Category Archives: Exercise addiction

Let’s get physical: Exercise addiction (revisited)

At present, exercise addiction is not officially recognised in any medical or psychological diagnostic frameworks such as the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM) or the World Health Association’s International Classification of Diseases. However, there has been a lot of research into whether exercise can be classed as a bona fide addiction. In spite of the widespread usage of the term ‘exercise addiction’ there are many different terminologies that describe excessive exercise syndrome. Such terms include ‘exercise dependence’, ‘obligatory exercising’, ‘exercise abuse’, and ‘compulsive exercise’. Exercise addiction has been conceptualised as a behavioural addiction. The symptoms and consequences of exercise addiction have often been characterised by six common components of addiction: salience, mood modification, tolerance, withdrawal symptoms, personal conflict, and relapse.

For some people, exercise addiction is a primary problem in the person’s life whereas in others it can be a secondary problem as a consequence of other psychological dysfunctions (like eating disorders such as anorexia nervosa). In the former case, the dysfunction is considered as primary exercise addiction, while in the latter case it is termed as secondary exercise addiction because it co-occurs with another dysfunction. The differentiating feature between the two is that in primary exercise addiction the objective is the exercise itself, whereas in secondary exercise addiction the objective is weight loss, where excessive exercise is one of the primary means in achieving the desired objective.

The incentive or motive for fulfilling planned exercise is an important distinguishing characteristic between addicted and nonaddicted exercisers. The reason people exercise is often for an intangible reward such as feeling in shape, looking good, being with friends, staying healthy, building muscles, losing weight, etc. The personal experience of the anticipated reward reinforces and strengthens the exercise behaviour. Committed exercisers maintain their exercise for benefiting or gaining from their activity and thus, their behaviour is motivated via positive reinforcement. However, empirical research has demonstrated that addicted exercisers have to exercise in order to avoid negative feelings or withdrawal. The individual’s exercise may become a chore that has to be fulfilled, or otherwise an unwanted event would occur (such as the inability to cope with stress, or gaining weight, becoming moody, etc.). Every time a person undertakes behaviour to avoid something negative, bad, and/or unpleasant, the motive behind that behaviour acts as a negative reinforcement. In these situations, the person feels they have to do it rather than wanting to do it.

Mood modification is a key factor among the symptoms of exercise addiction and suggests there is a self-medication aspect of exercise that facilitates the distinction between normal and abnormal exercise. Addicts do not simply exercise to experience the joy of it, but rather to escape negative, unpleasant feelings and everyday difficulties.

The Exercise Addiction Inventory is one of the most recent and most widely used screening tools in the research area of exercise addiction, primarily because of its brevity and excellent psychometric properties (i.e., reliability and validity). The EAI comprises only six statements, each corresponding to one of the symptoms in the ’components’ model of addiction. Each statement is rated on a 5-point Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree). The EAI cut-off score for individuals considered at-risk of exercise addiction is 24 out of 30. To date, the only nationally representative study examining exercise addiction is a study that I co-authored with some Hungarian colleagues. We surveyed over 2,700 Hungarian adults aged 18–64 years and assessed exercise addiction using the EAI. Results showed that the proportion of the people at risk for exercise addiction was 0.5%.

There are numerous theories that deal with both the causes of exercise addiction and the process and mechanisms of its development and maintenance. A significant number of psychological theories are based on learning theory or the cognitive psychology approach. According to the theory of functioning, both positive reinforcers (e.g., a feeling of euphoria following exercise or muscle growth from exercise) and negative reinforcers (e.g. an end to unpleasant feelings through exercise or avoidance of the presumed negative effect of missed exercise) may lie behind the development and maintenance of exercise addiction which, according to the fundamental principles of learning theory, may contribute to the establishment of compulsive and addictive exercise that may be viewed as maladaptive.

One of my research colleagues, Dr. Attila Szabo stresses the role of cognitive appraisal mechanisms in the development of the vicious cycle that leads to excessive exercise. The process starts when the habitual exerciser uses exercise as a means of coping with stress, and the affected individual learns to depend on exercise at times of stress. The addicted exerciser is then trapped in a vicious cycle of needing increased amounts of exercise to deal with the consistently increasing life stress, part of which is caused by exercise itself.

It also appears that the issue of self-assessment represents a further significant factor among the psychological factors in the sense that during exercise, the physical strength experienced through exercise in a person dissatisfied with his or her body or body image contributes to the formation of a more positive self-image and self-assessment. It has also been shown that exercise activities (such as weightlifting) have a positive effect on body image and self-esteem both in men and in women. Perfectionism, obsessive-compulsive functioning, and heightened anxiety have also been claimed to be determining factors in exercise addiction.

The public promotion of healthy and appropriate exercise patterns may reduce the incidence of exercise addiction. It is important in public health programs and campaigns to (i) stress the healthy nature of regular exercise and (ii) communicate the message that exercise when taken to excess can be potentially harmful. It is important to raise awareness of potential harm within the population of regular exercisers. Some psychologists claim that individuals with exercise addiction have a poor understanding of the negative health consequences of excessive exercising, of the mechanism of exercise adaptation, and the need for rest between exercise sessions. The use of education may be an effective step in the prevention and treatment of exercise addiction.

As with other addictive disorders, the environment of regular exercisers also plays a significant role in recognising this condition early. In more severe cases psychotherapeutic interventions may be needed. When treating exercise addiction, abstinence from exercise may not be a required and/or realistic goal, because exercise has many benefits for health and no one would advocate doing no exercise. Therefore, the typical treatment goal would more likely be be to return to moderate and controlled exercise. In some cases, a different form of exercise may be recommended.

CASE STUDY

Joanna is a 25-year old student, well-educated female, from a stable family background, who realized that she had a problem surrounding exercise, and more specifically the martial art Jiu-Jitsu. Here, Joanna’s behavior is described in terms of the main components of addiction:

  • Salience: Jiu-Jitsu is the most important activity in Joanna’s life. Even when not actually engaged in the activity, she is thinking about the next training session or competition. She estimates that she spends approximately six hours a day (and sometimes much more) involved in training (e.g., weight training, jogging, general exercise, etc.).
  • Tolerance: Joanna started Jiu-Jitsu at an evening class once a week during her teenage years and built up slowly over a period of about five years. She now exercises every single day, and the lengths of the sessions have become longer and longer (suggesting tolerance).
  • Withdrawal: Joanna claims she becomes highly agitated and irritable if she is unable to exercise. She claims she also gets headaches and feels nauseous if she goes for more than a day without training or has to miss a scheduled session.
  • Mood modification: Joanna experiences mood changes in a number of ways. She feels very high and ‘buzzed up’ if she has done well in a Jiu-Jitsu competition (especially so if she wins). She also feels high if she has trained hard and for a long time.
  • Conflict: Joanna’s relationship with her long-term partner ended as a result of her exercise. She claimed she never spent much time with him and was not even bothered about their break-up. Her university work suffered because of the lack of time and concentration.
  • Loss of control: Joanna claims she cannot stop herself engaging in exercise when she “gets the urge”. Once she has started, she has to do a minimum of a few hours of exercise.
  • Relapse: Joanna has continually tried to stop and/or cut down but claims she cannot. She becomes highly anxious if she is unable to engage in exercise and then has to go out and train to make herself feel better. She is well aware that exercise has taken over her life but feels powerless to stop it.
  • Negative consequences: Joanna spends money beyond her means to maintain her exercising habit (e.g., on entrance fees for weight training, swimming, entrance fees enter Jiu-Jitsu tournaments across the country, etc.). She has resorted to socially unacceptable means (e.g., stealing) in order to get money to fund herself

In short, exercise is the most important thing in Joana’s life, and the number of hours engaged in physical activity per week has increased substantially over a five-year period. She displays withdrawal symptoms when she does not exercise, and experiences euphoric experiences related to various aspects of her exercising (e.g., training hard, winning competitions, etc.). She experiences conflict over exercise in many areas of her life and acknowledges she has a problem. Furthermore, she has lost friends, her relationship has broken down, her academic work has suffered, and she has considerable debt.

