The following three criteria are necessary for a diagnosis of secondary exercise dependence: |
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Impaired functioning*
The individual shows evidence of impaired functioning in at least two of the following areas:
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Psychological—e.g. ruminations or intrusive thoughts about exercise, salience of thoughts about exercise, anxiety, or depression
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Social and occupational—e.g. salience of exercising above all social activities, inability to work
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Physical—e.g. exercising causes or aggravates health or injury yet continues to exercise when medically contraindicated
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Behavioural—e.g. stereotyped and inflexible behaviour
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Withdrawal
The individual shows evidence of one or more of the following:
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Clinically significant adverse response to a change or interruption of exercise habits. Response may be physical, psychological, social, or behavioural, e.g. severe anxiety or depression, social withdrawal, self harm†
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Persistent desire and/or unsuccessful efforts to control or reduce exercise
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Presence of an eating disorder‡
Associated features
The following features are indicative but not definitive:
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Tolerance—i.e. increasing volumes of exercising required
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High volumes of exercising and/or exercising at least once daily
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Solitary exercising
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Deception—e.g. lying about exercise volume, exercising in secret
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Insight—e.g. denial that exercising is a problem
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