A few years ago, I wrote a story for Vanity Fair about my journey with exercise addiction, and it may have been one of the scariest things I’ve ever done. This is saying a lot, considering I’ve been an open book about my own eating disorder, documenting years of anorexia in dozens of outlets. But something felt particularly vulnerable about publicly discussing my problems with exercise. I knew there was something relatable in my journey, but I was grappling with some doubts about its validity. I’d heard from countless people—including medical professionals—that there was “no such thing” as too much exercise and that I should be so lucky to have an “addiction” to such a “healthy” habit. But my own experience said otherwise: I knew something was off with my relationship to exercise.

So is exercise addiction real? Read on to learn more about exercise addiction, how it relates to eating disorders, and how to seek help for a very real problem.

Is exercise addiction a real diagnosis?

The phrase “exercise addiction” is currently a bit contentious, but diagnostic criteria for “exercise dependence” was developed in 1987, based on the symptoms of alcohol addiction. The original definition of “exercise dependence” was a “multidimensional, maladaptive pattern of exercise, leading to clinically significant impairment, or distress.” And while this concept was often interchangeably referred to as an “addiction,” many experts today agree that there are potentially more accurate descriptors for the thoughts and behaviors associated with exercise dependence.

“While the term exercise addiction is sometimes used in clinical settings—and even in some validated clinical assessment tools—more often, ‘unhealthy’ exercise thoughts and behaviors are captured by other terms, like ‘maladaptive,’ ‘problematic,’ ‘compulsive,’ ‘compensatory’ and ‘excessive,’ says Equip’s Head of Nutrition and Physical Activity Research, Megan Hellner. “I find myself leaning away from using the term ‘addiction’ with patients, mostly because it feels so final and heavy, and may not resonate with someone who is just beginning to re-examine that relationship.”

With that said, Hellner does acknowledge that a problematic relationship with exercise can certainly include some characteristic features of addiction, including dependence and withdrawal symptoms. “In a nutshell, exercise can become something that we misuse to manage or avoid experiencing negative emotions,” she says. “There’s often intense rigidity in terms of exercise mode and duration, and a strong sense of obligation to follow through with exercise plans despite negative consequences. So yes, it is a real phenomenon, and something we observe often as a core symptom in folks with eating disorders.”

Equip’s Product Operations Manager, Kimmy Packebush, experienced precisely what Hellner describes. “When I think about my relationship with exercise, I know it reached toxicity when I joined a second gym,” she says. “At the time, I could have defended and justified this until I was blue in the face. My CrossFit workouts didn't push me enough and therefore required me to spend extra time in the gym to work towards my goals. Now, looking back, I can clearly see the serotonin and dopamine bursts I used to get from working out weren't doing it for me anymore, so I had to go multiple times a day.”

Some researchers do still use the term “exercise addiction” when discussing these problematic patterns. A 2023 paper, for example, examined over 1,000 articles over a 12-year period on the topic of exercise addiction, acknowledging that there’s still a lot to learn about the issue. As the authors note, “despite its known dysfunctional characteristics,” exercise addiction is still not recognized as a diagnosis in the clinical reference manual, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). So while exercise addiction—and all other names that may be used for this phenomenon—is, in fact, a real thing, it’s not yet recognized as its own distinct form of mental illness.

How can you tell if you’re “addicted” to exercise?

The challenging part of recognizing exercise addiction is that physical activity is generally celebrated and encouraged in our society. So much so, that many people (and, as mentioned above, many medical professionals) are unaware of the real repercussions of excessive workouts, including fatigue, depression, injuries, anxiety, and more.

“Problematic exercise behaviors often hide in plain sight, as exercise is thought of as a virtuous health-promoting behavior, worthy of praise,” Hellner says. “Because of that, it can be confusing to try to separate the healthy from the unhealthy. When I think of exercise addiction, I think of a person who feels an intense pull to engage in exercise at the expense of other activities, opportunities, and relationships. And they aren’t able to give the risks of doing so appropriate or full consideration.”

Because there is no single diagnostic definition for exercise addiction, there’s also no exhaustive list of signs and symptoms. In general, the concept of exercise addiction/dependence is defined by a person’s insistence on exercising “excessively and obsessively to a point of dependence and, often injury or illness.” According to Hellner, some red flags that might indicate exercise addiction include:

• Recurrent or slow-to–heal overuse injuries, like stress fractures
• Fatigue
• Plateau or decline in performance
• Hair loss
• Menstrual cycle disruptions (absent, or short, irregular periods)
• Depressed mood
• Altered bone density

“The tricky thing about identifying exercise addiction is that people with it are really, really good at justifying it,” Packebush says. “Like with an eating disorder, it becomes normal and like something you're ‘supposed’ to do. ‘I feel better when I move’ or ‘it makes me feel less anxious’ are things that can be true and are often sold as benefits of exercise. And, like an eating disorder, exercise addiction can do a really good job of convincing you that it's necessary and totally normal.”

If you’re concerned that you or a loved one might be struggling with exercise addiction, it can be helpful to ask the following questions:

• Are you/they able to find joy and connection through other activities that aren’t centered around movement?
• Are you/they able to honor rest days, and to rest when sick or injured?
• Are you/they exercising outside of planned training hours/schedules, or at inappropriate times?
• Are you/they consistently training beyond what’s been prescribed by a coach?
• Are you/they finding it hard to disentangle food intake from urges to exercise? That is, does what/how much you/they eat often drive exercise behavior?
• Are you/they struggling to regulate emotions when unable to exercise as planned?

