Disruptions in the brain’s dopamine-related reward pathways have been identified in individuals with exercise addiction, similar to those seen in other behavioral addictions or substance addiction.
In individuals with exercise addiction, substance use has been observed to improve negative mood, reduce stress, and produce a feeling of being high, while a decline in sympathetic activity following exercise leads to another drop in mood and a need to exercise.
Studies of individuals with exercise addiction have found areas of the brain showing altered activity and abnormalities in laboratory values related to the stress response.
Differential diagnosis of exercise addiction
First, a detailed assessment should establish the frequency, intensity, and strenuousness of exercise. It is necessary to determine whether the condition has developed secondary to another mental disorder.
If there is an underlying eating disorder (for example, excessive exercise as a compensatory behavior in bulimia), the individual should be referred for cognitive behavioral therapy if they are motivated to engage in psychotherapy. If they are not motivated, motivational interviewing should be used to encourage willingness to change. When exercise addiction develops as a secondary condition, as in this case, it is more difficult to manage than primary exercise addiction. These individuals may often be more exhausted, more pessimistic, or have more severe psychopathology.
How is exercise addiction diagnosed?
Tolerance: Increasing the level of exercise to achieve the desired effect, or no longer experiencing the same effects when exercising at the same level.
Withdrawal Symptoms: Experiencing anxiety, distress, or tension when unable to exercise or when reducing exercise, or exercising the same amount to relieve these symptoms.
Intention Effects: Frequently exercising more or for longer than intended.
Lack of Control: A strong urge to exercise, or unsuccessful attempts to control or stop exercising.
Time: Spending excessive amounts of time exercising.
Reduction in Other Activities: Reducing or giving up other activities in order to exercise.
Continuance: Continuing to exercise despite knowing that one has a physical or medical problem (for example, despite an injury).
Exercise addiction should be considered when 3 or more of these symptoms are present and the individual’s functioning is impaired.
Risk factors for a poorer course
A co-occurring eating disorder and the presence of alcohol or substance use are risk factors for a poorer course. Research emphasizes the importance of cognitive behavioral therapies, psychoeducation, and motivational interviewing. Particularly when an eating disorder is also present, this issue should be addressed with an experienced psychotherapist.
