The Phenomenon of Sports Addiction
II. Behavioral addiction as a disorder – an attempt at defining it
III. Endurance addiction
2. Definition and phenomenology
2.1. Category I
2.2. Category II
2.3. Category III
2.4. Healthy vs. pathological exercising
4. Circumstances fostering endurance addiction
5.1. Physiological approaches
5.2 Psychological approaches
6. Withdrawal symptoms
The term of sport, which in its allocated meaning originally was the equivalent to distraction and pleasure, did almost turn into a synonym for physical exertion in the Western societies, where physical work is on the decline. The phenomenon sport reflects the principles of performance, competition, and equality as elevated by our industrial society.1 And it is indeed undisputed that regular exercise can of course have a positive effect on mind and body and that it offers the best protection against civilization diseases as overweight, diabetes, hypertension, etc. “Two to three times per week for 30 to 60 minutes of endurance sport, this is recommended”, according to the sports psychologist Gugutzer.2 But what if the healthy makes room for the pathological? In remembrance of the run by Pheidippides3, the marathon (42.195 km) as the longest running discipline was part of the competition at the 1896 Olympic Games in Athens. In the meantime, the multiple of this distance is covered in one stretch. What is today considered traditional is for example the 100-km-run of Biel and the 78.5-km-long Swiss-Alpine-Marathon over the high mountain region of Davos with the challenge of extreme differences in altitude (up to 2,320 meters). The ultra-long-distance-run „Trans-America-Foot-Race“ across North America from the Pacific to the Atlantic Ocean (ca. 4,700 km) can be seen as an extreme escalation of distance.4
Although the phenomenon of sports addiction has been known since 1970, when it was discovered by Baekelund, the potential addictive nature only came progressively to the forefront for the public and the scientific community during the last fifteen to twenty years – among other things, driven by the increasing popularity of the running movement at the end of the 1970s and the almost inflationary proliferation of fitness studios replying to the developing fitness trend in the USA, which was a little later also sweeping to Europe.5 The discovery of the sports addiction phenomenon by Baekelund was more or less accidental. He actually did realize that despite of financial compensation, many athletes did not want to participate in his study about sport and sleep, because they were not willing to give up their sport. From this, he concluded that an excessive practice of sport met the criteria of an addiction and that this could occur in the form of a sports addiction.6 Sports addiction is a behavioral addiction of a non-substance-related nature and can manifest itself in several kinds of sport. The essence of sports addiction is a known entity in the bodybuilding scene – then we speak of bodybuilding- or muscle addiction (muscle dysmorphia) – as well as the endurance area (running- or endurance addiction). In addition, high-risk sports and their link with addiction increasingly gained attention.
This term paper aims at summarizing the knowledge base about this relatively young subject of investigation that is endurance addiction, representative of sports addiction. Due to the limited focus of this paper, the subject of addiction in risky sports with its very specific characteristics of “pushing boundaries” and “looking for adventure”7 cannot be included. Likewise, addiction in the bodybuilding sport has to be left out of the discussion. Since sports addiction and herewith endurance addiction is considered a behavioral addiction, it is imperative to first define the term behavioral addiction. Subsequently, the phenomenology of running addiction will be presented extensively, more precisely by deriving a definition in conjunction with the determination of diagnostic criteria. Then the circumstances that can be conducive to sports addiction and the causes of sports addiction are discussed. Another point of interest is the topic of withdrawal symptoms occurring addiction-specifically with refraining from sports. Subsequently, the question about therapeutic approaches and therapy possibilities should be raised.
The fact that sports addiction is a relatively young subject of investigation is also indicative for respective literature being considered scarce and expandable. For example, there was no publication available in the German-speaking region, which would extensively and exclusively focus on sports addiction. For the most part, sports addiction is perceived and studied as just one of distinct behavioral addictions, as is the case for the most pertinent publications in the context of this paper: “Nicht nur Drogen machen süchtig” (Not only drugs lead to addiction) by Poppelreuter and Gross8, and “Verhaltenssucht” (behavioral addiction) by Grüsser and Thalemann9. In order to present a well-rounded picture of endurance addiction, however, additional sources like essays, respectively monographs touching the topic, and primarily plausible reports on the experiences with the affliction, and moreover the medium of the Internet are being included.
