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March 2017
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Sport is known and promoted as a natural way to stay healthy in terms of both the prevention and treatment of physical, psychological and social problems, but it can also become a obsession which is harmful for our health, as is shown by many examples of what is called, although sometimes incorrectly, an addiction to sport.

From sport mania to addiction to sport

When we talk about addiction to sport or, as this syndrome is often defined in American terms, an addiction to physical exercise, we are referring to a condition which does not necessarily involve a quantitative abuse of sporting practice, but rather symptoms which are similar to those typical of other addictions.
The first phase of understanding this phenomenon is not using common terms which are designed to be used in any situation in which people practice sport excessively, thus taking on a purely quantitative meaning. From the point of view of assessing the problem, the first attempts to deal with this problem were made in sports medicine from a physiological perspective.
In this context, addiction to sport was defined as ‘overtraining syndrome’, that is a physiological condition of imbalance which derives from intense, physical effort when it is carried out too often, thus there is no time for energetic or neurobiological recovery, nor the possibility to recover from the strain by recharging physically and psychologically.
A similar view point is that that exclusively considers behavioural measures, defining, for example, running programmes carried out for 5 days a week, or a minimum of 15 hours a week,  as ‘addictive corridors’, taking on a sort of ‘time trial’ diagnosis.
‘Sport mania’, which is another term used incorrectly as a synonym for ‘sport addiction’, is an excessive behavioural tendency which causes an imbalance in one’s relationship with sport and which does not always manifest itself in the symptoms common to addictions. Sport mania can evolve into prolonged abuse of sporting activities and cause over-reaching, that is, a subtle form of overtraining which can require a resting period of a few weeks for psycho-physical rest, or even bring on a more stabile state of overtraining which requires months of rest as well as a daily, physical correctional programme. 
However, sport dependency, or sport addiction, is not always a quantitative problem and does not simply involve the abuse of sport. It does not necessarily cause overtraining either, because the constant practising of sport does not always result in an exhausting activity and, above all, it is connoted by some distinctive, psychological characteristics. The frequency of training does not represent a good diagnostic measure since it does not provide any information about the important motivational, attitudinal and emotional differences which have allowed us to distinguish between three types of people who turn to to sport in an unbalanced and sometimes manic and intense way. The first category, called ‘obsessive sportsmen’, is represented by so called ‘healthy neurotics’, or more precisely, those who get a positive improvement from practising sport which is accompanied by a sense of wellbeing, realisation and success. Others are a part of the group called ‘compulsive sportsmen’ for whom physical activity is a way to maintain a precise routine which gives them a sense of control and moral superiority. The last group is made up of ‘addicted sportsmen’ for whom sporting activities play a role of regulating their mood and internal imbalances and for whom sports ever increasingly dominate their entire lives.
It is only those suffering from this last condition who are truly addicted to sport, defined as a primary addiction if independent from other illnesses, or secondary when it is associated with symptoms of underlying food illnesses, for which physical exercise plays a fundamental role in the attempt to control bodyweight and body image.

Characteristic traits of an ‘addiction to sport’

Research has allowed us to identify the main psychological characteristics which indicate an addiction to sport thanks to analyses of narratives made by sportsmen and women suffering from this problem. The results supplement and confirm the valid, traditional and diagnostic criteria for addictions according to the Diagnostic and Statistical Manual of Mental Disorders. In precise terms, four general features can be seen which are indicators of an addiction to physical exercise (table 1). Addicts do not have to show signs of all the symptoms though, since some features represent traits which are not always active in every sport addict. 

  1. Impaired functioning (in at least two of the following areas):
    - Psychological
    Example: unable to concentrate on an activity because of recurring thoughts of physical exercise
    - Social or professional
    Example: social, family or professional problems connected to practising sport
    - Physical
    Example: overtraining or training in spite of injuries or against medical advice
    - Behavioural
    Example: inflexible sporting conduct, stereotyped or aiming for self-punishment
  2. Withdrawal symptoms:
    Example: persistent desire and unsuccessful attempts to control or reduce the amount of physical activity practised. Physically and psychologically uncomfortable since reducing or stopping training habits
  3. Psychological and behavioural characteristics typical of addicted individuals: 
    - Tolerance (gradual increase in the amount of physical exercise done)
    - excessive physical activity
    training alone – self-deception (lying so as to do exercise)
    - obsessive motivations which guide sporting activities (for example, for performance, to control their mood/tiredness, for self-esteem, for weight control, to control body image)
  4. Food disorders (anorexia, bulimia) or controlling food intake (diets and consumption of food supplements).

It should be emphasised that there is often a frequent presence of anorexia and bulimia nervosa associated with addictions to sport and these disorders are fed by the same weight control and body image motivations which are the foundations of sport addiction, especially in women. For men, motivations regarding sport addictions are related to controlling body image and these motivations often cause so called ‘inverse anorexia’, or in other words, a pathological fear, typical of body builders, of becoming to thin, weak and underdeveloped in terms of their muscles. What does appear to be quite common is exercising extreme control over food and suffering from an addiction to sport. 

Sport as a drug for the brain

Many studies have attempted to establish which neurobiological mechanisms are involved in transforming sport into a drug which can help us (in the right doses) to get over chronic, psychological problems, such as anxiety and depression, but which can also become a drug that is able to produce pleasure, as well as actual physical withdrawal symptoms. What seems clear is that sport has the ability to activate the availability of dopamine and so called ‘beta-endorphins’, which are endogenous, chemical substances of the brain which have a similar effect to exogenous opioids, like heroin and morphine. The conclusion, therefore, is that sport, and especially aerobic exercise, can activate an addiction because of their ability to produce a lot of these substances, and when they are no longer available, the brain registers this absence resulting in withdrawal symptoms.

Qualitative treatment

In light of the description of the qualitative characteristics which distinguish addictions to sport, it is important to understand that there are psychological components which tend to foster this kind of problem. Consequently, interrupting sporting activity does not necessarily mean recovery from the problem and the underlying psychological causes of the addiction must be studied and resolved, sometimes with professional help, so they do not turn into other symptoms. It is also not unheard of that a superficial attempt to interrupt an addiction to sport by an anorexia sufferer, who uses sport to control his/her body weight, can aggravate problems related to food. It is precisely for this reason that qualitative treatment must be aimed at making the addict realise (again) the importance the body has and this is done by helping the recovering addict to find a good rhythm and understand his/her body’s capabilities through a recovery programme which uses sport in a pure sense, that is, one that allows the individual to find a good internal and external (regarding his/her body image) balance once again. 

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