K. Physical exercise and well-being: A critical review. Br. J. Sports Med 1998, 32, 111–120. [Google Scholar]
- Goodman, A. Sexual Addiction: An Integrated Approach; International Universities Press: Madison, CT, USA, 1998. [Google Scholar]
- Christenson, GA; Faber, RJ; de Zwaan, M; Raymond, C; Specker, M; Ekern, D; Mitchell, JE. Compulsive buying: Descriptive characteristics and psychiatric comorbidity. J. Clin. Psychiatr 1994, 55, 5–11. [Google Scholar]
- George, AJ. Central nervous system stimulants. Best Practice & Research Clinical Endocrinology & Metabolism 2000, 14, 79–88. [Google Scholar]
- National Institute on Drug Abuse, Info Facts: Steroids (Anabolic-Androgenic); National Institutes of Health: Washington, DC, USA, 2009; pp. 1–4. Available online: http://www.drugabuse.gov/PDF/Infofacts/Steroids09.pdf accessed on 22 August 2011.
- Carnes, PJ; Murray, RE; Charpentier, L. Bargains with chaos: Sex addicts and addiction interaction disorder. Sexual Addiction and Compulsivity 2005, 12, 79–120. [Google Scholar]
- Haylett, SA; Stephenson, GM; LeFever, RMH. Covariation of addictive behaviors: A study of addictive orientation using the Shorter Promis Questionnaire. Addict. Behav 2004, 29, 61–71. [Google Scholar]
- MacLaren, VV; Best, LA. Multiple addictive behaviors in young adults: Student norms for the Shorter PROMIS questionnaire. Addict. Behav 2010, 35, 252–255. [Google Scholar]
- Bamber, DJ; Cockerill, IM; Rodgers, S; Carroll, D. Diagnostic criteria for exercise addiction in women. Br. J. Sports Med 2000, 37, 393–400. [Google Scholar]
- Klein, DA; Bennett, AS; Schebendach, J; Foltin, RW; Devlin, MJ; Walsh, BT. Exercise “addiction” in anorexia nervosa: Model development and pilot data. CNS Spectrums 2004, 9, 531–537. [Google Scholar]
- An Overview of Activity Anorexia. In Activity Anorexia: Theory, Research, and Treatment; Epling, WF; Pierce, WD (Eds.) Lawrence Erlbaum Associates: Mahwah, NJ, USA, 1996; pp. 3–11.
- O’Dea, JA; Abraham, S. Eating and exercise disorders in young college men. J. Am. Coll. Health 2002, 50, 273–278. [Google Scholar]
- Griffiths, MD. A “components” model of addiction within a biopsychosocial framework. J. Subst. Use 2005, 10, 191–197. [Google Scholar]
- Thornton, EW; Scott, SE. Motivation in the committed runner: Correlation between self-report scales and behavior. Health Promot. Int 1995, 10, 177–184. [Google Scholar]
- Griffiths, M. Exercise addiction: a case study. Addict. Res 1997, 5, 161–168. [Google Scholar]
- Craft, LL; Perna, FM. The benefits of exercise for the clinically depressed. Prim. Care Companion J. Clin. Psychiatry 2004, 6, 104–111. [Google Scholar]
- Stahl, SM. Stahl’s Essential Psychopharmacology: Neuroscientific Basis and Practical Applications, 3rd ed; Cambridge University Press: New York, NY, USA, 2008. [Google Scholar]
- Adams, J. Understanding exercise addiction. J. Contemp. Psychother 2009, 39, 231–240. [Google Scholar]
- Charlton, JP. A factor-analytic investigation of computer “addiction” and engagement. Br. J. Psychol 2002, 93, 329–344. [Google Scholar]
- Crabbe, JC. Genetic contributions to addiction. Annu. Rev. Psychol 2002, 53, 435–462. [Google Scholar]
- Gapin, J; Etnier, J; Tucker, D. The relationship between frontal brain asymmetry and exercise addiction. J. Psychophysiol 2009, 23, 135–142. [Google Scholar]
- Larose, R; Lin, CA; Eastin, MS. Unregulated internet usage: Addiction, habit, or deficient self-regulation? Media Psychol 2003, 5, 225–253. [Google Scholar]
- Johnston, O; Reilly, J; Kremer, J. Excessive exercise: From quantitative categorisation to a qualitative continuum approach. Eur. Eat. Disord. Rev 2011, 19, 237–248. [Google Scholar]
- Adams, J; Kirkby, RJ. Excessive exercise as an addiction: A review. Addict. Res. Theory 2002, 10, 415–437. [Google Scholar]
- Kohut, H. The Kohut Seminars on Self-Psychology and Psychotherapy with Adolescents and Young Adults; Elson, M, Ed.; Norton: New York, NY, USA, 1987. [Google Scholar]
- Brown, RIF. A theoretical model of the behavioural addictions—Applied to offending. In Addicted to Crime? Hodge, JE, McMurran, M, Hollins, CM, Eds.; John Wiley: Chichester, UK, 1997. [Google Scholar]
- Drug Addiction. Exercise may be beneficial for overcoming cocaine addiction. Drug Addiction Treatment. Available online: http://www.drugaddictiontreatment.com/drug-addiction-treatments/exercise-may-be-beneficial-for-overcoming-cocaine-addiction/ accessed on 3 December 2010.
- Herring, MP; O’Connor, PJ; Dishman, RK. The effect of exercise training on anxiety symptoms among patients: A systematic review. Arch Intern Med 2010, 170, 321–331. [Google Scholar]
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Freimuth, M.; Moniz, S.; Kim, S.R. Clarifying Exercise Addiction: Differential Diagnosis, Co-occurring Disorders, and Phases of Addiction. Int. J. Environ. Res. Public Health 2011, 8, 4069-4081. https://doi.org/10.3390/ijerph8104069
Freimuth M, Moniz S, Kim SR. Clarifying Exercise Addiction: Differential Diagnosis, Co-occurring Disorders, and Phases of Addiction. International Journal of Environmental Research and Public Health. 2011; 8(10):4069-4081. https://doi.org/10.3390/ijerph8104069Chicago/Turabian Style
Freimuth, Marilyn, Sandy Moniz, and Shari R. Kim. 2011. "Clarifying Exercise Addiction: Differential Diagnosis, Co-occurring Disorders, and Phases of Addiction" International Journal of Environmental Research and Public Health 8, no. 10: 4069-4081. https://doi.org/10.3390/ijerph8104069