II. Behavioral addiction as a disorder – an attempt at defining it
Trettner and Müller argue that any human behavior can lead to some sort of exhilaration. The experienced high tempts to repeat. If the urge for repetition wins, the affected individual enters a spiral of “more” and “again”. This is the very basis of the nature of addiction, which is also called craving (addicted desire). Any human behavior, especially when it has already turned into a habit, can derail to become addictive. Addiction is a pathological event, characterized by a behavior-perpetuating autonomy of the addictive genesis, interfering with psychological, physiological and social functions.10
Trettner and Müller explain that the term addiction embodies two characteristics of human behavior:
1. “Excessive behavior with regard to extent, duration, and/or frequency of the behavior“, along with an „inability to distance yourself from the behavior, respectively restrain from it (minimization of the capability to sustain abstinence) and/or being able to slow down or stop the behavior at any time (loss of control).”
2. “The behavior is connected with the generation of states of pleasure, respectively the minimization of states of unpleasure.”11
Hitherto, the pathological pattern of behavioral addiction has not found any consideration yet as an autonomous disorder in the conventional classification systems of psychological disorders, the ICD-10 and the DSM-IV-TR. “Pathological gambling” presents the exception, which is classified in the category “personality and behavioral disorders” as “abnormal habit and impulse control disorder” (ICD-10), respectively „disruption of impulse control, not classified elsewhere“ (DSM-IV-TR). Therefore it is only possible to diagnose other behavioral addictions, including sports and endurance addiction, analogous to the classification of “pathological gambling” as “miscellaneous abnormal habits and impulse control disorders” (ICD-10), respectively “not specifically described impulse control disorder” (DSM-IV-TR).12
Since for the time being, the classification of other behavioral addictions has to occur analogous to the classification of “pathological gambling”, the diagnostic criteria for “pathological gambling” as stated by Grüsser-Sinopoli, respectively Grüsser and Thalemann are for the present purpose of simplifying abstracted, in order to obtain universally valid statements regarding the diagnostic criteria for a behavioral addiction. Those can in turn be applied to sports addiction.
According to Grüsser-Sinopoli, respectively Grüsser and Thalemann there exist the following diagnostic criteria for a behavioral addiction:
Difficult to control, intense desire to „doing“,
Continuous, repeated „doing“ over a time span of at least a year,
Persistent and often even increased „doing“ despite of negative social repercussions,
Constant mental and conceptual preoccupation with the „doing“.
The quoted authors note that the diagnostic criteria for a behavioral addiction herewith are content-wise in concordance with the diagnostic criteria of a substance addiction.13 Though the intensity and speed of addictive self-destruction with non-substance-related addictions is usually not quite as massive as with alcoholism or drug abuse, the self-destruction in the end-stage of a behavioral addict is hardly distinguishable from the end-stage of an alcoholic or junkie, with regard to physical decline as well as troubled social interactions.14
III. Endurance addiction
First, an example in accordance with the mentioned diagnostic criteria for behavioral addiction shall vividly visualize the phenomenon of sports addiction. The sports journalist Detlef Vetten15 knows this phenomenon from his own experience. He is a tri-athlete and ultra-runner. In an essay about self-perception he reports about his relationship with sports and his seemingly addictive longing for sports.16
“The drift into excessive sports happened in a way that was barely noticeable. Nevertheless, again and again there were experiences that were characteristic: A 90-kilometer-race on cross-country-skis, after which I could barely lift my feet anymore; the run up Mount Kinabalu, the highest mountain in Southeast Asia, which I finished crawling; a wonderful inline-tour from Frankfort to Bamberg, a 250 kilometer distance; the endless-day at the “Ironman” on Hawaii; my first 24-hour-race in a prefab panel-housing subdivision in the Saxonian Reichenbach. Many memories did accumulate. [Sign of a perpetual, repeated doing.] The good moments did stay. The crossing of the finish line, the exhilaration during the exertion, the pride over the accomplished. Those moments are suppressed, when sport wasn’t in the least