Note: An expanded version of this article was first published by Rehabs.com

Dr. Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Allegre, B., Souville, M., Therme, P., & Griffiths, M.D. (2006). Definitions and measures of exercise dependence, Addiction Research and Theory, 14, 631-646.

Allegre, B., Therme, P., & Griffiths, 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.

Berczik, K., Szabó, A., Griffiths, M. D., Kurimay, T., Kun, B., Urbán, R., & Demetrovics, Z. (2012). Exercise addiction: symptoms, diagnosis, epidemiology, and etiology. Substance Use and Misuse, 47, 403-417.

Downs, D. S., Hausenblas, H. A., & Nigg, C. R. (2004). Factorial validity and psychomaetric examination of the Exercise Dependence Scale-Revised. Measurement in Phisical Education and Exercise Science, 8, 183-201.

Griffiths, M. (1997). Exercise addiction: A case study. Addiction Research, 5, 161-168.

Griffiths, 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, e30-31.

Hausenblas H. A., & Downs, S. D. (2002a) Exercise dependence: a systematic review. Psychology of Sport Exercise, 3, 89-123.

Hausenblas, H. A., & Downs, S. D. (2002). How much is too much? The development and validation of the exercise dependence scale. Psychology and Health, 17, 387-404.

Mónok, K., Berczik, K., Urbán, R., Szabó, A., Griffiths, M.D., Farkas, J., Magi, A., Eisinger, A., Kurimay, T., Kökönyei, G., Kun, B., Paksi, B. & Demetrovics, Z. (2012). Psychometric properties and concurrent validity of two exercise addiction measures: A population wide study in Hungary. Psychology of Sport and Exercise, 13, 739-746.

Sussman, S., Lisha, N., & Griffiths, M. D. (2011). Prevalence of the addictions: A problem of the majority or the minority? Evaluation and the Health Professions, 34, 3-56.

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.

Szabo, A., & Griffiths, M. D. (2007). Exercise addiction in British sport science students. International Journal of Mental Health and Addiction, 5, 25-28.

Terry, A., Szabo, A., & Griffiths, M. (2004). The exercise addiction inventory: a new brief screening tool. Addiction Research and Theory, 12, 489-499.

Winning runs? Another look at exercise addiction

Research appears to indicate that at times of psychological and/or emotional hardship, some habitual exercisers engage in such activity as a form of escape. The reliance on exercise as a means of coping with adversity has the potential become obsessive as well as compulsive. Associated with increased tolerance, over-exercising may lead to physical injuries, and (in extreme cases) irreversible health consequences, and mortality. Over-exercising to the point where a person loses control over the exercise routine has been termed ‘exercise addiction’ or ‘exercise dependence’. Due to the multidisciplinary nature of the literature regarding problematic exercise, different screening instruments have been formulated to assess the problem. In a 2013 issue of the journal Psychology of Sport and Exercise, I and a team of Hungarian researchers published the first ever national study of exercise addiction, and compared two different screening instruments (i.e., the Exercise Addiction Inventory [EAI] and the Exercise Dependence Scale [EDS]).

We made the assumption that these two instruments attempt to assess the same phenomenon. We also published a comprehensive review examining the literature on problematic exercise in a 2012 issue of Substance Use and Misuse and came to the conclusion that the most appropriate term to use is ‘exercise addiction’ because it incorporates both ‘dependence’ and ‘compulsion’. However, most researchers in the field use the terms ‘exercise addiction’, ‘exercise dependence’ and ‘compulsive exercise’ to mean the same thing.

These six core components of addictive behaviour that I outlined in my very first blog served the theoretical foundation for the Exercise Addiction Inventory (EAI). The EAI is a short, psychometrically validated questionnaire that comprises only six statements, each corresponding to one of the symptoms in the ‘components’ model of addiction. However, the cut-off points for exercise addiction were never tested psychometrically. The Exercise Dependence Scale (EDS) was based on the Diagnostic and Statistical Manual of Mental Disorder-IV criteria for substance dependence. The higher the score, the higher is the risk for addiction.

The EAI and the EDS are perhaps the most recent and most widely used screening tools in the research area of exercise addiction, primarily because of their superior psychometric properties in contrast to other instruments, and secondarily because of their theoretical underpinning. However, until our recently published study, these two tools had never been used in a nationally representative study. We assessed exercise addiction within the framework of the National Survey on Addiction Problems in Hungary (NSAPH).

The final sample comprised 2,170 people, stratified according to geographical location, degree of urbanization, and age. Those in this sample who engaged in regular exercise at least on a weekly basis (17.5%) were invited to complete the EAI and the EDS and comprised 474 participants (270 males and 204 females). In line with our assumptions, there was a high correlation between the two exercise addiction/dependence measures. On the basis of results we obtained, we reported that 0.3-0.5% of population is involved in addictive exercise (and equates to 1.9% to 3.2% of weekly regular exercisers).

As mentioned above, our study is the first national study ever to assess the prevalence of exercise addiction in a representative national sample and therefore there are no studies to compare our national findings of the study to. Our study provides primary benchmark data that subsequent national studies will need to be compared to. It is also the first ever study to compare the psychometric properties of (arguably) the two most widely used screening instruments that assess exercise dependence/addiction.

Based on the results of our study, it appears that both of the tools we examined (i.e., EAI and EDS) can reliably be applied in the future for both scientific research in the exercise addiction field, and as a screening instrument in non-research settings. For instance, the short, 6-item EAI could be used as a screening instrument in empirical surveys as a way of combating questionnaire fatigue. It could also be used as a ‘quick and easy’ tool that can be used by health practitioners (such as GPs with their patients) in screening for exercise addiction. The EDS also appears to be suitable for acquiring a more detailed and greater empirical insight to the problem in future studies.

However, there were also a number of limitations to our study. Owing to the sampling method, it was financially impractical to use observational data on physical activity and/or face-to-face clinical interviewing, and therefore we had to base our analysis solely on the basis of self-reports. Self-report data is also prone to the weaknesses of survey methodologies more generally including factors such as recall bias and social desirability. Another limitation was the cross-sectional nature of the dataset, therefore the causality inferences are limited, although further research may identify trends in exercise behaviours and provide models to determine the changes in exercise addiction. Another important question is the generalizability of these results to other countries. However, this question cannot be answered in a reliable way. Though the prevalence of regular exercise is lower in Hungary than in most of the other countries of the European Union, this result, in and of itself, does not necessarily mean that prevalence of excessive exercise is lower as well. It is also possible that though the prevalence of regular exercise is lower than in other countries, prevalence of exercise addiction among the exercisers is higher.

Our results indicate that while optimal regular exercising is a key component of preserving and improving physical and mental health, in case of a small proportion of the population, excessive exercise can generate significant problems. Both the EDS and EAI are adequate screening solutions to assessing exercise dependence/addiction within target populations. While the seven-factor EDS might give a more complex picture on the problem, the short, 6-item EAI has the added advantage of providing anyone who uses the instrument with an estimation of problems with exercise very quickly. Nevertheless, clinical validation of these assessment tools needs to be further targeted and scrutinized by future research.

Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Allegre, B., Souville, M., Therme, P., & Griffiths, M.D. (2006). Definitions and measures of exercise dependence, Addiction Research and Theory, 14, 631-646.

Allegre, B., Therme, P., & Griffiths, 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.

Berczik, K., Szabó, A., Griffiths, M. D., Kurimay, T., Kun, B., Urbán, R., & Demetrovics, Z. (2012). Exercise addiction: symptoms, diagnosis, epidemiology, and etiology. Substance Use and Misuse, 47, 403-417.

