Exercise addiction

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Addiction and dependence glossary [1] [2] [3]
  • addiction – a biopsychosocial disorder characterized by persistent use of drugs (including alcohol) despite substantial harm and adverse consequences
  • addictive drug – psychoactive substances that with repeated use are associated with significantly higher rates of substance use disorders, due in large part to the drug's effect on brain reward systems
  • dependence – an adaptive state associated with a withdrawal syndrome upon cessation of repeated exposure to a stimulus (e.g., drug intake)
  • drug sensitization or reverse tolerance – the escalating effect of a drug resulting from repeated administration at a given dose
  • drug withdrawal – symptoms that occur upon cessation of repeated drug use
  • physical dependence – dependence that involves persistent physical–somatic withdrawal symptoms (e.g., fatigue and delirium tremens)
  • psychological dependence – dependence socially seen as being extremely mild compared to physical dependence (e.g., with enough willpower it could be overcome)
  • reinforcing stimuli – stimuli that increase the probability of repeating behaviors paired with them
  • rewarding stimuli – stimuli that the brain interprets as intrinsically positive and desirable or as something to approach
  • sensitization – an amplified response to a stimulus resulting from repeated exposure to it
  • substance use disorder – a condition in which the use of substances leads to clinically and functionally significant impairment or distress
  • tolerance – the diminishing effect of a drug resulting from repeated administration at a given dose

Exercise addiction is a state characterized by a compulsive engagement in any form of physical exercise, despite negative consequences. While regular exercise is generally a healthy activity, exercise addiction generally involves performing excessive amounts of exercise to the detriment of physical health, spending too much time exercising to the detriment of personal and professional life, and exercising regardless of physical injury. [4] [5] [6] It may also involve a state of dependence upon regular exercise which involves the occurrence of severe withdrawal symptoms when the individual is unable to exercise. [4] Differentiating between addictive and healthy exercise behaviors is difficult but there are key factors in determining which category a person may fall into. [7] Exercise addiction shows a high comorbidity with eating disorders. [5]

Contents

Exercise addiction is not listed as a disorder in the fourth revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). This type of addiction can be classified under a behavioral addiction in which a person's behavior becomes obsessive, compulsive, and/or causes dysfunction in a person's life. [8]

Classification

A concrete classification of exercise addiction has proven to be difficult due to the lack of a specific and widely accepted diagnostic model. [9] Most interpretations of addiction have traditionally been limited to drugs and alcohol, which makes it even more difficult to identify addictive tendencies in exercise. [10] While excessive exercise is the overarching theme with exercise addiction, the term also includes a variety of symptoms like withdrawal, "exercise buzz", and impaired physical function. [11] Excessive exercise has been classified in different ways; sometimes as an addiction and sometimes as a more general compulsive behavior. Psychiatric case studies have shown that exaggerated exercise could lead to negligence of work and family life. With an addiction, individuals become "hooked" to the feeling of euphoria and pleasure that exercise provides. This pleasure keeps the individual from stopping and leads to excessive exercise. With a compulsion people often do not necessarily enjoy repeating certain tasks, as they may feel like performing it will fulfill a duty that is required of them. [12] There are many opinions on whether concrete diagnostic criteria should be created for this type of addiction. Some say preoccupation with exercise that causes significant impairment in a person's life, not due to another disorder, may be enough criteria to label this disorder. [11] Others say there is not enough information about exercise addiction to develop diagnostic criteria. As of 2007, the term "excessive exercise" continues to be used while the "exercise addiction" model continues to be debated. [13]

Three main types of disorders are associated with excessive exercise: [14]

  1. Anorexia athletica (obligatory exercise) - When an individual feels compelled to exercise beyond the point of benefitting one's body. Individuals will participate in athletic activities regardless of pain, injury, illness, etc., and will try to arrange their lives in order to maximize workout time.
  2. Exercise bulimia - When an individual has binge eating sessions that are followed by periods of high-intensity exercise.
  3. Body dysmorphic disorder - When an individual is obsessed with parts of their body and perceive them to be different or odd. These individuals will create highly regimented routines in order to improve their perception of the "flawed" body part.

Signs and symptoms

Five indicators of exercise addiction are: [7]

  1. An increase in exercise that may be labeled as detrimental, or becomes harmful.
  2. A desire to experience euphoria; exercise may be increased as tolerance of the euphoric state increases.
  3. Not participating in physical activity will cause dysfunction in one's daily life.
  4. Severe withdrawal symptoms following exercise deprivation including anxiety, restlessness, depression, guilt, tension, discomfort, loss of appetite, sleeplessness, and headaches.
  5. Exercising through trauma and despite physical injuries.

