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Exercise Addiction
Exercise Addiction
Amanda D. Kaberline
James Madison University
PSY 497 Senior Seminar: Addictive Behaviors
November 3, 2006
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Exercise Addiction
Table of Contents
Introduction
Chapter 1: The Nature of Exercise Addiction................................................................ 2
Chapter 2: The History of Exercise Addiction .............................................................. 13
Chapter 3: Current Information:
Health and Human Services ...................................................................... 15
Exercise Addiction Research .................................................................... 19
Bibliography ..................................................................................................................
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Introduction
Exercise addiction, a startling new disorder, has recently come to the attention of the
medical, psychological and sociological communities. With no clear definition, test for
diagnosis, or treatment plans set up, it is easy to see just how new of a concept exercise addiction
really is. With new research being completed every year, the outlook for exercise addiction
seems bright. After all, it is only from the empirical research being completed that conclusions
can be drawn and knowledge can be gained about this new and mysterious disorder. This book is
designed to give an overview of the knowledge base on exercise addiction. An overall
understanding of exercise addiction will be achieved by breaking down this disorder into its
parts; the nature of exercise addiction, the history behind the disorder, current research and topics
being discussed in the research community.
Chapter 1: The Nature of Exercise Addiction
Exercise addiction (EA) has no clear or universal definition. Depending on the field,
medical doctors and psychologist seem to disagree about what exactly constitutes an EA. Le
Grange and Eisler, said it best in their article from 1993 when they said, “It’s not always clear
that these terms represent the same phenomenon because effective definitions are often not
present in research papers.” EA has been defined as, “a compulsion to exercise excessively even
when the consequences are harmful to an individual’s health, family relationships and personal
health,” (Griffiths, 1997: Hausenblas and Downs, 2002, Loumidis and Wells, 1998). A typical
definition for EA given by someone in the medical field might look more like the definition that
Dishman provides in his article published in 1985. Dishman defines EA as, “seeking exercise as
a means to alter mood state, especially to experience a euphoric ‘high’ or ‘buzz’, which many
habitual exercisers describe as a motivation to exercise, can be labeled as an addictive behavior,”
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(Dishman, 1985). Anyway that it is phrased, the underlying principle of exercise addiction being
that of a person who engages in an excessive amount of exercise, for many possible reasons, and
observable deleterious consequences stem from or are exasperated by the exercise behavior.
Exercise addiction is known by many different names including; exercise dependence,
obligatory exercise, anorexia athletica, compulsive exercise, exercise abuse, morbid exercise and
habitual exercise. In going by numerous different names, EA has become extremely difficult to
diagnose. Without the ability to assign a clear name to a specific set of symptoms, there is no
way that a diagnosis, let alone treatment, can be prescribed. Given the multiple names for this
disorder, there comes great variability in the parameters of EA.
The Diagnostic and Statistical Manual of Mental Disorders (DSM) does not currently
recognize EA as an identified disorder. Instead, EA is listed as a symptom of anorexia nervosa.
Research has found a strong correlation between anorexia and exercise addiction. A study done
by Davis et al., in 1997 looked at the prevalence rate of excessive exercise among a population
of adolescents and adults being treated for anorexia. In an effort to pinpoint a more accurate
excessive exercise prevalence rate among eating disordered populations, participants were
interviewed in detail as to the extent of their exercise habits both before and during the onset of
the eating disorder. In the conclusion and analysis of this study, it was found that 81% of the
anorexic participants were excessively exercising during the active phase of their eating disorder.
It was also found that within the anorexic participant community, 56% reported being active in a
sport/team/exercise routine before the onset of their destructive eating behaviors. Lastly, this
study showed that the problem with exercising in these individuals began in early childhood as
50% of the anorexic participants reported an above average activity level even as young children.
Research on eating disorders and the role played by exercise as well as the DSM’s decision to
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add excessive exercise as a symptom of anorexia nervosa, have proven the theory that exercise
addiction and anorexia are comorbid in most cases.
The signs and symptoms of EA are multiple and varied because there is no set list due to
the lack of recognition by the DSM. With such numerous symptoms of EA, they can be
categorized into three separate types: psychological symptoms, biological symptoms and social
symptoms. Psychologically, Brown’s (1993) 6 elements of addiction hold true. Brown
introduced the idea of addicts going through these 6 phases; salience, euphoria, tolerance,
withdrawal symptoms, conflict and relapse. Salience is when the addiction takes over the whole
life, thought process and behaviors of the addict. The euphoria mentioned is the “high” that the
addict feels in direct connection with the abuse of whatever stimuli they crave. Tolerance comes
with increased use of the stimuli, in that more of it is needed to induce the euphoria feeling.
Withdrawal symptoms are experienced in both physical and psychological ways. The addict also
experiences conflict as their habit becomes increasingly important and other loved ones or duties
fall away. Finally, relapse is a common step or sign of an addiction. Exercise addicts can
experience all of these phases laid out by Brown in 1993. Exercise addicts tend to let exercising
consume their daily schedule, they experience the “runner’s high” from the exercise which is a
reward for their behavior. Many times, these exercise addicts find themselves lengthen their
work out or even adding an extra work out to help achieve that ‘high’. An article written by
Susan Wichmann and D.R. Martin for, The Physician and Sportsmedicine, discusses the most
common withdrawal symptoms seen in exercise addicts who are unable to work out. Mentioned
in this article are symptoms such as anxiety, restlessness, tension, guilt, muscle twitching and
discomfort. The withdrawal symptoms seem to be very difficult to deal with to the extent that
many researchers have found it near impossible to even find participants who are willing to
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complete a study if it means that they have to cease physical activity. The lack of willing
participants has been a problem and one of the reasons for the lack of research knowledge about
EA. Looking at the physical symptoms of EA, some signs that there may be a problem include;
muscle soreness, stiffness, weight loss and overuse injuries that never seem to heal (Wichmann
& Martin, 1992). Socially, an exercise addict tends to plan their whole life around physical
activities and thus will shut out any or all of their family, friends and loved ones. In this process
they tend to skip social events, show up late to work/school and the productivity level when they
are at school or work suffers as well. When these social, psychological and physical signs are
apparent then there is a very good chance that the person has a problem with exercise.
Diagnosing an exercise addiction is made difficult by the fact, yet again, that there is no
universal definition for EA which means no set list of signs and symptoms and no set basis on
which to diagnose. Although there are no formally set guidelines for diagnosing EA, there are
many diverse inventories that were drafted to diagnose exercise problems. The obligatory
exercise questionnaire (OEQ), (Pasman & Thompson, 1998), was designed to look at the
relationship that exercise plays with food, body image and the participant. Once put into use, the
OEQ was able to facilitate the finding that women are actually much more susceptible to body
image and food issues than their comparable male counterparts. Another inventory used for the
diagnosis of EA is the Exercise Dependence Questionnaire (EDQ), (Ogden et al., 1997). This
inventory is made up of multiple parts and questions that investigate the participant’s motive for
the exercise behavior, as well as the participant’s perceived social consequences due to this
behavior. The Exercise Dependence Scale (EDS), (Hausenblas and Symons Downs, 2001,
2002b), is unique in the way that the study’s authors came up with their own definition of
exercise addiction that would be measured by this scale. The definition given here for exercise
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addiction was, “Excessive exercise is described as a craving for exercise that results in
uncontrollable excessive physical activity and manifests in physiological symptoms,
psychological symptoms, or both.” (Hausenblas and Symons Downs, 2002a, 2002c). The EDS is
a commonly used inventory for EA diagnosis for many reasons. Molded from the DSM-IV
criteria for substance abuse, the EDS has a very broad spectrum and is able to cover so much in
one inventory. Another important feature of the EDS is the separation of the different types of
participants into three groups; the at risk group, the non-dependent- symptomatic group and the
dependent- symptomatic group. Finally, the Exercise Addiction Inventory (EAI), (Terry et al,
2004) is very specific and straight forward. Comprised of mainly a self-reported measure, the
EAI focuses on the participant’s attitudes and how they effect the beliefs around exercise and the
idea of relapse. Problems encountered in addicts having to do with their social lives, money
issues and self conflict are all addressed in this inventory. It seems that for the time being, with
such a lack of research on the onset and diagnosis of EA, inventories are the best tool a
psychologist can use to diagnose excessive exercise.
