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Chapter 10 - How to Treat Exercise Addiction

Psychological Interventions and New Pharmacological Perspectives

from Section 1 - From Exercise to Addiction: An Introduction to the Phenomenon

Published online by Cambridge University Press:  30 March 2023

By
Ilaria De Luca ,
Attilio Negri  and
Giuseppe Bersani
Edited by
Ornella Corazza  and
Artemisa Rocha Dores
Ornella Corazza
Affiliation:
University of Hertfordshire and University of Trento, Italy
Artemisa Rocha Dores
Affiliation:
Polytechnic Institute of Porto and University of Porto, Portugal
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Summary

Exercise addiction (EA) is probably the most ‘hidden’ of the behavioural addictions. In a society in which a fit body is normally considered to be a symptom of a healthy lifestyle and success, the assessment and treatment of a maladaptive and health-threatening pattern of exercise may be challenging for healthcare professionals. Furthermore, the lack of guidance and literature on the topic may represent an additional complication on the diagnostic and therapeutic pathway. Although EA is not included in the DSM-5, it is mandatory to inform clinicians about it, as well as other healthcare providers (e.g., psychotherapists, physiotherapists), in order to better identify early signs of such an addiction and prevent injuries or other serious effects on physical or mental health. This chapter provides information on the aetiological basis of EA as well as a compendium of psychological and pharmacological interventions.

Keywords

behavioural addictionsexercise addictionfitspirationtreatment
Type
Chapter
Information
The Body in the Mind
Exercise Addiction, Body Image and the Use of Enhancement Drugs
 , pp. 145 - 162
Publisher: Cambridge University Press
Print publication year: 2023

