Their website offers resources, webinars, and information on body positivity and HAES principles. NEDA is a non-profit organization dedicated to supporting individuals affected by eating disorders. While not solely focused on body positivity, they promote body acceptance and work towards eliminating body image issues.

They offer helplines, resources, and educational materials on eating disorders and body image concerns. The Body Positive is a non-profit organization that empowers individuals to cultivate self-love and a positive body image.

They offer workshops, educational programs, and online resources to promote body acceptance and resilience. Their approach emphasizes self-care, self-compassion, and body neutrality. Be Nourished is a body trust organization that offers workshops, trainings, and resources centered around body acceptance and healing from disordered eating.

They emphasize the importance of body autonomy, intuitive eating, and challenging diet culture. The Center for Mindful Eating is a non-profit organization that promotes mindful eating practices to support a healthy relationship with food and body.

They offer resources, webinars, and professional training to promote a compassionate and non-judgmental approach to eating. The information contained on or provided through this service is intended for general consumer understanding and education and not as a substitute for medical or psychological advice, diagnosis, or treatment.

All information provided on the website is presented as is without any warranty of any kind, and expressly excludes any warranty of merchantability or fitness for a particular purpose.

Need Help - Find A Treatment Program Today. Eating Disorder Helplines The Alliance for Eating Disorders Awareness Helpline The Alliance for Eating Disorders Awareness Helpline offers support and resources for individuals dealing with eating disorders.

Crisis Text Line Crisis Text Line is a confidential support service that provides help and resources to individuals in crisis. Phone: Veterans Crisis Line The Veterans Crisis Line is a confidential support service provided by the U.

Jan Feb Anorexia athletica also known as Exercise Bulimia is a form of an eating disorder where an individual exercises to the point of malnourishment, injury and even death. Anorexia athletica is an eating disorder characterized by excessive and compulsive exercising.

Most common among athletes, anorexia athletica is a mental illness which gives those suffering from it a sense of having control over their body. Commonly, people with the disorder tend to feel they have no control over their lives other than their control of food and exercise. In actuality, they have no control over the mental illness without professional help; they cannot stop exercising or regulating food intake without feeling guilty.

Unlike anorexia nervosa , anorexia athletica does not have as much focus with body image as it does with performance. Scand J Psychol. Article Google Scholar. Andreassen CS, Pallesen S, Griffiths MD. The relationship between addictive use of social media and video games and symptoms of psychiatric disorders: a large-scale cross-sectional study.

Psychol Addict Behav. Apter MJ, Yanko V. The eating attitudes test: psychometric features and clinical correlates. Psychol Med. Buckholdt KE, Parra GR, Anestis MD, Lavender JM, Jobe-Shields LE, Tull MT, Gratz KL.

Emotion regulation difficulties and maladaptive behaviors: examination of deliberate self-harm, disordered eating, and substance misuse in two samples. Cogn Ther Res. Berczik K, Szabó A, Griffiths MD, Kurimay T, Kun B, Urbán R, Demetrovics Z.

Exercise addiction: symptoms, diagnosis, epidemiology, and etiology. Subst Use Misuse. Blasi MD, Giardini A, Colonnello V. Attachment styles and emotion regulation strategies: a systematic review.

J Psychol Psychother Res. Brand R, Rüütel J, Hurst P, Sabiston CM. Exercise addiction and mental health literacy in endurance sport. J Sports Sci. Brennan KA, Clark CL, Shaver PR. Self-report measurement of adult attachment: an integrative overview.

In: Simpson JA, Rholes WS, editors. Attachment theory and close relationships. New York: Guilford Press; Brenning K, Soenens B, Braet C, Bosmans G.

Attachment and depressive symptoms in middle childhood and early adolescence: testing the validity of the emotion regulation model of attachment.

Pers Relat. Brewerton TD, Stellefson EJ, Hibbs N, Hodges EL, Cochrane CE. Characteristics of women runners with a history of bulimia nervosa. Int J Eat Disord.

Brown RIF. Gambling and problem gambling: aetiology, prevalence and treatment. Brumariu LE. Parent-child attachment and emotion regulation. New Dir Child Adolesc Dev. Chen LJ. Exercise addiction and its associated mental health factors among college students in Taiwan.

J Exerc Sci Fit. Chrisman-Miller K. Examining the role of attachment anxiety and attachment avoidance in somatic symptom severity. J Soc Clin Psychol. Coffey KA. Attachment and emotional regulation: theoretical foundations and clinical applications.

