Blog Archives

Ride on high: Another look at the psychology (and cycleology) of ‘cycling addiction’

Back in 2012, I wrote an article on cycling addiction for my blog and classed the behaviour as a sub-type of exercise addiction. Recently (June 2016), I was interviewed by Cycling Weekly magazine for an article on addiction to cycling, so I thought it opportune to look at the issue again. Over the last five years or so there has been an increase in the amount of research into exercise addiction (as I have outlined in a number of papers with my Hungarian colleagues Attila Szabo and Zsolt Demetrovics – see ‘Further reading’ below). However, there has still been no empirical research specifically into cycling addiction. In his 1997 book Motivation and Emotion in Sport, Dr. John Kerr speculated that endurance type exercise activities (e.g. running, cycling, swimming, aerobics and weight training) were most often associated with exercise addiction and dependence but this was based more on anecdotal as opposed to scientific evidence.

For the Cycling Weekly article, I was interviewed by Dr. Josephine Perry (who just happed to be both a psychologist and a cyclist). She noted in her article that:

“As a regular cyclist, it’s very likely you take a close interest in performance and have a strong drive to improve coupled with a willingness to push yourself hard in training and racing. Sometimes you probably feel under attack from family or colleagues who question or tease you about your ‘obsessive’ cycling habit. You no doubt retaliate by citing the many benefits of cycling: the brilliant friendships, massive health improvements, toned body and all the places you get to explore on your bike. But do your critics occasionally have a point? Does your relentless drive to improve sometimes go too far and place you in danger of crossing the thin line from dedication into addiction? Addiction to cycling is defined by an incessant internal need to train hard every day without taking the time off that you need to rest and recover — not to mention attend to other commitments in your life. In other words, addiction is defined by harm. You ignore the pleas from family or friends to cut back. Your priorities get rearranged, and nothing is allowed to come between you and your bike. Once this line is crossed, the benefits of cycling begin to diminish. The addicted cyclist feels more aches and pains, becomes prone to physical injuries, regular colds and hidden illnesses”.

In a recent (2016) book chapter, my colleagues and I noted that exercise addiction (irrespective of the sub-type) is a condition in which a regularly exercising person loses control over her or his exercise behaviour, while acting compulsively and exhibiting dependence, resulting in negative consequences in their day-to-day health and/or life. This maladaptive exercise behaviour is characterized by severe withdrawal symptoms when exercise is not possible, similar to both chemical addictions (e.g., alcohol addiction) and other behavioural addictions (e.g., gambling addiction). Based on the scientific evidence, exercise addiction is relatively rare, ranging from 0.3% to 0.5% as noted in the only study published using a representative national sample of the general population that we carried out in Hungary back in 2012 (published in the journal Psychology of Sport and Exercise). Given that exercise addiction (in general) is rare, the prevalence of cycling addiction would therefore be even lower. However, that doesn’t mean it doesn’t exist.

A recent study carried out by Dr. Bernd Zeulner and his colleagues among 1,031 endurance athletes (that included an unspecified number of cyclists) assessed the prevalence of exercise addiction using the Exercise Addiction Inventory (EAI; a scale that I co-developed with my colleagues Attila Szabo and Annabel Terry). The study (published in the journal Advances in Physical Education) found that 2.7% had the potential to develop an exercise addiction and that is higher than the prevalence among the general population.

Another study published in the Journal of Clinical Sport Psychology by Dr. Jason Youngman and Dr. Duncan Simpson examined exercise addiction among 1,285 triathletes (cycling, swimming and running) also using the EAI. The study found that approximately 20% of triathletes were at risk for exercise addiction, and that training for longer distance races puts triathletes at greater risk for exercise addiction than training for shorter races. They also found that as the number of weekly training hours increased, so did a triathlete’s risk for exercise addiction. Despite the lack of empirical evidence specifically on cycling addiction, Dr. Perry also noted in her article that:

“[Addicted cyclists] can also become susceptible to burnout and all that comes with it: decreased performance, low mood, changes in appetite, difficulty sleeping and generally a feeling that the outcomes are not matching the intensity of the effort being put in. For a cycling addict, this loss of form and the feelings of difficulty can be devastating…Other research has found the risks are highest in those exercising over five times a week. With the average amount of training for serious amateur cyclists being around 10 hours a week, they are certainly in the higher-risk category”.

