Summary: Compulsive exercise (CE) is a term used to describe what happens when exercise changes from a healthy, life-affirming activity to one that causes disruption and difficulty.
Key Points:
- Neither the Diagnostic and Statistical Manual of Mental Disorders Volume 5 (DSM-5) nor the International Classification of Diseases Volume 11 (ICD-11) classify CE as a clinical mental health disorder
- Compulsive exercise is associated with specific personality traits
- Compulsive exercise is associated with several negative physical, psychological, and emotional outcomes
Too Much Exercise: Connection to Mental Health
There’s very little research on the topic of CE. To fill this gap in research, a group of researchers in Europe published a review of the available studies on the topic called “Compulsive Exercise: Links, Risks, and Challenges Faced.” Here’s how the authors describe the goal of their research effort:
“The aim of this literature review was to critically examine the research on links (comorbidity), risks (negative consequences), and challenges faced (problems in a treatment context).”
Most medical and mental health professionals understand compulsive exercise as solely related to eating disorders (ED). There is a strong connection: people with eating disorders may use exercise in an unhealthy way, as one sub-component of purging associated with disordered eating. Patients may exercise to purge calories from overeating or binge eating. They may also exercise in order to address body dysmorphia or fulfill an intense drive or desire for thinness/skinniness.
However, research shows that exercising beyond certain frequencies, intensities, and durations is associated with increased psychological distress, and can exacerbate mental health disorders such as depression and anxiety.
From Runner’s Euphoria to Compulsive Exercising (CE)
In 1977, Dr. William Glasser, an expert on exercise and mental health, published a paper indicating that runners can develop an addiction to running. In this original context, Glasser calls it a positive addiction because of the connection between running and positive emotions such as joy and pleasure. However, in a paper published two years later called “Negative Addiction in Runners.” Dr. Glasser recognizes a counter-productive aspect to excess running and excess exercising:
“A hard-core exercise[r] ‘can’t live’ without daily running, manifests withdrawal symptoms if deprived of exercise, and runs even when his physician says he shouldn’t.”
In the following two decades, various exercise and mental health experts designed scales to measure exercise and determine whether individual approaches to exercise were healthy or unhealthy, including:
- Negative Addiction Scale (NAS)
- Obligatory Exercise Questionnaire (OE)
- Running Addiction Scale (RAS)
- Exercise Dependence Questionnaire (EDQ)
- The Exercise Beliefs Questionnaire (EBQ)
- Exercise Addiction Inventory (EAI)
Those scales all measure habits, attitudes, and beliefs related to exercise. And they all face the same challenge:
How do we determine when something that’s fundamentally good for you – like exercise – becomes something that can bad for you?
In mental and behavioral health, the answer to this question is relatively straightforward. When a habit or behavior impairs the ability to participate in the essential functions of daily life, or causes significant emotional or psychological distress, then it’s no longer healthy, and moves close to a category of behavior called a disorder.
However, as we mention above, compulsive exercise is not an official clinical disorder. Nevertheless, the study we cite in the introduction to this article shows an association between excessive exercise and several serious comorbidities and risks.
We’ll discuss those now.
What are the Consequences of Compulsive Exercise (CE)?
After a thorough review of the available research on the topic, the research team identified the following consequences of compulsive exercise (CE):
Comorbidities, I.E. Disorders Associated With Compulsive Exercise:
- Orthorexia nervosa
- Muscle dysmorphia/body dysmorphia
- Obsessive -compulsive disorder
In addition, the research team identified the following personality traits associated with compulsive exercise:
Personality Traits and Compulsive Exercise
Perfectionism:
- Characterized by low tolerance for personal flaws/making mistakes, connected to physical appearance in some people.
Neuroticism:
- Defined as a chronic propensity for anxiety, depression, and self-doubt.
Narcissism:
- In individuals, a persistent belief that they’re superior to/better than everyone else, alongside a persistent, chronic need for reassurance and admiration from others. Related to, but less intense and disruptive than narcissistic personality disorder, a subtype of personality disorders.
High extraversion/low agreeableness:
- In individuals, characterized by high energy coupled with a an unwillingness to cooperate, especially around changing exercise habits to make room for different activities
The research team also identified the following risks associated with compulsive exercise:
Additional Negative Outcomes Associated With Compulsive Exercise
Pain and injury
- Individuals who exercises compulsively will continue exercises even when pain and injury pose a threat to long term physical health and wellbeing
Social impairment
- When a person who exercises compulsively chooses exercise over relationships, relationships suffer, including relationships with family, friends, peers, and spouses/romantic partners.
Anxiety
- People who report exercising compulsively score higher on metrics that evaluate symptoms of anxiety
Depression
- People who report exercising compulsively score higher and metrics that evaluate symptoms of depression
Now that we know what compulsive exercise is, let’s take a look at how we can identify and address it, in order to avoid the negative consequences we list above.
How Much is Too Much – And What to Do About It
A new study identifies a cutoff score on the Compulsive Exercise Test (CET) for determining the point at which exercising can cause harm:
On the CET, a score of 13.5 or higher is associated with negative physical, emotional, and psychological outcomes.
However, although the CET Is an effective measure, scoring it is complicated, and research indicates that poor scoring can lead to false positives. Therefore, in order to determine whether exercise is a positive or negative component of your life, ask yourself the following question:
Does my exercise routine cause problems or disrupt other areas of my life, such as work, school, interpersonal relationships, and family?
If so, we encourage you to reevaluate your relationship with exercise. If this idea itself causes psychological distress, we encourage you to seek a full psychiatric evaluation, in order to better understand the relationship between your emotions and your exercise habits.
