Activity (exercise) Disorder

1. Activity (exercise) Disorder Ana Chavez, Rosalba Aldama, Parth Rajput

2. What is exercise addiction? • Characterized by a craving for physical training, which leads to uncontrollable excessive exercise behavior with harmful consequences. Two types have been classified: • Primary exercise addiction: a sole primary addiction to exercise without an eating disorder. • Secondary exercise addiction: Excessive addiction combined by an existing eating disorder such as Anorexia Nervosa or Bulimia Nervosa.

3. Erin’s story

4. Etiology • Activity (exercise) disorder, also known as activity compulsive disorder, is believed to be a form of behavioral addiction although the Diagnostic and Statistical Manual of Mental Disorders do not acknowledge it as such. • Behavioral Addiction involves the failure to stop the impulse, or temptation to carry out an action that may be harmful to others or the individual. • Very similar to substance addictions

5. Etiology (con’t.) • Biological Approach • Current studies are interpreting behavior addictions as a type of dysfunction with the regulation and response to dopamine. • Ex. there has been a correlation between an increase in the activity of dopamine pathways in excessive gamblers • Increases in dopamine production and expression within the brain has been shown to provoke an individual to repeat the action.

6. Etiology (con’t.) • Behavioral Approach • “Primary Exercise Dependence” refers to an exercise dependence that does not have any underlying disorders or inherent addictions • Individuals who have primary exercise dependence are less likely to develop secondary exercise dependence based off of their psychopathological characteristics • Primary exercise dependence is more prevalent in males while secondary is more prevalent in females • Since there are no apparent disorders that coincide with primary, it is hard to diagnose as any form of addiction, unless there is any form of bodily harm that is occuring.

7. Etiology (con’t.) • Behavioral Approach • “Secondary exercise dependance” refers to an individual who has a pre-existing eating disorder and uses exercise to help maintain or exacerbate the illness • Most commonly found within Bulimia Nervosa and Anorexia Nervosa patients • In a study used on rats, they demonstrated that on a low caloric diet and an input of excessive exercise, the subjects would lower their caloric intake voluntarily while exercising almost to the point of starvation or death. • These results indicate a correlation of an “activity based anorexia” in both animals and humans.

8. Psychopathology • Psychologists have determined that exercise addiction are synonymous to other disorders and underlying issues such as: • Obsessive Compulsive Disorder (OCD) • Individuals who suffer from previous addiction problems or have addictive personality traits • Individuals who use exercise as a coping mechanism • Individuals who suffer from body dysmorphic disorder or eating disorders (BN, AN)

9. Pathophysiology • Joint inflammation/damage. • Loss of muscle mass. • Sprained ligaments. • Strained or torn muscle or tendons. • Female athlete Triad • Heart damage, heart rhythm disorder, enlarged arteries • Decrease libido in men • Suppression of the immune system

10. Diagnosis Universal signs and symptoms of someone addicted to exercising: • Obsessing over the behavior. • Engaging in the behavior even though it’s causing harm. • Engaging in the behavior despite wanting to stop. • Engaging in the behavior in secret.

11. Diagnosis cont. Exercise disorder is identified based on the following modified criteria of the DSM-IV: • Tolerance: ⬆ amount of exercise to feel a sense of accomplishment • Withdrawal: in absence of exercise individual experiences (-)effects • Lack of control: unsuccessful attempts to reduce exercise level • Intention effects: unable to stick to one’s intended routine • Time: too much time spent preparing for, engaging in & recovering • Reduction in other activities: other daily activities occur less often • Continuance: continuing to exercise despite knowing this activity is creating problems

12. Diagnosis cont. Questionnaires developed to help identify & measure (-) exercise attitudes: • The Negative Addiction Scale (NAS): 1st to measure (-) running behavior • The Obligatory Exercise Questionnaire: (OEQ): covers a range of exercise behaviors. • The Exercise Dependence Questionnaire: measures exercise dependence. • The Exercise Addiction Inventory: quick and easy screening tool for health practitioners.

13. Treatment -#1 issue: getting patient to see they have the addiction -If severe then find treatment center -Treat any co-occurringdisorders to prevent any disorders from worsening -Eating disorders, substance abuse, depression, anxiety, negative body image -Some cases need to refraining from exercise altogether at beginning -Medication during withdrawal anxiety or depression -Medication for any injuries -Cognitive Behavioral Therapy

14. Recovery Goal: Developing a healthy relationship with exercise -Give time for physical harm to recover -Exercise less often and/or switch to gentler form of exercise -Avoid relapse -Workout with others -Schedule before something else so you can’t keep working out -Exercise for healthy reasons

15. Conclusion • Exercise addiction is characterized by abnormal patterns of exercise, resulting in harm to the person affected. • Driven by urges and cravings for behavior accompanied by withdrawal symptoms. • Prevalence for exercise addiction is low, ranging between 0.3% and 0.5% in the general population, and possibly 3.0% of the individuals who exercise regularly. • This addiction does not have a dx recognized by the American Psychiatric association, therefore there is no specific criteria to use in its dx.

16. References ACSM's International Health & Fitness Summit. (n.d.). Retrieved from https://www.acsm.org/ Centers for Disease Control and Prevention. (n.d.). Retrieved from https://www.cdc.gov/ Freimuth, M., Moniz, S., & Kim, S. R. (2011). Clarifying Exercise Addiction: Differential Diagnosis, Co-occurring Disorders, and Phases of Addiction. International Journal of Environmental Research and Public Health, 8(10), 4069-4081. doi:10.3390/ijerph8104069 Grant, J.E., Potenza, M.N. (2010). Introduction to Behavioral Addictions. The American Journal of Drug and Alcohol Abuse vol 36 (5): 233-241. doi:10.3109/00952990.2010.491884 Lichtenstein, M. B., Hinze, C. J., Emborg, B., Thomsen, F., & Hemmingsen, S. D. (2017). Compulsive exercise: Links, risks and challenges faced. Psychology Research and Behavior Management, Volume 10, 85-95. doi:10.2147/prbm.s113093 Adama, J. (2009).Understanding Exercise Dependence. Journal of Contemporary Psychotherapy doi. https://link-springer-com.libaccess.sjlibrary.org/article/10.1007/s10879-009-9117-5#Sec1

17. Content Questions • What characteristics differentiate someone addicted to exercise from the everyday gym enthusiast? • Do you feel exercise addiction and addiction to substances can be compared on the same spectrum? • What are some ways to avoid relapse?