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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.
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.
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.
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.
Eat to the beat: What is the relationship between exercise addiction and eating disorders?
In previous blogs I briefly examined both exercise addiction and eating addiction. However, there is some research that these two disorders sometimes co-occur. In some of the papers I have co-written we have reviewed the evidence as to whether exaggerated exercise behaviour is a primary problem in the affected person’s life or whether it emerges as a secondary problem in consequence of another psychological dysfunction. In the former case, the dysfunction is usually classified as primary exercise addiction because it manifests itself as a form of behavioural addiction. In the latter case, it is usually termed as secondary exercise addiction because it co-occurs with another dysfunction, typically with eating disorders, such as anorexia nervosa or bulimia nervosa.
In primary exercise addiction, the motive for over-exercising is typically geared toward avoiding something negative, although the affected individual may be totally unaware of their motivation. It is a form of escape response to a source of disturbing, persistent, and uncontrollable stress. However, in the case of a secondary exercise addiction, the excessive exercise is used as a means of weight loss (in addition to very strict dieting). Thus, secondary exercise addiction has a different etiology than primary exercise addiction. Nevertheless, it should be highlighted that many symptoms and consequences of exercise addiction are similar whether it is a primary or a secondary exercise addiction. The distinguishing feature between the two is that in primary exercise addiction, the exercise is the main objective, whereas in secondary exercise addiction, weight loss is the main objective, while exaggerated exercise is one of the primary means in achieving the objective.
In a qualitative study published by Dr Diane Bamber (University of Cambridge), she and her team interviewed 56 regularly exercising adult women. On the basis of the analysis of the results, the authors identified three factors in the diagnostic criteria of secondary exercise addiction. Among these factors, only the presence of eating disorder symptoms differentiated secondary from primary exercise addiction. The other two factors (i.e., dysfunctional psychological, physical, or social behaviour, and the presence of withdrawal symptoms) were nonspecific to secondary exercise addiction.
However, Dr Michelle Blaydon (formerly of the University of Hong Kong) and colleagues attempted to further sub-classify secondary exercise addiction based on the primary source of the problem, which in their view was related to either a form of eating disorder or to an exaggerated preoccupation with body image. Although this appears to have face validity, to date, there is no empirical evidence for such speculation. Furthermore, a different research study by Dr Diane Bamber found no evidence for primary exercise addiction. In fact, they believe that all problematic exercise behaviours are linked to eating disorders. However, this view remains critically challenged in the literature and there are documented case studies – including one that I published myself back in 1997 where no eating disorders were present at all.
In addition to several studies that have reported disordered eating behaviour often (if not always) accompanied by exaggerated levels of physical exercise, the reverse relationship has also been established. Individuals affected by exercise addiction often (but not always) show an excessive concern about their body image, weight, and control over their diet. This co-morbidity makes it difficult to establish which is the primary disorder. This dilemma has been investigated using trait and personality-oriented investigations. In an early but widely cited controversial study led by Dr Alayne Yates (University of Hawaii) concluded that addicted male long-distance runners resembled anorexic patients on a number of personality dispositions (e.g., introversion, inhibition of anger, high expectations, depression, and excessive use of denial) and labelled the similarity as the “anorexia analogue” hypothesis.
To further test the hypothesis, Yates and colleagues examined the personality characteristics of 60 male obligatory exercisers and then compared their profiles with those of clinical patients diagnosed with anorexia nervosa. While the study did not lend support to the hypothesis, the authors claimed that running and extreme dieting were both dangerous attempts to establish an identity, as either addicted to exercise or anorexic. The study has been criticized for a number of shortcomings, including the lack of supporting data, poor methodology, lack of relevance to the average runner, over-reliance on extreme cases or individuals, and exaggerating the similarities between the groups.
Indeed, later investigations also failed to reveal similarities between the personality characteristics of people affected by exercise addiction and those suffering from eating disorders. Therefore, the anorexia analogue hypothesis has failed to secure empirical support. Numerous studies have further examined the relationship between exercise addiction and eating disorders but no consensus has emerged. One reason for the inconsistent findings may be attributed to the fact that the extent of co-morbidity could vary from case to case depending on personality predispositions, the underlying psychological problem that has led to exercise addiction, and/or the interaction of the two, as well as the form and severity of the eating disorder.