The exact causes for the development of exercise addiction are still a mystery. There are
however, three big psychophysiological theories that were identified in Murph’s 1994 literature
review. These three theories, the thermogenic hypothesis, the catecholamine hypothesis and the
endorphin hypothesis, aim to sort out exercise addiction. The thermogenic hypothesis is centered
on the basic understanding that when a person exercises, their internal body temperature
increases which in turn helps to lower anxiety levels (de Vries, 1981; Morgan & O’Connor,
1988). The lowering of anxiety levels acts as positive reinforcement for the exercise behavior.
When a person experiences that lowering of anxiety, they couple that effect with the act of
exercising. Once the relationship between exercise and reduction in anxiety has been made, it is
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possible that as the person experiences increasing levels of anxiety, they will also increase the
duration or difficulty of their exercise. Thus, the use of exercise to induce mood changes can be
recognized as one of the phases in addiction developed by Brown (1993).
The catecholamine hypothesis is based on the theory that through exercise, catecholamine
levels in the body are increased (Kety, 1966). Catecholamine is responsible for the regulation of
mood, attention, movement, stress responses and cardiovascular responses. In regulating the
stress response, catecholamine directly affects the levels of noradrenalin, adrenaline and
dopamine in the brain. These neurotransmitters are all responsible for mood and play a role in
the phenomenon called, “runner’s high”. With such powerful psychological effects it is not hard
to recognize catecholamine as a possible culprit in the onset of exercise addiction.
The final of the three theories, the endorphin hypothesis, is the most popular and more
widely studied of the three. The basis of this theory is that exercise leads to higher levels of
endorphins in the brain which act as reinforcing mood boosters as well. A lot like catecholamine,
endorphins are the body’s own natural form of drugs such as morphine. Endorphins also play a
role in, “runner’s high”.
Social aspects also need to be considered when attempting to identify the basis of
exercise addiction. Obesity rates have been on the rise for many years now, sighting an increase
of 40% between 1980 and 1990 (Rippe, Crossley & Ringer, 1998). Many government agencies
have become increasingly aware of the obesity problem facing modern Americans. In an effort to
stop this epidemic, these organizations have come together to create programs meant to reach out
to these overweight children and teach not only the child, but the family as well, a more healthy
lifestyle. One such program is the Steps to a HealthierUS program which was developed by the
U.S. Public Health Service in response to President George W. Bush’s call for a healthier nation.
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The ‘Steps’ program, as it is nicknamed, focuses on the reduction in the number of treatable
chronic disease in the US. One of these chronic diseases that is addressed by the Steps program
is obesity. The U.S. Public Health Service claims that, “more than 64% of the U.S. adult
population is overweight or obese. At least 400,000 deaths each year are related to poor diet and
physical inactivity,” (2005). With such great numbers of obesity it seems that physical activity is
rightfully emphasized in children as young as kindergarteners. In most cases, this powerful
message of the lifelong benefits of exercise is a great accomplishment. However, the message
that is being sent to these young children has often been misconstrued, either by the
administrators or the children. Often times, the message that ends up with these young children is
that exercise is ultimately good and the way that a person looses weight is through exercise. This
idea continues in their minds to mean that if you can maintain or loose a little bit of weight with
moderate exercise, then excessive exercise would mean ultimate weight lose resulting in the type
of body that society reinforces and finds beautiful. This is a dangerous message to be sending to
our nation’s children. There has to be a fine line between informing and educating the nation on
the risks of being overweight and the risks of taking actions that would put those affected at the
other end of the spectrum. Balance in all aspects of health and lifestyle need to be stressed in
order to truly succeed at decreasing the number of people effected by obesity, without increasing
the number of eating disorder and exercise addiction cases.
In the case of all of the sources of onset listed above, it seems that the type of exercise,
duration, personality and features of the person involved, and the comorbid conditions all play a
role in the influence that society, psychology and biology play in the onset of exercise
addiction. Like most other disorders, no individual cause can be sited but instead the
combination of circumstances provides for the correct situation for exercise addiction to develop.
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The consequences derived from exercise addiction can be seen biologically,
psychologically and socially. Biologically, a person suffering form exercise addiction endures
much pain and stress related to their need for physical activity. Specific consequences include
muscle soreness/stiffness; withdrawal symptoms similar to those experienced by other types of
addiction; soft tissue damage; pressure-sores and blisters (Liberman & Palek, 1984); anemia;
gastro-intestinal blood loss (Liberman & Palek, 1984) and in sever cases, death (Noakes et al.,
1977). Controversy has loomed over the exact nature of the psychological consequences of
exercise addiction. Blumenthal et al., suggests that the excessive exercise is in fact a positive
way that the person chooses to deal with the psychological problems and conflict in their life. In
this way, Blumenthal views the replacement of negative feelings and behaviors with exercise as
a positive step. Veale (1987) points out, in his review of Blumenthal’s theory, that in taking such
a stance, the detrimental effects of exercise on physical and social health are not even
considered. Exercise addicts experience their own psychological stressors through their exercise
cravings and especially when withdrawal symptoms are present. Blumenthal is correct in that
excessive exercise may be capable of covering up some previous psychological conflicts, but
only in that way that EA creates its own psychological conflicts- stress, anxiety, nervousness- for
the addict to handle.
The social consequences of EA are visible in the relationships that matter most to the
addict. When life is centered around physical activity and the guilt that comes from missed work
outs, family and friends are not a priority. Social withdrawal is one of the major cornerstones in
most addictions and it is not an exception in exercise addiction (Cockerill & Riddington, 1996).
Due to this deterioration of relationships with family and friends, exercise addicts tend to
experience severe social consequences. As long as the addiction continues, these negative social
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consequences do not seem relative but as soon as the addict seeks treatment and recovers, the
lack of support and meaningful relationships is evident.
As mentioned earlier, the prevalence of exercise addiction in the common population is
unknown. The lack of a strict definition, diagnosis criteria and a limited knowledge base have all
lead to the difficulties in producing an accurate prevalence rate for exercise addiction. Problems
finding participants willing to commit to research studies, in which they might have to cease
physical activity, has been a major issue preventing prevalence data from being collected as
well. In 1999, Lauder et al., investigated the number of exercise addicts within the general
female anorexic population. He found that 1% of general female population is effected by
anorexia and of that effected group, 15-62% were physically active (Lauder et al., 1999).
