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Exercise Addiction - Status, Identification and Treatment

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Abstract

The term "exercise addiction" has been used in the scientific literature since the late 1970s. It is used to refer to persistent excessive exercise despite negative physical, psychological and social consequences, with unsuccessful attempts to reduce or stop the behavior. In this article, the evidence for exercise addiction as a behavioral addiction is presented. Symptoms and psychiatric comorbidities are explained, and recommendations for identification and treatment of exercise addiction are presented.

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Background and Aims: Exercise addiction has not yet been designated as an addictive disorder in the DSM-5 due to a lack of detailed research. In particular, associations with other psychiatric diagnoses have received little attention. In this study, individuals with a possible exercise addiction are clinically assessed, in order to establish a profile of co-occurring psychiatric disorders in individuals with exercise addiction. Methods: One hundred and fifty-six individuals who reported exercising more than 10 h a week, and continued to do so despite illness or injury, were recruited for the study. Those who met the cut-off of the Exercise Dependence Scale (n = 32) were invited to participate in a screening with the Structured Clinical Interview for DSM-5 (SCID-5-CV) and personality disorders (SCID-5-PD). Additionally, an interview based on the DSM-5 criteria of non-substance-related addictive disorders was conducted to explore the severity of exercise addiction symptoms. Results: 75% of participants fulfilled the criteria for at least one psychiatric disorder. Depressive disorders (56.3%), personality disorders (46.9%) and obsessive-compulsive disorders (31.3%) were the most common disorders. Moreover, there was a significant positive correlation between the number of psychiatric disorders and the severity of exercise addiction (r = 0.549, p = 0.002). Discussion: The results showed a variety of mental disorders in individuals with exercise addiction and a correlation between the co-occurrence of mental disorders and the severity of exercise addiction. Exercise addiction differs from other addictive und substance use disorders, as obsessive-compulsive (Cluster C), rather than impulsive (Cluster B) personality traits were most commonly identified. Conclusions: Our results underscore the importance of clinical diagnostics, and indicate that treatment options for individuals with exercise addiction are required. However, the natural history and specific challenges of exercise addiction must be studied in more detail.
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Everyday physical activity plays an important part in health maintenance and disease prevention. Excess exercise, however, can cause detrimental effects on both physical and mental health. It can also hamper the quality of life to an extent that individual is unable to regulate this behavior. 'Addicted' exercisers are more likely to work out for intrinsic rewards and experience troubling feelings of deprivation. In comparison, 'committed' exercisers participate in physical activity for extrinsic benefits and, when they cannot exercise, do not experience extreme withdrawal symptoms. Sportspersons indulge themselves in long hours of training as a response of their quest to improve endurance and performance in the face of common setbacks. Recognizing the addiction to exercise is also a contentious idea and the aim of this article is to draw an attention towards the same. Exercise Addiction diagnosis needs employment of questionnaires such as Exercise Dependence Scale, Obligatory Exercise Questionnaire, and Exercise Addiction Inventory. They need to be employed in the pre-participation evaluation of an individual participating in any sports event. Physiotherapists are often the first to meet an individual with exercise addiction. Physiotherapists play an important role in diagnosis of exercise addiction as well as in prevention as they are aware of challenges of treating exercise addicted patients and develop specific approaches to deal with their issues. As if it goes unnoticed, the prognosis can even be fatal.
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Athletes train on a pre-determined training schedule. Scheduled behaviors are difficult to become “addictive” because urges and cravings cannot be scheduled. Still, many scholars think that elite or competitive athletes can become addicted to their sport or exercise. The aim of this systematic literature review was to analyze scholastic papers on exercise addiction in athletes with a special view on their focus and prevalence estimates. Four databases were scrutinized, including PsycINFO, PubMed/Medline, Crossref, and ScienceDirect, which resulted in 17 eligible articles based on the inclusion and exclusion criteria. The bulk of these studies compared athletes to non-athletes and employed a cross-sectional design. Their results suggest that the risk of exercise addiction is greater in athletes than non-athletes, along with a prevalence rate of up to >40%, which is ten times greater than that reported in a population-wide study. These findings are in discord with the definition and conceptualization of exercise addiction, which, according to previous calls, begs for the urgent clearer conceptualization of exercise addiction.
