When Exercise Becomes Too Much

August 22, 2016

In a world where only 1 in 5 American adults meet the minimum daily exercise requirements, exercise addiction can seem like the opposite of a problem. Don’t let that fool you, says Marilyn Freimuth, a clinical psychologist at Fielding Graduate University, in Santa Barbara. “Exercise addiction can completely take over someone’s life. They’re getting injured, all they can do is think about exercising, but because our culture values physical activity,” she says, “we overlook the issue.”

In their 2015 book The Truth About Exercise Addiction: Understanding the Dark Side of Thinspiration, author Katherine Schreiber and Jacksonville University professor of kinesiology Heather Hausenblas write, “Exercise addicts experience physical activity as both a coping mechanism and a compulsion without which they feel they cannot survive.”

People generally feel better both physically and mentally after working out. But for exercise addicts, that positive surge—similar to the ones gambling- and sex-addicts feel—is substantially higher: It can give athletes and non-athletes alike a powerful buzz of pleasure that can leave them coming back for more, ultimately leading to a life tethered to the treadmill, so to speak, and serious medical consequences, including fatigue, overuse injuries (stress fractures, pulled muscles, tendonitis), infections that won’t go away, electrolyte imbalances, cardiac issues, and, perhaps paradoxically, listlessness.

To see this play out, we may need to look no further than the Olympics. Exercise addiction seems to increase, at least among athletes, the more elite they become, according to a study, published last month, in Journal of Behavioral Addictions.

Tim Brewerton, a physician at the Medical University of South Carolina, agrees. “We venerate Olympic athletes almost like gods. We give them lots of praise and attention, but if we knew anything of what their lives were like…” he says, trailing off. “I think many of them likely experience some type of exercise addiction—they are training constantly for years.”

What makes exercise addiction a thorny phenomenon to study, though, is its complicated relationship with eating disorders. In the 1800s, for example, physicians treating young women with anorexia nervosa, an eating disorder characterized by self-starvation and persistent weight loss, often noted their extreme restlessness and need to constantly move about. And in a 1984 study, a group of physicians had noted in the Journal of the American Medical Association that considerably dedicated male runners, or “obligatory runners,” shared many of the same psychological traits as young women with anorexia, such as perfectionism and depression, although to a lesser degree.

“Passion exists on a continuum with addiction. Gamblers love to gamble…until they don’t.”

One potential difference between people addicted to exercise and those addicted to, well, pretty much everything else, Brewerton points out, is that people who become addicted to exercise may be prone to addictive behaviors but are also simultaneously risk-averse. They’re not the ones who are going to be binge drinking at a party or trying to score some smack in a sketchy part of town.

What’s more, they get lots of positive social reinforcement for their addiction, which provides a boost for their perfectionism. It’s rare for someone to be told they exercise too much, Freimuth says. Instead, they are roundly praised for their self-discipline. Neuroscientists have identified altered reward pathways in individuals with eating disorders that make self-punishment, like self-starvation and over-exercise, paradoxically feel quite rewarding.

But when researchers went looking for exercise addiction in individuals without eating disorders, they had a hard time finding it, which led some eating-disorders professionals to conclude that exercise addiction only existed in tandem with an eating disorder. They point out the increasing number of Olympic athletes who have disclosed their own history of eating disorders. As many as 31 percent of Olympic athletes were found to have eating disorders, for example, compared to just 13 percent of the general population, according to a 2009 International Olympic Committee report.

“Eating disorders and exercise addiction often appear together, but only eating disorders are recognized as diagnoses,” say Mia Lichtenstein, a clinical psychologist at the University of Southern Denmark, and her colleague, in a study published in March.

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