Key differences between healthy and addictive levels of exercise include the presence of withdrawal symptoms when exercise is stopped as well as the addictive properties exercise may have leading to a dependence on exercise. [12]

Those who succumb to exercise addiction may experience overtraining, which is best defined as a “condition of poor adaptation to a chronic period of excessive stress caused by a physical exertion, resulting in the development of the syndrome, compromising the health and sports performance”. [15]

Overtraining includes one or more of the following: [16] [ unreliable source ]

Exercise addiction may also lead to mood disturbances. Those who undergo rigorous training without adequate rest are more likely to experience depression, anger, fatigue and confusion. [17]

Excessive exercise can lead to premature osteoporosis, where the lack of testosterone accelerates bone loss, and elevated levels of cortisol alters calcium and bone metabolism by “increasing bone reabsorption and decreasing bone formation or intestinal absorption of calcium”. [18] Calcium undernutrition may eventually occur, accelerating premature osteoporosis.

Mechanisms

As of 2016, the mechanisms involved in the development of an exercise addiction, associated with the transition from healthy committed exercise to compulsive exercise, are unknown.

Exercise addiction, however, has long been known to begin with a desire for physical fitness. An eating disorder, such as anorexia nervosa or bulimia supports an unhealthy obsession with exercise, as such. A body image disorder can likely cause exercise addiction as well. [19] One of the prevailing mechanisms for this addiction lies within these activities that expose individuals to the mood-altering effects of this behavior, and can many times deposit dopamine directly into the blood flow.

The chemical functioning of the brain may also play an integral role in potential mood changes based on exercise. Griffiths [20] reported a lengthy case study of exercise addiction and laid out three viable prospects of biological mechanisms that pair an improved satisfactory mood with exercise:

Griffiths' findings suggest that once exercise occurs at high frequencies, it must be maintained in a similar manner and is very difficult to break the pattern. [19] Similarly,  it can be argued [23] that with reduced voluptuary pleasure from other activities, it is likely that a person may have to maintain such levels of intense exercise in order to optimize and activate certain reward systems within the mesolimbic dopamine system in the brain. If they are not activated, the person will continue feeling the original level of distress prior to exercise.

Assessment

Different assessment tools can be used to determine if an individual is addicted to exercise. [24] Most tools used to determine risk for exercise addiction are modified tools that have been used for assessing other behavioral addictions. Tools for determining eating disorders can also show a high risk for exercise addiction. [25]

The Obligatory Exercise Questionnaire was created by Thompson and Pasman in 1991, consisting of 20 questions on exercise habits and attitudes toward exercise and body image. Patients respond to statements on a scale of 1 (never) to 4 (always). [26] This questionnaire aided in the development of another assessment tool, the Exercise Addiction Inventory. [24]

The Exercise Addiction Inventory was developed by Terry et al in 2004. This inventory was developed as a self-report to examine an individual's beliefs toward exercise. The inventory is made up of six statements in relation to the perception of exercise, concerning: the importance of exercise to the individual, relationship conflicts due to exercise, how mood changes with exercise, the amount of time spent exercising, the outcome of missing a workout, and the effects of decreasing physical activity. Individuals are asked to rate each statement from 1 (strongly disagree) to 5 (strongly agree). If an individual scores above 24 they are said to be at-risk for exercise addiction. [24]

When Exercise Addiction and Personality Disorders Coexist

Common co-occurring disorders are prominent in that they can mask exercise addiction and/or complicate treatments for many patients. Eating disorders and Impulse Control Disorder, like many other anxiety disorders, can oftentimes be disguised as exercise addiction and are maintained primarily by negative reinforcement through anxiety reduction.[ citation needed ] Addictive behavior, more commonly described as impulsivity, [27] consists of jerky, rapid and unplanned responses to external or internal stimuli. Impulsive behavior can result in many negative consequences and is intuitively driven by a desired end-goal of a positive reward, [28] similar to the one received after a good workout.