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Background and Aims: While a number of studies have reported on individuals who exercise excessively, and feel unable to stop despite negative consequences, there is still insufficient evidence to categorize exercise as an addictive disorder. The aim of this meta-review is to summarize the published articles and to compile a list of symptoms reported in the qualitative literature in conjunction with excessive exercise. This list is compared with the DSM-5 criteria for gambling disorder, and initial diagnostic criteria for exercise addiction are suggested. Methods: The databases MEDLINE, Web of Science and PsycInfo were searched for qualitative studies or case reports, in which excessive exercise was the main focus. All symptoms reported in conjunction with excessive exercise were extracted from each study and documented. Symptoms were also compared to the diagnostic criteria for gambling disorder. Results: Seventeen studies were included in the review, yielding 56 distinct symptoms. The Critical Appraisal Skills Program tool showed that the majority of the studies were of acceptable quality. Exercise-related symptoms corresponded with seven of the nine DSM-5 criteria for gambling disorder. The ten suggested criteria for exercise addiction are: increasing volume, negative affect, inability to reduce, preoccupation, exercise as coping, continuation despite illness/injury, minimization, jeopardized relationships, continuation despite recognizing consequences, guilt when exercise is missed. Discussion: Our results suggest that excessive exercise may constitute a behavioral addiction, based on the criteria of the DSM-5. Conclusions: Subsequent studies should aim to systematically classify symptoms of excessive exercise; in addition, it should be noted that basic questionnaires may be need to be supplemented with detailed clinical examinations.
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Background Exercise addiction is associated with multiple adverse outcomes and can be classified as co-occurring with an eating disorder, or a primary condition with no indication of eating disorders. We conducted a meta-analysis exploring the prevalence of exercise addiction in adults with and without indicated eating disorders. Methods A systematic review of major databases and grey literature was undertaken from inception to 30/04/2019. Studies reporting prevalence of exercise addiction with and without indicated eating disorders in adults were identified. A random effect meta-analysis was undertaken, calculating odds ratios for exercise addiction with versus without indicated eating disorders. Results Nine studies with a total sample of 2140 participants (mean age = 25.06; 70.6% female) were included. Within these, 1732 participants did not show indicated eating disorders (mean age = 26.4; 63.0% female) and 408 had indicated eating disorders (mean age = 23.46; 79.2% female). The odds ratio for exercise addiction in populations with versus without indicated eating disorders was 3.71 (95% CI 2.00–6.89; I2 = 81; p ≤ 0.001). Exercise addiction prevalence in both populations differed according to the measurement instrument used. Discussion Exercise addiction occurs more than three and a half times as often as a comorbidity to an eating disorder than in people without an indicated eating disorder. The creation of a measurement tool able to identify exercise addiction risk in both populations would benefit researchers and practitioners by easily classifying samples.
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Exercise addiction is a term gaining widespread use in the scientific literature and popular press. However, despite numerous studies of risk factors and affected groups, there is no consensus on how the term should be defined. More importantly, it remains unclear whether problematic exercise habits should be categorised as a behavioral addiction at all, or whether the symptoms are better understood as occurring in the course of other psychiatric disorders. A brief review highlights the large impact that cross-sectional questionnaire-based research has had in this field and suggests an approach to more reliably categorizing problematic exercise as either a disorder or a symptom cluster.
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Exercise addiction is a rising preoccupation for researchers as a susceptible cause of serious health issues and negative consequences for individuals. Although there are numerous studies that have analysed exercise addiction, only a few have examined possible gender differences. To estimate if there is a prevalence difference between men and women relating to exercise addiction, a systematic review was conducted. Bibliographic searches were performed via PubMed and PsycINFO databases limited to English language, studies on humans, and since 2000, with the search terms: ‘exercise addiction inventory’ and ‘exercise dependence scale’, with a result of 590 potential relevant entries. Titles were then reviewed for duplicates and non-peer reviewed papers, which were then excluded. This resulted in a list with of 433 articles. Subsequently, abstracts and methods were reviewed using the following inclusion criteria: studies using the Exercise Addiction Inventory and/or the Exercise Dependence Scale, as these are the only available screening tools to identify the individual at risk of exercise addiction. The full text of the resulting 88 articles was then analysed, focusing on studies providing data about gender differences on the prevalence of exercise addiction (number of participants, percentages, and/or means and standard deviations). As reported by the 27 studies included in the final systematic review that met all the inclusion criteria, the effect size reflects variation in gender differences. Cohen’s d was between .04 and .98, suggesting that men are more addicted to exercise than women. Only two studies reported that the prevalence for exercise addiction was higher in women than men. However, our study concludes that more research is needed to understand the gender differences on the prevalence of exercise addiction, and the nature of this potential disorder. © 2018, Editura Universitatii din Pitesti. All rights reserved.