Downs, D. S., Hausenblas, H. A., & Nigg, C. R. (2004). Factorial validity and psychomaetric examination of the Exercise Dependence Scale-Revised. Measurement in Phisical Education and Exercise Science, 8, 183-201.

Griffiths, M. (1997). Exercise addiction: A case study. Addiction Research, 5, 161-168.

Griffiths, 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, e30-31.

Hausenblas H. A., & Downs, S. D. (2002a) Exercise dependence: a systematic review. Psychology of Sport Exercise, 3, 89-123.

Hausenblas, H. A., & Downs, S. D. (2002). How much is too much? The development and validation of the exercise dependence scale. Psychology and Health, 17, 387-404.

Mónok, K., Berczik, K., Urbán, R., Szabó, A., Griffiths, M.D., Farkas, J., Magi, A., Eisinger, A., Kurimay, T., Kökönyei, G., Kun, B., Paksi, B. & Demetrovics, Z. (2012). Psychometric properties and concurrent validity of two exercise addiction measures: A population wide study in Hungary. Psychology of Sport and Exercise, 13, 739-746.

Sussman, S., Lisha, N., & Griffiths, M. D. (2011). Prevalence of the addictions: A problem of the majority or the minority? Evaluation and the Health Professions, 34, 3-56.

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.

Szabo, A., & Griffiths, M. D. (2007). Exercise addiction in British sport science students. International Journal of Mental Health and Addiction, 5, 25-28.

Terry, A., Szabo, A., & Griffiths, M. (2004). The exercise addiction inventory: a new brief screening tool. Addiction Research and Theory, 12, 489-499.

Give me strength: Muscle Dysmorphia as an addiction

Muscle Dysmorphia (MD) describes a condition characterised by a misconstrued body image in individuals interpret their body size as both small and weak even though they may look normal or even be highly muscular. Those experiencing the condition typically strive for maximum fat loss and maximum muscular build. MD can have potentially negative effects on thought processes including depressive states, suicidal thoughts, and in extreme cases, suicide attempts. These negative psychological states have also been linked with concurrent use of Appearance and Performance Enhancing Drugs (APED) including Anabolic Androgenic Steroids (AAS).

MD was originally categorised in 1993 by Dr. H.G. Pope and colleagues (in the journal Comprehensive Psychiatry) as Reverse Anorexia Nervosa, due to characteristic symptoms in relation to body size. It has been considered to be part of the spectrum of Body Dysmorphic Disorders (BDD) referring to a range of conditions that tap into issues surrounding body image and eating behaviours. Consequently, there is a lack of consensus amongst researchers whether MD is a form of BDD, Obsessive-Compulsive Disorder (OCD) or a type of eating disorder. Earlier this year, Andy Foster, Dr. Gillian Shorter and I published a paper in the Journal of Behavioral Addictions about the ‘Addiction to Body Image’ model, and arguing that MD could perhaps be conceptualized as an addiction.

Our ‘Addiction to Body Image’ (ABI) model attempts to provide an operational definition and to introduce a standard assessment across the research area. The ABI model uses my addiction components model (outlined is a previous blog) as the framework in which to define muscle dysmorphia as an addiction. For the purposes of our paper, body image was defined using Sarah Grogan’s definition (from her 2008 book Body image: Understanding body dissatisfaction in men, women, and children) who said it was a person’s “perceptions, thoughts and feelings about his or her body”. We argued that the addictive activity in MD is the maintaining of body image via a number of different activities such as bodybuilding, exercise, eating certain foods, taking specific drugs (e.g., anabolic steroids), shopping for certain foods, food supplements, and/or physical exercise accessories, etc.).

In the ABI model, the perception of the positive effects on the self-body image is accounted for as a critical aspect of the MD condition. The maintenance behaviours of those with ABI may include healthy changes to diet or increases in exercise. However, such behaviours can hide or mislead those with ABI away from the negative thought processes that are driving their addiction. It is in the cognitive dysfunction of MD where we believe there is a pathological issue, and why the field has encountered problems with the criteria for the condition. The attempt to explain MD in the same manner as other BDDs may not be adequate due to the cognitive dysfunction occurring in the context of the potentially positive physical effects via improvements in shape, tone, and/or health of the body.

We also argued that there is a difference in the cognitive dysfunction with a misconstrued self-body image compared to other BDDs. The cognitive dysfunction causes the individual with MD to have a misconstrued view of their own body image, and the person believes they are small and puny. This negative mindset has the potential to cause depression and other disorders, and may facilitate the addiction. Unlike other conceptualizations of MD in the BDD literature, we would argue that the agent of the addiction is the perceived body image that is maintained by engaging in secondary behaviours such as specific types of physical activity and food. The most important thing in the life of someone with MD is how their body looks (i.e., their body image). The behaviours that the person with MD engages in (such as excessive exercise or disordered eating) are merely the vehicles by which their addiction (i.e., their perceived body image) is maintained.

Based on empirical evidence to date, we proposed that Muscle Dysmorphia could be re-classed as an addiction due to the individual continuing to engage in maintenance behaviours that cause long-term psychological damage. More research is needed to explore the possibilities of MD as an addiction, and how this particular addiction is linked to substance use and/or other comorbid health conditions. Controversy about the conceptual measurement of the condition, has led to a number of different scales adapted from different criteria that may not fully measure the experience of MD.

However, a group of questions that might test the applicability of the ABI approach to measuring and conceptualising MD have not been asked. Questionnaires such as the Exercise Addiction Inventory and the Bergen Work Addiction Scale (two scales that I co-developed) could be adapted to fit MD characteristics. Adequate conceptualisation is key to explore the clinically relevant condition. This new ABI approach may also have implications for diagnostic systems around similar conditions such as other BDDs or eating disorders.

Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Additional input: Andy Foster and Dr. Gillian Shorter

Further reading

Andreassen, C.S., Griffiths, M. D., Hetland, J. & Pallesen, S. (2012). Development of a Work Addiction Scale. Scandinavian Journal of Psychology, 53, 265-272.

Foster, A.C., Shorter, G.W.& Griffiths, M.D. (2014). Muscle Dysmorphia: Could it be classified as an Addiction to Body Image? Journal of Behavioral Addictions, in press.

Griffiths, M.D. (1997). Exercise addiction: A case study. Addiction Research, 5, 161-168.

Griffiths, M. D. (2005). A ‘components’ model of addiction within a biopsychosocial framework. Journal of Substance Use, 10, 191-197.

Griffiths, 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, 30-31.

Grogan, S. (2008). Body image: Understanding body dissatisfaction in men, women, and children. London: Routledge.

Mosley, P.E. (2009). Bigorexia: Bodybuilding and muscle dysmorphia. European Eating Disorders Review. 17, 191-198.

Murray, S. B., Rieger, E., Touyz, S. W., & De la Garza Garcia, Y. (2010). Muscle Dysmorphia and the DSM-V Conundrum: where does it belong? International Journal of Eating Disorders, 43, 483-491.

Nieuwoudt, J. E., Zhou, S., Coutts, R. A., & Booker, R. (2012). Muscle dysmorphia: Current research and potential classification as a disorder. Psychology of Sport and Exercise, 13, 569-577.

Olivardia, R. (2001). Mirror, mirror on the wall, who’s the largest of them all? The features and phenomenology of muscle dysmorphia. Harvard Review of Psychiatry, 9, 254–259.

Phillips, K. A. & Hollander, E. (1996). Body dysmorphic disorder.In T.A. Widige, A.J. Frances, H.A. Pincus, R. Ross, M.B. First, & W.W. Davis, Eds. DSM-IV Sourcebook, Volume 2. Washington DC: American Psychiatric Association.

