When fitness becomes fixation

Whether it’s gym workouts, a brisk daily walk or playing group sports, exercise is great for longevity, staying in shape and managing stress. But there’s a fine line between a healthy training regimen and a dangerous obsession.

 

EXERCISE ADDICTION AFFECTS about 3% of the population. This may be hard for people to understand, especially those of us who wish we could drop our bodies off at the gym and pick them up when the session is over. Exercise addiction manifests as an unhealthy obsession with exercise and physical fitness, and can result from poor body image or eating disorders. The DSM–5* (which provides a framework for classifying disorders and defining diagnostic criteria for these disorders) classifies excessive exercise under ‘behavioural addiction.’ The result is the person’s behaviour becomes obsessive, compulsive and/or causes dysfunction in their life, making it similar to other addictions, like gambling or substance abuse.

Dr Kirsten van Heerden, a sports and performance psychologist at Newton Sports Agency in Durban, and a former South African swimmer, explains that there is a scientific reason for this. ‘During exercise, neurotransmitters (our body’s feel-good chemical messengers), such as endorphins, dopamine, serotonin and norepinephrine, interact with the receptors in our brain that reduce our perception of pain, and trigger a positive feeling in the body. Just like morphine.’

Think of it as jolt to the brain’s reward centre, one which helps you anticipate pleasure, feel motivated and maintain hope. So, when you stop exercising, the activity of these neurotransmitters is reduced significantly. In order to trigger their release again, an addict has to exercise more and more frequently.

Compulsive exercising can be loosely divided into primary exercise addiction, which is less about getting leaner and more about being addicted to the feeling and a particular appearance. With secondary exercise addiction or anorexia athletica, the addiction is primarily about weight loss.

Dr Van Heerden says,

‘Although diagnostic criteria are useful, sometimes there is an arbitrary line between being “officially” diagnosed or not. People are complex and don’t often fit into nice neat boxes.’

So, who is more likely to become an addict? Dr Karen Vieira, who has a PhD in Biomedical Sciences from the University of Florida College of Medicine says, ‘Rates of exercise addiction are shown to be higher among those who use technology to aid in their related sport or exercise programme. Fitness technology in the form of various apps, trackers and social media platforms are used frequently by the general population and athletes.’

However, when the motivation for exercise addiction is evaluated, it is often present alongside other mental health conditions, such as:

  • Anorexia and bulimia (with 39–48% of those with an eating disorder engaging in compulsive exercise)
  • Muscle dysmorphia
  • Obsessive-compulsive

 

Exercise addiction is also more commonly seen in people who exhibit certain personality traits, such as perfectionism, neuroticism and narcissism.

We are all encouraged to keep fit and exercise for our mental and physical wellbeing, so what are the signs when that fine line has been crossed? According to Dr Van Heerden, ‘As with all addictions, it’s when the person’s social and work life become affected in a negative way.’ In fact, the diagnostic criteria in the DSM-5 includes the following: ‘Causes significant distress or impairment in social, occupational or other important areas of functioning.’

‘If a person is skipping seeing their friends to work out (not just once in a while, but is constantly choosing exercises over socialising), or they are not getting work done because they leave early to get to the gym, it is a problem. But, it’s often the people around the “addict” who notice the negative impact first. It’s important to hear what family and friends have to say when dealing with any addiction,’ she adds.

What about competitive athletes who have to work out excessively to excel?

‘Interestingly, many elite athletes are terrible at resting and slowing down,’ says Dr Van Heerden. ‘They need to be told by a coach or a doctor to take a break and when to come back after injury. When diagnosing any mental health issue, you have to take context into account. The obsessive focus and training of elite athletes is completely out of the norm and could be seen as excessive and problematic. But within the elite sports world it’s perfectly normal and what’s necessary to succeed.’

Dr Vieira agrees, saying

‘the prevalence of exercise addiction in competitive athletes and gym goers is around 10%’. She identifies triathletes as having the highest percentage at 52%, marathon runners at 50%, endurance athletes 14.2% and gym goers 8.2%’

The following symptoms of exercise addiction have been adapted from the DSM-5’s criteria for substance dependence:

  • Tolerance: Increasing the amount of exercise in order to feel the desired effect.
  • Withdrawal: In the absence of exercise the person experiences negative effects such as anxiety, irritability, restlessness and sleep problems
  • Lack of control: Unsuccessful at attempts to reduce exercise levels or cease exercising.
  • Intention effects: Exceeding the amount of time devoted to exercise or consistently going beyond the intended amount.
  • Time: Excessive time is spent preparing for, engaging in and recovering from exercise.
  • Reduction in other activities: Social, occupational and/or recreational activities occur less often or are stopped
  • Continuance: Continuing to exercise despite knowing that this activity is creating or exacerbating physical, psychological and/or interpersonal problems.

How do you treat exercise addiction? Dr Van Heerden says, ‘If the person has an eating disorder, you would need to treat this first as the exercise is simply an extension of the eating disorder. Often there is a comorbid mental health issue, most commonly depression or anxiety, and this would need to be treated as well.’

As with any addiction, relapse rates are high so a good team of people around you and a real desire to beat the addiction is crucial.

*The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) is the official manual of the American Psychiatric Association.

Getting Hooked

Bodybuilder Brian Smith* (28) says his journey to exercise addiction began when his brother gave him a flier offering free workouts.

‘On my first day, one of the trainers told me I would have killer biceps and a six-pack by the end of the year,’ Brian explains. ‘I was hooked. The release of endorphins, combined with low self-esteem and the need to belong became the perfect cocktail, the ideal escape.

‘As I built muscle, the other bodybuilders in the gym kept the validation glass overflowing and soon I was using whey as a muscle supplement. I wasn’t a skinny guy anymore. Hearing someone in the gym say ‘nice lats’ is the greatest validation a bodybuilder can get. It’s almost as if you’re being sucked into a cult – a cult that is separate from those weak “outsiders” and gives you a greater purpose in life.’

Brian spent more and more time at the gym, adding weights and lifts. He convinced himself that building muscle would make everything better – one more set and he’d finally have his father’s approval.

Intervention for this addiction is slow. While you’re gradually turning into a sculpted Greek god, concern and pity is scarce. Even when he was fired for being late (because of a gym workout), Brian did not realise he had a problem.

It’s not unusual for exercise addicts to be fired.

Home and work fall by the wayside as ‘users’ spiral out of control. Jobs can become all but impossible to find because of the insistence that they not interfere with the training schedule.

Eventually Brian found a new job but admits most of his salary went towards buying supplements. Obsessive training soon meant he was late for work too many times and, once again, he was fired.

Finally, five years after his addiction started, those close to Brian recognised he had a problem. His parents insisted he see a psychologist who determined he had muscle dysmorphia – the root of his exercise addiction. ‘It doesn’t matter who you are,’ Brian says, ‘Your mind is programmed to hate what you see in the mirror. It’s a prison from which you can’t escape and it takes a while to realise that gorilla arms do not make your life better.

‘As with most addicts, the biggest challenge was giving up my social group because many of those people facilitated my addiction because they too were addicted.’

It takes time to overcome the addiction and Brian is no different. He is still recovering and his muscles are down to a reasonable size. Withdrawal from continuous compliments from fellow bodybuilders and accepting his new body have been difficult. But he is on the road to recovery.

*Name has been changed.

 

 


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