• Abstract and Figures
• Public Full-text

Exercise Addiction 1

Exercise Addiction

Amanda D. Kaberline

James Madison University

PSY 497 Senior Seminar: Addictive Behaviors

November 3, 2006 Exercise Addiction 2

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...... Exercise Addiction 3

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,” Exercise Addiction 4

(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 Exercise Addiction 5 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 Exercise Addiction 6 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 Exercise Addiction 7 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 Exercise Addiction 8 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. Exercise Addiction 9

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. Exercise Addiction 10

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 Exercise Addiction 11 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. Cultural support for diet and exercise: ‘more is better’ 2. Pleasure derived from improvements in body functioning and appearance 3. Persistent ambivalence about independence 4. Use of activity to control appetite and relieve dysphoria 5. Locking in phenomenon Exercise Addiction 12

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 Exercise Addiction 13 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 Exercise Addiction 14 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 Exercise Addiction 15

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 Exercise Addiction 16 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 Exercise Addiction 17 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 Exercise Addiction 18 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 Exercise Addiction 19 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 Exercise Addiction 20 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 blood- brain 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 self- reporting. 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

Adams, Jeanine M., Miller, Thomas W., & Kraus, Robert F. (2003). Exercise Dependence: Diagnostic and

therapeutic issues for patients in psychotherapy. Journal of Contemporary Psychotherapy. 33, 93-107.

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

Research and Theory. 10, 415-437.

This article is located in a peer reviewed article specifically for addictions and was published in 2002. This source is reliable and recent.

Anorexia Nervosa and Related Eating Disorders, Inc., (2005). Male and female athletes and obligatory exercise.

Retrieved October 28, 2006, from Anorexia Nervosa and Related Eating Disorders Web site:

http://www.anred.com/ath_obex.html

This article is from an informational organization’s website. The website is fairly new, 2005, and the reliability of the information found is of acceptable reliability.

Benyo, Richard (1990). The Exercise Fix: How the aerobic athlete’s compulsive need for the next workout

is self-destructive. Champaign, Illinois: Leisure Press.

This source is a book published in 1990. The book was obtained through the James Madison University library and although some of the information is outdated, there is still a large amount of useful information.

Blair, Gwenda (2005, Feb). What's behind runner's high? It is endorphins, adrenaline or simply a sense of

accomplishment? Here, we explain the chemical link between exercise and good mood. Shape Magazine, 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.

Blumenthal, J.A., O’Toole, L.C. and Chang, J.L. (1984). Is running an analogue of anorexia nervosa? Journal of

the American Medical Association, 252, 520-523.

Although this peer reviewed article is relatively older in nature, published in 1984, it is one of the cornerstone studies in exercise addiction research.

Brown, R.I.F. (1993). Some contributions of the study of gambling to the study of other addictions. In W.R.

Eadington & J.A. Cornelius, Gambling Behavior and Problem Gambling. 241-272. Reno: University of

Nevada Press.

This article was written and included in a book on gambling. The reliability of this source is average and it was published in 1993.

Brown, T., Cash, T., & Mikulka, P. (1990). Attitudinal body-image assessment: Factor

analysis of the Body Self Relations Questionnaire. Journal of Personality Assessment, 55, 135-144.

This peer reviewed journal article is older, published in 1990, but is of average reliability.

Carmack, M.A., and Martens, R. (1979). Measuring commitment to running: A survey of runner’s attitudes

And mental states. Journal of Sport Psychology, 1(1), 25-42.

One of the oldest sources used, this article was one of the first in exercise addiction history. Historical information from this article is very reliable.

Cockerill, Ian, & Riddington, Megan (1996). Exercise dependence and associated disorders: A review.

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

Journal of Sport Psychology, 18, 215-222.

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

Resources, Odessa, FL.

The NEO PI-R manual is a very reliable source even though it is relatively old.

Cumella, Edward J. (2005, Sep/Oct). The heavy weight of exercise addiction: Treating this often-overlooked

disorder can save patients' lives. Behavioral Healthcare Magazine, 25(5), pp. 26-31.

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

Psychiatry,42, 168-175.

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.

This source is a peer reviewed journal article also from another country, England, and is of average reliability due to that fact.

De Vries, H.A. (1981) Tranquilizer effect of exercise: A critical review. The Physician and SportsMedicine,

9(11), 47-53.

This article is taken from a peer reviewed journal that was published over 20 years ago. The reliability is average due to the age. Exercise Addiction 37

Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington, DC, American

Psychiatric Association, 2000.

The reliability of the DSM is very strong and the updated versions insure that new ideas and concepts are added.

Dishman, R.K. (1985). Medical psychology in exercise and sport. Medical Clinics of North America, 69: 123-143.

This peer reviewed journal article is old but has average reliability.

Draegar, J., Yates, A., & Crowell, D. (2005). The Obligatory exerciser: Assessing an overcommitment to exercise.

Physician and Sportsmedicine. 33(6), 13.

This peer reviewed journal article was published just last year and has strong reliability.

Garfinkle, P.E., Garner, D.M., & Goldbloom, D.S. (1987). Eating disorders: Implications for the 1990’s. Canadian

Journal of Psychiatry, 32, 624-631.

Due to the focus of this article, the 1990’s, it’s hard to give this peer reviewed journal article from Canada anything but an average reliability rating.

Garner, D.M., 1991. Eating Disorder inventory-2 manual. Psychological Assessment Resources, Odessa,

FL.

This is a reliable manual even though it was published in 1991.

Gavin, M.L. (2004, November). Compulsive Exercise. Retrieved October 18, 2006, from For Parents & Cargivers

Web site: http://www.kidshealth.org/PageManager.jsp?lic=175&cat_id=146&article_set=20251

This website is linked to the US Department of Health and Human Services. The reliability is great and the information is useful.

Girls on the Run International, (1996). The Girls on the Run Program. Retrieved November 1, 2006, from Girls on

the Run International- Homepage Web site: http://www.girlsontherun.org/theprogram.html 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 the US, it has a reliability rating of average.

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. Exercise Addiction 39

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 40

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 43

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.

Load more

  43

Copy Link