fun anymore. When I hit a tree with my bike at night. When I was so nauseated in my bivouak on Mount Kilimanjaro that I was puking bile. When I got lost during a 100-mile-race in Alaska at 25 degrees Celsius below zero and found myself in serious trouble. When I caught a virus after hard weeks of training and collapsed because of a weakened immune system, which sent me to the hospital. My wife worrying, because my training was not getting less […]. [Training despite of health concerns and downsides.] Things like this are blanked out. The memory of a sports fanatic is filled with situations that yearn for repetition. [Hint to an urge for the doing and mental preoccupation with the doing that is hard to control.] However, a repetition alone is not enough. It has to be a little more. A higher mountain, a longer distance, a harder week of training, still more weight on the dumbbell. [Display of persistent and intensified doing.]”17
2. Definition and phenomenology
The attempts to define sports addiction are various. The first definitions of sports addiction exclusively referred to (long distance) running. It is striking, that the most diverse definitions can essentially be divided in three categories, which in their intrinsic values step by step build on each other. The most pertinent definitions will be presented in fragments, using three categories of choice, whereby the last category can be considered current scientific state-of-the-art.
2.1. Category I
The first category comprises all the definitions referring to a positive, respectively negative subdivision of sports addiction. These definitions are the first in an attempt to define sports addiction. In 1976, Glaser distinguished between positive and negative sports addiction. A positive addiction involving sports could manifest itself through activities like running, while negative addictions would be connected to harmful substances like drugs. The positively sports-addicted individual falls into a “trance-like, transcendental mental state”. Consequently, the positive addiction would be a good thing for a human being, due to the increase in mental fortitude and the fun factor. In contrast to negative addiction, the life of the affected is not dominated, although psychological and physiological discomfort does occur, if the activity cannot be executed. Three years later, this concept was challenged by Morgan, who pointed to the continuation of a sport despite of negative effects on the health.
Sports addiction could definitely be a negative addiction, provided that the two following criteria are met:
The affected person has to have the feeling that the sport is necessary to manage the daily demands of life.
In the case that the sport is not practiced, withdrawal symptoms, like depression, anxiety, and irritability have to occur.
Often, pursuing a sport implies the neglect of other important areas in life, like partnership, profession, and health in favor of the sport.18
2.2. Category II
The second category includes all definitions that contain a time-related component, respectively a frequency- or quantity component. In this respect Sachs and Pargman raise the issue that a person could only be considered addicted to sports, if this person demonstrates to be physically and mentally dependent on regular running workouts. Likewise, withdrawal symptoms, such as anxiety, restlessness, irritability, and discomfort should be evident. In someone who is affected with sports addiction, these symptoms should appear within 24 to 36 hours after ceasing physical activity.19 Similarly, Anshel stresses the time-related component. According to his definition from 1992, a runner is considered addicted, when over a time period of 20 weeks this person has participated 15 or more hours in sports programs at least five days out of seven per week.20
2.3. Category III
The third category comprises all definitions that distinguish between a “pure” sports addiction and an “associated” sports addiction in combination with an eating disorder. These definitions rather focus on the psychological characteristics of addiction and criticize among other things, that the evidence of a sports addiction should not alone be made dependent on the frequency and the quantity of workouts. The probably most emphatic definition is the one by Veale from 1995, because the criteria characterizing his definition of sports addiction align themselves with the traits of a dependency syndrome according to the (then still valid) DSM-III-R. He makes the distinction between a primary sports addiction, i.e. sports addiction as an independent disorder, and a secondary sports addiction, a sports addiction that occurs in association with an eating disorder.