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References

Bouchard, C, Shephard, RJ, Stephens, T. Physical Activity, Fitness, and Health: International Proceedings and Consensus Statement. Human Kinetics Publishers, 1994.CrossRefGoogle Scholar
Szabo, A. The impact of exercise deprivation on well-being of habitual exercisers. Aust J Sci Med Sport 1995; 27: 68–75.Google Scholar
Szabo, A. Studying the psychological impact of exercise deprivation: are experimental studies hopeless? J Sport Behav 1998; 21: 139–47.Google Scholar
Szabo, A. Physical activity as a source of psychological dysfunction. In: Biddle, SJ, Fox, KR, Boutcher, SH, eds. Physical Activity and Psychological Well-Being. Routledge, 2000: 130–53.Google Scholar
Smith, LL. Overtraining, excessive exercise, and altered immunity. Sports Med 2003; 33: 347–64.Google Scholar
Morgan, WP. Negative addiction in runners. Phys Sportsmed 1979; 7: 57–70.CrossRefGoogle ScholarPubMed
Hailey, BJ, Bailey, LA. Negative addiction in runners: a quantitative approach. J Sport Behav 1982; 5:150–4.Google Scholar
Hausenblas, HA, Downs, DS. Relationship among sex, imagery, and exercise dependence symptoms. Psychol Addict Behav 2002; 16: 169–72.CrossRefGoogle ScholarPubMed
Veale, DMW. Exercise dependence. Br J Addict 1987; 82: 735–40.Google Scholar
Hausenblas, HA, Downs, DS. How much is too much? The development and validation of the Exercise Dependence Scale. Psychol Health 2002; 17: 387–404.Google Scholar
Downs, DS, Hausenblas, HA, Nigg, CR. Factorial validity and psychometric examination of the Exercise Dependence Scale-Revised. Meas Phys Educ Exerc Sci 2004; 8: 183–201.Google Scholar
Haasova, M, Warren, FC, Ussher, M et al. The acute effects of physical activity on cigarette cravings: systematic review and meta-analysis with individual participant data. Addiction 2013; 108: 26–37.CrossRefGoogle ScholarPubMed
Read, JP, Brown, R. The role of physical exercise in alcoholism treatment and recovery. Prof Psychol Res Pr 2003; 34: 49–56.CrossRefGoogle Scholar
Manthou, E, Georgakouli, K, Fatouros, I et al. Role of exercise in the treatment of alcohol use disorders. Biomed Rep 2016; 4: 535–45.CrossRefGoogle ScholarPubMed
Lichtenstein, MB, Emborg, B, Hemmingsen, SD, Hansen, NB. Is exercise addiction in fitness centers a socially accepted behavior? Addict Behav Rep 2017; 6: 102–5.Google ScholarPubMed
Mabe, AG, Forney, KJ, Keel, PK. Do you like my photo? Facebook use maintains eating disorder risk. Int J Eat Disord 2014; 47: 516–23.CrossRefGoogle Scholar
Meier, EP, Gray, J. Facebook photo activity associated with body image disturbance in adolescent girls. Cyberpsychol Behav Soc Netw 2014; 17: 199–206.Google Scholar
Corazza, O, Simonato, P, Demetrovics, Z et al. The emergence of exercise addiction, body dysmorphic disorder, and other image-related psychopathological correlates in fitness settings: a cross sectional study. PLoS ONE 2019; 14: e0213060.CrossRefGoogle ScholarPubMed
Holland, G, Tiggemann, M. A systematic review of the impact of the use of social networking sites on body image and disordered eating outcomes. Body Image 2016; 17: 100–10.CrossRefGoogle ScholarPubMed
Holland, G, Tiggemann, M. “Strong beats skinny every time”: disordered eating and compulsive exercise in women who post fitspiration on Instagram. Int J Eat Disord 2017; 50: 76–9.CrossRefGoogle ScholarPubMed
Brown, I. A theoretical model of the behavioural addictions—applied to offending. In: Hodge, JE, McMurran, M, Hollins, CR, eds. Addicted to Crime? John Wiley & Sons, 1997: 13–65.Google Scholar
Andreassen, CS, Griffiths, MD, Gjertsen, SR et al. The relationships between behavioral addictions and the five-factor model of personality. J Behav Addict 2013; 2: 90–9.Google Scholar
Griffiths, MD, Szabo, A, Terry, A. The Exercise Addiction Inventory: a quick and easy screening tool for health practitioners. Br J Sports Med 2005; 39: e30.Google Scholar
Lichtenstein, MB, Emborg, B, Daugaard Hemmingsen, S, Hansen, NB. Is exercise addiction in fitness centers a socially accepted behavior? Addict Behav Rep 2017; 6: 102–5.Google ScholarPubMed
Lichtenstein, MB, Christiansen, E, Elklit, A, Bilenberg, N, Støving, RK. Exercise addiction: a study of eating disorder symptoms, quality of life, personality traits and attachment styles. Psychiatry Res 2014; 357: 410–16.Google Scholar
