Compulsive exercise is a condition described since 1970s. It is characterized by a craving for physical training, resulting in uncontrollable excessive exercise behavior with harmful consequences, such as injuries and impaired social relations. It has not been accepted as a mental disorder in either International Classification of Diseases or Diagnostic and Statistical Manual of Mental Disorders. 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). This review found that compulsive exercise is associated with eating disorder pathology, perfectionism, neuroticism, narcissism, and obsessive compulsive traits. The most prominent negative consequences were injuries, social impairment, and depression, but more research is needed to uncover the potential dysfunction resulting from compulsive exercise. As the condition is not recognized as a psychiatric disorder, studies on treatment interventions are sparse. Problems with compliance have been reported; therefore, motivational interviewing has been proposed as a treatment approach, in combination with cognitive behavioral therapy. This review summarizes and discusses findings on links/comorbidity, risks/negative consequences, and treatment challenges. We suggest that future studies should pay attention to both prevention and counseling in sports settings, where compulsive exercise appears, as the condition may be associated with harmful consequences.

IntroductionExercise addiction is characterized by the use of physical activity to cope with emotions and mood, while sports injuries can lead to psychological distress such as depression and anxiety. The aim of the present study was to investigate the association between risk of exercise addiction and psychological distress, and whether this association was modified by injury status.MethodsA cross-sectional study with injured and non-injured recreational exercisers (n = 1083). Using the Exercise Addiction Inventory participants were classified into the following groups: High risk of exercise addiction (HREA) with musculoskeletal injury (n = 44); HREA without musculoskeletal injury (n = 31); Low risk of addiction (LREA) with injury (n = 563); LREA without injury (n = 445). The outcomes were depression using the Major Depression Inventory, and emotional stress using the Perceived Stress Scale. Data were analyzed using binomial regression analysis with prevalence proportion difference (PPD) as measure of association.ResultsCompared with LREA-exercisers, more HREA exercisers were depressed (PPD = 13% points [95%CI 3.6; 22.4]) or experienced emotional stress (PPD = 26.2% points [95%CI 14.5; 37.8]). Amongst injured exercisers, more HREA exercisers had depression (PPDHREA-injured = 15.9% points [95%CI 2.5; 29.3]) compared with LREA-exercisers.ConclusionsRecreational exercisers with high risk of exercise addiction reported more symptoms of depression and emotional stress, and this relationship seemed exacerbated in the presence of musculoskeletal injury. Psychological assessment and counseling may be useful supplements to somatic injury interventions for addressing emotional distress.

Lichtenstein, M. B., Malkenes, M., Sibbersen, C. & Hinze, C. J. (2019). Work addiction is associated with increased stress and reduced quality of life: Validation of the Bergen Work Addiction Scale in Danish. Scandinavian Journal of Psychology, 60, 145-151.Addiction to work is defined as a compulsion or an uncontrollable need to work incessantly. Only few measures exist to identify work addiction and the health consequences are sparsely explored. The Bergen Workaholic Scale (BWAS) measures seven core elements of work addiction and has been used in Norway, Hungary, Brazil, Italy, USA and Poland. The aim of this study was to validate the BWAS in a Danish sample and to investigate if high risk of work addiction was associated with stress and reduced quality of life. We conducted an online screening survey with 671 participants aged 16-68 years with the Danish translation of the BWAS. We added the perceived stress scale (PSS) and the quality of life scale EQ-5D-5L. Those with high risk of work addiction reported significantly higher mean PSS scores (20.0 points) compared to those with low risk of addiction (12.5 points) and poorer quality of life (61.9) compared to the low risk group (81.3). Furthermore, work addiction was associated with more weekly working hours (44.0 vs. 35.6 hours/week) and having more leadership responsibility. A preliminary estimate of work addiction prevalence was 6.6%. The BWAS demonstrated good reliability (a = 0.83), and factor analyses pointed at a single factor structure. Work addiction seems to be associated with health problems in terms of stress and poorer quality of life. The BWAS is recommended as a reliable and valid tool to identify work addiction in Danish.

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