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Exercise addiction is widely studied in sport science and psychology, but at this time it is not recognized as an independently diagnosable mental or psychiatric disorder. Indeed, studies on exercise addiction assess a level of risk for disordered exercise behaviour, characterized by lack of control and negative personal consequences. It is argued that commitment and passion are two overlapping features of high exercise involvement which obscure the fine line between healthy and unhealthy exercise. The present case study examined a successful female body builder who initially claimed that she was addicted to exercise. During an interview she also completed three questionnaires and her appraisal of well-being in eight life domains were assessed at present, as well as retrospectively before her intensive involvement with exercise. She was screened under the Non-Substance Related Disorders category of Substance-Related and Addictive Disorders classification of DSM-5 for gambling, by replacing the word "gambling" with "exercise". Although she was susceptible to exercise addiction, attained high scores on obsessive passion, exhibited more than four symptoms on the DSM list, she exhibited no signs of loss of control and she mainly reported positive experiences associated with her exercise behaviour. She has obtained a nearly maximum score on commitment to exercise and high score on harmonious passion. Almost all aspects of her life have changed in positive direction after getting intensely involved in exercise. This case illustrates that the current scholastic path to the study of exercise addiction may be obscured by ambiguous assumptions and unilateral quantitative focus.
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To explore, using qualitative methods, the concept of exercise dependence. Semistructured interviews were undertaken with subjects screened for exercise dependence and eating disorders. Female exercisers, four in each case, were allocated a priori to four groups: primary exercise dependent; secondary exercise dependent, where there was a coincidence of exercise dependence and an eating disorder; eating disordered; control, where there was no evidence of either exercise dependence or eating disorder. They were asked about their exercise and eating attitudes and behaviour, as well as about any history of psychological distress. Their narratives were taped, transcribed, and analysed from a social constructionist perspective using QSR NUD*IST. Participants classified as primary exercise dependent either showed no evidence of exercise dependent attitudes and behaviour or, if they exhibited features of exercise dependence, displayed symptoms of an eating disorder. Only the latter reported a history of psychological distress, similar to that exhibited by women classified as secondary exercise dependent or eating disordered. For secondary exercise dependent and eating disordered women, as well as for controls, the narratives largely confirmed the a priori classification. Where exercise dependence was manifest, it was always in the context of an eating disorder, and it was this comorbidity, in addition to eating disorders per se, that was associated with psychological distress. As such, these qualitative data support the concept of secondary, but not primary, exercise dependence.
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This review highlights recent work evaluating the relationship between exercise, physical activity and physical and mental health. Both cross-sectional and longitudinal studies, as well as randomized clinical trials, are included. Special attention is given to physical conditions, including obesity, cancer, cardiovascular disease and sexual dysfunction. Furthermore, studies relating physical activity to depression and other mood states are reviewed. The studies include diverse ethnic populations, including men and women, as well as several age groups (e.g. adolescents, middle-aged and older adults). Results of the studies continue to support a growing literature suggesting that exercise, physical activity and physical-activity interventions have beneficial effects across several physical and mental-health outcomes. Generally, participants engaging in regular physical activity display more desirable health outcomes across a variety of physical conditions. Similarly, participants in randomized clinical trials of physical-activity interventions show better health outcomes, including better general and health-related quality of life, better functional capacity and better mood states. The studies have several implications for clinical practice and research. Most work suggests that exercise and physical activity are associated with better quality of life and health outcomes. Therefore, assessment and promotion of exercise and physical activity may be beneficial in achieving desired benefits across several populations. Several limitations were noted, particularly in research involving randomized clinical trials. These trials tend to involve limited sample sizes with short follow-up periods, thus limiting the clinical implications of the benefits associated with physical activity.