Anandkumar, S, Manivasagam, M, Kee, VTS, Meyding-Lamade, U. Effect of physical therapy management of nonspecific low back pain with exercise addiction behaviors: a case series. Physiother Theory Pract 2018; 34: 316–28.CrossRefGoogle ScholarPubMed
Schwellnus, M, Soligard, T, Alonso, JM et al. How much is too much? (Part 2) International Olympic Committee consensus statement on load in sport and risk of illness. Br J Sports Med 2016; 357: 1043–52.Google Scholar
De Souza, MJ, Nattiv, A, Joy, E et al. 2014 Female Athlete Triad Coalition Consensus Statement on Treatment and Return to Play of the Female Athlete Triad: 1st International Conference held in San Francisco, California, May 2012 and 2nd International Conference held in Indianapolis, Indiana, May 2013. Br J Sports Med 2014; 48: 289.Google Scholar
Meeusen, R, Duclos, M, Foster, C et al. Prevention, diagnosis, and treatment of the overtraining syndrome: joint consensus statement of the European College of Sport Science and the American College of Sports Medicine. Med Sci Sports Exerc 2013; 45: 186–205.Google ScholarPubMed
Hausenblas, HA, Schreiber, K, Smoliga, JM, Addiction to exercise. BMJ 2017; 357: j1745.Google Scholar
Weinstein, A, Maayan, G, Weinstein, Y. A study on the relationship between compulsive exercise, depression and anxiety. J Behav Addict 2015; 4: 315–18.CrossRefGoogle Scholar
Antunes, HK, Leite, GS, Lee, KS et al. Exercise deprivation increases negative mood in exercise-addicted subjects and modifies their biochemical markers. Physiol Behav 2016; 357: 182–90.Google Scholar
Pope Jnr, HG, Katz, DL, Champoux, R. Anabolic-androgenic steroid use among 1,010 college men. Phys Sportsmed 1988; 16: 75–81.Google Scholar
Corazza, O, Demetrovics, Z, van den Brink, W, Schifano, F. ‘Legal highs’ an inappropriate term for ‘Novel Psychoactive Drugs’ in drug prevention and scientific debate. Int J Drug Policy 2013; 24: 82–3.CrossRefGoogle ScholarPubMed
Van Hout, MC. SMART: an Internet study of users’ experiences of synthetic tanning. Perform Enhanc Health 2014; 3: 3–14.CrossRefGoogle Scholar
Mooney, R, R Simonato, P, Ruparelia, R et al. The use of supplements and performance and image enhancing drugs in fitness settings: an exploratory cross-sectional investigation in the United Kingdom. Hum Psychopharmacol 2017; 32: e2619.Google Scholar
Freimuth, M, Moniz, S, Kim, SR. Clarifying exercise addiction: differential diagnosis, co-occurring disorders, and phases of addiction. Int J Environ Res Public Health 2011; 8: 4069–81.CrossRefGoogle ScholarPubMed
Bruno, A, Quattrone, D, Scimeca, G et al. Unraveling exercise addiction: the role of narcissism and self-esteem. J Addict 2014; 2014: 987841.CrossRefGoogle ScholarPubMed
Levallius, J, Collin, C, Birgegård, A. Now you see it, now you don’t: compulsive exercise in adolescents with an eating disorder. J Eat Disord 2017; 5: 9.CrossRefGoogle ScholarPubMed
Rocks, T, Pelly, F, Slater, G, Martin, LA. Prevalence of exercise addiction symptomology and disordered eating in Australian students studying nutrition and dietetics. J Acad Nutr Diet 2017; 117: 1628–36.CrossRefGoogle ScholarPubMed
Klein, DA, Bennett, AS, Schebendach, J et al. Exercise “addiction” in anorexia nervosa: model development and pilot data. CNS Spectr 2004, 9: 531–7.Google Scholar
Veale, DMW. Does primary exercise dependence really exist? In: Annet, J, Cripps, B, Steinberg, H, eds. Exercise Addiction: Motivation for Participation in Sport and Exercise. British Psychological Society, 1995: 71–5.Google Scholar
Adams, J, Kirkby, RJ. Exercise dependence and overtraining: the psychological and physiological consequences of excessive exercise. Res Sports Med 2001; 10: 199–222.Google Scholar
Adams, JM, Miller, TW, Kraus, RF. Exercise dependence: diagnostic and therapeutic issues for patients in psychotherapy. J Contemp Psychother 2003; 33: 93–107.Google Scholar
Blaydon, MJ, Lindner, KJ, Kerr, JH. Metamotivational characteristics of eating-disordered and exercise-dependent triathletes: an application of reversal theory. Psychol Sport Exerc 2004; 3: 223–36.Google Scholar
Berczik, K, Szabó, A, Griffiths, MD et al. Exercise addiction: symptoms, diagnosis, epidemiology, and etiology. Subst Use Misuse 2002; 47: 403–17.Google Scholar
Adams, J, Kirkby, RJ. Excessive exercise as an addiction: a review. Addict Res Theory 2002; 10: 415–37.CrossRefGoogle Scholar
Canadian Society for Exercise Physiology. Make Your Whole Day Matter: The Canadian 24-Hour Movement Guidelines for Adults (18-64 years). Canadian Society for Exercise Physiology, 2016. www.csepguidelines.ca/adults-18-64Google Scholar