Philips, K. A., Gunderson, C. G., Mallya, G., McElroy, S. L., & Carter, W. (1998). A comparison study of body dysmorphic disorder and obsessive-compulsive disorder. Journal of Clinical Psychiatry, 59, 568–575.

Pope, H. G., Jr., Gruber, A. J., Choi, P., Olivardia, R., & Phillips, K. A. (1997). Muscle dysmorphia. An underrecognised form of body dysmorphic disorder. Psychosomatics, 38, 548–557.

Pope, H. G., Jr., Katz, D. L., & Hudson, J. I. (1993). Anorexia nervosa and ‘‘reverse anorexia’’ among 108 male bodybuilders. Comprehensive Psychiatry, 34, 406–409.

Pope, C. G., Pope, H. G., Menard, W., Fay, C., Olivardia, R., & Phillips, K.A. (2005). Clinical features of muscle dysmorphia among males with body dysmorphic disorder. Body image, 2, 395-400.

Veale, D. (2004) Body dysmorphic disorder. Postgraduate Medical Journal. 80, 67-71.

Stats entertainment (Part 2): A 2013 review of my personal blog

My last blog of 2013 was not written by me but was prepared by the WordPress.com stats helper. I thought a few of you might be interested in the kind of person that reads my blogs. I also wanted to wish all my readers a happy new year and thank you for taking the time to read my posts.

Here’s an excerpt:

The Louvre Museum has 8.5 million visitors per year. This blog was viewed about 860,000 times in 2013. If it were an exhibit at the Louvre Museum, it would take about 37 days for that many people to see it.

Click here to see the complete report.

Out of this whirled: Can dancing be addictive?

I don’t know about the rest of the world, but here in the UK, celebrity dancing television shows (such as Strictly Come Dancing and Dancing On Ice) have become highly popular as evidenced by the huge ratings successes over the last few years. As my family are big fans of these shows I’ve come to learn more about dance than I would care to admit. It’s also because of this that a recent paper published in the Journal of Behavioral Addictions caught my eye. It’s a paper by French researchers Remi Targhetta, Bertrand Nalpas, and Pascal Perney entitled Argentine tango: Another behavioral addiction?’ I’m sure many of you reading this will be sceptical about whether dancing can be addictive, but I have always argued that any behaviour can be addictive if there are constant rewards for the individual.

For those of you who know nothing about the Argentine tango (me included before I read this paper), the authors note that:

“Tango is a popular dance for two, which originated in Rio de la Plata, Argentina, in the mid-19th century. Although several styles exist, tango is mostly danced in either open or close embrace, with long elegant steps and complex figures often with sensual connotation. Dancers, men and women, wearing specific clothes and shoes, are perfumed and very elegant”.

The first author of this study (Dr. Targhetta) admits in the paper that he himself is an experienced tango dancer. He got the idea to investigate ‘tango addiction’ because of someone who had attended every night of a 10-day tango festival. Dr. Targhetta developed a friendly relationship with the dancer and suspected that the dancer might be “addicted” to tango. Dr. Targhetta then formally interviewed the dancer:

“He was a white collar in an insurance firm and has a very good income; he suddenly stopped working at 52 years of age in order to practice more and more tango as he wanted; then he moved to Argentina for 2 years to improve and intensify his practice; in Buenos Aires he danced every day from 11 PM to 4 AM and moreover spent 2 hours at least for preparation; he has never considered to reduce or stop dancing and, conversely, he started liking dancing more and more because he was feeling growing pleasure. He claimed that this practice presented no drawback, and on the contrary, there have been advantages such as well-being and self-confidence. Finally, the only time he did not dance was during a holiday week, he developed symptoms looking like those observed during withdrawal such as sadness, feeling uncomfortable and leg prickling”.

Following the interview, Dr. Targhetta concluded that the tango dancer might indeed be addicted but was substantially different from other similar behavioural addictions such as exercise dependence on sports such as running or body-building because “tango dancing requires usually smooth physical effort, it is always performed in an arousing senses environment, while embracing consecutively different partners”. (I’m not sure I follow this line of argument but it’s not critical for a appreciation of the study carried out).

Dr. Targhetta’s observations became the basis for carrying out a much bigger study to examine whether dancing can be addictive. The authors recruited their participants from subscribers to a monthly magazine called ToutTango devoted to tango dancing. Of the 15,000 subscribers, 1,129 tango dancers participated in the study (following an advertisement in the magazine asking for tango dancers to take part in an online survey entitled ‘Are you tango addicted?’). The survey included three measures of addiction: (i) the first measure was based on the DSM-IV criteria for substance dependence, (ii) the second measure comprised Dr. Aviel Goodman’s criteria of dependence, and (iii) the third measure was a self-evaluation of the degree of addiction to tango. More specifically, the authors wrote:

“We built a questionnaire based upon DSM-IV by re-writing each criterion to adapt them to tango, but without modifying their actual meaning; to complete our evaluation toolbox, we also adapted [Dr. Aviel Goodman’s 1990] diagnostic criteria for addictive disorders and, secondly, we added a Likert scale from 0 to 5 for self-evaluation of the degree of addiction to tango…To fit with the future DSM-V definition of substance use disorders, we added a question regarding craving for tango. On the basis of the information recorded from the dancer’s interview, we added some specific and hedonic questions related to the positive (physical or psychological) effects and some items related to the negative (physical or psychological) effects experienced”.

The authors reported that the “dependence rates” were 45% for the adapted DSM-IV criteria, 7% for Goodman’s criteria, and 36% self-rating scores. The difference in these prevalence rates is likely to be because of inadequate conceptualizations of the phenomenon to identify or from differences in the screening tools used. However, they also noted that physical withdrawal symptoms were reported one-fifth of the total sample and that a “strong craving” for dancing was reported by one-third of the total sample. Only 64 dancers (5.6%) were dependent according to all three addiction measures and it is this small percentage that is most likely to be the “hard core of dependent dancers”. Other interesting results included:

“Positive effects were high both in dependent and non-dependent groups and were markedly greater than negative effects. Long practice of tango dancing did not modify the dependence rate or reduce the level of positive effects”… According to our results, tango dancing satisfies several criteria of addiction: feelings of tension or arousal and craving state before dancing, pleasure or relief when dancing, tolerance characterized by a need to increase time spent dancing, and finally physical withdrawal symptoms following abstinence. Altogether this suggests that dependence on tango could exist…[However] tango dependence is associated with several strong and sustained positive effects (pleasure, self-esteem, reduced stress, physical health, etc.) while negative effects are weak”.

There are obviously some major limitations to the study in that the data were based purely on self-report, and the sample was totally self-selected (and was likely to include the most fanatical tango dancers as they were subscribers to a very specialist tango magazine). The authors concluded that if tango addiction exists, it most resembles exercise addiction (in fact, the authors cited our work on exercise addiction to support their argument). Personally, I think it would take more robust data to convince me that excessive tango dancing could be classed as an addiction, but at least there is now an empirical study that future research can build upon.

Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Allegre, B., Souville, M., Therme, P. & Griffiths, M. (2006). Definitions and measures of exercise dependence. Addiction Research and Theory, 14, 631–646.

Berczik, K., Szabo, A., Griffiths, M. D., Kurimay, T., Kun, B., Rand, R. & Demetrovics, Z. (2012). Exercise addiction: Symptoms, diagnosis, epidemiology, and etiology. Substance Use and Misuse, 47, 403–417.

Demetrovics, Z. & Griffiths, M.D. (2012). Behavioral addictions: Past, present and future. Journal of Behavioral Addictions, 1, 1-2.

Goodman, A. (1990). Addiction: Definition and implications. British Journal of Addiction, 85, 1403–1408.

Griffiths, M.D. (1996). Behavioural addictions: An issue for everybody? Journal of Workplace Learning, 8(3), 19-25.

