Compulsive Exercise and Muscle Dysmorphia

An ongoing study hopes to point to better guidelines for treatment.


In the past, many people with EDs were advised to avoid exercise. This abstinence approach could be viewed as analogous to the common approach used in substance use disorder treatment. Recently there seems to be more interest in including physical activity and healthy exercise as a normal part of ED treatment.

Dr. Jordan Andre Martenstyn, of the University of Sydney and his colleagues are conducting a systematic review of this. Compulsive exercise generally refers to a highly driven, rigid urge to exercise, combined with a perception that one is unable to stop exercising despite knowing its risks. Among ED patients, the risk of compulsive exercise ranges anywhere from 17% to 85% in teens and 32% to 80% in adults (Comp Psychiatry. 2008. 49:346). Unhealthy exercise is also a core feature of muscle dysmorphia, a condition where a person has an intense fear that he or she is not big enough or is not more muscular than the average person. Body builders call this bigorexia.

For people with EDs, unhealthy exercise can lead to a poorer prognosis, lower quality of life, longer hospitalizations, greater risk of suicidal behavior, and increased risk of relapse (Psychol Med. 2004. 34:671). Despite the poor prognosis, the authors note, there is no clear definition of “excessive exercise” paired with an ED.

Guidelines for safe exercise are needed.

Information is sorely needed on many questions. Current practice advocates introducing safe exercise into an ED treatment program where appropriate (J Eat Disord.2018. 6:34). Although many studies have outlined treatment interventions for compulsive exercise among ED patients, the authors note that no systematic review has yet summarized this, and thus guidelines are urgently needed. The authors’ review includes studies that sample teens, defined as older than 10 years of age and/or adult participants of both sexes diagnosed with either an ED or muscle dysmorphia.

Another study goal is to note changes in compulsive exercise from pre- to post-intervention. The authors included only studies that measure compulsive exercise using standardized tests, such as the Compulsive Exercise Test (Eur Eat Disor Rev. 2011. 19:256), the Exercise Addiction Inventory (Br J Sports Med. 2005. 39:e30). or the Obligatory Exercise Questionnaire (Eat Disord. 1999. 7:219). Moreover, even the best definitions of unhealthy exercise, as well as the relationship between compulsive exercise and body dysmorphia, remain unclear.

The authors hope that the review will shed light on these questions regarding compulsive exercise in EDs and muscle dysmorphia.

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