The diagnostic criteria of a primary, or “pure” sports addiction according to Veale are:
A constant and stereotypical mental preoccupation with the sport following a set routine,
Accompanied with a clinically relevant suffering or with impairments, among others, in physical, social, professional areas,
Severe withdrawal symptoms, when refraining from workouts.
A primary addiction would present itself, if the mental preoccupation with the sport cannot be described more appropriately with any other psychological disorder.
In contrast, a secondary sports addiction according to Veale exists, if:
The behavioral repertoires are so narrow, that with respect to workouts on the basis of a structured training program with one or several training units per day, stereotypical behavior is exhibited,
The affected person puts other activities aside in favor of the sport,
Withdrawal symptoms are evident when not working out or not completing the workout schedule,
A development of tolerance regarding the extent of workouts over the years is recognizable (an increase of the “sport dose” allows to prevent or alleviate withdrawal symptoms),
The affected person has a subjective awareness that a desire, or maybe to better describe it, a compulsion to exercise does exist.21
Again, Bamber, Cockerill, Rodgers and Carroll, figuratively speaking, put the cart in front of the horse, for the reason that those participants addicted to sports always suffered from an eating disorder at the same time. Hence, in their opinion, pathologically excessive exercising is always accompanied with an eating disorder. Their three criteria (First: impairment at psychological, social, professional, physical, and behavioral levels; Second: withdrawal symptoms; Third: evidence of an eating disorder) are similar to Veale’s. If however, contrary to expectation, a primary sports addiction would be diagnosed, an eating disorder had to be verifiably excluded.22
1 Finking, Bernard (200): Extremsportler. Szenen von erlebnishungrigen Adrenalin-Junkies der sportlichen „Kick-Kultur“(Extreme athletes. Scenes by adventure-hungry adrenaline-junkies in the sports “kick-culture”), Berlin, p. 15.
2 Quoted from Pichler, Johannes: http://www.netdoktor.de/feature/sportsucht.htm; See also: Knoll, Michaela (1997): Sporttreiben und Gesundheit. Eine kritische Analyse vorliegender Befunde (Exercising and health. A critical analysis of available findings), Schorndorf, p. 19 f.
3 Near the Greek village of Marathon, the battle of Marathon took place between the Persians and Athenians in 490 BC, from which the Athenians under the commander Miltiades rose victoriously. A legend around this battle centers around the messenger Pheidippides. In the most popular version of the story, Pheidippides did bring the news of the victory from the battlefield to Athens (about 40 km) and supposedly did die from exhaustion after delivering the news on the Aeropag. This legend can’t be found sooner than with Plutach, who lived about 600 years after the battle, and turned into the basis of the modern marathon run.
4 Allmer, Henning (1995): “No risk – no fun”. Zur psychologischen Erklärung von Extrem- und Risikosport. (to the psychological explanation of extreme and risky sports.) In: Allmer, Henning/ Schulz, Norbert (ed.): Erlebnissport – Erlebnis Sport (Adventure sports – sport as an adventure), Sankt Augustin, p. 61. Additionally: http://de.wikipedia.org/wiki/Swiss_Alpine_Marathon, As well as: http://de.wikipedia.org/wiki/100- km-Lauf_Biel.
5 See Pope, Harrison G./ Phillips, Katharine A./ Olivardia, Roberto (2001): Der Adonis-Komplex. Schönheits- wahn und Körperkult bei Männern. (Adonis-complex. Beauty mania and bodycult with men), München, p. 13.
6 At this point a critical note is warranted, stressing that there are indeed differential views regarding the phenomenon of sports addiction. This understanding was relayed to me in an interview with a specialist for psychiatry and psychotherapy with a psychoanalytical therapeutic approach, by saying he would refrain from talking about addiction in the proper sense, but – certainly dependent on an individual case basis – rather would see the diagnostic criteria for a compulsive personality disorder fulfilled. As subsequently sports addiction will remain the focus, it shall be noted here, that according to school and theoretical approach, by all means, different opinions about the nature of sports addiction do exist. (A contributing factor is certainly that the behavioral addiction is not yet included as an individual disorder in the conventional classification systems of psychological disorders, the ICD-10 and DSM-IV-TR, with the exception of the „pathological gambling“, which is listed under the category of „personality- and behavioral disorders“ as „abnormal habits and disruption of impulse control“ (ICD-10), respectively „disruption of impulse control, not classified elsewhere“ (DSM-IV-TR).)
