Exercise addiction: Symptoms, diagnosis, epidemiology, and etiology

Substance Use and Misuse

Volumn 47, Issue 4, 2012, Pages 403-417

  Berczik, Krisztina ^a   Szabó, Attila ^a,b   Griffiths, Mark D ^c   Kurimay, Tams ^d   Kun, Bernadette ^a   Urbán, Róbert ^a   Demetrovics, Zsolt ^a  

^a EÖTVÖS LORÁND UNIVERSITY   (Hungary)

^b National Institute for Sport   (Hungary)

^c NOTTINGHAM TRENT UNIVERSITY   (United Kingdom)

^d ST JOHN'S HOSPITAL   (Hungary)

Author keywords

Behavioral addiction; Epidemiology; Etiology; Exercise addiction; Obsessive compulsive behavior; Positive addiction

Indexed keywords

ADDICTION; CLASSIFICATION; COMPULSION; EXERCISE; HUMAN; OBSESSION; PATHOPHYSIOLOGY; PSYCHOLOGICAL ASPECT; REVIEW;

BEHAVIOR, ADDICTIVE; COMPULSIVE BEHAVIOR; EXERCISE; HUMANS; OBSESSIVE BEHAVIOR;

EID: 84856031422     PISSN: 10826084     EISSN: 15322491     Source Type: Journal    
DOI: 10.3109/10826084.2011.639120     Document Type: Review

References (102)