Thaxton reported in 1982, that the prevalence rate of exercise addiction within the running
community is about 10%. Furthermore, in a book titled, Sport Psychology: Contemporary
Themes, by Lavallee, it is claimed that within the population of females who are clinically
diagnosed with anorexia, as much as 80% of them are habitual exercisers. Although it is thought
that exercise addiction may not be affecting a very large portion of the population, it is suspected
to be effecting more than most practitioners think or are aware of. Garfinkle, Garner and
Goldbloom put together a list of factors that their research had shown to be present and common
among eating disorder patients (1987). This list of factors that seem to play a role in the onset of
eating disorders also seem to play a role in construction of the perfect situation for the onset of
exercise addictions. According to Garfinkle, Garner and Goldbloom (1987) these factors include:
1.
2.
3.
4.
5.
Cultural support for diet and exercise: ‘more is better’
Pleasure derived from improvements in body functioning and appearance
Persistent ambivalence about independence
Use of activity to control appetite and relieve dysphoria
Locking in phenomenon
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6. Increase in egocentricity, depression, seclusions, and hostility secondary
to physical deprivation
7. Endorphin effects
(Garfinkle et al., 1987)
Along with the factors that may put certain individuals at risk for EA, there are also
particular groups that are at an elevated risk as well. First, gender seems to play a role in the
onset of exercise addiction. Many research studies have supported the idea that women
(especially young to middle-aged women) are at a higher risk of developing exercise addiction
symptoms than are men. A study conducted in 2003, by Zmijewski and Howard supported the
idea that women are at a higher risk for exercise addiction symptoms than are men. Using the
Exercise Dependence Questionnaire (EDQ) as the instrument of testing for EA, their results
showed that women scored significantly higher indicating higher incidence of exercise addiction
symptoms. College students (especially colligate athletes) are also at higher risk for exercise
addiction. Athletes in general who tend to be involved in sports where body size and weight are
stressed tend to be in an environment that greatly stresses physical activity and it’s
overwhelmingly positive effect on the body (Cumella, 2005). This type of environment can
prove to be potentially dangerous to the correct person. Another possible factor in risk groups for
exercise addiction is certain personality characteristics. The specific relationship between
exercise addiction and personality was examined by Hausenblas and Giacobbi in 2004. In their
research, Hausenblas and Giacobbi found a link positive relationship between neuroticism and
exercise addiction, as well as extraversion and exercise addiction. Although it can’t be proven
yet, there seem to be many factors that can aid in the onset of exercise addiction and make a
particular group more susceptible.
In conclusion, exercise addiction is a fairly new phenomenon that has an extremely
limited knowledge base. Without a clear definition or diagnosis criteria, it is very difficult to
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conduct empirical research and be sure of its accuracy. This is a growing research field with
much opportunity for original discovery.
Chapter 2: The History of Exercise Addiction
The history of exercise addiction dates back to the late 1960s to the early 1970s. The
idea of exercise addiction shows up first in 1969 when Little conducted research on ‘athlete’s
neurosis’, the first of many names given to the concept of exercise addiction. Little observed and
documented EA in action among a group of male runners who continued to train even in the face
of injury. In 1970, the idea of exercise addiction came up again when Baekeland looked at those
that exercise and how a break in their routine would impact sleep patterns. This marked the first
time that a researcher would have trouble finding participants who were willing to temporarily
stop physical activity for a research study. At that point it was evident that these people suffering
from exercise addiction had a serious problem and needed help.
In 1976, researchers witnessed the emersion of a new disordered relationship between
people and exercise. This type of relationship was deemed, ‘exercise addiction’ and it seemed to
exhibit a lot of the same signs and symptoms of drug or other addictions. Also In 1976, Glasser
was the first person to study and describe in detail, the negative addictive properties of exercise.
He listed the withdrawal symptoms as being due to “injury, illness, or circumstance,” (Glasser,
1976). The withdrawal symptoms were then isolated and studied by Thaxton in 1982. It was
then that he discovered that an exercise addict deprived of physical activity yields mood changes
tending towards depressive states.
In 1979, Morgan observed symptoms in exercise addicts that were directly related to the
addiction and not the withdrawal of the stimuli. These harmful byproducts of an addiction to
exercise were seen though fatigue, restlessness, lack of concentration, deterioration of social
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relationships and even the occurrence of making bad decisions not otherwise accounted for. Also
in 1979, the first inventory was developed and tested to be used with runners. The inventory was
called, The Commitment to Running Scale, and was created by Cormack and Martens (1979). It
makes sense to see the first inventory, created exclusively for excessive exercise, be centered
around running, as that was the sport of EA’s origin. It was about this same time that endorphins
were discovered by Choh Li, a professor at the University of California Berkeley. The debate on
the effect of endorphins and their role in exercise addiction would come many years later. The
idea of exercise addiction was applied to sports other than running in 1987 with the introduction
of the Commitment to Physical Activity Scale (Corbin et al., 1987).
The history of the American population and disordered exercise relationships can be
traced back into the late 1960’s. In 1968, Kenneth Cooper, MD, coined the phrase “aerobics”
and the fitness world began. In the early 1970s a new type of sport was created for those who
were looking for an extreme challenge of both land and sea, it was called the triathlon.
Specifically, in 1972, a famous athlete named Frank Shorter influenced the physical activity of
the whole country. Due to Shorter’s success in the Olympic sport of long distance running, many
Americans wanted to emulate his and took up running. This period of time is referred to as the
“running revolution”. The real fitness revolution began in the 1980s. Around this same time, the
idea of an ‘exercise fix’ was coined and became prevalent in popular language.
In 1987, that the Gallup Leisure Activities Index reported that 12% of the adult America
population was logging time pounding the pavement just like Shorter. Of the 12% of joggers,
26% claimed to run everyday. The Gallup Index also reported that on a whole, almost half of the
American population (49%) participated in some sort of a fitness plan. To accommodate these
new long distance runners and to bring together ‘ultra runners’, Tim Key founded a group in
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May of 1980 called, “The Flatlanders”. Key and five of his friends began this group for people
who ran over 50 and 100 miles, landing it as the first documented group in the U.S. with the sole
concentration of ‘ultra-running’. To achieve membership to this elite group, 100 miles would
have to be run in under 24 hours and if that was completed then the members of the club would
vote on the candidate. With a 2/3 vote the candidate would be admitted into the club (Team Slug
Ultramarathoners, 1990).
Such extreme groups like the Flatlanders, requiring excessive exercise to
acquire membership, are perfect illustrations of the development of exercise addiction in history.
Chapter 3: Current Information
Professional Groups and Health and Human Services
The professional world has just recently been made aware of exercise addiction. Due to
the lack of knowledge and research on EA, there is a major absence of any type of active
professional organization or association that deals exclusively with exercise addiction. However,
EA is discussed by not only the community focusing on eating disorders, but also the healthy
exercise community as well. Looking at the eating disorder organizations, the National Eating
Disorders Association (NEDA) addresses sports and their effect on people and exercise. With
such a strong relationship between anorexia and exercise addiction, NEDA is a good source of
information. Another source with information about compulsive exercise is Anorexia Nervosa
and Related Eating Disorders (ANRED). This group has a full page of information about EA and
its symptoms, causes, ideas for diagnosis and other information. This group is also quick to
admit that the knowledge is limited in this area. In the exercise community, it is difficult to find
an organization that is willing to bring up exercise addiction. It seems like the reasoning behind
this may be justified. In a society with such a large obesity problem, giving information about the
addictive properties of exercise in certain populations may act as a deterrent for those people
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who really should be exercising to improve their health and wellbeing. The National Women’s
Health Information Center (NWHIC) under the US Department of Health and Human Services
has put together a special group to help young girls and inform them on health care issues. This
special interest group has constructed a webpage just for young girls who are looking for
answers. The webpage features colorful starry pages with useful and appealing information.
