When sport becomes an addiction

For most people, sports is something with which to keep an inner balance and a means by which to invest into a good body feeling. In some cases, however, it can lead to addictive behaviour. This article, written with help of sports psychiatrist Dr. med. Malte Claussen, should sensitise you as a runner for this problem.  

Before going into the different forms of such addictions, it is necessary that we differentiate between different groups of sports people. According to Dr. Claussen, we can distinguish between hobby sports people, who, for example, play tennis once a week. People who pursue the goal of improving their performance are called performance athletes. The category of high performance athletes refers to people who regularly train for and take part in national or even international competitions. Professional athletes are people who can earn a living with competing.

The biggest risk for developping an addiction in the context of sports, according to Dr. Claussen, exists for performance athletes. Those athletes train a lot and are very performance-oriented, but, as opposed to high performance athletes and professional athletes, they often lack professional supervision. They are often not aware of what amount of physical effort is healthy and they underestimate the importance of recovery. These athletes often train a considerable amount, but only take very short recoveries.

Endurance sport is special in the sense that, as a beginner, you make quick progress. Even for people with little talent for running training pays off and they usually improve rather rapidly. This quick effect can have a very positive influence on our body when we feel that we can perform better or if we start getting a better feeling in our body or in life in general. However, this very effect also brings with it the danger of getting addicted and not being able to do without it. It is easy to get used to the reassurance and the progress. As soon as a certain level has been reached from where you cannot make the same progress with “simply” running training, one might start feeling the need of training even more or of taking other performance-enhancing measures such as, for example, a weight reduction.

Exercise addiction is not bound to substance. Nevertheless, according to Mr. Claussen, the symptoms of an exerise addiction do not diverge from those of substance-bound addictions: Need of an ever higher dose, withdrawal symptoms, readiness for a high physical risk or strong impairment of the social environment. Affected people set themselves goals related to performance, to which they subordinate everything else. Exercise addicts are controlled by their behaviour and not the other way around. Exercise addiction consists of different stages, which German sports scientist and psychologist Thomas Schack describes as the successful taking up of sports, followed by a strong devotion to sports (“sports bonding”) and the subsequent transfer phase, characterised by avoidance motives (avoidance of withdrawal symptoms) (Held-Beck et al. 2016).

Within the area of exercise addiction, literature differentiates between primary and secondary addictions. A primary addiction is at hand, if, apart from the excessive physical activity, no other psychological problem is in place. In the case of a secondary addiction, on the other hand, other psychological illnesses such as eating disorders depressions are involved. According to Mr. Claussen, the vast majority of the observed cases are to be categorised as secondary sports addictions.

Exercise addiction is thus mostly a multidimensional phenomenon. According to Held-Beck et al. (2016) it can originate on different levels, on which the problem is often mutually reinforced: the physiologcal level, the level of self-perception and self-assessment, an the social level. The physiological level concerns the production of Beta-Endorphins, on the level of self-perception, the aim is to upgrade ones self-image, while the goal on the social level is to obtain social recognition and respect.

Especially on the two latter levels, the goals are significantly defined by norms and ideals. Since exercise is a lot about the human body and its capacity, in the case of exercis addicts, these norms and ideals are predominantly concerned with the body. Aside from the performance capacity, the composition of the body plays a central role. Both in society and in sports specifically, there are social norms which predefine what a body should look like or how much it should weigh. The bigger the discrepancy between the real body and the ideal pursued by a person, the bigger the possibility that he or she feels dissatisfied and feels the pressure to adjust to the often unattainable ideal.

A factor which enforces the problem is social media, where people tend to exhibit their bodes and their performances. However, the content presented on social media does not always represent reality. The pictures often just show a person’s best sides. If you still struggle to come closer to your ideal, this can result in frustration and ever bigger readiness to do anything to arrive there. Training loads are increased, energy intake is reduced, recovery times are shortened. Possible consequences are mental and physical states of exhaustion. According to Malte Claussen, this can already be a form of a depression, or “only” a factor increasing the risk for it, as he said in an interview with the NZZ am Sonntag in February 2018: “The line between overtraining and a depression is difficult to draw. […] It is clear, however, that depressions often remain undetected in the case of sports people”, he says.

Apart from the societal ideal in terms of the human body each sport has its own sports-specific body ideal. Running, like other endurance sports, belongs to the “leanness sports”, where a low body weight and a low fat mass lead to better performances (Ewers et al. 2017). Endurance athletes thus don’t only strive for the societal ideal, but also for the one which is typical for their sport. However, this ideal can hardly be achieved only through training, but it also takes big restrictions in energy intake. “If you look at the thin arms of the cyclists after Tour de France, you soon realise that these performances ivolved considerable energy deficits”, Malte Claussen says.

The constant orientation to such body ideals can lead to various forms of eating disorders or disturbed eating behaviour. Addicts often find strategies to conceal their problem. Yvonne Z. from the example in the NZZ article of February 2018 suffers from a combination of anorexia and sports addiction. The instructors at her gym had noticed her extreme physical activity and had banned her from training there (“If you first train three hours on the bike and then two hours on the stepper, the instructors get suspicious”, she said). Yvonne in the example solved the problem by simply start training in several different gyms.

For sports people, aside from the classic eating disorders anorexia nervosa and bulimia nervosa, further sports-specific eating disorders need to be considered, such as, for example, the exercise bulimia, which is often discussed in internet forums, but really is a bulimia nervosa, thus, a severe disorder of the eating behaviour. Exercise bulimia refers to a special form of bulimia where binge eating, or even normal consumption of food, is consciously and speficically compensated through physical activity. According to Ewers et al. (2017), typical characteristics of this disorder are the desire and the obsession of compensating, that is, burning, of all the consumed calories. Addicts either accurately calculate the calories to be burnt, or they just move until they have reached a feeling of “emptiness”. Another sports-specific eating disorder is the anorexia athletica, which is better established in the literature than the aforementioned exercise bulimia. The anorexia athletica takes up the issue of the BMI (body mass index) of sports people often being within the “normal zone” and not dropping to below the 17.5kg/m2 marking the upper limit for the anorexia nervosa. Malte Claussen mentions that the measuring of body proportions with help of the BMI is problematic in the case of athletes: “This index is designed for non-athletes. Muscles are heavier than fat, though, and this often leaves athletes believing that their BMI is normal. The chase for the perfect body continues despite the fat mass being very low already.” The fact that the low fat mass is often not very obvious or measurable doesn’t make it less severe.

There are different risk factors for a disturbed eating behaviour and eating disorders in sports, as discussed by Ewers et al. (2017). They distinguish between predisposing factors, trigger factors and maintaining factors. While the predisposing factors refer to generally encouraging factors for disturbed eating behaviour (e.g. low self-esteem, emotional problems, family members with an eating disorder), keeping a diet, weight fluctuation or an early start with sport-specific training are considered typical trigger factors. Maintaining factors can, for example, be the bahaviour of coaches or the increases in performance which occur after a first weight reduction.

Exercise addiction and/ or eating disorders are often severe mental illnesses, which, according to Claussen, require a pyschiatric-pyschotherapeutic treatment by an expert. Special consultation-hours for sportspsychiatric and sports-psychotherpeutical matters are, for example, offered at the Psychiatric Clinic ot the University of Zürich.

 

This blog entry was written by: Marion Aebi

 

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