When Fitness Turns Into Exercise Addiction

What distinguishes a competitive athlete or exercise enthusiast from an individual who may be harboring unhealthy compulsions? Exercise addiction, also referred to as "exercise dependence," "exercise compulsion" and, in athletes, "obligatory exercise," indeed can be a moving target.

"I think the problem is somewhat common because exercise is a behavior most people believe is positive," says psychologist Ron Thompson, PhD, who specializes in treating athletes with eating disorders, "and many believe that you cannot get too much of this good thing."

However, research evaluating the physical and psychological risks of over-exercising includes overuse injuries, interference with work and family, and the inability to reduce exercise amounts. Other studies have focused on withdrawal symptoms, such as anxiety, depression and fatigue.

Individuals of any temperament and personality are potentially susceptible to an unhealthy relationship with exercise; however, those with obsessive-compulsive tendencies may be more likely to develop an exercise addiction. "The types of people attracted to excessive training are those who feel the extreme need to control their lives," says Greg Chertok, MEd, CC-AASP, sports psychology consultant at the American College of Sports Medicine.

In addition, excessive exercise has long been associated with disordered eating behaviors. In fact, approximately 39 percent to 48 percent of people with eating disorders also struggle with exercise addiction. The same drive for control that is behind exercise addiction also may cause the person to become highly regimented in other aspects of their lives, potentially compelling them to obsessively measure calorie intake or to lean heavily on personal fitness trackers to monitor calories burned or steps taken.

Because physical activity is part of a healthful lifestyle, exercise addiction poses challenges for diagnosis and treatment — and different assessment tools have evolved over the years, such as the Commitment to Running Scale, the Obligatory Exercise Questionnaire and the Exercise Dependence Questionnaire.

According to the Exercise Dependence Scale-21 Manual, which was based on modifications of the Diagnostic and Statistical Manual of Mental Disorders, 4th ed., criteria for substance abuse, exercise dependence may lead to clinical impairment or distress when three or more of the following are exhibited:

Tolerance
The exerciser increases 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
The person makes unsuccessful attempts to reduce his or her exercise level or to cease exercising for a certain period of time.

Intention Effects
The exerciser is unable to stick to an 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 or recreational activities occur less often or are stopped.

Continuance
The person continues to exercise despite knowing that this activity is creating or exacerbating physical, psychological or interpersonal problems.

In 2013, the American Psychiatric Association published the Diagnostic and Statistical Manual of Mental Disorders, 5th ed. Although it does not cover exercise addiction specifically, the updated inclusion of behavioral addictions and new diagnostic language potentially opens the door for more research into forms of excessive behaviors. That research could help identify when the compulsive behavior actually represents an addiction or when it may be a manifestation of a coexisting or separate disorder.

In the meantime, if you suspect someone may be exercise dependant, refer him or her to a sports psychologist or a clinical psychologist who specializes in sports. These professionals are trained to identify potential problems and address further treatment options.

Heather Mangieri