The phenomenon of exercise addiction: diagnostic criteria, neurobiological underpinnings, and differential challenges at the interface of psychiatry and sports medicine
DOI:
https://doi.org/10.12775/QS.2026.59.72682Keywords
exercise addiction, behavioural addiction, eating disorders, overtraining syndrome, neuroimaging, differential diagnosisAbstract
Background: Regular physical activity is broadly considered a cornerstone of somatic and psychological health, yet a subset of practitioners progresses toward a maladaptive pattern in which exercise acquires features resembling a behavioural addiction. This shift from a salutogenic behaviour to a compulsion sits at the interface of psychiatry and sports medicine and lacks a unified nosological position.
Aim: The review aims to synthesise contemporary evidence on the conceptualisation, diagnostic criteria, neurobiological underpinnings and differential diagnosis of exercise addiction (EA), with attention to its overlap with eating disorders, OCD and overtraining syndrome.
Material and methods: A structured search of PubMed, Scopus, Web of Science and Google Scholar covered publications from 1976 to 2025. Empirical studies, systematic reviews and meta-analyses on the symptomatology, epidemiology, neural substrates and treatment of EA were synthesised qualitatively.
Results: Around 3% of regular exercisers may be at risk of EA, with notably higher estimates among endurance athletes. Diagnostic models tend to converge on Griffiths' six components and are operationalised through the EDS-21 and the EAI. Neuroimaging findings suggest alterations in mesolimbic dopaminergic circuits, opioid and endocannabinoid signalling, and reduced grey matter in the orbitofrontal cortex and inferior frontal gyrus.
Conclusions: EA appears to constitute a clinically meaningful yet under-recognised behavioural syndrome whose identification requires careful distinction from eating disorders, OCD, overtraining and elite athletic commitment. Cognitive–behavioural interventions remain best-supported; pharmacotherapy is largely restricted to comorbid conditions.
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