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Physical exercise modulates food reward and helps control body weight. The endogenous µ‐opioid receptor (MOR) system is involved in rewarding aspects of both food and physical exercise, yet interaction between endogenous opioid release following exercise and anticipatory food reward remains unresolved. Here we tested whether exercise‐induced opioid release correlates with increased anticipatory reward processing in humans. We scanned 24 healthy lean men after rest and after a 1 h session of aerobic exercise with positron emission tomography (PET) using MOR‐selective radioligand [11C]carfentanil. After both PET scans, the subjects underwent a functional magnetic resonance imaging (fMRI) experiment where they viewed pictures of palatable versus nonpalatable foods to trigger anticipatory food reward responses. Exercise‐induced changes in MOR binding in key regions of reward circuit (amygdala, thalamus, ventral and dorsal striatum, and orbitofrontal and cingulate cortices) were used to predict the changes in anticipatory reward responses in fMRI. Exercise‐induced changes in MOR binding correlated negatively with the exercise‐induced changes in neural anticipatory food reward responses in orbitofrontal and cingulate cortices, insula, ventral striatum, amygdala, and thalamus: higher exercise‐induced opioid release predicted higher brain responses to palatable versus nonpalatable foods. We conclude that MOR activation following exercise may contribute to the considerable interindividual variation in food craving and consumption after exercise, which might promote compensatory eating and compromise weight control.
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Just like other wonder drugs, running has the potential for abuse. A hard-core exercise addict 'can't live' without daily running, manifests withdrawal symptoms if deprived of exercise, and runs even when his physician says he shouldn't. Exercise addicts may give their daily runs higher priority than job, family, or friends. Running should be a means to an end, and the end should be achievement of positive health-both physical and mental. The running experience should not become an end in itself, because at this point runners may lose perspective, adopt questionable priority systems, move inwardly, and finally, self destruct.
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Overtraining syndrome (OTS) occurs where an athlete is training vigorously, yet performance deteriorates. One sign of OTS is suppressed immune function, with an increased incidence of upper respiratory tract infection (URTI). An increased incidence of URTIs is also associated with high volume/intensity training, as well as with excessive exercise (EE), such as a marathon, manifesting between 3–72 hours post-race. Presently, there is no encompassing theory to explain EE and altered immune competence. Recently, it has been conclusively established that T helper lymphocytes (TH), a crucial aspect of immune function, represent two distinct functional subsets: TH1 and TH2 lymphocytes. TH1 lymphocytes are associated with cell-mediated immunity (CMI) and the killing of intracellular pathogens, while TH2 lymphocytes are associated with humoral immunity and antibody production. When TH-precursor cells are activated, the balance is tipped in favour of one or the other. Furthermore, the most appropriate means of determining the TH-subset, is by the prevailing cytokine ‘pattern’. This paper hypothesises that exercise-related immunosuppression is due to tissue trauma sustained during intense exercise, producing cytokines, which drive the development of a TH2 lymphocyte profile. A TH2 cell response results in simultaneous suppression of CMI, rendering the athlete susceptible to infection. Additionally, increased levels of circulating stress hormones (cortisol and catecholamines), as well as prostaglandin E2, support up-regulation of TH2 lymphocytes. Marathon-related data are presented to support this hypothesis. It is concluded that an increased incidence of illness associated with OTS and in response to EE is not due to immunosuppression per se, but rather to an altered focus of immune function, with an up-regulation of humoral immunity and suppression of CMI.
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A growing body of research has investigated the potential health risks of excessive exercise on human health. There is now a clear need for an up-to-date, critical synthesis of reliable findings on this topic. Objective. To determine the potential adverse biological effects of excessive exercise and overtraining among - initially - healthy men and women. Design. Brief review. Material and method. In order to identify relevant studies, the electronic database Medline was searched using the following terms/key words: “excessive exercise” OR “overtraining”” AND “adverse effects”. Studies had to: a) be written in English, b) published from January 1980- March 2014, and c) involve healthy men and women (individuals with no pre-existing medical conditions). Results and discussion. The main adverse effects associated with excessive exercise and overtraining among healthy individuals were musculoskeletal injuries, adverse cardiovascular effects, exercise-induced muscle damage, exerciserelated alterations of immunity, exercise-related reproductive dysfunction, chronic negative energy balance, osteoporosis, and sleep disorders. Conclusions. The findings of the present study suggest that excessive exercise and overtraining can have serious health consequences. Sports physicians, trainers and health educators should be aware of these risks and advise the people accordingly. Further research needs to be carried out in this area, including high quality trials.