Among the different disorders talked about is a whole page on compulsive exercise. The
NWHIC has stepped up to the plate and helped provide information to the impressionable young
girls who are at increased risk of developing exercise addiction.
Just as with the lack of associations specifically for exercise addiction, without any
associations there is no source of conferences on exercise addiction. Through the link from
exercise addiction to anorexia and eating disorders, there was information presented at the 14th
International Conference on Eating Disorders held in Alpbach, Austria, October 19-21. This
annual conference is held by the Austrian Eating Disorder Association and it helps to recognize
the research being done in the field as well as highlight current findings. At this conference, there
were a few studies on anorexia athletica that were presented. Tappauf, Trabi and Scheer, with
the University clinic for child and youth medicine Graz, Austria, presented their study titled,
Anorexia athletica, a new illness? Karl Sudi, of Karl Franzens University, Institute for sport
sciences in Austria, also presented his research on Anorexia athletica. Although it seems like the
audience for information on EA is small and very limited, the growth of the theories, research
and ideas on this new and up and coming disorder are being graciously accepted into general
knowledge.
Exercise addiction has not been confined to the academic world, but has become common
knowledge for everyday people. One way in which the information about such disorders gets
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from the academic world to the outside community is through the avenue of magazines and
newspapers. One recent article published in Shape Magazine in February of 2005, was titled,
‘What’s behind runner’s high? Is it endorphins, adrenaline or simply a sense of
accomplishment? Here we explain the chemical link between exercise and good mood,’ (Blair,
2005). The purpose of
this article centered around conveying a few different ideas as to the
mechanism behind the phenomenon known as a ‘runner’s high’. Starting with endorphins, the
author Gwenda Blair discusses in layman’s terms how mysterious endorphins still are to
scientists. In three decades of research there is still controversy over the role that endorphins play
in mood and exactly how they interact with the receptors in the brain. Blair goes into detail,
talking about the blood-brain barrier and the supposed inability of endorphins to pass through it
and move on to receptors in the brain. After raising suspicion about the role of endorphins, other
chemicals such as adrenaline and dopamine are suggested as the culprits behind the enhancement
of mood after exercise. The link between exercise and addiction is made later on in the article,
introducing the possibility of tolerance and dependence on exercise in certain people.
Another way that the general population receives information from the academic
community is through reviews or commentaries of articles on research being done or completed.
A recent study done by the National Eating Disorders Association (NEDA) was reviewed in
Market Wire online new source (National Eating Disorders Association, 2006). NEDA conducted a poll
across numerous college campuses all over the country. Unlike most studies on eating disorders
and exercise addiction, this poll covered females and males, all ethnicities and socioeconomic
groups. The sample was representative of the general population of college students. The poll
found that an alarming amount of college students (20%) admitted to having an eating disorder
(National Eating Disorders Association, 2006).
Not only that, but this poll was able to collect further
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data in that it reported the number of students who knew someone who compulsively exercised
(defined as work outs of more than two hours on more days than not) was 44.4% of the
population. Of this same population, only 7.9% reported being familiar and aware of compulsive
exercise before this poll. The effect of the NEDA poll is widespread. The percent of college
students who have or have had an eating disorder in their lifetime is a wake up call to the
academic community. Efforts need to be focused on this particular demographic group where the
development of unhealthy habits and addictions are forming.
Prevention is one way in which health professionals seek to reach out to demographic
groups, or the whole population, in an effort to educate people about a possible problem before it
evolves. In some cases, such as prevention for AIDS or the flu, specific guidelines can be set out
and programs can be constructed to address the known and proven factors that cause these
illnesses. In the case of exercise addiction, there is no one set cause or factor that can be
addressed in a program. Prevention in exercise addiction is highly linked with the prevention of
eating disorders. Ideas of self-worth and self-esteem develop at very young ages and with that
come the need for a good body image. Body image is just one among the many factors that
influences the development of eating disorders and exercise addiction. A good prevention
program for exercise addiction would have to address healthy lifestyles, good body image
development and physical fitness as a part of health, not as a part of a diet to lose weight. One
such program, the ‘Girls on the Run International Program’ (Girls on the Run International, 1996), is
designed for young girls from age 8 through 13. Created by Molly Barker, known for her four
time Hawaii Ironman Triathlete status, this program integrates a running program with
encouragement and social support in an effort to provide young girls with the coping tools and
skills to become healthy, positive women. The program’s mission statement reads, “To educate
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and prepare girls for a lifetime of self-respect and healthy living.” The program centers around
structured “self-esteem enhancing, uplifting workouts”. The overall goals of this program
include the healthy development of the physical, mental, spiritual, social and emotional self. The
‘Girls on the Run International’ program is modeled around the cornerstone that through positive
experiences with peers and development of self, the participants will be more resilient and
resistant to the troubles faced by young girls today; alcohol and tobacco use, pregnancy, eating
disorders, obesity. This prevention program has a wide range of problems that it is focused on
effecting. Through healthy use of physical fitness, the participant learns how to integrate exercise
into a healthy lifestyle while still maintaining their social life. This type of training works with
young girls at the impressionable stage in their lives and teaches a healthy lifestyle is a positive,
balanced and focused self. This relatively innovative prevention plan has proven to be a rather
refreshing option for many young girls. Focused on the positives of life, these young girls are
given the encouragement to reach for their goals while learning how to recognize the obstacles
that they are sure to face. There are not many prevention programs available for females today,
which are not using scared straight models, or negative messages to get the point across. This
program not only inspires young girls to be healthy, it also teaches them the definition of healthy
without using fear tactics to do so. Although there is no empirical data yet to show the success
rate of the ‘Girls on the Run International’ program, it seems to be one of the most positive and
constructive options in preventing exercise addiction.
Exercise Addiction Research
Current research in the field of exercise addiction is just at the beginning stages of
piecing together this disorder. Trying to understand any new disorder includes finding the
initiating factors or circumstances and from there prevention plans can be developed. The
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research community has been conducting studies on these initiation factors, trying to come up
with the most important factors that lead to exercise addiction.
In trying to find the cause of exercise dependence, it has been mentioned that maybe
endorphins are to blame, or maybe the link between anorexia nervosa is the answer, or even
better, maybe personality plays a role? There are currently many different ideas as to the
initiating factors of exercise addiction.
Pierce and Eastman set out to challenge the endorphin theory in 1993. The participants
for this study were 8 female aerobic dance class participants who were participating in at least 3
aerobics dance classes a week and were skilled in the style of exercise. The participants signed
informed consent forms before beginning. The participants filled out an exercise dependence
inventory and provided a baseline resting blood sample. The participants joined in a 45 minute
session of aerobic dance. At the end of the session, the participants provided a second blood
sample. The authors compared the level of plasma B-endorphins from the two samples. A paired
subject t test analyzed the results. The authors found that the plasma B-endorphin levels for the
post-workout samples as compared to the pre-workout samples were significantly higher.
Although it seems as if the increased levels of endorphins during exercise confirms the
endorphin theory, the authors go on to describe how there is no correlation between the scores
from the exercise dependence scale filled out before the session and the plasma B-endorphin
levels. The inability of endorphins to reach the neurotransmitters in the brain due to the bloodbrain barrier stands in opposition to the endorphin theory.