Griffiths, M.D.  (2005). A ‘components’ model of addiction within a biopsychosocial framework. Journal of Substance Use, 10, 191-197.

Targhetta, R., Nalpas, B. & Perney, P. (2013). Argentine tango: Another behavioral addiction? Journal of Behavioral Addictions, DOI: 10.1556/JBA.2.2013.007.

Stats entertainment: A review of my 2012 blogs

My last blog of 2012 was not written by me but was prepared by the WordPress.com stats helper. I thought a few of you might be interested in the kind of person that reads my blogs. I also wanted to wish all my readers a happy new year and thank you for taking the time to read my posts.

Here’s an excerpt:

About 55,000 tourists visit Liechtenstein every year. This blog was viewed about 180,000 times in 2012. If it were Liechtenstein, it would take about 3 years for that many people to see it. Your blog had more visits than a small country in Europe!

Click here to see the complete report.

Riding high: Can cycling be addictive?

One of the many music books I got for Christmas this year was David Buckley’s excellent 2012 biography of Kraftwerk. Given the media shyness of the band since their official formation in 1970, I was surprised that there was enough material to even fill a chapter, let alone a whole book. However, I read the whole book by December 27th and one of the things I found most fascinating was the claim that the two key founding members of the band – Ralf Hütter and Florian Schneider – were obsessed with cycling. Cycling was so much a part of their daily lives from the early 1980s that – according to the other members of the ‘classic’ line-up, Karl Bartos and Wolfgang Flür – it partly explains (along with the band’s perfectionist nature) the relatively low number of albums they released between 1981’s seminal Computer World and the present day. Even the most casual of Kraftwerk observers are probably aware of the band’s love of cycling as they released a single in 1983 about the Tour De France, and then 20 years later released their  2003 album Tour De France Soundtracks (their most recent album of original music).

People often talk about the ‘cycle of addiction’ but rarely about ‘addiction to cycling’ except occasional academic references in relation to exercise addiction (including some papers I have published myself). For instance, Dr. John Kerr in his 1997 book Motivation and Emotion in Sport speculated on the likely meta-motivational style of those people who are addicted to exercise. Dr. Kerr noted that it was the endurance type exercise activities (e.g. running, cycling, swimming, aerobics and weight training) that are most often associated with exercise addiction and dependence.

David Buckley devotes a whole section in his Kraftwerk biography to Hütter and Schneider’s obsession with cycling. He notes that “there is something compulsive about cycling; and this is not simply based on anecdotal evidence”, something with which I would concur based on the small amount of scientific evidence examining various types of exercise addiction. Most of the section on ‘cycling addiction’ relates to Hütter (although Schneider appears to be as equally enthusiastic about the joy of cycling). Buckley reported that:

“Ralf Hütter…the man-machine became the human bicycle. There is no denying that cycling was, and indeed still is, very important for Ralf Hütter…It is probably inaccurate to describe his passion for cycling as a hobby…it became more like a second (unpaid) job…The main problem with the [cycling] was, firstly, it took a huge chunk out of the conventional working day, and secondly, the effect of the work-out on the motivation of the individual”.

As Buckley then noted, after six hours cycling, the last thing Hütter wanted to do was work when he finally got to their infamous Kling Klang studio. He then went on to note:

“As [Hütter’s] fitness levels increased, he began attempting harder and harder climbs, longer and longer routes…[Hütter] estimated that at his peak, he was cycling around 200 kilometres a day. It had been reported that on occasion on Kraftwerk tours, the bus would drop [Hütter] off around 100 kilometres from the venue, and [Hütter] would complete the final stretch on his bike”.

To those of us who work in the addiction studies field, this description of engaging in ‘harder and harder [cycling] climbs’ by Buckley appears to be an example of ‘tolerance’ in all but name (i.e., the needing of more and more of an activity to gain the desired mood modification effect). Ralf Dorper, founder member of another of my favourite 1980s bands, Propaganda, said that in the mid-1980s:

“The only chance to meet Kraftwerk…would have been at one of these cycling shops. But then [Hütter and Schneider] got more and more into it, and they went to the really specialist shops outside of Dusseldorf…They would probably easily do 50 to 100 kilometres a day”.

Kraftwerk member Wolfgang Flür noticed his band members shift their focus away from music and on to cycling. He said that his colleagues became “fanatics” and “insane” about their cycling, and he also claimed in an interview with Buckley that cycling was an addiction and “became a kind of drug” for Hütter. Buckley also recounts Hütter’s cycling accident that left him in a coma. The most amusing anecdote was that on coming out of his coma, Hütter’s alleged first words were “Is my bike OK? What happened to my bike?” (something that Hütter denied in a June 2009 interview with British newspaper The Guardian). Hütter doesn’t deny his cycling passion and noted in one online interview I came across that:

Cycling is the man-machine, it’s about dynamics, always continuing straight ahead, forward, no stopping. He who stops falls over. There are really balanced artists who can remain upright at a standstill, but I can’t do that. It’s always forwards”

If newspaper reports are to be believed, Hütter may not be the only pop musician with a cycling addiction. An article in an October 2009 issue of The Guardian claimed that Gary Kemp of Spandau Ballet was “now a road cycling addict” based on his new-found enthusiasm for cycling. The article then went on to talk about Ralf Hütter and that “his obsession with [cycling] reportedly became so all-encompassing it threatened the group”.

Arguably the most infamous ‘cycling addict’ was the 55-year old American man ‘Tom’ from Mt. Pleasant (Texas) who appeared on the US television show My Strange Addiction who cycles eight hours a day, seven days a week (over one million miles in a 25-year period). According to the show, Tom rides his bike at home, outside, and even in his office as he works. It was also revealed that Tom was in constant stress from his cycling, and that his constant cycling had made it painful for him to stand, and can barely walk. Alternatively, there is also an amusing 2010 article by Diana North listing ‘26 signs of cycling addiction’ (e.g., ‘Have you seriously considered building a second bike room addition to your home?’, ‘Are there more than three bike-related tattoos on your body?’, ‘Do people leaving messages on your voicemail start with “I know you’re on your bike right now, but…?”, etc.). There are also a variety of online accounts (mostly by cyclists) questioning whether their passion is an addiction such as an article by Scott Saifer in the magazine Road: The Journal of Road Cycling and Culture, an e-zine article by Nebojsa Djekanovic, and a personal account by ‘Doug’ who runs the Cycle Hub blog).

Although there is a fairly established scientific literature on exercise addiction in general, there is almost nothing on cycling addiction specifically (although I did come across one online article where a professional cyclist had adapted the Internet Addiction Test for other cyclists to self-diagnose whether they are addicted to cycling). A fairly recent 2007 book entitled Exercise Dependence edited by Drs. John Kerr, Koenraad Lindner and Michelle Blaydon had about 20 mentions of cycling in the context of exercise addiction (although again almost nothing specific). Most of the references were in relation to cycling being one of the endurance sports that can also be engaged in individually, and that individual endurance sports are more highly associated with exercise addiction.

There are also occasional references to triathletes (who run, cycle and swim) being dependent and/or addicted to exercise. There was also reference to research examining eating disorders among different professional athletes (as there is a relationship between exercise addiction and eating disorders that I reviewed in a previous blog). Kerr and colleagues quoted a group of 1990s studies by Dr. J. Sundgot-Borgen showing that the prevalence of eating disorders among elitist cyclists was 20% compared to cross-country skiers (33%), middle and long distance runners (27%), swimmers (15%) and orienteers (0%). Interestingly, one of the traits that appears to be associated with exercise addiction is perfectionism according to a 1990 paper by Dr. Caroline Davis that appeared in the journal Personality and Individual Differences (which when linked back to Ralf Hütter’s experiences in Kraftwerk made me raise an eyebrow).