Eating disorders are the most common co-occurring disorder with exercise addiction, with 39–48% of people suffering from both. For some, the primary motivation for exercise is extreme weight, which has been given a special name: anorexia athletica. When exercise addiction and eating disorders co-occur for many trying to bulk up, only one problem will be treated which raises an alarming concern. Often the eating disorder, which is also the more-known and apparent disorder, is the primary focus of treatment and the secondary exercise addiction is disguised and often tossed aside . [29] Despite a healthier, now improved relationship to food and one’s appetite, the individual will still not gain any additional weight, and thus leads to a repetitive cycle that is managed through a more potent exercise regimen.

Treatment

Behavioral addiction and substance abuse disorders are treated similarly; treatment options include exposure and response prevention. No medications have been approved for the treatment of behavioral addictions. Studies have shown promise in the use of glutamatergic altering drugs to treat addictions other than exercise. [30] Exercise addictions comorbid in patients with an eating disorder may be treated through psychotherapy involving education, behavioral interventions, and a strengthened family support structure. In treating the eating disorder, obsessions and compulsions produced by obscured body image ideals will also be treated, this includes exercise addiction. [31]

Epidemiology

Most research has focused on adult population or on college students, but little is known about epidemiology of behavioral addictions in adolescence. [8] A study conducted by Villella et al looked at a group of students and the prevalence of various addictions. His results showed exercise addiction was the second most prevalent, after compulsive buying. [8] High risk groups that appear to be addicted to exercise include athletes in sports encouraging thinness or appearance standards, young and middle-age women, and young men. [8]

Prognosis

Individuals with exercise addiction may put exercise above family and friends, work, injuries, and other social activities. [7] If not identified and treated, an exercise addiction may lead to a significant decline in one's health. [7]

Comorbidity

An addiction, by definition, includes repeated compulsive behaviors that negatively affect daily living. [6] There are two ways to classify addictive behaviors: substance addiction and process addiction. An exercise addiction is a type of process addiction, in which an individual's mood toward a certain event becomes dependent on addictive behaviors. [6] Many educational, occupational, and social activities are stopped due to excessive exercising. Depression may develop if exercise is neglected or may result from reoccurring physical injuries that limit exercise. [6] Exercise addiction is often related to obsessive-compulsive disorder as exercise addicts may have obsessions or compulsions toward physical activity. Exercise addiction is also commonly associated with eating disorders as a secondary symptom of bulimia or anorexia nervosa. [12] Approximately 39-48% of people that have an eating disorder are also addicted to exercise. [32] When diagnosing bulimia, exercise addiction is referred to as a compensatory behavior and indicator of the underlying disorder. Research also shows exercise addiction influences not only the development of eating disorders but also their maintenance. [12]

Animal models

As with many human diseases and disorders, animal models are sometimes used to study addiction. For example, voluntary wheel running by rodents, viewed as a model of human voluntary exercise, has been used to study withdrawal symptoms, such as changes in blood pressure, when wheel access is removed from mice. [33]

See also

Related Research Articles

Pornography addiction is the scientifically controversial application of an addiction model to the use of pornography. Pornography may be part of compulsive behavior with negative consequences to one's physical, mental, social, or financial well-being. While the World Health Organization's ICD-11 (2022) has recognized compulsive sexual behaviour disorder (CSBD) as an "impulsive control disorder", CSBD is not an addiction, and the American Psychiatric Association's DSM-5 (2013) and the DSM-5-TR (2022) do not classify compulsive pornography consumption as a mental disorder or a behavioral addiction.

Drug tolerance or drug insensitivity is a pharmacological concept describing subjects' reduced reaction to a drug following its repeated use. Increasing its dosage may re-amplify the drug's effects; however, this may accelerate tolerance, further reducing the drug's effects. Drug tolerance is indicative of drug use but is not necessarily associated with drug dependence or addiction. The process of tolerance development is reversible and can involve both physiological factors and psychological factors.

Motivational salience is a cognitive process and a form of attention that motivates or propels an individual's behavior towards or away from a particular object, perceived event or outcome. Motivational salience regulates the intensity of behaviors that facilitate the attainment of a particular goal, the amount of time and energy that an individual is willing to expend to attain a particular goal, and the amount of risk that an individual is willing to accept while working to attain a particular goal.

A food addiction or eating addiction is any behavioral addiction that is primarily characterized by the compulsive consumption of palatable food items which markedly activate the reward system in humans and other animals despite adverse consequences.