Pierce and Eastman’s (1993) article is weak in the sample size that is used. Starting a
study with fewer than ten participants leaves no room for generalization. It was never mentioned,
what demographic, ethnicity, age, weight, general health that these participants are in. Without
Exercise Addiction
21
any information on the participants other than their gender, it is hard to give the authors any
credit for their results. The authors found that although endorphin levels increase significantly
during exercise, that fact is independent of predicting an exercise addiction. With the little
amount of research about endorphins and their role in the brain, it’s also difficult to see how the
authors were able to make the connections in the finding above. Although endorphins seem to
play some sort of role in exercise addiction, it is still very much unclear exactly what they do.
The idea of personality being related to the symptoms of exercise dependence is called
into question in an article by Hausenblas and Giacobbi conducted in 2004. The study focused on
the proposed link between a few specific dimensions of personality (neuroticism, extraversion,
agreeableness, openness, conscientiousness) and exercise dependence symptoms. Starting with
the hypothesis that a positive correlation would be observed between exercise dependence
symptoms and neuroticism, the authors hoped to make connections that would generalize to the
whole population of exercise dependent individuals.
To achieve their goal, Hausenblas and Giacobbi used a sample of 390 college university
students as their participants. These participants were designated as non-athletes who happened
to be seniors, graduate students, juniors and freshmen. It was also stated that this sample was
primarily white, but included those of African-American, Hispanic, Asian and American-Indian
decent. The research study was designed to be based on self-reported surveys in which the
participants were asked to fill out four different inventories. The list of inventories started with
the NEO Five Factor Inventory (Costa & McCrae, 1992) that was used to measure the levels of
the ‘big 5’ personality dimensions (neuroticism, extraversion, openness, agreeableness and
conscientiousness). The Exercise Dependence Scale (Hausenblas & Symons Downs, 2002b) was
next, in which the signs and symptoms of exercise dependence were assessed. The Leisure Time
Exercise Addiction
22
Exercise Questionnaire (Godin & Shephard, 1985) was then administered to determine the
intensity of the leisurely activity that the participants were involved in. The last inventory used
was the Drive for Thinness Scale (Garner, 1991) that was actually a subscale of the Eating
Disorder Inventory-2 (Garner, 1991). This inventory was primarily used to give some idea as to
how important and preoccupied the participants were with their body weight.
To conduct the study, the researchers made sure that all IRB concerns and rules were
followed. Researchers gave the participants 20 minutes to then get through all of the inventories.
Once the inventories were completed, the researchers conducted statistical analyses on the data
in the form of a bivariate correlational analysis.
The results of this study showed that neuroticism and extraversion were positively
correlated with the occurrence of exercise dependence symptoms. In addition, analysis of the
data on agreeableness and symptoms of exercise dependence produced a negative correlation.
After final analysis, the last two remaining dimensions of personality, openness and
conscientiousness failed to produce any significant correlation with the symptoms of exercise
dependence.
In conclusion, Hausenblum and Giaccobbi were able to satisfy their hypothesis that
neuroticism does indeed have a positive correlation with exercise dependence symptoms. It
seemed that these neurotic individuals saw exercise as more of a coping tool and an outlet for
their stress and thus were likely to display those exercise dependence symptoms. Next, the
researchers claim that the personality dimension extraversion could actually predict the extent of
exercise dependence symptoms. People who score high on the extraversion scale seemed to be
very out going and energetic which obviously would be required for those who also show many
exercise dependence symptoms. Agreeableness also seemed to be related to exercise
Exercise Addiction
23
dependence symptoms in the very same way, acting as a predictor. The researcher’s theory
behind this relationship seems to be that the low scorer on the agreeableness dimension of
personality would either use exercise as an outlet for their competitive nature or they were not
giving accurate information on the exercise dependence scale. Either way, it was mentioned that
more research should be done in follow up here to determine what exactly was giving these
results.
Overall, the study seemed to have some strong points. The sample size, 390 university
students, was large enough to get an accurate picture of the student body and their exercise
characteristics and personality dimensions. It also seemed as though the inventories used to
measure the personality dimensions were a good choice. It was mentioned that the internal
consistency, reliability and validity of these measures was considered and approved before the
use of such items in the study. The choice of analysis mechanism was correct as well. Due to the
fact that this study could not prove any causality, the researchers had to be careful not to say that
any personality dimension caused the exercise dependence symptoms.
There were also some weak points of this study as well. In this afore mentioned lack of
causality, the researchers were careful about how they related to the relationships between
personality and exercise dependence symptoms. Even though they were careful here, the
statement that a personality dimension might act as a predictor for exercise dependence
symptoms is a rather bold statement. It seems that a more correct statement could have been
made just stressing the strength of the relationship between the personality dimension and the
symptoms instead of giving the predictor status. It just seems that not enough empirical research
has been done in this area to claim such a hefty correlation.
Exercise Addiction
24
Another weakness of this study is the fact that the results can not be very well generalized
due to the specialized sample. Due to the fact that this study was performed on a group of
university students, the majority of which was Caucasian, doesn’t give much room for the
authors to apply the findings to other populations except those exactly like the one tested. Further
research into the relationship between personality dimensions and exercise dependence
symptoms would need to be done in a more representative sample of the country’s population
before we could say that these findings and correlations were universal. There were still other
problems with the participant pool used in this study. Looking at the author’s discussion of the
participants, the percentages of the participants by year in school fails to add up to 100 percent.
There is no mention if the study included any sophomores and by failing to account for the last
16.9 percent of the group of participants, it leaves one to wonder if those missing are the
sophomore participants?
Yet another important weakness in this study would be the design called for selfreporting. It is known that self-reporting measures tend less accurate side and may provide
unwarranted results. The fact that the areas being reported on are delicate in themselves makes
the use of self-reporting even more influential here. The researchers needed to find some other
way to measure the participant’s personality dimensions, exercise behaviors/ routines and mind
set towards exercise, so that the information being reported can be trusted as accurate, unbiased
and objective.
This study seems to represent a step in the right direction in that its goal is to learn more
about the precipitating factors of exercise dependence. By examining the possible role that
personality could play in the onset of this condition, the research community is striving for
further understanding which will ultimately lead to more effective treatment of exercise
Exercise Addiction
25
dependence. Hopefully, studies like this one will encourage other researchers to take these
findings, scrutinize them and then try to see how they can relate to the population as a whole.
Further research needs to be done in a more representative population to see if these findings can
hold up there as well. If these relationships show to be present in a more representative
population, then the correlation between personality and exercise dependence can be easily
generalized. If these correlations are not found in the population as a whole then all is not a loss.
At that point, it would be obvious that the correlations observed show how personality may be
affecting just a subset of the population that is in a critical stage in development. Either way, this
information could be valuable to the research community.
The research community is not the only group that would stand to benefit from more
information about this condition. Through this continued understanding of exercise dependence
comes more knowledge about the treatments and signs and symptoms. This knowledge translates
back to the general public who are the ones who actually experience this condition. The research
being done and the new findings coming forth will only enhance the psychological and medical
community’s ability to help those who are experiencing exercise dependence. Thus, the overall
importance and reach of this research is extensive enough to touch not only the research
community but also the regular average person who may themselves one day suffer from this
condition.
Looking briefly at another article on research of initiating factors, Pierce and Eastman in
1993, investigated the claimed involvement of endorphins in exercise addiction.
Treatment of exercise addiction is the next step for the research community.
Unfortunately, because of the lack of knowledge about exercise addiction, the treatments are
Exercise Addiction
26
very limited. There is no known specific treatment program just for exercise addicts. Most
exercise addicts receive treatment through eating disorder programs. The adaptation of eating
disorder programs into exercise addiction specific programs will take more work and research
into the best type of program. In construction of such a program in the future, the initiating
factors, which are still to be found as well, need to be addressed in pursuit of recovery.