Bogers, RP, van Assema, P, Brug, J, Kester, ADM, Dagnelie, PC. Psychosocial predictors of increases in fruit and vegetable consumption. Am J Health Behav 2007; 31: 135–45.CrossRefGoogle ScholarPubMed
Seligman, HK, Wallace, AS, DeWalt, DA et al. Facilitating behavior change with low-literacy patient education materials. Am J Health Behav 2007; 31: S69–78.Google Scholar
Miller, WR, Rollnick, S. Motivational Interviewing: Preparing People for Change, 2nd ed. The Guilford Press, 2002.Google Scholar
Miller, WR, Rollnick, S. Motivational Interviewing: Preparing People to Change Addictive Behavior. The Guilford Press, 1991.Google Scholar
Dunn, C, Deroo, L, Rivara, FP. The use of brief interventions adapted from motivational interviewing across behavioral domains: a systematic review. Addiction 2001; 96: 1725–42.Google Scholar
Beck, JS. Cognitive Behavior Therapy: Basics and Beyond, 2nd ed. The Guilford Press, 2011.Google Scholar
Field, TA, Beeson, ET, Jones, LK. The new ABCs: a practitioner’s guide to neuroscience-informed cognitive-behavior therapy. J Ment Health Couns 2015; 37: 206–20.Google Scholar
Benjamin, CL, Puleo, CM, Settipani, CA et al. History of cognitive-behavioral therapy (CBT) in youth. Child Adolesc Psychiatr Clin N Am 2011; 20: 179–89.CrossRefGoogle ScholarPubMed
Cowlishaw, S, Merkouris, S, Dowling, N et al. Psychological therapies for pathological and problem gambling. Cochrane Database Syst Rev 2012; 11: CD008937.Google Scholar
Hook, JN, Reid, RC, Penberthy, JK, Davis, DE, Jennings, DJ 2nd. Methodological review of treatments for nonparaphilic hypersexual behavior. J Sex Marital Ther 2014; 40: 294–308.Google Scholar
Christianini, AR, Conti, MA, Hearst, N et al. Treating kleptomania: cross-cultural adaptation of the Kleptomania Symptom Assessment Scale and assessment of an outpatient program. Compr Psychiatry 2015; 56: 289–94.CrossRefGoogle ScholarPubMed
Lourenço Leite, P, Pereira, VM, Nardi, AE, Silva, AC. Psychotherapy for compulsive buying disorder: a systematic review. Psychiatry Res 2014; 219: 411–19.Google Scholar
Wichmann, S, Martin, DR. Exercise excess: treating patients addicted to fitness. Phys Sportsmed 1992; 20: 193–200.CrossRefGoogle Scholar
Fisher, LA, Wrisberg, CA. A “positive psychology” of athletic training. Athl Ther Today 2004; 9: 58–9.Google Scholar
Cumella, E. The heavy weight of exercise addiction. Behav Health Manag 2005; 25: 26–31.Google Scholar
Moeller, FG, Schmitz, JM, Steinberg, JL et al. Citalopram combined with behavioral therapy reduces cocaine use: a double-blind, placebo-controlled trial. Am J Drug Alcohol Abuse 2007; 33: 367–78.Google Scholar
Adams, J. Understanding exercise dependence. J Contemp Psychother 2009, 39: 231–40.Google Scholar
Manicavasgar, V, Parker, G, Perich, T. Mindfulness-based cognitive therapy vs. cognitive behaviour therapy as a treatment for non-melancholic depression. J Affect Disord 2011; 130: 138–44.Google Scholar
Hofmann, SG, Sawyer, AT, Fang, A. The empirical status of the “new wave” of cognitive behavioral therapy. Psychiatr Clin N Am 2010; 33: 701–10.CrossRefGoogle ScholarPubMed
Hayes, SC, Villatte, M, Levin, M, Hildebrandt, M. Open, aware, and active: contextual approaches as an emerging trend in the behavioral and cognitive therapies. Annu Rev Clin Psychol 2011; 7: 141–68.CrossRefGoogle ScholarPubMed
Zgierska, A, Rabago, D, Chawla, N et al. Mindfulness meditation for substance use disorders: a systematic review. Subst Abus 2009; 30: 266–94.Google Scholar
Shonin, E, Van Gordon, W, Griffiths, MD. Buddhist philosophy for the treatment of problem gambling. J Behav Addict 2013; 2: 63–71.Google Scholar
Marazziti, D. Farmacoterapia Clinica, 5th ed. Fioriti, 2013.Google Scholar
Goldstein, RZ, Volkow, ND. Drug addiction and its underlying neurobiological basis: neuroimaging evidence for the involvement of the frontal cortex. Am J Psychiatry 2002; 159: 1642–52.Google Scholar
Marazziti, D, Presta, S, Baroni, S, Silvestri, S, Dell’Osso, L. Behavioral addictions: a novel challenge for psychopharmacology. CNS Spectr 2014; 19: 486–95.CrossRefGoogle ScholarPubMed
Hollander, E, DeCaria, CM, Mari, E. Short-term single-blind fluvoxamine treatment of pathological gambling. Am J Psychiatry 1998; 155: 1781–3.Google Scholar
Hollander, E, DeCaria, CM, Finkell, JN et al. A randomized double-blind fluvoxamine/placebo crossover trial in pathologic gambling. Biol Psychiatry 2000; 47: 813–17.CrossRefGoogle ScholarPubMed
