What Is Exercise Addiction and Dependence?

Note from GGS: We get a lot of questions regarding exercise addiction and dependence. "How do I know if I'm addicted to exercise?" "Why do I feel so guilty if I miss a training session?" "I HATE rest days! Do I have to take them?" This is a really tricky subject, and we are happy to have Dr. Krista Rompolski back to help shed some light on it.

I've spent the past few months researching disordered and/or compulsive exercise. I wanted to try to determine the line between a disciplined, healthy behavior and a problem, and the relationship with this condition and injury recovery.

There seems to be a mere few points on a scale between a healthy habit and a disorder. This research was inspired by yet another repetitive stress injury that has me sidelined from what I would like to do physically for the foreseeable future. Had I rested months ago, I would most likely not be here right now.

I bought every book and research study about rehab protocols for my injury, did every exercise that physiotherapists gave me to the max, but what I failed to do was listen to my body and rest. 

The amount of times I said to myself, “this will probably be OK,” is embarrassing; telling myself that I wasn't causing any damage because it didn't hurt to do something. However, pain is often one of the final stages in the onset of an injury, meaning damage is occurring before a pain sensation is produced.

I sit here now, after 10 months of trying to "cut corners" in my recovery wherever I could to maintain my activity level. Why? To burn calories, so that I could stay lean without sacrificing food intake.

I personally dislike the feeling of having to restrict food, but I love to be active, so it has always been way easier to simply maintain a much higher activity level. The problem? When my activity is restricted, I experience anxiety and depression, and I have no one to blame but myself.

Doctors aren't too helpful with this aspect of injury. When I asked one of my doctors questions about what activity I could do, he looked at me like I was crazy to be asking those questions. I felt he was thinking, "If it hurts so badly, why would you want to be biking or swimming? Don't you prioritize healing over exercise, especially if exercise is what's causing your pain?"

I have a hard time explaining to a doctor that pain is the least of my worries.

We are a community of dedicated, determined women, but when does dedication turn detrimental?

When is all our positivity a socially acceptable mask over the inner drive towards a likely unattainable body image? When does discipline turn into rigidity that causes anxiety if any disturbances in routine occur?

Girls Gone Strong owner, Molly Galbraith, touched on this in this article, challenging us to answer the question of why we want to be leaner, or what it really does for us. I think it’s a question worth asking again, and certainly one heavy on my mind. Perhaps your friends and family have suggested that you are too rigid, but you are afraid to relax. You take pride in your dedication in a sea of people who struggle to take a walk each day.

Perhaps you have become reliant on a level of activity to give you a sense of body image security at the sake of your health, but don't know how to slow down. Perhaps you don't even realize that your behaviors are clinically disordered which can be food for thought.

My hope for this article is that we can start a discussion about the anxiety that comes for so many of us on skipping a workout, having to slow down, and the possible dependence on exercise for emotional and mental release. Maybe you have no idea how someone could ignore pain for the sake of leanness or stress release, but you can help someone else by learning more about it.

Exercise Addiction, Dependence, Compulsion, Oh My!

As a professor who teaches courses in clinical research, this is a tough subject to discuss, as there is no accepted term for an abnormal relationship with exercise, and it has been called by many names in the medical literature.

First, let us look at the DSM-IV criteria for substance dependence, adapted for exercise, from the International Journal of Environmental Research in Public Health, 2011 article titled "Clarifying Exercise Addiction: Differential Diagnosis, Co-occurring Disorders, and Phases of Addiction.”

1. Tolerance - increasing the amount of exercise in order to feel the desired effect, be it a "buzz" or sense of accomplishment.
2. Withdrawal - in the absence of exercise the person experiences negative effects such as anxiety, irritability, restlessness and sleep problems.
3. Lack of control - unsuccessful at attempts to reduce exercise level or cease exercising for a period of time.
4. Intention effects - unable to stick to one's intended routine as evidenced by exceeding the amount of time devoted to exercise or consistently going beyond the intended amount.
5. Time - a great deal of time is spent preparing for, engaging in, and recovering from exercise.
6. Reduction in other activities - as a direct result of exercise social, occupational and or recreational activities occur less often or are stopped.
7. Continuance - continuing to exercise despite knowing that this activity is creating or exacerbating physical, psychological, and/or interpersonal problems.

The authors of this paper point out the need to distinguish "exercise that occurs at a high frequency" from "exercise addiction."

For example, an Olympic athlete may devote a great deal of time and reduction in other activities for their sport, and even experience withdrawal when that activity is cut back, but this does not imply that the elite athlete is "addicted" to his or her sport. As you can imagine, the difficulty in distinguishing between these two situations has led to confusion and difficulty in psychology literature.

When trying to research the relationship between overuse injury rates and compulsive exercise, I found almost nothing tackling both topics together. I found a few articles discussing a psychological mindset during injury, but most examined the effect of beliefs or positivity on injury recovery. I've yet to find evidence that someone entering a sports medicine doctor's office with an overuse injury is being screened for exercise dependence.

Exercise dependence is frequently grouped in with, or under the umbrella of disordered eating, with some purporting that “drive for thinness”, one of the major subscales of eating disorder inventories, drives exercise addiction exclusively. However, more and more researchers and psychologists are classifying exercise dependence as a primary disorder or secondary to an eating disorder.

Below is a short list of the questions on the Compulsive Exercise Test. They are graded on a 5-point Likert scale ranging from “never true" to "always true.”

Please note: no psychological scales for exercise dependence or any other condition should be interpreted without the consultation of a trained psychologist, psychiatrist or physician.

• I like my days to be organized and structured of which exercise is just one part.
• I feel less anxious after I exercise.
• If I feel I have eaten too much, I will do more exercise.
• I feel extremely guilty if I miss an exercise session.
• I usually continue to exercise despite injury or illness, unless I am very ill or too injured.
• If I cannot exercise I feel agitated and/or irritable.
• If I cannot exercise, I worry that I will gain weight.
• I feel like I’ve let myself down if I miss an exercise session.

Do any of these resonate strongly with you?

To be clear, my intent is certainly not for us to self-diagnose or cause anyone alarm. As I said earlier, no score on a scale can fully encapsulate everything that makes up one person’s psyche or explain their behaviors.

However, I think we all may have a sense of how much something does or does not ring true to us. If you have been experiencing social, personal, or physical consequences due to your exercise routine, perhaps you will be inspired to seek some sort of assistance in coping or readjusting your framework around exercise.

Dedication and determination are excellent qualities in an exercise program, but it is only one part of what makes you, what makes all of us, strong women.

As we wrap up, we at GGS would love to know:

Have you ever struggled with these feelings regarding exercise?

How do you personally manage your dedication to a healthy lifestyle with realistic expectations of your schedule and your body?

Have you found a "sweet spot" in terms of exercise type, frequency, and duration?

Do you feel you could use some help achieving a healthy, balanced training routine? We can help.