In 2003, Adams, Miller and Kraus discussed the issues needing to be addressed in a good
treatment program for EA. The article, Exercise dependence: Diagnostic and therapeutic issues
for patients in psychotherapy, was designed to give researchers and practitioners some guidelines
for creating successful treatment programs for exercise addiction. The authors describe in detail
some important factors that therapists keep in mind in treatment of EA. Some of these points
include:

Accept the role and responsibility of primary support for the person and
participate in the management process

Recognize that the addiction is likely to cause a breakdown in
communication with others

Recognize that the likely response is intense fear of losing control,
helplessness, and that this may show itself through disorganized behavior
through compulsions

Psychotherapeutic intervention utilized individualized approaches
depending on the psychopathology noted in the patient.
(Adams et al., 2003)
Adams, Miller and Kraus also list some ways in which exercise addiction can be treated.
Starting with education for the patient, breaking the reinforcement nature of exercise and
Exercise Addiction
27
teaching the patient other coping skills for times they feel the need to excessively exercise, and
finding a way to get through to the patient about the health risks they are exposing themselves to
while helping them find their voice again. Through this coming back into themselves, Adams
and colleagues believed that the patient would feel powerful in their own skin again and begin to
make decisions based on their own wants/needs, not the addiction to exercise.
Adams, Miller and Kraus shed light on the idea of treatment tailored to exercise addicts.
Their article shows strength in its innovative ideas on the future treatment models. The research
community has to begin thinking of ways in which to help people with this new disorder.
Although the treatment ideas concerning the patient finding themselves again seem idealistic, the
ability to get through to an irrationally thinking patient is made to seem too easy in this article.
Specific treatment steps and models are needed to clarify the process of treatment for people
suffering from exercise addiction. Future research, like that of Smith, Wolfe and Laframboise, is
headed into the direction of treatment.
Smith, Wolfe and Laframboise took a chance and carried out an experiment in 2001, in
the emerging field of treatment for obligatory exercise. This study focused on the evaluation of
cognitive-behavioral therapy (CBT) as a treatment option for obligatory exercisers. The
experiment included a total of 94 female participants who randomly answered a flyer for
research participants. Those who responded to the inquiry were screened to make sure that they
weren’t already receiving psychotherapy, didn’t have an active eating disorder, were of normal
weight, weren’t on medication, and could handle the time commitment and follow up required
for the experiment. The authors controlled for many possible confounding variables. The 94
participants were given the Obligatory Exercise Questionnaire (Pasman & Thompson, 1988) as
part of the pretreatment process. Based on the scores from the OEQ, the authors divided
Exercise Addiction
28
participants into two groups; the obligatory exercisers group included participants scoring higher
than 50, and the nonobligatory exercisers group included participants scoring lower than 50 on
the OEQ. Of the 94 participants, 34 female participants were categorized as obligatory exercisers
and 60 female participants were placed in the nonobligatory exercisers group. The obligatory
exercisers group was randomly assigned to two subgroups; a treatment group receiving CBT and
a control group told that they were on the ‘waiting list’. The nonobligatory exercisers group was
randomly assigned as well, to the treatment and ‘wait list’ (WL) groups. The structure of the
experiment ensured that there would always be a very similar control group to compare the data
with at the end of the experiment.
An extensive pretreatment routine was conducted with each participant. The first step in
the pretreatment was the mailing of the Multidimensional Body- Self Relations Questionnaire
(Brown, Cash & Mikulka, 1990; Cash, 1994b) and the OEQ to each of the participants. Then as
mentioned, the participants who returned these inventories were randomly assigned to the
obligatory and nonobligatory exerciser groups. The next step in pretreatment involved the
Exercise Involvement Questionnaire (Elliot & Smith, 2001) that was used to record the current
amount of activity that the participant engaged in on a day to day basis. The Adjustable Light
Beam Apparatus (ALBA) was used next, as a way to measure the participant’s body- image
feelings through what their body actually looked like, what they perceived it looked like and
what they wished it could look like. Using beams of light the participants were asked to move the
light displayed on a wall to accurately show the width of their hips or thighs. The last inventory
given was the Maudsley Obessional-Compulsive Inventory [MOCI] (Hodgson & Rachman,
1977) assessing behaviors indicative of obsessive-compulsive disorder and personality.
Exercise Addiction
29
Four different hypotheses were constructed and applied to this experiment, starting with
the hypothesis that participants that were placed in the obligatory exercisers group would come
into the experiment with much lower body-images when compared to those participants deemed
nonobligatory exercisers. Smith, Wolfe and Laframboise (2001) also hypothesized that when the
MOCI was given to the participants as a part of the pretreatment process, the obligatory
exercisers would have higher scores than those of the nonobligatory exercisers group. The next
hypothesis looked at the treatment in particular, in that the treatment would be the most effective
in the nonobligatory group as compared to the obligatory group. The final hypothesis stated that
in the whole experiment, obligatory or nonobligatory exercisers, the groups treated with the CBT
would conclude the experiment with higher body images than that of the comparable control
group.
After the hypotheses were constructed and the pretreatment was completed, it was time to
begin the actual treatment. The treatment groups (three groups of obligatory exercisers, three
groups of nonobligatory exercisers) consisted of six to ten people who met for an hour and half,
once a week for eight weeks. It took the researchers two years to complete the eight week
treatment for all 12 groups. The treatment they received was CBT administered by trained
counselors and assistants. The authors were careful to design the study so that it was a double
blind experiment in that the counselors didn’t know which participants were in the obligatory or
nonobligatory groups just as the participants were unaware as well. Using a double blind design
ensures that experimenter bias is controlled. It was also made apparent that there was no moral
issue in that the wait list group was denied treatment. The wait list group was allowed treatment
after the completion of the experiment and the follow up. The follow up took place two months
after the end of the treatment groups. To help keep the experiment as controlled as possible, the
Exercise Addiction
30
same procedures and materials were used for the follow up as were for the experiment. Looking
at the ALBA, the follow up rates were very similar in that a majority of the participants in the
study on them after the completion of the treatment group then also were available to complete
the follow up.
With so many different inventories and assessments given to the participants, the
statistical procedures needed to analyze the data were plentiful. In all, there were many different
findings that characterized the data. First, after completing a 2x2 ANOVA on the MBSRQ data,
there was an observed difference between the two treatment groups. The CBT groups were more
worried and anxious about their weight than the wait list groups. Many differences were also
found between the obligatory and nonobligatory exercise groups. The obligatory exercise group
showed higher scores on the OEQ which would be expected as they were categorized into this
group due to those high scores. These obligatory exercisers also self-reported having more of
their day consumed by exercise and physical activities. In this increased time spent on exercise,
the obligatory exercisers also reported being involved in a greater number of activities as well.
Some general characteristics that the obligatory exercisers seemed to have in common was a
lower BMI, higher scores on the MOCI and when the caliper was used in measuring of the hips
of the participants it was also noted that this group had lower body measurements.
Looking strictly at the pretreatment testing, there were also some obvious differences
between the two groups, the obligatory and nonobligatory, even at that point. The obligatory
group was more anxious about the idea of fat as conveyed through the MBSRO. This group also
showed greater dissatisfaction when the ALBA test focused on the hip and thigh area. These
participants were more upset and unhappy with their body, showing a lowered body –image, than
their nonobligatory counterparts.
