On the pitfalls of conceptualizing excessive physical exercise as an addictive disorder: Commentary on Dinardi et al. (2021)

Abstract

This commentary challenges some of the proposals made in the opinion paper entitled “The expanded interactional model of exercise addiction” by Dinardi, Egorov, and Szabo (2021). We first question the usefulness of the (expanded) interactional model of exercise addiction to determine the psychological processes underlying distress and functional impairment in excessive physical exercise. We then consider the authors’ use of the Self-Determination Theory to model exercise addiction, which risks the misclassification of strenuous, but adaptive, patterns of physical exercise as exercise addiction. We finally address broader concerns regarding the idea that maladaptive exercising could be conceptualized as an addictive disorder.

Apples and oranges in the basket of a clinical model for exercise addiction: Rebuttal to Brevers et al. (2022)

“…Finally, Brevers et al (2022) implicate our report in “… pathologizing intensive physical exercise, ” which is inaccurate because we do not discuss exercise volume or intensive physical exercise at all. Indeed, the EIMEA does not link exercise volume to exercise addiction because, apparently, there is no relationship between them ( Szabo & Kovacsik, 2019 ).…”

“…We thank Brevers et al.’s (2022) attention to our recent article by commenting on it. Yet, the commentary addresses many issues not or only remotely pertinent to the Expanded Interactional Model of Exercise Addiction (EIMEA).…”

“… Brevers et al. (2022) discuss a “primary versus secondary disorder fallacy” in the context of our paper, while we state that “ This model describes only primary exercise addiction …” p. 627).…”

“…In this section, Brevers et al. (2022) imply that we “ claim that fitness is driven by a desire to enhance one's physical appearance or health, whereas sport participation is driven by performance,” when in fact, instead of categorization, we only mean to provide examples of the two: “ For example, the desire to enhance one's physical appearance or health are common motivations in exercise, while seeking improved sports performance, either for competitive reasons or to achieve personal goals, is associated with training.” Then they say: “ Perhaps even more problematic is the fact that the proposed model itself does not inform on how distinct motivational patterns differentially lead to maladaptive physical exercise .” This view reveals a misinterpretation of the EIMEA via inference to (an expected) generalized nomothetic context, despite Egorov and Szabo's (2013) posit that: “ …nomothetic research could yield results about proneness or risk while actual clinical cases can only be examined through idiographic research .” Indeed, the EIMEA cannot account for the general connections of motivational constructs to exercise addiction because it focuses on individual-specific interactions contained within the ‘black box’ of the person that only mental health professionals can open.…”

Thinking beyond cut-off scores in the assessment of potentially addictive behaviors: A brief illustration in the context of binge-watching

“…As the BWESQ is increasingly used in various contexts (e.g., Alfonsi et al, 2022;Boursier et al, 2021;Costa, Bugatti, & Lucchini, 2022;Demir & Batik, 2020;Gabbiadini, Baldissarri, Valtorta, Durante, & Mari, 2021;Munawar & Siraj, 2022;Tolba & Zoghaib, 2022), dozens of researchers have recently requested cut-off scores to identify problematic binge-watching. However, although following a diagnostic approach (i.e., comparing "clinical" cases with "healthy" controls) is core to psychiatry research and clinical practice, such an approach has been criticized in relation to putative behavioral addictions (Billieux, Schimmenti, Khazaal, Maurage, & Heeren, 2015), especially because these behaviors concern daily life activities and leisure, which can be performed at high levels of engagement without involving negative consequences and functional impairment (Bőthe, T.th-Kir.ly, Orosz, Potenza, & Demetrovics, 2020;Brevers, Maurage, Kohut, Perales, & Billieux, 2022;Charlton & Danforth, 2007;Whelan, Laato, Islam, & Billieux, 2021). Although the BWESQ was not developed as a diagnostic tool, we addressed this request by exploring whether reliable BWESQ cut-off scores could be determined.…”