Exercise addiction revisited: From symptoms to treatment

Abstract

This paper critically examines “exercise addiction,” a form of dysfunctional exercise behavior often mischaracterized as “exercise dependence.” While dependence is part of addiction, compulsion plays an equally significant role. Unlike substance-based addictions, exercise addiction involves delayed gratification achieved through intense physical effort. It often includes a masochistic drive to uphold self-imposed personal standards or maintain a positive social image. This addiction presents unique symptoms and significant challenges in assessment, as evaluations among healthy exercisers only yield questionnaire-based “risk” scores. The rate at which such high-risk scores turn into morbidity is unknown. Thus, the literature can be misleading via an artificial connection between research-based risk scores and clinically problematic cases. Indeed, such cases typically surface in clinics, not research settings. This complex and diverging path between research endeavors and applied medicine hinders the gathering of robust evidence for exercise addiction being a mental dysfunction, which is the reason why it is currently not classified as a dysfunction in the DSM-5. This paper clarifies exercise addiction and presents evidence for problematic cases based on symptoms and areas of self-harm. Furthermore, the paper distinguishes between commitment and addiction to exercise, presenting the most common theoretical models for exercise addiction. Finally, the work forwards a hierarchical 10-stage treatment framework. Overall, the paper emphasizes the urgent need for close collaboration between researchers and clinicians to accurately classify and address this complex behavioral disorder.