Exercise Addiction
31
Some of the group differences were only visible at the follow up procedure. In the
MBSRQ, the CBT treatment group showed significant increases in the dimensions of appearance
evaluation and body areas satisfaction. In other words, the group treated with CBT saw a
significant increase in their body image, supporting one of the original hypotheses. After the
treatment was completed, data showed that appearance orientation and self-classified weight
were two other dimensions that produced a noted difference between the two groups.
Some of the four original hypotheses were supported by the data. Starting with the first,
the data seemed to very weakly back up the idea that the participants coming into the experiment
as obligatory exercisers would start out with a much lower body image than that of the
nonobligatory exercisers. Looking at the ALBA test, the data showed that the obligatory
exercise group showed lower ratings of satisfaction with the two regions of their body. The next
hypothesis saying that the obligatory exercisers would score higher on the MOCI was also
supported. In pretreatment the obligatory exercisers did score higher on the MOCI but it was
noted by the authors that the scores from this inventory were not high enough to indicate
obsessive-compulsive disorder (OCD). Recognizing that lack of diagnosable disorder is
important because if the participants had scored high enough to put them in OCD territory then
that alone could have been a confounding variable. The next hypothesis was that the
nonobligatory exercisers would finish the treatment with better results overall than the obligatory
exercisers. This hypothesis seems logical in that the group that begins the experiment with less of
a problem, after treatment, should present even less of a problem. The data here were
inconclusive. In all, the CBT treatment experiment did show that this type of treatment is an
effective one for treating people suffering from obligatory exercise. There aren’t many treatment
programs available to obligatory exercisers but it looks like CBT is a step in the right direction.
Exercise Addiction
32
There were many strengths of the Smith, Wolfe and Laframboise article. To begin with,
this study is one of the first of its kind in that it used a more representative sample to look at
obligatory exercise. Most other research that has been conducted in this field consists of samples
of college aged participants, usually one predominant ethnicity. This study, however, consisted
of 41% minorities and more of a representative participant pool. The only problem was that only
females were used as participants. Obligatory exercise is thought to occur more frequently in the
female population but males needed to be represented as well to make the sample truly
representative of the population. The next strength of this experiment would be the care that the
authors took in setting up the experiment so that many possible confounding variables were
controlled for through a pretreatment phase and screening of the participants before entering the
participant pool. The fact that there was a double blind set up in the treatment groups, where the
counselors giving the treatment and the participants were unaware of their group status, gave
great strength to the experiment in itself. Here again, the experimenter bias was controlled for.
These were small but crucial steps taken by the authors to really ensure that the conclusions they
would make about the data were as accurate as could be. The extra care in this experiment was
very obvious and this fact gives good strength to the findings.
There were some weaknesses in the experiment as well. Overall, this experiment was
rather complicated and intense. The participants had many rigorous inventories, tests and follow
ups to complete and this seemed to be a little much at times. The need for this complexity can be
justified in the fact that body-image seems to very important in obligatory exercise prevention. In
trying to test, or even define, body-image there is a lot of controversy. The idea of body-image
seems to be more of a concept than an actual tangible item. The measures and subtopics that
make up a person’s overall idea of body-image are more of the tangible items than the concept of
Exercise Addiction
33
body-image itself. This lack of clear definition adds a layer of confusion and complexity to the
idea of testing body-image in participants. Another weakness was the small sample size.
Conducting this experiment with more than 94 participants would have been ideal. The last
weakness was the low rate of follow up after the end of the experiment. The authors of the article
talk in their introduction about the problems that a missing follow up can cause for an
experiment and the strength of the data associated with such an experiment. It seems that a low
follow up and a nonexistent follow up in an experiment are somewhat similar. The data collected
when there is a low percentage of follow up participants has to be looked at with such
information in mind.
Overall, the Smith, Wolfe and Laframboise experiment was innovative in its approach to
testing CBT as a treatment for obligatory exercise. The data found and the results that came from
this experiment will be able to greatly help those interacting with obligatory exercisers. Until
now there haven’t been many options on how to treat obligatory exercise. With the new data and
connections made within a more representative sample than just college aged people, the
psychology community as a whole is benefiting. With new treatment options and empirical data
to back it up comes the furthering of our understanding of a newly identified disorder. From
there, more effective treatment and understanding can come for those who deal with obligatory
exercise on a daily basis.
Exercise Addiction
34
Bibliography
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This article is from a peer reviewed journal with high reliability and was published in 2003.
Adams, Jeremy, & Kirkby, Robert (2002). Excessive exercise as an addiction: A Review. Addiction
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This article is located in a peer reviewed article specifically for addictions and was published in 2002. This source is
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although some of the information is outdated, there is still a large amount of useful information.
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Exercise Addiction
35
Feb. 2005.
Shape magazine’s article seemed to be less reliable than all of my other sources. With no real references listed it
leave the reader to guess where the information being presented comes from.
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One of the oldest sources used, this article was one of the first in exercise addiction history. Historical information
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Counseling Psychology Quarterly. 9, 119-129.
This is a peer reviewed journal article published in 1996 with average reliability.
Exercise Addiction
36
Corbin,C.B., Nielson, A.B., Borsdorff, L.L., & Laurie, D.R. (1987). Commitment to physical activity. International
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This source is a peer reviewed article that was published a long time ago, in 1987, and it’s reliability would be
average reliability due to it’s age.
Costa Jr., P.T., & McCrae, R.R., 1992. The NEO PI-R: professional manual. Psychological Assessment
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The NEO PI-R manual is a very reliable source even though it is relatively old.
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This article is from a health magazine and because of this it’s reliability isn’t great. It’s not clear if this article was
peer reviewed and the references cited are not thorough themselves.
Davis, C. (1997). Eating disorders and hyperactivity: a psychobiological perspective. Canadian Journal of
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This source is from a peer reviewed journal in Canada. Being that it is from another country, the reliability might not
be quite as strong as some of the other sources. The generalizing aspects of exercise addiction have not been proved
so the findings in another country might not be accurate for anywhere other than that country.
De Coveley Veale, D.M.W. (1987). Exercise Dependence. British Journal of Addiction. 82, 735-740.
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Exercise Addiction
37
Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington, DC, American
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The reliability of the DSM is very strong and the updated versions insure that new ideas and concepts are added.
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This peer reviewed journal article was published just last year and has strong reliability.
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Due to the focus of this article, the 1990’s, it’s hard to give this peer reviewed journal article from Canada anything
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This is a reliable manual even though it was published in 1991.
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Exercise Addiction
38
This website gives information on a non-profit organization/ prevention program but has very little technical
information on when the website was last updated and other source information. The reliability of the information
used was good but the overall website is of average reliability.
Glasser, W. (1976). Positive Addictions. Harpers and Row, New York.
This is a book source that was written over 30 years ago. The reliability is of average rating.
Godin, G. & Shephard, R.J., 1985. A simple method to assess exercise behavior in the community.
Canadian Journal of Applied Sport Science. 10, pp. 141-146.
This peer reviewed journal article is from Canada and was published in 1985. Due to its age and location outside of
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Griffiths, M. (1997).Exercise addiction: A case study. Addiction Research. 5 (2), 161-168.
This source is a case study from the peer reviewed journal specifically looking at addiction research. It was
published almost 10 years ago but is still reliable.
Hausenblas, Heather A., & Giacobbi, Jr., Peter R., 2004. Relationship between exercise dependence
symptoms and personality. Personality and Individual Differences. 36, 1265-1273.
This article, published recently in 2004, is the next building block in exercise addiction. It reviews the newest
theories and has great reliability.