1. Ackard, D. M., Brehm, B. J., & Steffen, J. J. (2002). Exercise and eating disorders in college-aged women: Profling excessive exercisers. Eating Disorders, 10(1), 31-47. (Pubitemid 34201953)
2. Albrecht, U., Kirschner, N. E., & Grüsser, S. M. (2007). Diagnostic instruments for behavioural addiction: An overview. Psycho-Social Medicine, 4. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2736529/
3. Allegre, B., Souville, M., Therme, P., & Griffths, M. D. (2006). Defnitions and measures of exercise dependence. Addiction Research and Theory, 14, 631-646.
4. Allegre, B., Therme, P., & Griffths, M. D. (2007). Individual factors and the context of physical activity in exercise dependence: A prospective study of "ultra-marathoners". International Journal of Mental Health and Addiction, 5, 233-243.
5. American Psychiatric Association. (2000). Diagnostic and statistical manual for mental disorders (4th ed., rev. ed.). Washington, DC: American Psychiatric Publishing.
6. Bamber, D. J., Cockerill, I. M., & Carroll, D. (2000). The pathological status of exercise dependence. British Journal of Sports Medicine, 34(2), 125-132. (Pubitemid 30261433)
7. Bamber, D. J., Cockerill, I. M., Rodgers, S., & Carroll, D. (2000). "It's exercise or nothing": A qualitative analysis of exercise dependence. British Journal of Sports Medicine, 34(6), 423-430.
8. Bamber, D. J., Cockerill, I. M., Rodgers, S., & Carroll, D. (2003). Diagnostic criteria for exercise dependence in women. British Journal of Sports Medicine, 37(5), 393-400. (Pubitemid 37260283)
9. Bartz, J. A., & Hollander, E. (2006). Is obsessive-compulsive disorder an anxiety disorder? Progress in Neuro-psychopharmacology and Biological Psychiatry, 30(3), 338-352.
10. Basson, C. J. (2001). Personality and behaviour associated with excessive dependence on exercise: Some refections from research. South African Journal of Psychology, 31(2), 53-59. (Pubitemid 33683276)
11. Biddle, S. J., Gorely, T., & Stensel, D. J. (2004). Health-enhancing physical activity and sedentary behaviour in children and adolescents. Journal of Sports Sciences, 22(8), 679-701. (Pubitemid 39220414)
12. Biddle, S., & Mutrie, N. (1991). Psychology of physical activity and exercise: A health-related perspective. London: Springer-Ve r l a g.
13. Blair, S. N., Kohl, H. W., 3rd, Paffenbarger, R. S., Jr., Clark, D. G., Cooper, K. H., & Gibbons, L. W. (1989). Physical ftness and all-cause mortality: A prospective study of healthy men and women. Journal of the American Medical Association, 262(17), 2395-2401. (Pubitemid 19261810)
14. Blaydon, M. J., & Lindner, K. J. (2002). Eating disorders and exercise dependence in triathletes. Eating Disorders, 10(1), 49-60. (Pubitemid 34201954)
15. Blaydon, M. J., Lindner, K. J., & Kerr, J. H. (2002). Meta-motivational characteristics of eating-disordered and exercise-dependent triathletes: An application of reversal theory. Psychology of Sport and Exercise, 3(3), 223-236.
16. Blaydon, M. J., Lindner, K. J., & Kerr, J. H. (2004). Metamotiva-tional characteristics of exercise dependence and eating disorders in highly active amateur sport participants. Personality and Individual Differences, 36(6), 1419-1432. (Pubitemid 38305120)
17. Blumenthal, J. A., O'Toole, L. C., & Chang, J. L. (1984). Is running an analogue of anorexia nervosa? An empirical study of obligatory running and anorexia nervosa. Journal of the American Medical Association, 252(4), 520-523. (Pubitemid 14088107)
18. Brown, R. I. F. (1993). Some contributions of the study of gambling to the study of other addictions. In W. R. Eadington & J. A. Cornelius (Eds.), Gambling behavior and problem gambling (pp. 241-272). Reno, NV: University of Nevada Press.
19. Carmack, M. A., & Martens, R. (1979). Measuring commitment to running: A survey of runners' attitudes and mental states. Journal of Sport Psychology, 1, 25-42.
20. Caspersen, C. J., Powell, K. E., & Christenson, G. M. (1985). Physical activity, exercise and physical ftness: Defnitions and distinctions for health-related research. Public Health Reports, 100, 126-131. (Pubitemid 15064369)
21. Castle, D. J., & Phillips, K. A. (2006). Obsessive-compulsive spectrum of disorders: A defensible construct? Australian and New Zealand Journal of Psychiatry, 40(2), 114-120. (Pubitemid 43379403)
22. Chapman, C. L., & De Castro, J. M. (1990). Running addiction: Measurement and associated psychological characteristics. Journal of Sports Medicine and Physical Fitness, 30(3), 283-290. (Pubitemid 20347022)