Substance dependence, also known as drug dependence, is a biopsychological situation whereby an individual's functionality is dependent on the necessitated re-consumption of a psychoactive substance because of an adaptive state that has developed within the individual from psychoactive substance consumption that results in the experience of withdrawal and that necessitates the re-consumption of the drug. A drug addiction, a distinct concept from substance dependence, is defined as compulsive, out-of-control drug use, despite negative consequences. An addictive drug is a drug which is both rewarding and reinforcing. ΔFosB, a gene transcription factor, is now known to be a critical component and common factor in the development of virtually all forms of behavioral and drug addictions, but not dependence.

Sexual addiction is a state characterized by compulsive participation or engagement in sexual activity, particularly sexual intercourse, despite negative consequences. The concept is contentious; neither of the two major mainstream medical categorization systems recognise sex addiction as a real medical condition, instead categorizing such behavior under labels such as compulsive sexual behavior.

Sensitization is a non-associative learning process in which repeated administration of a stimulus results in the progressive amplification of a response. Sensitization often is characterized by an enhancement of response to a whole class of stimuli in addition to the one that is repeated. For example, repetition of a painful stimulus may make one more responsive to a loud noise.

Anorexia athletica, also referred to as hyper-gymnasia, is an eating disorder characterized by excessive and compulsive exercise. An athlete with sports anorexia tends to overexercise to give themselves a sense of having control over their body. Most often, people with the disorder tend to feel they have no control over their lives other than their control of food and exercise. In actuality, they have no control; they cannot stop exercising or regulating food intake without feeling guilty. Generally, once the activity is started, it is difficult to stop because the person is seen as being addicted to the method adopted.

An addictive behavior is a behavior, or a stimulus related to a behavior, that is both rewarding and reinforcing, and is associated with the development of an addiction. There are two main forms of addiction: substance use disorders and behavioral addiction. The parallels and distinctions between behavioral addictions and other compulsive behavior disorders like bulimia nervosa and obsessive-compulsive disorder (OCD) are still being researched by behavioral scientists.

Reverse tolerance or drug sensitization is a pharmacological phenomenon describing subjects' increased reaction to a drug following its repeated use. Not all drugs are subject to reverse tolerance.

Psychological dependence is a cognitive disorder that involves emotional–motivational withdrawal symptoms – such as anxiety or anhedonia – upon cessation of prolonged drug abuse or certain repetitive behaviors. It develops through frequent exposure to certain psychoactive substances or behaviors, which leads to an individual requiring further exposure to avoid withdrawal symptoms, as a result of negative reinforcement. Neuronal counter-adaptation is believed to play a role in generating withdrawal symptoms, which could be mediated through changes in neurotransmitter activity or altered receptor expression. Environmental enrichment and physical activity can attenuate withdrawal symptoms.

<span class="mw-page-title-main">FOSB</span> Protein

Protein fosB, also known as FosB and G0/G1 switch regulatory protein 3 (G0S3), is a protein that in humans is encoded by the FBJ murine osteosarcoma viral oncogene homolog B (FOSB) gene.

<span class="mw-page-title-main">Internet addiction disorder</span> Excessive internet use that causes psychological disorders

Internet addiction disorder (IAD) can otherwise be referred to as problematic internet use or pathological internet use. It is generally defined as problematic, compulsive use of the internet, that results in significant impairment in an individual's function in various aspects of life over a prolonged period of time. Young people are at particular risk of developing internet addiction disorder, with case studies highlighting students whose academic performance plummets as they spend more and more time online. Some also experience health consequences from loss of sleep, as they stay up later and later to chat online, check for social network status updates or to further progress in a game.

Behavioral addiction, process addiction, or non-substance-related disorder is a form of addiction that involves a compulsion to engage in a rewarding non-substance-related behavior – sometimes called a natural reward – despite any negative consequences to the person's physical, mental, social or financial well-being. In the brain's reward system, a gene transcription factor known as ΔFosB has been identified as a necessary common factor involved in both behavioral and drug addictions, which are associated with the same set of neural adaptations.