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DELTA (slow wave, stages 3 and 4) sleep has been widely thought of as deep sleep according to criteria involving cerebral responsiveness or ease of arousal.1-5 On the other hand, it is commonly felt that exercise promotes sound or deep sleep, a notion supported by recent experimental studies which indicate the delta sleep-promoting effects of exercise both in animals6,7 and man.8 Although it was shown in this laboratory8 that subjects (Ss) who exercise regularly have more delta sleep on days with exercise than on days without it, it was not possible to determine the duration of the effects of exercise on sleep since the Ss never went without exercise for more than two consecutive days. Hence, we decided to study the sleep of a group of Ss used to regular exercise both while they were exercising and over a relatively prolonged
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This paper presents five studies with 2,420 total participants on the development and validation of the Exercise Dependence Scale (EDS), which is conceptualized based on the Diagnostic and Statistical Manual-IV (APA, 1994) criteria for substance dependence, and differentiates among at-risk, nondependent-symptomatic, and nondependent-asymptomatic exercisers. Results of the studies revealed evidence for the a priori hypothesized components, acceptable test-retest and internal consistency reliability, and content and concurrent validity of the EDS. Individuals at-risk for exercise dependence reported more strenuous exercise, perfectionism, and self-efficacy compared to the nondependent groups. The findings provide initial support for the EDS and indicate the need for a multifaceted approach to its conceptualization and measurement.
Overtraining is a condition in which the physiological demand of an exercise regime outweighs the ability of the body to adjust to the demand. The consequences of overtraining are widespread, negatively affecting several physiological systems, including the neuroendocrine, immunological, cardiovascular, and musculoskeletal systems, respectively. Overtraining could also result in several negative psychological disturbances. Exercise dependence a pathology in which a person becomes addicted to exercise, often exercising twice or more daily, while experiencing physical and psychological withdrawal symptoms is also a probable cause of overtraining. Because of his or her excessive exercising, a person diagnosed with exercise dependence is equally as vulnerable to overtraining as the committed athlete.
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This article examines the nature of exercise addiction. It presents a broad, congruent and discerning narrative literature review with the aim of providing a deeper understanding of the condition 'exercise addiction', including symptoms and options for treatment. In addition, guidelines are provided with respect to 'healthy' levels of exercise. Criteria used for determining the eligibility of studies evaluated in the review included the provision of relevant information in studies identified using pertinent search terms. The review highlights some of the key distinctions between healthy levels of exercise and exercise addiction. The findings suggest that an individual who is addicted to exercise will continue exercising regardless of physical injury, personal inconvenience or disruption to other areas of life including marital strain, interference with work and lack of time for other activities. 'Addicted' exercisers are more likely to exercise for intrinsic rewards and experience disturbing deprivation sensations when unable to exercise. In contrast, 'committed' exercisers engage in physical activity for extrinsic rewards and do not suffer severe withdrawal symptoms when they cannot exercise. Exercisers must acquire a sense of life-balance while embracing an attitude conducive to sustainable long-term physical, psychological and social health outcomes. Implementation of recommendations by the Canadian Society for Exercise Physiology, which states that all apparently healthy adults between 18 and 64 years of age should accumulate at least 150 minutes of moderate (5 or 6 on a scale of 0-10) to vigorous (7 or 8 on a scale of 0-10) intensity aerobic physical activity per week in bouts of 10 minutes or more, also expressed as 30 minutes per day distributed over 5 days per week, would be a good start.
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Introduction: Physical activity activates brain regions and transmitter systems that represent the reward system (i.e., the ventral striatum [VS] and dopamine). To date, the effect of training status and acute exercise on reward processing has not been investigated systematically in humans. To address this issue, we examined highly trained (HT) physically inactive (PIA) men with a monetary incentive delay (MID) paradigm. Methods: We used functional magnetic resonance imaging (fMRI) to investigate the neural correlates of monetary incentive processing after acute exercise. HT and PIA subjects were randomized into two groups. Subjects in one group ran on a treadmill (T) for 30 min at 60%-70% of their maximal oxygen uptake (V˙O2max), whereas subjects in the other group performed placebo exercise (P). Approximately 1 h after exercise, the MID task was conducted. Mood was assessed using the Positive and Negative Affect Schedule before and after the exercise intervention. Results: The psychological assessment showed that exercise significantly increased mood in HT and PIA men. During gain anticipation and gain feedback of the MID task, the VS was significantly stronger activated in the placebo group than in the treadmill group. No effect of training status and no interactions between training status and acute exercise were found. Conclusions: Acute exercise diminishes sensitivity to monetary rewards in humans. This finding is discussed concerning interactions between tonic and phasic dopamine in the VS.