Hausenblas, H.A. & Symons Downs, D., 2002. Exercise dependence: a systematic review. Psychology of
Sport and Exercise, 3, pp. 89-123.
Again, this article is one of the more reliable sources used for this paper. It is recent and discusses the newest ideas
in the exercise addiction community.
Kety, S.S. (1966). Catecholamines in neuropsychiatric states. Pharmacological Review, 18, 787-798.
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This article is the oldest source used for this paper. It was published over 45 years ago but serves well as historical
documentation as to where exercise addiction started. The reliability for historical purposes is good but not for
current research.
Klein, Diane, Bennett, Andrew, Schebendach, Janet, Foltin, Richard, Devlin, Michael, & Walsh, Timothy
(2004). Exercise 'addiction' in anorexia nervosa: Model development and pilot data. 9, 531-537.
This article is just pilot data and has an average reliability rating.
Lauder, T.D., Williams, M.V., Campbell, C.S., Davis, G.D., & Sherman, R.A. (1999). Abnormal eating behaviors
in military women. Medicine & Science in Sports & Exercise, 3:9, 1265-1271.
Published in 1999, this article is a peer reviewed journal submission and has good reliability.
Lavallee, Basingstroke, Macmillin, Palgrave. (2004). Sport Psychology: Contemporary Themes.
This source is a novel recently published and seen in bookstores. It’s reliability is just of average rating due to the
commercially pleasing way that it was written which leads to some lack of detail.
Le Grange, D. and Eisler, I. (1993). The link between anorexia nervosa and excessive exercise: a review.
European Eating Disorders Review, 1, 100-109.
This source is from a peer reviewed journal from Europe. It has average reliability.
Leuenberger, Andrea (2006).Endorphins, exercise, and addictions: A Review of exercise dependence.
Impulse: The Premier Journal for Undergraduate Publications in the Neurosciences. 1-9.
This article is over very strong reliability as it was published this year and discusses current themes in exercise
addiction.
Liberman, R.B. & Palek, J. (1984). Hematologic abnormalities simulating anorexia nervosa in an obligatory athlete.
The American Journal of Medicine, 76, 950-952.
Exercise Addiction
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This source is a research article published in a medical peer reviewed journal. It was published over 20 years ago but
still has good reliability.
Little, J.C. (1969) The athlete's neurosis-a deprivation crisis. ACTA Psychiatrica Scandinaviaca 45, 187-197.
This source is from a different country and is one of the oldest sources cited. The innovative discoveries of it’s
author at the time were history making in exercise addiction research.
Loumidis, K.S., Wells, A. (1998). Assessment of beliefs in exercise dependence: the development and preliminary
validation of the exercise beliefs questionnaire. Personality of Individual Differences, 25: 553-567.
This source was published within the past 20 years and is located in a peer reviewed journal.
Morgan, W.P. & O’Connor, P.J. (1988). Exercise and mental health. In R.K.Dishman (Ed.), Exercise Adherence:
Its Impact on Public Health. Champaign, IL. Human Kinetics, 91-121.
This source was published well over 15 years ago and is located in a public health book. It has average reliability.
National Eating Disorders Association, (2006, Sep 26). National Eating Disorders Association announces results of
eating disorders poll on college campuses across the nation. Retrieved October 20, 2006, from Market
Wire, Inc. Web site:
http://www.marketwire.com/mw/release_html_b1?release_id=166558&tsource=3&hitscounted=N
This source is very recent and comes from a reliable source, the National Eating Diorders Assiciation.
Noakes, T., Opie, C., Beck, W., McKechni, J., Benchimol, A., & Desser, K. (1977). Coranary heart disease in
marathon runners. Annals of the New York Academy of Science, 301, 593-619.
This source is relatively old but useful in the historical data it provides on the disorder of exercise addiction.
Ogden, J., Veale, D., and Summers, Z. (1997). The development and validation of the Exercise Dependence
Exercise Addiction
41
Questionnaire. Addiction Research, 5, 343-356.
This source was published in 1997 and is located in a peer reviewed journal specifically for addiction research,
giving it a good reliability rating.
Pasman, L. & Thompson, J.K. (1988). Body image and eating disturbances in obligatory
runners, obligatory weightlifters, and sedentary individuals. International Journal
of Eating Disorders, 7, 759-769.
This source is from an international journal and was published back in 1988. It’s reliability is not very strong.
Pierce, E.,, Eastman, N., Tripathi, H., Olson, K., Dewey, W. (1993). B- Endorphin
response to endurance exercise: Relationship to exercise dependence. Perceptual and Motor Skills.
77, 767-770.
This source was published in 1993 in a peer reviewed journal. It has average reliability.
Rippe, J.M., Crossley, S., & Ringer, R. (1998). Obesity as a chronic disease: Modern medical and lifestyle
Management. Journal of the American Dietetic Association, 98(10), S9-S15.
This source was published in 1998 and has average reliability.
Smith, J.E., Wolfe, B.L., & Laframboise, D.E. (2001). Body image treatment for a
community sample of obligatory and nonobligatory exercisers. International Journal of Eating Disorders.
30, 375-388.
This source is a recently article from the international journal of eating disorders and has good reliability.
Team Slug Ultramarathoners, (1990). Team Slug International. Retrieved October 29, 2006, from The Flatlanders of
San Francisco Web site: http://www.angelfire.com/ultra2/teamslug/flatlanders.html
This source was the only one I could find online or in print about the Flatlanders club. It comes from a personal
website and the reliability can not even be rated. Due to scarce nature of the information this source was used even
Exercise Addiction
42
though it may not be extremely reliable. The nature of the information used is solely historical and thus doesn’t play
a role in the overall effect of the paper.
Terry, Annabel, Szabo, Attila, & Griffiths, Mark (2004). The exercise addiction
inventory: A new brief screening tool. Addiction Research and Theory, 12, 489- 499.
This source is very recent and is reliable.
Thaxton, L. (1982). Physiological and psychological effects of short-term exercise addiction on habitual runners.
Journal of Sport Psychology, 4, 73-80.
This source is rather old but contains some useful information. It is of average reliability.
U.S. Department of Health and Human Services. (2005). Steps to a HealthierUS. Retrieved October 20, 2006,
from Steps to a HealthierUS Initiative Web site: http://www.healthierus.gov/steps/index.html
This source is a very reliable one as it comes from the government and the US Department of Health and Human
Services.
Wichmann, S., & Martin, D.R. (1992). Exercise Excess: Treating patients addicted to fitness. The Physician
and Sportsmedicine. 20 (5), 193-200.
This source is a peer reviewed article in a medical journal that was published in 1992. It has average reliability.
Woods, Joycelyn (2003). The Discovery of endorphins. Retrieved October 15, 2006, from National Alliance of
Methadone Advocates Web site: http://www.methadone.org/library/woods_1994_endorphin.html
This source is primarily a historical outline of the discovery of endorphins. It was published rather recently and the
information it includes checks out with other sources that were compared against it. This source has great reliability.
Yates, Alayne (1991). Compulsive Exercise and the Eating Disorder: Toward an integrated theory of activity.
New York, New York: Brunner/Mazel Publishers.
Exercise Addiction
This source was published in 1991 and is a book. Its reliability is average.
Zmijewski, AuthorC.F., & Howard, M.O. (2003). Exercise dependence and attitudes toward eating among young
adults. Eating Behaviors. 4, 181-195.
Published in a peer reviewed journal specifically about eating behaviors, this article is recent and reliable.
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