<span class="mw-page-title-main">Substance use disorder</span> Continual use of drugs (including alcohol) despite detrimental consequences

Substance use disorder (SUD) is the persistent use of drugs despite the substantial harm and adverse consequences to one's own self and others, as a result of their use. In perspective, the effects of the wrong use of substances that are capable of causing harm to the user or others, have been extensively described in different studies using a variety of terms such as substance use problems, problematic drugs or alcohol use, and substance use disorder. The National Institute of Mental Health (NIMH) states that "Substance use disorder (SUD) is a treatable mental disorder that affects a person's brain and behavior, leading to their inability to control their use of substances like legal or illegal drugs, alcohol, or medications. Symptoms can be moderate to severe, with addiction being the most severe form of SUD". Substance use disorders (SUD) are considered to be a serious mental illness that fluctuates with the age that symptoms first start appearing in an individual, the time during which it exists and the type of substance that is used. It is not uncommon for those who have SUD to also have other mental health disorders. Substance use disorders are characterized by an array of mental/emotional, physical, and behavioral problems such as chronic guilt; an inability to reduce or stop consuming the substance(s) despite repeated attempts; operating vehicles while intoxicated; and physiological withdrawal symptoms. Drug classes that are commonly involved in SUD include: alcohol (alcoholism); cannabis; opioids; stimulants such as nicotine, cocaine and amphetamines; benzodiazepines; barbiturates; and other substances.

An addictive personality refers to a hypothesized set of personality traits that make an individual predisposed to developing addictions. This hypothesis states that there may be common personality traits observable in people suffering from addiction; however, the lack of a universally agreed upon definition has marked the research surrounding addictive personality. Addiction is a fairly broad term; it is most often associated with substance use disorders, but it can also be extended to cover a number of other compulsive behaviors, including sex, internet, television, gambling, food, and shopping. Within these categories of addiction a common diagnostic scale involves tolerance, withdrawal, and cravings. This is a fairly contentious topic, with many experts suggesting the term be retired due to a lack of cumulative evidence supporting the existence of addictive personality. It has been claimed that characteristics of personality attributed to addictive personality do not predict addiction, but rather can be the result of addiction. However, different personality traits have been linked to various types of addictive behaviors, suggesting that individual addictions may be associated with different personality profiles. The strongest consensus is that genetic factors play the largest role in determining a predisposition for addictive behaviors. Even then, however, genes play different roles in different types of addictions. Forty to seventy percent of the population variance in the expression of addictions can be explained by genetic factors.

<span class="mw-page-title-main">Addiction</span> Disorder resulting in compulsive behaviours

Addiction is a neuropsychological disorder characterized by a persistent and intense urge to use a drug or engage in a behaviour that produces natural reward, despite substantial harm and other negative consequences. Repetitive drug use often alters brain function in ways that perpetuate craving, and weakens self-control. This phenomenon – drugs reshaping brain function – has led to an understanding of addiction as a brain disorder with a complex variety of psychosocial as well as neurobiological factors that are implicated in addiction's development. Classic signs of addiction include compulsive engagement in rewarding stimuli, preoccupation with substances or behavior, and continued use despite negative consequences. Habits and patterns associated with addiction are typically characterized by immediate gratification, coupled with delayed deleterious effects.

Drunkorexia is a colloquialism for anorexia or bulimia combined with an alcohol use disorder. The term is generally used to denote the utilization of extreme weight control methods to compensate for planned binge drinking. Research on the combination of an eating disorder and binge drinking has primarily focused on college-aged women, though the phenomenon has also been noted among young men. Studies suggest that individuals engage in this combination of self-imposed malnutrition and binge drinking to avoid weight gain from alcohol, to save money for purchasing alcohol, and to facilitate alcohol intoxication.

Addiction vulnerability is an individual's risk of developing an addiction during their lifetime. There are a range of genetic and environmental risk factors for developing an addiction that vary across the population. Genetic and environmental risk factors each account for roughly half of an individual's risk for developing an addiction; the contribution from epigenetic risk factors to the total risk is unknown. Even in individuals with a relatively low genetic risk, exposure to sufficiently high doses of an addictive drug for a long period of time can result in an addiction. In other words, anyone can become an individual with a substance use disorder under particular circumstances. Research is working toward establishing a comprehensive picture of the neurobiology of addiction vulnerability, including all factors at work in propensity for addiction.

References

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  32. ↑ Freimuth, Marilyn; Moniz, Sandy; Kim, Shari R. (2011-10-21). "Clarifying Exercise Addiction: Differential Diagnosis, Co-occurring Disorders, and Phases of Addiction". International Journal of Environmental Research and Public Health. 8 (10): 4069–4081. doi: 10.3390/ijerph8104069 . PMC   3210598 . PMID   22073029.
  33. ↑ Kolb, E. M., S. A. Kelly, and T. Garland, Jr. 2013. Mice from lines selectively bred for high voluntary wheel running exhibit lower blood pressure during withdrawal from wheel access. Physiology & Behavior 112-113:49–55.
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