There is also some preliminary evidence that professional cyclists may be more prone to drug addictions than other groups of people. Although I was unable to fully read a French paper by Dr. J.C. Seznec in a 2002 issue of the Annales Medico-Psychologiques Revue Psychiatrique, the author claimed that sportsmen were specifically vulnerable to addiction. Seznec – a psychiatrist and sports doctor – highlighted there are some factors (predisposing factors, initiation factors and maintenance factors) that explain the association. Seznec concluded that:

“These addictions seem to be in direct relation with the brutal transformation that high-level sport towards professionalism suffered. This study makes us conclude that the practising of a professional sport predisposes to the development of an addiction and that it requires a specific preventive help”.

I’m certainly of the opinion that it is theoretically possible to be addicted to cycling, although the number of people genuinely affected is likely to be small. This is one area that I might consider doing some personal research into – especially if it meant I could interview the members of Kraftwerk!

Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Allegre, B., Souville, M., Therme, P. & Griffiths, M.D. (2006). Definitions and measures of exercise dependence, Addiction Research and Theory, 14, 631-646.

Berczik, K., Szabó, A., Griffiths, M.D., Kurimay, T., Kun, B. & Demetrovics, Z. (2011). Exercise addiction: Symptoms, diagnosis, epidemiology, and etiology. Substance Use and Misuse, 47, 403-417.

Buckley, D. (2012). Kraftwerk Publication. London: Omnibus.

Davis, C. (1990). Weight and diet preoccupation and addictiveness: The role of exercise. Personality and Individual Differences, 11, 823-827.

Griffiths, M. D. (1997). Exercise addiction: A case study. Addiction Research, 5, 161-168.

Griffiths, 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), e30-31.

Kerr, J. H. (1997) Motivation and Emotion in Sport: Reversal Theory. Hove: Psychology Press.

Kerr, J.H., Lindner, K.J. & Blaydon, M. (2007). Exercise Dependence. Oxford: Routledge.

Seznec, J. C. (2002). Toxicomanie et cyclisme professionnel [Drug addiction and professional cycling]. Annales Medico-Psychologiques Revue Psychiatrique, 160, 72-76.

Sundgot-Borgen, J. (1993). Prevalence of eating disorders in female elite athletes. International Journal of Sport Nutrition, 3, 29-40.

Sundgot-Borgen, J. (1994). Eating disorders in female athletes. Sports Medicine, 17, 176-188.

Sundgot-Borgen, J. (1994) ‘Risk and trigger factors for the development of eating disorders in female elite athletes. Medicine and Science in Sports and Exercise, 26, 414-419.

Sundgot-Borgen, J., Torstveit, G. and Klungland, M. (2004). Prevalence of eating disorders in elite athletes is higher than in the general population. Clinical Journal of Sport Medicine, 14, 25-32.

Terry, A., Szabo, A., & Griffiths, M. D. (2004). The exercise addiction inventory: A new brief screening tool. Addiction Research and Theory, 12, 489-499.

Working out: Are Olympic athletes addicted to exercise and/or work?

As someone who has spent over 25 years carrying out research into behavioural addiction, I have published a fair amount on exercise addiction over the years. One question I am often asked when the Olympics comes around is to what extent athletes are addicted to exercise. One of the problems answering this question is that in spite of the widespread usage of the term ‘exercise addiction’ there are many different terminologies that describe excessive exercise syndrome. Such terms include (i) exercise dependence, (ii) obligatory exercising, (iii) exercise abuse, and (iv) compulsive exercise.

In a review on excessive exercise that I co-wrote with colleagues at Eotvos Lorand University (Budapest) and to be published in the journal Substance Use and Misuse, we argued that the term ‘addiction’ is the most appropriate because it incorporates both dependence and compulsion. Based on research carried out internationally, we believe that exercise addiction should be classified within the category of behavioural addictions. The resemblance is evidenced not only in several common symptoms (e.g., salience, mood modification, withdrawal symptoms, tolerance, conflict, relapse, etc.), but also in demographic characteristics, the prognosis of the disorder, co-morbidity, response to treatment, prevalence in the family, and etiology.

However, when it comes to Olympic athletes, we all know that they engage excessively in exercise and spend hours and hours every single day either training and competing. For many Olympians, their whole life is dominated by the activity and may impact on their relationships and family life. But does this mean they are addicted to exercise? In short, no! Why? Because the excessive exercise is clearly a by-product of the activity being their job. I would not call myself an internet addict just because I spend 5-10 hours a day on the internet. My excessive internet use is a by-product of the job I have as an academic. In short, the excessive internet use is functional.

However, just because I don’t believe Olympic athletes are addicted to exercise, it could perhaps be argued that they are addicted to work (and in this case, their work comprises the activity of exercise). I’m often asked what the difference is between a healthy enthusiasm and an addiction. In short, healthy enthusiasms add to life but addictions takes away from it. On this simple criterion, maybe there are some Olympic athletes who are ‘addicted’ to their work.

The term ‘workaholism’ has been around for over 40 years since the publication of Wayne Oates’ 1971 book Confessions of a Workaholic, and has now passed into the public mainstream. Despite four decades of research into workaholism (and like exercise addiction), no single definition or conceptualization of this phenomenon has emerged. Workaholics have been conceptualized in different ways. For instance, workaholics are typically viewed as one (or a combination) of the following:

  • Those viewed as hyper-performers
  • Those viewed as unhappy and obsessive individuals who do not perform well in their jobs
  • Those who work as a way of stopping themselves thinking about their emotional and personal lives
  • Those who are over concerned with their work and neglect other areas of their lives.

Some of these may indeed be applied to Olympic athletes (particularly the reference to ‘hyper-performers’ and the fact that other areas of their lives may be neglected in pursuit of the ultimate goal). Some authors note that there is a behavioural component and a psychological component to workaholism. The behavioural component comprises working excessively hard (i.e., a high number of hours per day and/or week), whereas the psychological (dispositional) component comprises being obsessed with work (i.e., working compulsively and being unable to detach from work. Again, these behavioural and psychological components could potentially be applied to Olympic athletes.

There are also those scholars who differentiate between positive and negative forms of workaholism. For instance, some view workaholism as both a negative and complex process that eventually affects the person’s ability to function properly. In contrast, others highlight the workaholics who are totally achievement oriented and have perfectionist and compulsive-dependent traits. Here, the Olympic athlete might be viewed as a more positive form of workaholism. Research appears to indicate there are a number of central characteristics of workaholics. In short, they typically:

  • Spend a great deal of time in work activities
  • Are preoccupied with work even when they are not working
  • Work beyond what is reasonably expected from them to meet their job requirements.
  • Spend more time working because of an inner compulsion, rather than because of any external factors.

Again, some or all of these characteristics could be applied to Olympians. Hopefully, very few Olympic athletes are addicted, but if they are addicted, I would argue that it is more likely to be to their work rather than the exercise itself.

Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Psychology Division, Nottingham Trent University, Nottingham, UK

Further reading

Allegre, B., Souville, M., Therme, P. & Griffiths, M.D. (2006). Definitions and measures of exercise dependence, Addiction Research and Theory,14, 631-646.

Allegre, B., Therme, P. & Griffiths, 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.

Andreassen, C.S., Griffiths, M.D., Hetland, J. & Pallesen, S. (2012). Development of a Work Addiction Scale. Scandinavian Journal of Psychology, 53, 265-272.

Berczik, K., Szabó, A., Griffiths, M.D., Kurimay, T., Kun, B. & Demetrovics, Z. (2012). Exercise addiction: symptoms, diagnosis, epidemiology, and etiology. Substance Use and Misuse, 47, 403-417.

Griffiths, M.D. (1997). Exercise addiction: A case study. Addiction Research,  5, 161-168.

Griffiths, M.D. (2005).  Workaholism is still a useful construct  Addiction Research and Theory, 13, 97-100.