I am not sure which study Dr. Perry is referring to in this quote, but in my interview with her, I noted that from my perspective, any behaviour can be potentially addictive if the reward mechanisms are in place but that we should be cautious about imposing the ‘addiction’ label. I told her that we can’t define whether someone is addicted just by the behaviour that they display. It is all to do with the context of that behaviour in their life. More importantly, it’s is not about the amount of time spent engaging in the behaviour but what impact the behaviour has on them. As I explained:

“A healthy enthusiasm adds to their life. An addiction takes away from it. If you have no dependants and both you and your partner enjoy the sport and there is no conflict, it would not be classed as an addiction. If family conflict becomes a factor, the exercise habit becomes fraught with complications.”

I noted in my previous blog on cycling addiction that 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. Research (by Dr. Heather Hasenblaus among others) has also found that extraversion, neuroticism, and agreeableness predict exercise addiction symptoms. I also noted in my interview with Dr. Perry that some people (such as those with Type A personalities) appear to have their risk for exercise addiction built into them. Some cyclists will be those Type-A achievers who are reward-orientated to do the best they can, in whatever they do. If they take up a sport, those personality traits previously used to be successful and focused in other areas such as work go into the new area.

I also noted in my Cycling Weekly interview that there are a number of signs that can help you spot if your attitude towards cycling is unhealthy. The most obvious one is when cycling becomes the most important activity in your life, dominating thinking, feelings and behaviour. If you need to cycle more to get the same mood benefit that you used to, your mood changes significantly and/or you feel physical effects when you can’t cycle, you may also be at risk. If you start to resent your family, job, social life, hobbies or other interests getting in the way of you cycling, you need to consider if you have crossed the line. Those addicted to cycling are more likely to get into debt to fund their habit, become excessively controlling over their eating to regulate weight and competitiveness, and find it hard to balance work, social and family commitments with training.

I was also asked for my views on the treatment of cycling addiction and said that cognitive-behavioural therapy would likely be the most effective (as the addict would be guided to identify goals that motivate them and be helped to find safe and reasonable ways to reach those goals) but that the type of treatment depends on whether the addiction to cycling was primary or secondary. Primary addicts, who are actually addicted because they love their sport, will find it is very hard to give up. Telling them they can’t continue will be stressful in itself. Secondary addicts may be trying to lose weight or to escape negative, unpleasant feelings or difficulties in their lives, using cycling to control their thoughts. These cyclists are using exercise as a coping mechanism. The key here is finding out why they are doing it to such an extent in the first place. Most will find their addiction is symptomatic of something else.

After interviewing me about whether cycling can be potentially addictive, Dr. Perry summed up my own views arguably better than I could have done it myself:

“[Cycling addiction] is not just about how many hours you are doing on the bike, how much you love your riding, or how many bikes you have; what matters is the impact on your life. If your work and family life allows it without conflict, and you’re not feeling over-stressed or over-tired, then your commitment to cycling is just that – a commitment. If you are suffering from continual injuries and not recovering fully, have found yourself feeling burnt out, dips in mood, feel obliged to miss family or social events for training, resulting in arguments, then you need to ask yourself seriously: am I addicted?”

Dr Mark Griffiths, Professor of Behavioural Addiction, 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., Griffiths, M.D., Szabó, A., Kurimay, T., Kökönyei, G., Urbán, R. and Demetrovics, Z. (2014). Exercise addiction – the emergence of a new disorder. Australasian Epidemiologist, 21(2), 36-40.

Berczik, K., Griffiths, M.D., Szabó, A., Kurimay, T., Urban, R. & Demetrovics, Z. (2014). Exercise addiction. In K. Rosenberg & L. Feder (Eds.), Behavioral Addictions: Criteria, Evidence and Treatment (pp.317-342). New York: Elsevier.

