Exercise Addiction and Compulsive Exercising: Relationship to Eating Disorders, Substance Use Disorders, and Addictive Disorders

Abstract

The recent addition of a behavioral addictions category in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) has provided a framework to examine when behaviors progress from normal to pathologically excessive. Several behaviors that are either typically harmless (e.g., gambling, shopping) or even healthy (e.g., alcohol consumption, sex) when performed in moderation have been identified as having addictive potential. Exercise is one such behavior that may be viewed as an addiction. However, the literature is confused by several terms such as compulsion, addiction, and dependence that all may refer to similar, if not the same, pathological patterns of problematic exercise. This chapter will first review the various terms that are widely used and provide a clear distinction among exercise addiction, dependence, and compulsion. Next, we will review assessment measures that are commonly used in research and in clinical practice to screen for problematic exercise patterns. Finally, we will discuss the emerging literature that examines the co-occurrence of problematic exercise and eating pathology, substance use disorders, and other behavioral addictions.

Exercise in Eating Disorders Treatment

“…exercise pathology/compulsion)(30) that may be a positive predictor of negative eating attitudes and behaviors (1,12) that appear to mediate the relationship between exercise and ED (10,14,15) and are associated with detriments in ED specific health related quality of life (9). For example, a recent prospective study has found reductions in exercise pathology scores (e.g.…”

Exercise dependence as a mediator of the exercise and eating disorders relationship: A pilot study

“…Exercise dependence is a term used to quantify and describe pathological behaviors and attitudes related to exercise (Hausenblas & Symons Downs, 2002) and refers to a phenomenon that has also been described as addictive, compulsive, driven, and/or obligatory exercise (Cook, Hausenblas, & Freimuth, 2014). Recently, exercise dependence has been identified as an important variable in the exercise and ED relationship (Bratland-Sanda et al, 2011).…”

Conceptualizing primary and secondary pathological exercise using available measures of excessive exercise

“…Additionally, high intensity exercise can induce feelings of euphoria, possibly as a result of exercise‐induced changes in central opioid neurotransmission . PE may differ from a compulsion in that exercise is initially perceived as enjoyable and only becomes a negative reinforcer once tolerance has developed and the desire to avoid withdrawal symptoms becomes a primary motivator …”

“…This stands in contrast to “secondary” PE, in which excessive exercise is viewed as secondary to an ED or as an ED symptom. While the former is motivated by a perceived need to relieve anxiety through exercise, the latter is motivated by a desire to lose weight . It has been suggested that while PE is always addictive in nature, it may have a stronger compulsive component when it exists in conjunction with an ED …”

“…A final aim was to provide prevalence estimates for primary and secondary PE in two large community samples, one of which did not target athlete or disordered eating populations. Discrepancies in conceptualization and measurement, as well as the use of sampling methods targeting athletes or those with EDs, have contributed to prevalence estimates ranging from 1.4% to 52% . To our knowledge, no other study reporting PE prevalence has used a heterogeneous sample.…”