Griffiths, M.D. (2011). Workaholism: A 21st century addiction. The Psychologist: Bulletin of the British Psychological Society, 24, 740-744.

Griffiths, 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, 30-31.

Mónok, K., Berczik, K., Urbán, R., Szabó, A., Griffiths, M.D., Farkas, J., Magi, A., Eisinger, A., Kurimay, T., Kökönyei, G., Kun, B., Paksi, B. & Demetrovics, Z. (2012). Psychometric properties and concurrent validity of two exercise addiction measures: A population wide study in Hungary. Psychology of Sport and Exercise, 13, 739-746.

Oates, W. (1971), Confessions of a Workaholic: The Facts About Work Addiction, World, New York.

Szabo, A. & Griffiths, M.D. (2007). Exercise addiction in British sport science students. International Journal of Mental Health and Addiction, 5, 25-28.

Terry, A., Szabo, A. & Griffiths, M. (2004). The Exercise Addiction Inventory: A new brief screening tool, Addiction Research and Theory, 12, 489-499.

Om Sweet Om: Can Transcendental Meditation be addictive?

Back in 1991, not long after I had been awarded my PhD, I was asked (by my then girlfriend) to attend on a course in Transcendental Meditation (TM). Up until that point, my only knowledge of TM was through my reading of many books about the Beatles and their association with the Maharishi Mahesh Yogi back in 1967-1968. Although somewhat skeptical of TM I attended the weekly sessions for the whole course and was eventually inducted into the world of TM by a lovely guy called Mike Turnbull.

We didn’t have Google back then, but as a psychologist, I carried out a literature search and found that Turnbull had actually published papers on TM including a study in a 1982 issue of the British Journal of Psychology with Hugh Norris (entitled “Effects of Transcendental Meditation on self-identity indices and personality”). The results of Turnbull and Norris’ study showed that participants practicing TM appeared to have experienced consistent and definable changes of a beneficial nature, and that the value of TM as a therapeutic tool was recommended. For the next couple of years I did TM daily but by the mid-1990s TM had dropped out of my daily routine and now I only very occasionally do it.

Also in 1990, I became a psychology lecturer at the University of Plymouth, and was given my own specialist research-based module to teach on ‘Addictive Behaviours’ (which I still teach to this very day). It was during my teaching preparation for that module that I first encountered TM in an academic capacity in the context of ‘positive addictions’ (an area that I looked at in one of my early blogs).

It was in Bill Glasser’s 1976 book Positive Addictions that I first encountered the argument that activities such as TM and jogging could be considered positive addictions. It was also argued by Glasser that activities like TM was the kind of activity that could be deliberately cultivated to wean addicts away from more harmful and sinister preoccupations. According to Glasser, positive addictions must be rewarding activities (like TM) that produce increased feelings of self-efficacy.

As I wrote in my previous blog on positive addictions, one of my mentors, psychologist Iain Brown (now retired from Glasgow University) suggested it might be better to call some activities “mixed blessing addictions”, since even positive addictions such as exercise addiction (suggested by Glasser) might have some negative consequences. I have published a fair amount on exercise addiction since 1997 and I am of the opinion that some excessive exercise is genuinely addictive. However, I have never researched into excessive TM and as far as I am aware, there is no empirical evidence that it is addictive.

Anecdotally, I have been told that some TM practitioners (particularly those that teach it) appear to be “addicted” to TM. As a consequence, I decided to do a little digging to see if I could unearth anything on the relationship between TM and addiction. This led me to a 2010 article by Michael Sigman in the Huffington Post entitled Meditation and Addiction: A Two-Way Street?” Sigman recounted the story about how one of his friends spent over two hours every day engaging in TM while in the lotus position. He then claimed:

“There are those few for whom meditation can become compulsive, even addictive. The irony here is that an increasing body of research shows that meditation – in particular Buddhist Vipassana meditation – is an effective tool in treating addiction. One category of meditation addiction is related to the so-called ‘spiritual bypass’. Those who experience bliss when they meditate may practice relentlessly to recreate that experience, at the expense of authentic self-awareness. A close friend who’s done Transcendental Meditation for decades feels so addicted to it, she has a hard time functioning when she hasn’t ‘transcended’”.

Obviously this is purely anecdotal but at least raises the issue that maybe for a very small minority, TM might be what psychologist Iain Brown calls a “mixed blessing addiction”. An article was published on the ‘TM-Free Blog’ entitled Addiction and transcendental Meditation” that (for purposes of balance and fairness) publishes “skeptical views of transcendental meditation and Maharishi Mahesh Yogi”. The article pulled no punches and opened with the claim:

“TM has addictive qualities. Acknowledging the addictive characteristics of TM and other practices, Carol Giambalvo and other cult experts founded ReFOCUS.org to help former cult members break their addiction to trance states… Some devout TMers on the monastic Purusha or Mother Divine programs behave as if in an autistic state. These participants meditate for many hours daily, sometimes for years”.

They also claim that because empirical studies have shown that TM can increase pain tolerance, that the body is producing its own morphine-like substances (i.e., endorphins). Therefore, the addictive qualities of TM may be due to increased endorphin production that creates a semi-dissociative blissful state. For those substance addicts that have been successfully treated using TM, it would be a case of ‘one addiction replacing another’ (which was basically Bill Glasser’s argument in his book Positive Addiction). The article also claimed that endorphin-induced trance states explain why individuals who attend long meditation courses have higher levels of receptivity.

In researching this blog, I did come across some self-reported accounts of people who thought that they might be genuinely addicted to TM. For instance:

“I sometimes worry about being addicted to meditation. I have a compulsive personality and usually think of meditation as a good addiction that not only improves life [and] replaces all other addictions (it was only after beginning to meditate that smoking and drinking dropped away for me). The fact remains, however, that there is an element of compulsive (and therefore possibly unconscious or unexamined) behaviour that motivates the desire to follow a strict twice-a-day-routine. Every so often I skip a session or, less frequently, a whole day. I have been surprised recently how quickly I seem to experience withdrawal symptoms. I just feel off as the day goes on. After meditating it is like all my settings have been returned to normal and I feel great again. Then I think: isn’t that, in essence, just the what the alcoholic or drug addict experiences? I have no plans to stop meditating but I wonder if there is an element that is beyond my control?”

An article in the Canadian newspaper, the Edmonton Sun reported that TM can be addictive based on an interview with former “TM guru” Joe Kellett (who now runs an anti-TM website). Kellett said there was “a compendium of 75 studies of TM technique in 2000 [which] found that 63% of practitioners suffered long-term negative mental health consequences from the repeated dissociation – or disconnection – with reality caused by going into a trance-like state”. I haven’t located the study Kellett referred to although many TM websites claim that there have been over 600 empirical studies highlighting the positive benefits of TM, particularly in relation to various healthcare outcomes. Kellett went on to claim in his interview that:

“Dissociative ‘bliss’ is often an easily produced substitute for true personal growth. As teachers we memorize almost everything we are to tell students. We were very careful not to tell them too much less they become ‘confused’ by things that they ‘couldn’t yet understand. Only after they had the ‘experience,’ could we start very gradually revealing TM dogma in easy, bite-sized chunks, always after they had just finished meditation and were therefore likely to be still in a dissociative state”

Obviously, it is difficult to answer the question of whether TM is genuinely addictive given the complete lack of empirical evidence. However, from both a psychological and biological perspective, I think that such a concept is theoretically feasible but we need to carry out the empirical research

Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Allegre, B., Souville, M., Therme, P. & Griffiths, M.D. (2006). Definitions and measures of exercise dependence, Addiction Research and Theory, 14, 631-646.

Berczik, K., Szabó, A., Griffiths, M.D., Kurimay, T., Kun, B. & Demetrovics, Z. (2012). Exercise addiction: symptoms, diagnosis, epidemiology, and etiology. Substance Use and Misuse, 47, 403-417.