A French study led by Professor Michel Lejoyeaux (Bichat and Maison Blanche Hospital) on 125 Parisian male and female current exercise addicts reported that 70% of their sample were bulimic. In another US study by Dr Patricia Estok and Dr Ellen Rudy among 265 young American adult women runners and non-runners, 25% of those who ran more than 30 miles per week showed a high risk for anorexia nervosa. In studies of people with eating disorders, a study by Peter Lewinsohn (Oregon Research Institute, US) found excessive exercise activity among males with binge eating disorders, but not females. However, the percentage overlap was not reported. Finally, in a review by Marilyn Freimuth (Fielding Graduate University, US), she and her colleagues reported that among people with eating disorders, 39% to 48% also experienced an exercise addiction.
Basically, the major weakness of the literature is the complete lack of large-scale studies. In a recent review of the addiction co-morbidity literature that I did with Dr Steve Sussman and Nadra Lisha (University of Southern California), we didn’t locate a single study on the co-occurrence of exercise addiction with other disorders with a sample size of more than 500 participants.
Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK
Further reading
Bamber, D.J., Cockerill, I.M., Rodgers, S., & Carroll, D. (2003). Diagnostic criteria for exercise dependence in women. British Journal of Sports Medicine, 37(5), 393–400.
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. (2002). Eating disorders and exercise dependence in triathletes. Eating Disorders, 10(1), 49-60.
Blaydon, M.J., Lindner, K. J., & Kerr, J. H. (2004). Metamotivational characteristics of exercise dependence and eating disorders in highly active amateur sport participants. Personality and Individual Differences, 36(6), 1419-1432.
Estok, P.J., & Rudy, E.B. (1996). The relationship between eating disorders and running in women. Research in Nursing & Health, 19, 377-387.
Freimuth, M., Waddell, M., Stannard, J., Kelley, S., Kipper, A., Richardson, A., & Szuromi, I. (2008). Expanding the scope of dual diagnosis and co-addictions: Behavioral addictions. Journal of Groups in Addiction & Recovery, 3, 137-160.
Griffiths, M. D. (1997). Exercise addiction: A case study. Addiction Research, 5, 161-168.
Lejoyeux, M., Avril, M., Richoux, C., Embouazza, H., & Nivoli, F. (2008). Prevalence of exercise dependence and other behavioral addictions among clients of a Parisian fitness room. Comprehensive Psychiatry, 49, 353-358.
Lewinsohn, P.M., Seeley, J.R., Moerk, K.C., & Striegel-Moore, R.H. (2002). Gender differences in eating disorder symptoms in young adults. International Journal of Eating Disorders, 32, 426-440.
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. (2010). Addiction to exercise: A symptom or a disorder? New York, NY: Nova Science Publishers.
Yates, A., Leehey, K., & Shisslak, C. M. (1983). Running – an analogue of anorexia? New England Journal of Medicine, 308(5), 251-255.
Running on empty: Can excessive exercise really be an addiction?
Back in 1997, I published my first academic paper on exercise addiction – a case study of a young women addicted to martial arts – at least according to the definition of exercise I was using. However, 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 (i) exercise dependence, (ii) obligatory exercising, (iii) exercise abuse, and (iv) compulsive exercise. In a recent review that I co-wrote with Dr Zsolt Demetrovics and colleagues at Eotvos Lorand University (Budapest), we believe 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, but also in demographic characteristics, the prognosis of the disorder, co-morbidity, response to treatment, prevalence in the family, and etiology.
But how is exercise addiction assessed? Several instruments have been developed and adopted for the assessment of exercise addiction. Two relatively early scales, the ‘Commitment to Running Scale’ and the ‘Negative Addiction Scale’ are no longer used because of theoretical and methodological shortcomings. Among the psychometrically tested instruments, the ‘Obligatory Exercise Questionnaire’ (OEQ), the ‘Exercise Dependence Scale’ (EDS), and the ‘Exercise Dependence Questionnaire’ (EDQ) have proved to be both psychometrically valid and reliable instruments for assessing the symptoms and the extent of exercise addiction.
