When An Exercise Becomes Addictive

Exercise Addiction
When exercise becomes too much
By Arthur Allen
WebMD Feature
Reviewed by Amal Chakraburtty, MD

Do you insist on rising at five to run each morning, even when your back is aching, black ice coats the streets, and your wife beseeches you to stay in bed? Do you only feel good when you’re training for triathlons? Is eating merely a way to replenish for the next race? Then you, my Spandex-clad friend, may have an exercise addiction.

Obligatory athletes

For the vast majority of us, exercise is a good that we don’t get enough of. But a small minority of perfectionist athletes are compulsive exercisers. Some call them exercise addicts, or obsessives, or “obligatory athletes.” As many as 10% of high-performance runners, and possibly an equal number of body builders, have an exercise addiction.

Thirty minutes a day of moderate physical activity is enough to help prevent things like diabetes, high cholesterol, and high blood pressure. Exercise addicts tend to think that a two-hour run makes them four times as healthy. It doesn’t work that way.

Too much exercise can lead to injuries, exhaustion, depression, and suicide. It can also cause lasting physical harm. Your adrenal gland, pumping out hormones as you pound the pavement, can only produce so much cortisol at a time. Suddenly, the heartbeat you’d lowered to a resting 48 is up to 80. You now run for two hours, then three hours. But you can’t improve your 10K times.

Extreme exercisers have an extreme need for control

You can distinguish healthy enthusiasts from exercise addicts by the following trait, says Ian Cockerill, a sports psychologist at the University of Birmingham, England:
“Healthy exercisers organize their exercise around their lives, whereas dependents organize their lives round their exercise.”

Excessive exercise, like extreme diets, attracts people who feel an extreme need for control in their lives. Like weight reduction, improved athletic performance is readily observable, Cockerill says.

But not everyone who likes to exercise a lot is an addict. At times, I thought my friend Matt was an exercise addict. In his 40s, he weighs what he weighed in college, and I often run into him at the local Starbucks after he’s just finished a 20-mile bike ride. But when I gave Matt the six-question Exercise Addiction Inventory, developed by British sports medicine expert Mark Griffiths, he fell far short of the cut.

Matt says, “My wife knows that if I don’t get a certain amount of biking in, I’m a pain in the ass.” He rides every Sunday for two hours with a group of friends, as well as two or three additional hours per week. But family comes first. And part of the pleasure he takes in biking is the opportunity it provides for socializing.

“Beer tastes better after exercise,” Matt says. “I think runners tend to be more solitary than bikers.”

Indeed, treatment for exercise addiction often includes encouraging patients to take up more social forms of exercise such as yoga and cycling instead of the solitary pursuits of running or going to the gym, which can be breeding grounds for perfectionist pathology.

Exercise addicts are high achievers

Psychiatrist Alayna Yates, MD, a professor emeritus at the University of Hawaii, has seen about 100 men and women she describes as “obligatory runners.” They’re an unusually high performing, smart bunch, with an average of 18 years of education.

“We need people like this,” Yates says, “but we need to help them diversify. These people are locked into their regimes. They eat one meal a day, or eat exactly the same foods at each meal every day. They measure everything — their caloric intake, how much starch they’re eating. They’re overly focused and overly serious about sport and it messes up the rest of their lives. There isn’t time or room for relationships.

They stop going to parties. They go to bed at eight so they can get up at four and run. There are divorces.”

It stands to reason that the best athletes would be exercise addicts — since their professional lives revolve around athleticism. But, says Yates, the best runners may or may not be the obligatory ones. “It’s just as likely to be the men who have jobs and go out running at night as it is the athletes. It has more to do with personality variables than profession.”

There seem to be as many definitions of addiction as there are addicts; but one thing they have in common is the repetition of a behavior past the point where it becomes self-injurious. In exercise, this means, quite literally, refusing to stop or even limit your regime when you’ve got an injury.

Addiction can also mean exercising at inappropriate times. “I have people who run in thunderstorms. I had a patient once who had to have a run while his wife was in labor,” says Yates

Still, it can be hard to diagnose exercise addiction in professional athletes: “I’ll say, ‘You have an Achilles injury. Why are you still running on that tendon?’” says Debbie Rhea, PhD, a professor of kinesiology at Texas Christian University. “And they’ll say, ‘I can’t stop because I’m injured. This is my job.’”

Society’s role in exercise addiction

Some over-exercisers have what psychiatrist Diane A. Klein, MD, of Columbia University’s College of Physicians and Surgeons, calls a “primary dependence.” Others are anorexics who run to help complete their obsession with food and weight control.

To be sure, the population of exercise addicts is a bit different from that of, say, cocaine addicts. Exercise, like being thin, is highly reinforced by society, says Klein. “So for people driven to achieve, to be perfectionists, and to be in optimal health, it’s kind of understandable that they become excessive.”

Rhea works with male body builders who are preoccupied with their looks. Unlike female anorexics, who always think they are too fat, men with muscle dysmorphia, as the condition is called, think they are too small and scrawny.

“They want to get bigger and bigger and bigger, not in fat but in muscle size,” Rhea says. And they often become so preoccupied with their strength exercises that they lose their jobs, lose their girlfriends and wives, and neglect their children.

Treatment for exercise addiction

Treatment for exercise addiction, say the therapists, involves getting the athletes to see they have a problem and that change is necessary. “You have to give them a sense of worth. Maybe they never had a good self-concept. Is it something that happened in childhood? Maybe there’s addiction in the family,” Rhea says.

Some runners who run into trouble start by becoming addicted to “runner’s high,” a feeling of elation caused by the release of hormones. Yates says, “There’s a change in the psyche — they talk about almost out-of-body experiences, feeling as if they can change the world.” But eventually, the adrenal gland burns out and they crash. “What was once gratifying becomes painful and controlling. It becomes a bad thing, but they can’t get out of it.”

Yates sees a cultural context for exercise addiction. “I think it has to do with very high expectations for autonomy and independence in the culture now. You have to move from place to place to get ahead in your job; you have to leave people behind who were significant to you. Many things make us need to be more independent than before.”

Yates tells her patients that “dependency is not a horrible thing. The expectations we have for ourselves and others may be off base. Autonomy is good. But when it gets carried too far, it can be unhealthy.” In other words, psychotherapy may be part of the path to getting off the treadmill. On the other hand, it may not be necessary in all cases.

For many athletes, obsessive exercising is a self-limiting condition, says Cockerill. “They tend to reduce their involvement to sensible levels themselves over time when their life, generally, is on an even keel.”