Edmonton Sun (2006). Dissociative bliss becomes addictive. April 17. Located at: http://www.religionnewsblog.com/14345/dissociative-bliss-becomes-addictive

Glasser, W. (1976), Positive Addictions, Harper & Row, New York, NY.

Griffiths, M.D. (1996). Behavioural addictions: An issue for everybody? Journal of Workplace Learning, 8(3), 19-25.

Griffiths, M.D. (1997). Exercise addiction: A case study. Addiction Research,  5, 161-168.

Griffiths, M.D.  (2005). A ‘components’ model of addiction within a biopsychosocial framework. Journal of Substance Use, 10, 191-197.

Griffiths, M.D. (2011). Behavioural addiction: The case for a biopsychosocial approach. Trangressive Culture, 1, 7-28.

Sigman, M. (2010). Meditation and Addiction: A Two-Way Street? Huffington Post, November 15. Located at: http://www.huffingtonpost.com/michael-sigman/meditation-and-addiction_b_783552.htm

TM-Free Blog (2007). Addiction and transcendental Meditation, February 23. Located at: http://tmfree.blogspot.co.uk/2007/02/addiction-and-transcendental-meditation.html

Turnbull, M.J. & Norris, H. (1982). Effects of Transcendental Meditation on self-identity indices and personality, British Journal of Psychology, 73, 57-68.

Never mind the anabolics! A brief overview of body building dependence

In a previous blog, I briefly examined exercise addiction and its relationship with eating disorders. A recent review of 11 different addictive behaviours – that I co-wrote with Dr Steve Sussman and Nadra Lisha (University of Southern California) – estimated the prevalence of exercise addiction in the general population to be close to 3%. This figure is even higher in research I have carried out into certain sub-groups of people such as ultra-marathon runners and sport science students. In this article, I briefly examine exercise dependence among another particular sub-group of people that may experience elevated rates of exercise addiction and dependence – namely, body builders.

Exercise dependence has been defined by Dr Heather Hausenblas (University of Florida, USA) and Dr Danielle Symons Downs (Pennsylvania State University, USA) as ‘‘a craving for exercise that results in uncontrollable excessive physical activity and manifests in physiological symptoms, psychological symptoms, or both’’. However, in the course of assessment of exercise addiction, several incongruent results have emerged. The most likely reason may be connected to two issues, namely (i) the instrument used in assessment of exercise addiction/dependence, and (ii) the target population studied (including the fact that sample sizes are typically very small compared with other studies of other potentially addictive behaviours).

One of the more interesting observations surrounding exercise addiction and dependence among body builders concerns their thoughts around body image and whether this may play a role in the development of the addiction. From a body image perspective, researchers have suggested that males in western society have developed significant body concerns that cause them to generate a ‘drive for muscularity’ to meet a perceived high societal standard for a muscular physique. Not all bodybuilders engage in the activity purely to develop a hyper-muscular physique. However, those who are body building to overcome weaknesses in self-esteem and body image, may be more susceptible to excessive exercise routines and obsessive eating disturbances. However, to date, the research findings are somewhat inconclusive.

There are several instruments available for assessing exercise addiction. However, they are either rarely adopted in research or are aimed at a specific form of physical activity, such as bodybuilding. For instance, the Bodybuilding Dependency Scale (BDS) was developed by Dr Dave Smith (University of Chester) specifically to assess compulsive training in bodybuilding and weightlifting and has been validated in a number of his subsequent studies. The BDS comprises three sub-scales: (i) social dependence (the need to be in the gym), (ii) training dependence (compulsion to train), and (iii) mastery dependence (the need to control training).

Dr Treven Pickett and colleagues at the Virginia Consortium Programme (Virginia Beach, USA) reported that ‘competitive bodybuilders’ and ‘non-competitive weight trainers’ were both more ‘appearance-invested’ than active athletic controls that didn’t lift weights. Other research studies have found bodybuilders have significantly higher concerns regarding the size and shape of their physique than power lifters. However, none of these studies have utilized validated ‘desire for masculinity’ measures. Furthermore, few studies have examined the relationship between exercise dependence and desire for masculinity in male exercisers although correlations have been found between exercise dependence with muscle-oriented body image and muscularity-related behaviors on the Drive for Muscularity Scale.

Up until recently, it was unclear whether there were any differences in the prevalence of exercise dependence among different types of weight lifters (such as bodybuilders, power lifters, and fitness lifters) even though there is some anecdotal evidence suggesting that these distinct groups have different motives for weight lifting. One of the best studies examining this issue was recently been carried out by Dr Bruce Hale and colleagues (Kinesiology Department, Penn State-Berks, USA). They examined 146 weight lifters (59 bodybuilders, 47 power lifters, and 40 fitness lifters) on the Exercise Dependence Scale (EDS), the Bodybuilding Dependence Scale (BDS), and the Drive for Muscularity Scale (DMS). Results showed that bodybuilders and power lifters were significantly higher than fitness lifters on EDS and BDS scales. In contrast, power lifters were found to be significantly higher on DMS than bodybuilders. They claim that their results suggest that exercise dependence may be directly related to the drive for muscularity.

Just to complicate things even further, there are some recent studies that suggest muscle dysmorphia – a pathological preoccupation with muscularity and related to body dysmorphic disorder – may also be linked to exercise dependence (but that will have to wait for another blog!).

Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Allegre, B., Souville, M., Therme, P. & Griffiths, M.D. (2006). Definitions and measures of exercise dependence, Addiction Research and Theory, 14, 631-646.

Allegre, B., Therme, P. & Griffiths, 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.

Berczik, K., Szabó, A., Griffiths, M.D., Kurimay, T., Kun, B. & Demetrovics, Z. (2012). Exercise addiction: symptoms, diagnosis, epidemiology, and etiology. Substance Use and Misuse, DOI: 10.3109/10826084.2011.639120.

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, 223-236.

Hale, B.D, Roth, A.D., DeLong, R.E. & Briggs, M.S. (2010). Exercise dependence and the drive for muscularity in male bodybuilders, power lifters, and fitness lifters. Body Image, 7, 234-239.

Chittester, N.I., & Hausenblas, H.A. (2009). Correlates of the drive for muscularity: The role of anthropometric measures and psychological factors. Journal of Health Psychology, 14, 872-877.

Hausenblas, H.A., & Downs, D. S. (2002a). Exercise dependence: A systematic review. Psychology of Sport and Exercise, 3(2), 89-123.

McCreary, D.R., Sasse, D.K., Saucier, D. & Dorsch, K.D. (2004). Measuring the drive for muscularity: Factorial validity of the Drive for Muscularity Scale in men and women. Psychology of Men and Masculinity, 5, 49-58.

Pickett, T.C., Lewis, R.J. & Cash, T.F. (2005). Men, muscles, and body image: Comparisons of competitive bodybuilders, weight trainers, and athletically active controls. British Journal of Sports Medicine, 39, 217-222.

Smith, D.K., & Hale, B.D. (2004). Validity and factor structure of the bodybuilding dependence scale. British Journal of Sports Medicine, 38, 177-181.

Smith, D.K., & Hale, B.D. (2005). Exercise-dependence in body- builders: Antecedents and reliability of measurement. Journal of Sports Medicine and Physical Fitness, 45, 401-408.

Smith, D.K., Hale, B.D., & Collins, D. (1998). Measurement of exercise dependence in bodybuilders. Journal of Sports Medicine and Physical Fitness, 38, 66-74.

Sussman, S., Lisha, N. & Griffiths, M.D. (2011). Prevalence of the addictions: A problem of the majority or the minority? Evaluation and the Health Professions, 34, 3-56.

Szabo, A. & Griffiths, M.D. (2007). Exercise addiction in British sport science students. International Journal of Mental Health and Addiction, 5, 25-28.