While these questions can’t definitively tell you whether you or a loved one are dealing with exercise addiction, their answers tell you valuable information. If there were a lot of “yeses,” it’s probably worth taking a close look at the role exercise is serving in your or your loved one’s life.

What does the research say about exercise addiction?

As Hellner reiterates, the term “exercise addiction” has become a bit of a controversial label in the research world, and is used somewhat infrequently in clinical settings since there is an absence of clinical criteria for diagnosing the issue.

“The lack of consensus hinders advancement in research,” Hellner says. “The underlying mechanisms of exercise addiction are not well understood, but we do know that this usually occurs in the setting of other psychiatric comorbidities, such as disordered eating, body dysmorphia, anxiety, or obsessive-compulsive disorder (OCD). So understanding how to effectively treat problematic exercise behaviors requires also understanding how to concurrently treat the underlying issues. We also know that endurance athletes are at higher risk.”

To Hellner’s point, research has shown that not only is exercise addiction more common among elite athletes, but the prevalence among that population also increases with the level of competition. Surveying 417 participants from 15 different sports disciplines, researchers found that 7.6% of respondents were at risk of exercise addiction, and the group was “younger, exhibited tendency to exercise despite pain and injury, felt guilty if not exercising enough, and reported substantial eating disorder symptoms.”

Research on ultra-endurance athletes (those participating in sporting events that last at least six hours) has also shown that certain personality traits, including neuroticism, may be associated with exercise addiction. Defined by the authors as “a persistent tendency to experience negative emotions while being aware of psychological suffering and exhibiting recurrent nervousness,” neuroticism is a trait that has also been associated with people struggling with alcohol, tobacco, and marijuana use disorders, as well as social media and gambling dependence. Researchers found that neuroticism is commonly related to the symptom of exercise withdrawal (i.e. negative effects in the absence of exercise) and that because neuroticism is related to negative emotions, people may use excessive exercise as a maladaptive coping strategy to try and alleviate unpleasant feelings.

How does exercise addiction relate to eating disorders?

While the phrase “exercise addiction” is used relatively infrequently in the eating disorder field, Hellner says the symptoms associated with it are extremely common. “Compulsive exercise is a core feature of eating disorder symptoms in the large majority of people with eating disorders,” she says. “When we think of those with bulimia, it’s common to think of self-induced vomiting as the form of purging, but compensatory exercise (i.e. exercising to ‘make up’ for calories consumed) is also a form of purging. It’s also common for folks with eating disorders. especially "anorexia athletica," to misuse exercise for purposes of changing weight or achieving a certain ‘athletic aesthetic.’”

Packebush also notes the potential psychological similarities between those with disordered eating and those struggling with exercise compulsions. “I think people addicted to exercise likely share temperament traits of those with eating disorders: perfectionism, attention to detail, perseverance,” she says. “Also, there is a certain level of anosognosia—not realizing there's something wrong or a sickness—that goes with exercise addiction..”

What should you do if you’re worried that you’re addicted to exercise?

While exercise addiction can be difficult to spot, it is a problem that merits support and there are effective treatments to address it.

“Treatment for problematic exercise depends on the underlying issues, and is more complex than simply interrupting the behavior,” Hellner says. “Effective treatment generally requires specialized multidisciplinary support. A medical provider can offer information about physiological consequences and guardrails around future exercise. A registered dietitian can assess whether or not you’re eating appropriately to meet the demands of training, and can make any necessary adjustments as time goes on (sports nutrition basics). A licensed therapist can bring in cognitive behavioral therapy-based or mindfulness-based approaches to address underlying thoughts and emotions that may be driving the problematic behaviors.”

While treatment may look different for everyone, Hellner says that in general, treatment teams will strongly encourage the person struggling to refrain from exercise as they begin treatment. Then, as treatment progresses, they can work toward a gradual reintroduction of exercise over time for those wishing to return to their sport. Hellner also underscores the importance of working with specialized providers who will take concerns about exercise addiction seriously, and who may be well-versed in the principles of relative energy deficiency in sport (RED-S), a condition characterized by “insufficient energy intake to meet the body's demands during exercise and essential daily functions like growth, respiration, and digestion.”

For me, working with a specialized team of clinicians, including therapists, dietitians, and medical doctors, helped me slowly rebuild my relationship to exercise. For others, reevaluating social networks and priorities can also make a big difference. “What helped me was to start hanging out with people who don’t exercise, or at least don’t view it as a must,” Packebush says. “This made me realize that maybe my behaviors weren’t as normal as I thought they were. I also had to remove myself from exercise for a while. When I did feel ready to return to exercise, it wasn’t back to a CrossFit gym. I had to completely redefine what movement meant to me.”

Regardless of how concerning your or your loved one’s relationship to exercise might seem, if you’re worried it’s always a good idea to reach out for information, guidance, and expert insight. “It’s never too early to ask questions and seek support!” Hellner says. “Initially, this may look like talking to a trusted professional like a registered dietitian, licensed therapist, or medical provider with relevant expertise to better understand the issue—and associated risks—and plan for next steps.”

Worried that you’re dealing with exercise addiction?Support is available.

Talk to our team