23. Cockerill, I. M., & Riddington, M. E. (1996). Exercise dependence and associated disorders: A review. Counselling Psychology Quarterly, 9(2), 119-129. (Pubitemid 26258159)
24. Coen, S. P., & Ogles, B. M. (1993). Psychological characteristics of the obligatory runner: A critical examination of the anorexia analogue hypothesis. Journal of Sport & Exercise Psychology, 15(3), 338-354.
25. Cousineau, D., Ferguson, R. J., de Champlain, J., Gauthier, P., Cote, P., & Bourassa, M. (1977). Catecholamines in coronary sinus during exercise in man before and after training. Journal of Applied Physiology, 43(5), 801-806. (Pubitemid 8238299)
26. Dalle Grave, R., Calugi, S., & Marchesini, G. (2008). Compulsive exercise to control shape or weight in eating disorders: Prevalence, associated features, and treatment outcome. Comprehensive Psychiatry, 49(4), 346-352.
27. Davis, C. (2000). Exercise abuse. International Journal of Sport Psychology, 31, 278-289.
28. Davis, C., Brewer, H., & Ratusny, D. (1993). Behavioral frequency and psychological commitment: Necessary concepts in the study of excessive exercising. Journal of Behavioral Medicine, 16(6), 611-628. (Pubitemid 24012917)
29. de Coverley Veale, D. M. (1987). Exercise dependence. British Journal of Addiction, 82(7), 735-740. (Pubitemid 17127085)
30. De Vries, H. A. (1981). Tranquilizer effect of exercise: A critical review. The Physician and Sports Medicine, 9(11), 47-53.
31. Downs, D. S., Hausenblas, H. A., & Nigg, C. R. (2004). Factorial validity and psychometric examination of the exercise dependence scale-revised. Measurement in Physical Education and Exercise Science, 8(4), 183-201. (Pubitemid 39546380)
32. Duncan, D. F. (1974). Drug abuse as a coping mechanism. American Journal of Psychiatry, 131(6), 724.
33. Farrell, P. A., Gates, W. K., Maksud, M. G., & Morgan, W. P. (1982). Increases in plasma beta-endorphin/beta-lipotropin immunore-activity after treadmill running in humans. Journal of Applied Physiology, 52(5), 1245-1249. (Pubitemid 12037776)
34. Folsom, A. R., Caspersen, C. J., Taylor, H. L., Jacobs, D. R., Luep-ker, R. V., Gomez-Marin, O., et al. (1985). Leisure time physical activity and its relationship to coronary risk factors in a population-based sample: The Minnesota Heart Survey. American Journal of Epidemiology, 121(4), 570-579. (Pubitemid 15113098)
35. Furst, D. M., & Germone, K. (1993). Negative addiction in male and female runners and exercisers. Perceptual and Motor Skills, 77(1), 192-194.
36. Glasser, W. (1976). Positive addiction. New York, NY: Harper & Row.
37. Goldberg, A. (1988). The sports mind: A workbook of mental skills for athletes. Northampton, MA: Competitive Advantage.
38. Goldfarb, A. H., & Jamurtas, A. Z. (1997). Beta-endorphin response to exercise: An update. Sports Medicine, 24(1), 8-16.
39. Goodman, A. (1990). Addiction: Defnition and implications. British Journal of Addiction, 85(11), 1403-1408.
40. Grant, J. E., Potenza, M. N., Weinstein, A., & Gorelick, D. A. (2010). Introduction to behavioral addictions. American Journal of Drug and Alcohol Abuse, 36(5), 233-241.
41. Griffths, M. D. (1996). Behavioural addictions: An issue for everybody? Journal of Workplace Learning, 8(3), 19-25.
42. Griffths, M. D. (1997). Exercise addiction: A case study. Addiction Research, 5, 161-168.
43. Griffths, M. D. (2005). A "components" model of addiction within a biopsychosocial framework. Journal of Substance Use, 10, 191-197.
44. Griffths, M. D. (2011). Workaholism: A 21st century addiction. The Psychologist: Bulletin of the British Psychological Society, 24(10), 740-744.
45. Griffths, M. D., Szabo, A., & Terry, A. (2005). The exercise addiction inventory: A quick and easy screening tool for health practitioners. British Journal of Sports Medicine, 39(6), e30.
46. Hailey, B. J., & Bailey, L. A. (1982). Negative addiction in runners: A quantitative approach. Journal of Sport Behavior, 5(3), 150-154.
47. Hamer, M., & Karageorghis, C. I. (2007). Psychobiological mechanisms of exercise dependence. Sports Medicine, 37(6), 477-484. (Pubitemid 46790272)
48. Hausenblas, H. A., & Downs, D. S. (2002a). Exercise dependence: A systematic review. Psychology of Sport and Exercise, 3(2), 89-123.
49. Hausenblas, H. A., & Downs, D. S. (2002b). How much is too much? The development and validation of the exercise dependence scale. Psychology & Health, 17(4), 387-404.
