Table 1

Proposed diagnostic criteria for primary and secondary exercise dependence4,8

Primary exercise dependence

  1. Preoccupation with exercise which has become stereotyped and routine

  2. Significant withdrawal symptoms in the absence of exercise (e.g. mood swings, irritability, insomnia)

  3. The preoccupation causes clinically significant distress or impairment in their physical, social, occupational, or other important areas of functioning

  4. The preoccupation with exercise is not better accounted for by another mental disorder (e.g. as a means of losing weight or controlling calorie intake as in an eating disorder)

Secondary exercise dependence

  1. Narrowing of repertoire leading to stereotyped pattern of exercise with a regular schedule once or more daily

  2. Salience with the individual giving increasing priority over other activities to maintaining the pattern of exercise

  3. Increased tolerance to the amount of exercise performed over the years

  4. Withdrawal symptoms related to disorder of mood after cessation of exercise schedule

  5. Relief or avoidance of withdrawal symptoms by further exercise

  6. Subjective awareness of a compulsion to exercise

  7. Rapid reinstatement of the previous pattern of exercise and withdrawal symptoms after a period of abstinence

Associated features

  1. Either the individual continues to exercise despite a serious physical disorder known to be caused, aggravated, or prolonged by exercise and is advised as such by a health professional, or the individual has arguments or difficulties with his/her partner, family, friends, or occupation

  2. Self inflicted loss of weight by dieting as a means towards improving performance