Blanco, C, Petkova, E, Ibanez, A, Saiz-Ruiz, J. A pilot placebo-controlled study of fluvoxamine for pathological gambling. Ann Clin Psychiatry 2002; 14: 9–15.Google Scholar
Kim, SW, Grant, JE, Adson, DE, Shin, YC, Zaninelli, R. A double-blind placebo-controlled study of the efficacy and safety of paroxetine in the treatment of pathological gambling. J Clin Psychiatry 2002; 63: 501–7.Google Scholar
Zimmerman, M, Breen, RB, Posternak, MA. An open-label study of citalopram in the treatment of pathological gambling. J Clin Psychiatry 2002; 63: 44–8.CrossRefGoogle ScholarPubMed
Black, DW, Shaw, M, Forbush, KT, Allen, J. An open-label trial of escitalopram in the treatment of pathological gambling. Clin Neuropharmacol 2007; 30: 206–12.Google Scholar
McElroy, SL, Satlin, A, Pope, HG, Keck, PE, Hudson, J. Treatment of compulsive shopping with antidepressants: a report of three cases. Ann Clin Psychiatry 1991; 3: 199–204.Google Scholar
McElroy, SL, Keck, PE Jr, Pope, HG Jr, Smith, JM, Strakowski, SM. Compulsive buying: a report on 20 cases. J Clin Psychiatry 1994; 55: 242–8.Google Scholar
Emmanuel, NP, Lydiard, RB, Ballenger, JC. Fluoxetine treatment of voyeurism. Am J Psychiatry 1991; 148: 950.Google Scholar
Stein, DJ, Hollander, E, Anthony, DT et al. Serotonergic medications for sexual obsessions, sexual addiction, and paraphilias. J Clin Psychiatry 1992; 53: 267–71.Google Scholar
Fedoroff, JP. Serotonergic drug treatment of deviant sexual interests. Ann Sex Res 1993; 6: 105–21.CrossRefGoogle Scholar
Sattar, P, Ramaswamy, S. Internet gaming addiction. Can J Psychiatry 2004; 49: 869–70.CrossRefGoogle ScholarPubMed
Dell’Osso, B, Altamura, AC, Hadley, SJ, Baker, BR, Hollander, E. An open-label trial of escitalopram in the treatment of impulsive-compulsive internet usage disorder. Eur Neuropsychopharmacol 2006; 16: S82–3.Google Scholar
American Society of Health-System Pharmacists. Naltrexone. Drugs.com, 2017. www.drugs.com/monograph/naltrexone.htmlGoogle Scholar
Kim, SW, Grant, JE, Adson, DE, Shin, YC. Double-blind naltrexone and placebo comparison study in the treatment of pathological gambling. Biol Psychiatry 2001; 49: 914–21.CrossRefGoogle ScholarPubMed
Grant, JE, Potenza, MN, Hollander, E et al. Multicenter investigation of the opioid antagonist nalmefene in the treatment of pathological gambling. Am J Psychiatry 2006; 163: 303–12.CrossRefGoogle ScholarPubMed
Bullock, K, Koran, L. Psychopharmacology of compulsive buying. Drugs Today (Barc) 2003; 39: 695–700.CrossRefGoogle ScholarPubMed
Guzman, CS, Filomensky, T, Tavares, H. Compulsive buying treatment with topiramate: a case report. Braz J Psychiatry 2007; 29: 383–4.Google Scholar
Bostwick, JM, Bucci, A. Internet sex addiction treated with naltrexone. Mayo Clin Proc 2008; 83: 226–30.CrossRefGoogle ScholarPubMed
Pittenger, C. Glutamate modulators in the treatment of obsessive-compulsive disorder. Psychiatr Ann 2015; 45: 308–15.Google Scholar
Grant, JE, Kim, SW, Odlaug, BL. N-acetyl cysteine, a glutamate modulating agent, in the treatment of pathological gambling: a pilot study. Biol Psychiatry 2007; 62: 652–7.Google Scholar
Grant, JE, Odlaug, BL, Mooney, M, O’Brien, R, Kim, SW. Open-label pilot study of memantine in the treatment of compulsive buying. Ann Clin Psychiatry 2012; 24: 119–26.Google ScholarPubMed
McElroy, SL, Pope, HG, Keck, PE et al. Are impulse control disorders related to bipolar disorder? Compr Psychiatry 1996; 37: 229–40.Google Scholar
Pallanti, S, Quercioli, L, Sood, E, Hollander, E. Lithium and valproate treatment of pathological gambling: a randomized single-blind study. J Clin Psychiatry 2002; 63: 559–66.Google Scholar
Dannon, PN, Lowengrub, K, Gonopolski, Y, Musin, E, Kotler, M. Topiramate versus fluvoxamine in the treatment of pathological gambling: a randomized, blind-rater, comparison study. Clin Neuropharmacol 2005; 28: 6–10.Google Scholar
Fong, T, Kalechstein, A, Bernhard, B, Rosenthal, R, Rugle, LA. A double-blind, placebo-controlled trial of olanzapine for the treatment of video poker pathological gamblers. Pharmacol Biochem Behav 2008; 89: 298–303.Google Scholar
Di Nicola, M, Martinotti, G, Mazza, M et al. Quetiapine as add-on treatment for bipolar I disorder with comorbid compulsive buying and physical exercise addiction. Prog Neuropsychopharmacol Biol Psychiatry 2010; 34: 713–14.Google Scholar

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