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.

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

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(10), 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), e30-31.

Griffiths, M.D., Urbán, R., Demetrovics, Z., Lichtenstein, M.B., de la Vega, R., Kun, B., Ruiz-Barquín, R., Youngman, J. & Szabo, A. (2015). A cross-cultural re-evaluation of the Exercise Addiction Inventory (EAI) in five countries. Sports Medicine Open, 1:5.

Hausenblas, H.A., & Giacobbi, P.R. (2004). Relationship between exercise dependence symptoms and personality. Personality and Individual differences, 36(6), 1265-1273.

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: Rutledge.

Kurimay, T., Griffiths, M.D., Berczik, K., & Demetrovics, Z. (2013). Exercise addiction: The dark side of sports and exercise. In Baron, D., Reardon, C. & Baron, S.H., Contemporary Issues in Sports Psychiatry: A Global Perspective (pp.33-43). Chichester: Wiley.

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.

Perry, J. (2016). Are you addicted to cycling? Cycling Weekly, July 21. Located at: http://www.cyclingweekly.co.uk/fitness/training/are-you-addicted-to-cycling-261852

Szabo, A., Griffiths, M.D., de La Vega Marcos, R., Mervo, B. & Demetrovics, Z. (2015). Methodological and conceptual limitations in exercise addiction research. Yale Journal of Biology and Medicine, 86, 303-308.

Szabo, A., Griffiths, M.D. & Demetrovics, Z. (2016). Exercise addiction. In V. Preedy (Ed.), The Neuropathology Of Drug Addictions And Substance Misuse (Vol. 3) (pp. 984-992). London: Academic Press.

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

Youngman, J., & Simpson, D. (2014). Risk for exercise addiction: A comparison of triathletes training for sprint-, Olympic-, half-Ironman-, and Ironman-distance triathlons. Journal of Clinical Sport Psychology, 8, 19-37.

Zeulner, B., Ziemainz, H., Beyer, C., Hammon, M., & Janka, R. (2016). Disordered Eating and Exercise Dependence in Endurance Athletes. Advances in Physical Education, 6(2), 76.

Target practice: The psychology of New Year’s resolutions and how to keep them

(Please note: This blog is a slightly extended and fully referenced version of an article that was first published in The Conversation).

Academic research by Dr. John Norcross and his colleagues has shown that up to 50% of adults make New Year’s resolutions (NYRs) and the most common resolutions are wanting to lose weight, doing more exercise, quitting smoking, and saving money. It’s a time that individuals want to re-invent themselves but less than 10% actually manage to keep the NYRs after a few months.

We’ve all made NYRs that we begin with the best of intentions but within a few weeks are back to our old ways. As a Professor of Behavioural Addiction I know how easy people can fall into bad habits, and why on trying to give up those habits is easy to relapse. NYRs usually come in the form of lifestyle changes and changing behaviour that has become routine and habitual (even if they are not problematic) can be very hard to break.

The main reason that people don’t stick to their NYRs is that they set too many and/or they are unrealistic to achieve. There has also been some research by Dr. Janet Polivy and Dr. Peter Herman into ‘false hope syndrome’ (FHS) that is applicable to NYRs. FHS is characterized by an individual’s unrealistic expectations about the likely speed, amount, ease, and consequences of changing their behaviour.

For some people, it takes something radical for them to change their ways. It took a medical diagnosis to make me give up alcohol and caffeine, and it took pregnancy for my partner to give up cigarette smoking. To change your day-to-day behaviour you also have to change your thinking. But there are tried and tested ways that can help individuals stick to their NYRs and here are my personal favourites:

Be realistic You need to begin by making NYRs that you can keep and that are practical. If you want to reduce your alcohol intake because you tend to drink alcohol every day, don’t immediately go teetotal. Try to cut out alcohol every other day or have a drink once every three days. Also, breaking up the longer-term goal into more manageable short-term goals can also be beneficial and more rewarding. The same principle can be applied to exercise or eating more healthily.