The OEQ is a 20-item self-report questionnaire that assesses the urge for undertaking exercise. The questionnaire has three subscales comprising (i) the emotional element of exercise, (ii) exercise frequency and intensity, and (iii) exercise preoccupation. The EDS conceptualizes compulsive exercise on the basis of the DSM criteria for substance abuse or addiction, and empirical research shows that it is able to differentiate between at-risk, dependent and non-dependent athletes, and also between physiological and non-physiological addiction. The EDS comprises seven subscales including (i) tolerance, (ii) withdrawal, (iii) intention effect, (iv) lack of control, (v) time, (vi) reduction of other activities, and (vii) continuance. In contrast to the EDS, the EDQ is aimed to measure compulsive exercise behaviour as a multidimensional construct. Furthermore, it can be used in assessing compulsion in many different forms of physical activities.
To generate a quick and easily administrable tool for surface screening of exercise addiction, I, and my colleagues (Annabel Terry and Attila Szabo), developed the ‘Exercise Addiction Inventory’ (EAI), a short 6-item instrument aimed at identifying the risk of exercise addiction. The EAI assesses the six common symptoms of addictive behaviours, namely (i) salience, (ii) mood modification, (iii) tolerance, (iv) withdrawal symptoms, (v) social conflict, and (vi) relapse. The EAI has been psychometrically investigated and has relatively high internal consistency and convergent validity with the EDS.
There are several other 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 body building (such as the ‘Bodybuilding Dependency Scale’). A more general but seldom adopted instrument is the ‘Exercise Beliefs Questionnaire’ (EBQ) that assesses individual thoughts and beliefs about exercise and it is based on four factors comprising (i) social desirability, (ii) physical appearance, (iii) mental and emotional functioning, and (iv) vulnerability to disease and aging. Empirical testing shows the instrument to have acceptable psychometric properties. There is also the ‘Exercise Dependence Interview’ (EXDI) that not only assesses compulsive exercising, but also eating disorders. However, one of the major limitations of this measure is that no psychometric properties have been reported.
Another scale is the ‘Commitment to Exercise Scale’ (CES) that examines the pathological aspects of exercising (e.g., continued training despite injuries) and compulsory activities (e.g., feeling guilty when exercise is not fulfilled). The CES has a satisfactory level of reliability. Finally the ‘Exercise Orientation Questionnaire’ (EOQ) measures attitudes towards exercise and related behaviours. The EOQ comprises six factors including (i) self-control, (ii) orientation to exercise, (iii) self-loathing, (iv) weight reduction, (v) competition, and (vi) identity.
Of these instruments outlined, the most popular currently are the EDS and the EAI (due to its brevity and easy scoring). Research has shown that when employed together, these two instruments yield comparable results. Despite the development of all these different scales and screening tools, their existence does not guarantee that exercise addiction will ever be officially recognised by the medical and/or psychiatric community.
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, DOI: 10.3109/10826084.2011.639120
Downs, D. S., Hausenblas, H. A., & Nigg, C. R. (2004). Factorial Validity and Psychometric Examination of the Exercise Dependence Scale-Revised. Measurement in Physical Education and Exercise Science, 8(4), 183-201.
Downs, D. S., Hausenblas, H. A., & Nigg, C. R. (2004). Factorial Validity and Psychometric Examination of the Exercise Dependence Scale-Revised. Measurement in Physical Education and Exercise Science, 8(4), 183-201.
Freimuth M., Moniz S., & Kim S.R. (2011). Clarifying exercise addiction: Differential diagnosis, co-occurring disorders, and phases of addiction. International Journal of Environmental Research and Public Health, 8, 4069-4081.
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.
Ogden, J., Veale, D. M., & Summers, Z. (1997). The development and validation of the Exercise Dependence Questionnaire. Addiction Research, 5(4), 343-355.
Pasman, L. N., & Thompson, J. K. (1988). Body image and eating disturbance in obligatory runners, obligatory weightlifters, and sedentary individuals. International Journal of Eating Disorders, 7(6), 759-769.
Terry, A., Szabo, A., & Griffiths, M. D. (2004). The exercise addiction inventory: A new brief screening tool. Addiction Research and Theory, 12(5), 489-499.
Yates, A., Edman, J. D., Crago, M., & Crowell, D. (2001). Using an exercise-based instrument to detect signs of an eating disorder. Psychiatry Research, 105(3), 231-241.
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