7 See also reviews by Allmer (1995), p. 60-90, Aufmuth, Ulrich (1986): Risikosport und Identitätsbegehren. Überlegungen am Beispiel des Extremalpinismus. In: Hortleder, Gerd/Gehbauer, Gunter (ed.): Sport – Eros – Tod (Risky sports and the yearning for identity. Reflections using extreme alpinism as an example. In: Hortleder, Gerd/Gehbauer, Gunter (ed.): Sport – Eros – Death), Frankfurt, p. 188-215. also Bartl, Gregor (2000): Sport und Sucht – Extremsportarten. (Sport and addiction – Extreme sports.) In: Poppelreuter, Stefan/ Gross, Werner (ed.): Nicht nur Drogen machen süchtig. Entstehung und Behandlung von stoffungebundenen Süchten, (Not only drugs lead to addiction. Development and treatment of non-substance-related addictions), Weinheim, p. 209-231.
8 Poppelreuter, Stefan/ Gross, Werner (ed.) (2000): Nicht nur Drogen machen süchtig. Entstehung und Behandlung von stoffungebundenen Süchten (Not only drugs lead to addiction. Development and treatment of non-substance-related addictions), Weinheim.
9 Grüsser, Sabine Miriam/ Thalemann, Carolin N. (2006): Verhaltenssucht. Diagnostik, Therapie, Forschung (Behavioral addiction. Diagnostics, therapy, research), Bern.
10 Tretter, Felix/ Müller, Angelica (ed.) (2001): Psychologische Therapie der Sucht. Grundlagen, Diagnostik, Therapie. (Psychological therapy of addiction. Basics, diagnostics, therapy), Göttingen, p. 22f.
11 Tretter/ Müller (2001), p. 23.
12 Grüsser/ Thalemann (2006), p. 20. also Grüsser-Sinopoli, Sabine Miriam (2006): Lerntheoretischer Erklärungsansatz zur Entstehung und Aufrechterhaltung von abhängigem Verhalten: Empirische Erhebungen des Verlangens (http://www.diss.fu-berlin.de/2006/517/Kapitel2.pdf), (Learning-theory-based explanation for the development and perpetuating of addictive behavior: Empirical investigation of desire) p. 4ff.
13 With the exemption of additional pivotal criteria “development of tolerance” and “withdrawal syndrome” for substance-related addiction, those are not mentioned with diagnostic criteria for a behavioral addiction.
14 Gross, Werner (1990): Sucht ohne Drogen. Arbeiten, Spielen, Essen, Lieben…(Addiction without drugs. Work, play, eat, love...), Frankfurt am Main, p. 13f.
15 Detlef Vetten, born 1956, former head of sports department with Stern and editor in chief with Horizont Sport Business, currently freelance author, among others for Süddeutsche Zeitung.
16 Vetten, Detlef (2005): Soweit die Füße tragen. In: Psychologie Heute, 32. (As far as the feet will carry. In: Psychology today)
17 Vetten, Detlef (2005): Soweit die Füße tragen. In: Psychologie Heute, 32. (As far as the feet will carry. In: Psychology today), p. 64-69.
18 Knobloch/ Allmer/ Schack (2000), p. 191ff., also Grüsser/ Thalemann (2006), p. 97ff.
19 Gross (1990), p. 186.
20 Grüsser/ Thalemann (2006), p. 101.
21 Grüsser/ Thalemann (2006), p. 100.
22 Grüsser/ Thalemann (2006), p. 99ff.