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Exercise addiction is an area of great speculation with only limited evidence for its existence. Despite a growing body of such literature, there have been few empirical reports and very few case studies. This paper therefore outlines a case study of a female excessive exerciser. The case study has been modelled around Brown's (1993) addictive components of salience, tolerance, withdrawal, euphoria, conflict and relapse. It is demonstrated that in the case of this individual that exercise is addictive and fulfils all of Brown's addictive components.
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The aim of this review is to synthesize the knowledge about the definitions and measures of exercise dependence based on the few studies available in the literature. This review presents the evolution of exercise dependence conceptualization (measures and definitions) around a number of key considerations and debates. Each of these considerations conceptualizes excessive exercise as a form of dependence. This article overviews a number of distinct areas: (i) the positive and/or negative nature of exercise dependence, (ii) the link between exercise dependence and eating disorders, (iii) the elaboration of diagnostic criteria for exercise dependence, and (iv) the use of substance dependence and the behavioral component model of addiction to conceptualize exercise dependence. Future research areas are also briefly outlined.
Chapter
Halten wir einen Menschen, der in der Woche 20 Stunden Sport treibt, für sportsüchtig? Unsere spontane Antwort („Ja!“) relativieren wir zumeist dann, wenn wir über Profisportler, über Olympiasieger oder Weltmeister nachdenken. Es scheint allerdings nahe liegender, das Etikett „Sucht“ dem Freizeitsportler zu geben, der ohne berufliche Zwänge und Notwendigkeiten ähnliche Belastungen auf sich nimmt, wenngleich bei genauerer Betrachtung auch hier Umstände vorliegen können, die die Abhängigkeit von der Bewegung fraglich erscheinen lassen würden. Wenn beispielsweise der Freizeitsportler jeden Tag mit einer Gruppe gleich gesinnter Hobbyradler drei Stunden in das Hinterland fährt, sich an Land und Leuten erfreut, statt sich vor den Fernseher zu legen, würden wir dieses Verhalten (insbesondere dann, wenn Partner und Kind auch noch mitmachen — welch’ Utopie), wohl nicht als Sucht bezeichnen. Dann jedoch, wenn kein Tag ohne Sport möglich ist, wenn alle anderen Dinge in den Hintergrund geraten und vernachlässigt werden, wenn selbst Familie, Existenz oder Verletzung kein Argument für das Einschränken der Aktivität sind, dann würden wir ernsthaft über eine krankhafte Verhaltensform nachdenken müssen. So zumindest tat es (1970), der zumeist als „Entdecker“ der Sportsucht bezeichnet wird. Er stellte im Rahmen eines Experiments fest, dass bestimmte Sportler selbst mit Geld nicht dazu zu bewegen sind, auf Sport zu verzichten.
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By analyzing psychological characteristics of physically active participants, the aim of this investigation was to use the Reversal Theory (RT) framework to determine whether primary and secondary exercise dependence could be considered as (two distinct) and independent conditions. Highly active amateur participants (N=393), of which 95 were clinically diagnosed as eating disordered, were allocated, on the basis of questionnaire responses, to one of four groups: Primary dependence (n=58), secondary dependence (n=52), eating disordered (n=45) and a control group (no dependence or disordered group, n=238). Canonical correlation initially found eating disorders and exercise dependence to have a positive relationship with telic and arousal avoidance characteristics. Exercise dependence also displayed a positive relationship to autic metamotivational dominance. A positive correlation was also evident between pessimism and eating disorders. However, (M)ANOVA subsequently revealed the two eating disordered groups to be significantly more telic, and arousal avoiding, but lower on optimism and negativistic characteristics than the non-eating disordered groups. The control group scored significantly higher in mastery dominance than the primary group. These results suggest that at amateur levels of sport, primary exercise dependence is distinct in its psychological characteristics from secondary exercise dependence and thus the psychological needs it represents.