Do one thing at a time One of the easiest ways routes to failure is to have too many NYRs. If you want to be fitter and healthier, do just one thing at a time. Give up drinking. Give up smoking. Join a gym. Eat more healthily. But don’t do them all at once. Chose just one and do your best to stick to it. Once you have got one thing under your control, you can begin a second resolution.

Be SMART Anyone working in a jobs that includes objective-setting will know that any goal should be SMART (i.e., specific, measurable, achievable, realist and time-bound). NYRs should be no different. Cutting down alcohol drinking is an admirable goal but it’s not SMART. Drinking no more than two units of alcohol every other day for one month is a SMART resolution. Connecting the NYR to a specific aspirational goal can also be motivating (e.g., dropping a dress size or losing two inches off your waistline in time for the next summer holiday).

Tell someone your resolution(s) Letting family and friends around you know that you have a NYR that you really want to keep will act as both a safety barrier and a face-saver. If you really want to cut down smoking or drinking, real friends will not put temptation in your way and can help you in monitoring your day-to-day behaviour. Never be afraid to ask for help and support from those around you.

Change your behaviour with others – Trying to change habitual behaviour on your own can be difficult. For instance, if you and your partner both smoke, drink and/or eat unhealthily, it is really hard for one partner to change their behaviour if the other is still engaged in the same old bad habits. By having the same NYR (e.g., going on a diet), the chances of success will improve if you are both in it together.

Behavioural change isn’t limited to the New Year Changing your behaviour (or some aspect of it) doesn’t have to be restricted to the start of the New Year. It can be anytime.

Accept lapses as part of the process – It is inevitable that when trying to give up something (alcohol, cigarettes, junk food) that there will be lapses. You shouldn’t feel guilty about giving in to your cravings but accept that it is part of the learning process in enabling behavioural change. Bad habits can take years to become engrained and there are no quick fixes in making major lifestyle changes. These may be clichés but we learn by our mistakes and every day is a new day and you can start each day afresh. Right here. Right now.

Finally, some of you reading this might think all of this sounds like too much hard work and that it’s not worth making NYRs to begin with. However, research by John Norcross and colleagues has also shown that individuals who make NYRs are ten times more likely to achieve their goals than those that don’t make explicit NYRs. Food for thought (rather than thought for food)!

Dr Mark Griffiths, Professor of Behavioural Addiction, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Koestner, R. (2008). Reaching one’s personal goals: A motivational perspective focused on autonomy. Canadian Psychology/Psychologie Canadienne, 49(1), 60-67.

Marlatt, G. A., & Kaplan, B. E. (1972). Self-initiated attempts to change behavior: A study of New Year’s resolutions. Psychological Reports, 30(1), 123-131.

Norcross, J. C. (2006). Integrating self-help into psychotherapy: 16 practical suggestions. Professional Psychology: Research and Practice, 37(6), 683-693.

Norcross, J. C., & Mrykalo, M. S. (2002). Auld Lang Syne: Success predictors, change Processes, and self-reported outcomes of New Year’s resolvers and nonresolvers. Journal of Clinical Psychology, 58, 397-405.

Norcross, J. C., Ratzin, A. C., & Payne, D. (1989). Ringing in the New Year: The change processes and reported outcomes of resolutions. Addictive Behaviors, 14(2), 205-212.

Norcross, J. C., & Vangarelli, D. J. (1989). The resolution solution: longitudinal examination of New Year’s change attempts. Journal of Substance Abuse, 1(2), 127-134.

Polivy, J. (2001). The false hope syndrome: Unrealistic expectations of self-change. International Journal of Obesity and Related Metabolic Disorders, 25, S80-84.

Polivy, J., & Herman, C. P. (2000). The False-Hope Syndrome Unfulfilled Expectations of Self-Change. Current Directions in Psychological Science, 9(4), 128-131.

Polivy, J., & Herman, C. P. (2002). If at first you don’t succeed: False hopes of self-change. American Psychologist, 57(9), 677-689.

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.

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.