50. Hausenblas, H. A., & Downs, D. S. (2002c). Relationship among sex, imagery, and exercise dependence symptoms. Psychology of Addictive Behaviors, 16(2), 169-172. (Pubitemid 34627545)
51. Hill, A. B. (1965). The environment and disease: Associations or causation? Proceedings of the Royal Society of Medicine 58:295-300.
52. Hollander, E. (1993). Obsessive-compulsive spectrum disorders: An overview. Psychiatric Annals, 23, 355-358.
53. Hollander, E., & Wong, C. M. (1995). Obsessive-compulsive spectrum disorders. Journal of Clinical Psychiatry, 56(Suppl 4), 3-6.
54. Hurst, R., Hale, B., Smith, D., & Collins, D. (2000). Exercise dependence, social physique anxiety, and social support in experienced and inexperienced bodybuilders and weightlifters. British Journal of Sports Medicine, 34(6), 431-435.
55. Kirkby, R. J., & Adams, J. (1996). Exercise dependence: The relationship between two measures. Perceptual and Motor Skills, 82(2), 366. (Pubitemid 126728165)
56. Kjaer, M., & Dela, F. (1996). Endocrine response to exercise. In L. Hoffman-Goetz (Ed.), Exercise and immune function (pp. 6-8). Boca Raton, FL: CRC Press.
57. Klein, D. A., Bennett, A. S., Schebendach, J., Foltin, R. W., Devlin, M. J., & Walsh, B. T. (2004). Exercise "addiction" in anorexia nervosa: Model development and pilot data. CNS Spectrums, 9(7), 531-537. (Pubitemid 38988549)
58. Lamb, K. L., Roberts, K., & Brodie, D. A. (1990) Self-perceived health among sports participants and non-sports participants. Social Science Medicine, 31(9), 963-969. (Pubitemid 20356453)
59. Lotan, M., Merrick, J., & Carmeli, E. (2005). Physical activity in adolescence: A review with clinical suggestions. International Journal of Adolescent Medicine and Health, 17(1), 13-21. (Pubitemid 40613744)
60. Loumidisa, K. S., & Wells, A. (1998). Assessment of beliefs in exercise dependence: The development and preliminary validation of the exercise beliefs questionnaire. Personality and Individual Differences, 25(3), 553-567. (Pubitemid 128179617)
61. Lyons, H. A., & Cromey, R. (1989). Compulsive jogging: Exercise dependence and associated disorder of eating. Ulster Medical Journal, 58(1), 100-102.
62. Morgan, W. P. (1979). Negative addiction in runners. The Physician and Sports Medicine, 7, 57-70.
63. Morgan, W. P., & O'Connor, P. J. (1988). Exercise and mental health. In R. K. Dishman (Ed.), Exercise adherence: Its impact on public health (pp. 91-121). Champaign, IL: Human Kinetics.
64. Morris, M. (1989). Running round the clock. Running, 104, 44-45.
65. Ogden, J., Veale, D. M., & Summers, Z. (1997). The development and validation of the Exercise Dependence Questionnaire. Addiction Research, 5(4), 343-355.
66. Paffenbarger, R. S., Jr., Hyde, R. T., Wing, A. L., & Hsieh, C. C. (1986). Physical activity, all-cause mortality, and longevity of college alumni. New England Journal of Medicine, 314(10), 605-613. (Pubitemid 16132724)
67. Pasman, L. N., & Thompson, J. K. (1988). Body image and eating disturbance in obligatory runners, obligatory weightlifters, and sedentary individuals. International Journal of Eating Disorders, 7(6), 759-769. (Pubitemid 19013356)
68. Pierce, E. F., Daleng, M. L., & McGowan, R. W. (1993). Scores on exercise dependence among dancers. Perceptual and Motor Skills, 76(2), 531-535.
69. Pierce, E. F., Eastman, N. W., Tripathi, H. L., Olson, K. G., & Dewey, W. L. (1993). Beta-endorphin response to endurance exercise: Relationship to exercise dependence. Perceptual and Motor Skills, 77(3 Pt 1), 767-770.
70. Piko, B. F. (2000). Health-related predictors of self-perceived health in a student population: The importance of physical activity. Journal of Community Health, 25(2), 125-137.
71. Piko, B. F., & Keresztes, N. (2006). Physical activity, psychoso-cial health, and life goals among youth. Journal of Community Health, 31(2), 136-145.
72. Royal College of Physicians. (1991). Medical aspects of exercise. Risks and benefts. London: Author.
73. Sachs, M. L. (1981). Running addiction. In M. Sacks & M. Sachs (Eds.), Psychology of running (pp. 116-126). Champaign, IL: Human Kinetics.
74. Sachs, M. L., & Pargman, D. (1984). Running addiction. In M. L. Sachs & G. W. Buffone (Eds.), Running as therapy: An integrated approach (pp. 231-252). Lincoln, NE: University of Nebraska Press.
75. Sforzo, G. A. (1988). Opioids and exercise: An update. Sports Medicine, 7, 109-124.
76. Sforzo, G. A., Seeger, T. F., Pert, C. B., Pert, A., & Dotson, C. O. (1986). In vivo opioid receptor occupation in the rat brain following exercise. Medicine and Science in Sports and Exercise, 18(4), 380-384. (Pubitemid 16005350)