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Exercise can become a compulsive behaviour and harmful to an individual. This review proposes diagnostic criteria for ‘exercise dependence’ to facilitate recognition in Sports clinics and further research. The importance of diagnosing exercise dependence lies in the prevention of morbidity and rarely mortality if exercise is continued in the presence of illness or injury. There is insufficient evidence to postulate opioid peptides as a physiological basis of dependence. A distinction is made between a primary form of exercise dependence and that which is secondary to an eating disorder.
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Excessive exercise and motor restlessness are observed in a substantial number of patients with eating disorders. This trait has been studied extensively among animal models of activity anorexia nervosa (AN) and may hold particular interest as an endophenotype for AN. We explored features associated with excessive exercise across subtypes of eating disorders. Participants were female probands and affected female relatives from the multi-site international Price Foundation Genetic Studies with diagnoses of AN, bulimia nervosa (BN), and both AN and BN or eating disorder not otherwise specified (ED-NOS) (N=1,857). Excessive exercise was defined based on responses to the Structured Interview for Anorexic and Bulimic Disorders (SIAB). Among the eating disorder diagnostic groups, excessive exercise was most common among the purging subtype of AN. Individuals who reported excessive exercise also reported lower minimum BMI, younger age at interview, higher scores on anxiety, perfectionism, and eating disorder symptom measures, more obsessions and compulsions, and greater persistence. Excessive exercise may be associated particularly with the purging subtype of AN as well as with a constellation of anxious/obsessional temperament and personality characteristics among women with eating disorders.
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To review information relevant to the question of whether substance-induced mental disorders exist and their implications. This paper utilized a systematic review of manuscripts published in the English language since approximately 1970 dealing with comorbid psychiatric and substance use disorders. The results of any specific study depended on the definitions of comorbidity, the methods of operationalizing diagnostic criteria, the interview and protocol invoked several additional methodological issues. The results generally support the conclusion that substance use mental disorders exist, especially regarding stimulant or cannabinoid-induced psychoses, substance-induced mood disorders, as well as substance-induced anxiety conditions. The material reviewed indicates that induced disorders are prevalent enough to contribute significantly to rates of comorbidity between substance use disorders and psychiatric conditions, and that their recognition has important treatment implications. The current literature review underscores the heterogeneous nature of comorbidity.
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The study was aimed at assessing the prevalence of compulsive exercising to control shape and weight in eating disorders (EDs) and its relationship with treatment outcome. Compulsive exercising to control shape and weight, defined according to a modified version of the Intense Exercising to Control Shape or Weight section of the Eating Disorder Examination (EDE), was assessed in 165 consecutive ED inpatients entering a protocol based on the transdiagnostic cognitive behavior theory and treatment of EDs. Baseline assessment also included anthropometry, the global EDE interview, the Beck Depression Inventory, the State-Trait Anxiety Inventory (STAI), the Eating Disorders Inventory-Perfectionism Scale, and the Temperament and Character Inventory. Of the patients, 45.5% were classified as compulsive exercisers, the prevalence being highest (80%) in restricting-type anorexia nervosa (AN), lowest in EDs not otherwise specified (31.9%), and intermediate in binge/purging AN (43.3%) and in purging-type bulimia nervosa (39.3%). Compulsive exercising to control shape and weight was independently predicted by the EDE restraint score (odds ratio, 1.32; 95% confidence interval, 1.06-1.64; P = .014) after adjustment for ED; the total amount of exercise was associated with EDE restraint, as well as with the Temperament and Character Inventory reward dependence. At follow-up, an improved EDE global score was predicted by lower baseline values, higher baseline STAI and STAI improvement, and lower amount of exercise in the last 4 weeks. Voluntary treatment discontinuation was not predicted by baseline exercise. Compulsive exercising to control shape and weight is a behavioral feature of restricting-type AN, associated with restraint and temperament dimensions, with influence on treatment outcome.
Exercise addiction in team sport and individual sport: Prevalences and validation of the exercise addiction inventory
  • M B Lichtenstein
  • K S Larsen
  • E Christiansen
  • R K Støving
  • Tvg Bredahl
Lichtenstein MB, Larsen KS, Christiansen E, Støving RK, Bredahl TVG. Exercise addiction in team sport and individual sport: Prevalences and validation of the exercise addiction inventory. Addiction Res Theory. 2014;22(5):431-437.