Table 3

New diagnostic criteria for secondary exercise dependence

*Exercise is unreasonably salient and/or stereotyped even when considered in appropriate context—e.g. individual is a competitive athlete.
†If individual had not abstained from exercise, or would refuse to do so, rate withdrawal according to anticipated response.
‡For a diagnosis of primary exercise dependence, all criteria may be the same as for secondary exercise dependence except for the absence, rather than presence, of an eating disorder.
The following three criteria are necessary for a diagnosis of secondary exercise dependence:
  1. Impaired functioning*

    The individual shows evidence of impaired functioning in at least two of the following areas:

    1. Psychological—e.g. ruminations or intrusive thoughts about exercise, salience of thoughts about exercise, anxiety, or depression

    2. Social and occupational—e.g. salience of exercising above all social activities, inability to work

    3. Physical—e.g. exercising causes or aggravates health or injury yet continues to exercise when medically contraindicated

    4. Behavioural—e.g. stereotyped and inflexible behaviour

  2. Withdrawal

    The individual shows evidence of one or more of the following:

    1. 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†

    2. Persistent desire and/or unsuccessful efforts to control or reduce exercise

  3. Presence of an eating disorder‡

    Associated features

    The following features are indicative but not definitive:

    1. Tolerance—i.e. increasing volumes of exercising required

    2. High volumes of exercising and/or exercising at least once daily

    3. Solitary exercising

    4. Deception—e.g. lying about exercise volume, exercising in secret

    5. Insight—e.g. denial that exercising is a problem