77. Shaffer, H. J., LaPlante, D. A., LaBrie, R. A., Kidman, R. C., Do-nato, A. N.,& Stanton, M. V. (2004). Towardsasyndrome model of addiction: Multiple expressions, common etiology. Harvard Review of Psychiatry, 12, 1-8.
78. Slay, H. A., Hayaki, J., Napolitano, M. A., & Brownell, K. D. (1998). Motivations for running and eating attitudes in obligatory versus nonobligatory runners. International Journal of Eating Disorders, 23(3), 267-275. (Pubitemid 28134423)
79. Smith, D. K., & Hale, B. (2004). Validity and factor structure of the bodybuilding dependence scale. British Journal of Sports Medicine, 38, 177-181. (Pubitemid 38446208)
80. Smith, D. K., & Hale, B. D. (2005). Exercise-dependence in bodybuilders: Antecedents and reliability of measurement. Journal of Sports Medicine and Physical Fitness, 45(3), 401-408.
81. Smith, D. K., Hale, B. D., & Collins, D. (1998). Measurement of exercise dependence in bodybuilders. Journal of Sports Medicine and Physical Fitness, 38(1), 66-74. (Pubitemid 28238534)
82. Steffen, J. J., & Brehm, B. J. (1999). The dimensions of obligatory exercise. Eating Disorders, 7, 219-226.
83. Stephens, T. (1988). Physical activity and mental health in the United States and Canada: Evidence from four population surveys. Preventive Medicine, 17(1), 35-47.
84. Sundgot-Borgen, J. (1994). Eating disorders in female athletes. Sports Medicine, 17(3), 176-188. (Pubitemid 24094048)
85. Sussman, S., Lisha, N. & Griffths, M. D. (2011). Prevalence of the addictions: A problem of the majority or the minority? Evaluation and the Health Professions, 34, 3-56.
86. Szabo, A. (1995). The impact of exercise deprivation on well-being of habitual exercisers. Australian Journal of Science and Medicine in Sport, 27, 68-75.
87. Szabo, A. (2000). Physical activity as a source of psychological dysfunction. In S. J. Biddle, K. R. Fox, & S. H. Boutcher (Eds.), Physical activity and psychological well-being (pp. 130-153). London: Routledge.
88. Szabo, A. (2010). Addiction to exercise: A symptom or a disorder? New York, NY: Nova Science Publishers.
89. Szabo, A., Frenkl, R., & Caputo, A. (1996). Deprivation feelings, anxiety, and commitment to various forms of physical activity: A cross-sectional study on the Internet. Psychologia, 39, 223-230.
90. Szabo, A., Frenkl, R., & Caputo, A. (1997). Relationships between addiction to running, commitment to running, and deprivation from running. European Yearbook of Sport Psychology, 1, 130-147.
91. Szabo, A., & Griffths, M. D. (2007). Exercise addiction in British sport science students. International Journal of Mental Health and Addiction, 5(1), 25-28.
92. Terry, A., Szabo, A., & Griffths, M. D. (2004). The exercise addiction inventory: A new brief screening tool. Addiction Research and Theory, 12(5), 489-499. (Pubitemid 39524087)
93. Thaxton, L. (1982). Physiological and psychological effects of short-term addiction on habitual runners. Journal of Sport Psychology, 4(1), 73-80.
94. Thompson, J. K., & Blanton, P. (1987). Energy conservation and exercise dependence: A sympathetic arousal hypothesis. Medicine and Science in Sports and Exercise, 19(2), 91-99. (Pubitemid 17058228)
95. Thornton, E. W., & Scott, S. E. (1995). Motivation in the committed runner: Correlations between self-report scales and behavior. Health Promotion International, 10, 177-184.
96. United States Department of Health and Human Services. (1996). Physical activity and health: A report of the surgeon general.
97. Atlanta, GA: United States Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, The President's Council on Physical Fitness and Sports.
98. Waddington, I. (2000). Sport, health, and drugs: A critical sociological perspective. London: Spoon Press.
99. Warburton D. E. R., Nicol, C. W., & Bredin, S. S. D. (2006). Health benefts of physical activity: The evidence. Canadian Medical Association Journal, 174(6), 801-809.
100. Yates, A., Edman, J. D., Crago, M., & Crowell, D. (2001). Using an exercise-based instrument to detect signs of an eating disorder. Psychiatry Research, 105(3), 231-241. (Pubitemid 34126367)
101. Yates, A., Leehey, K., & Shisslak, C. M. (1983). Running-an analogue of anorexia? New England Journal of Medicine, 308(5), 251-255.
102. Yates, A., Shisslak, C. M., Allender, J., Crago, M., & Leehey, K. (1992). Comparing obligatory to nonobligatory runners. Psy-chosomatics, 33(2), 180-189.