J Clin Psychol. Cook BJ, Hausenblas HA, Tuccitto DE, Giacobbi PR Jr, Kubitz KA. Eating disorder examination questionnaire: norms and psychometric properties among female collegiate athletes.

J Sport Exerc Psychol. Cortés-García L, González-Santos J, Salgado-Borges LJ. Exercise addiction: a review. Int J Psychol Psychol Ther.

Davis C, Claridge G, Fox J. Di Lodovico L, Dubertret C, Ameller A. Prevalence of exercise addiction: a systematic review. Psychol Sport Exerc. Driver HS, Taylor SR. Exercise and sleep. Sleep Med Rev.

Estévez A, Jáuregui P, Sánchez-Marcos I, López-González H, Griffiths MD. Attachment and emotion regulation in substance addictions and behavioral addictions.

J Behav Addict. Faber KM, Smit DJ, Brosschot JF, Peeters F. The relationship between eating disorders and anxious attachment: a meta-analysis. Fairbairn CE, Sayette MA, Aalen OO, Frigessi A. Alcohol and emotional contagion: an examination of the spreading of smiles in male and female drinking groups.

Clin Psychol Sci. Feeney JA. Adult attachment and long-term effects of trauma: a review. Attach Hum Dev. Ferraro FR, Taylor R. The impact of COVID on individuals with addictive disorders. Am J Addict. Gardner B, Lally P, Wardle J. Br J Gen Pract. Garner DM, Olmsted MP, Bohr Y, Garfinkel PE.

The Eating Attitudes Test: psychometric features and clinical correlates. Gassó P, Picouto MD, Cristóbal-Narváez P, Pérez-Navarro M. J Child Fam Stud.

George C, West M. The development and preliminary validation of a new measure of adult attachment: the adult attachment projective. George C, Kaplan N, Main M. Adult attachment interview.

Berkeley: University of California; Godoy-Izquierdo D, Ramírez MJ, Díaz I, Lopez-Mora C. A systematic review on exercise addiction and the disordered eating-eating disorders continuum in the competitive sport context.

Int J Ment Heal Addict. Grady MD, Kwapil TR, Pogue-Geile MF. The expression and experience of distress in the offspring of parents with bipolar disorder and parents with major depressive disorder.

J Abnorm Psychol. Hausenblas HA, Symons Downs D. How much is too much? The development and validation of the exercise dependence scale.

Psychol Health. Hazan C, Shaver P. Romantic love conceptualized as an attachment process. J Pers Soc Psychol. Hiebler-Ragger M, Unterrainer HF. Personality, quality of life, and coping among the homeless: a cross-sectional survey.

Int J Environ Res Public Health. Holmberg D, Thorell LB, Gardsjö H. Attachment style and self-reported symptoms of psychological ill health among university students. Huang C, Wang J, Chang Y, Huang Y. Associations among exercise motivation, exercise frequency, and unregulated eating behaviors in young adults.

Eat Behav. Illing V, Tasca GA, Balfour L, Bissada H, Lui W, Ritchie K. Attachment insecurity predicts eating disorder symptoms and treatment outcomes in a clinical sample of women.

J Nerv Ment Dis. Juwono J, Szabo A. Is exercise addiction a myth? J Clin Med. Kaye WH, Fudge JL, Paulus M. New insights into symptoms and neurocircuit function of anorexia nervosa. Nat Rev Neurosci. Kim J, Seo M, David P. Attachment styles and internet addiction in Korean adolescents: the mediating effects of self-esteem and self-regulation.

Comput Hum Behav. Kovacsik R, Griffiths MD, Pontes HM. The psychometric properties of the Online Cognition Scale among individuals with problematic pornography use across four countries.

Kuo PH, Carpenter LL, Lee SA, Smith ME, Bucci M. Attachment styles, emotion regulation, and affective states in daily life. Lally P. How are habits formed: modelling habit formation in the real world.

Eur J Soc Psychol. Lavender JM, Brown TA, Murray SB, Menatti AR, Crow SJ. A preliminary examination of the relationships between eating disorder symptoms and facets of impulsivity in an undergraduate sample.

Psychiatry Res. Lee IM, Shiroma EJ, Lobelo F, Puska P, Blair SN, Katzmarzyk PT, Lancet Physical Activity Series Working Group.

Effect of physical inactivity on major non-communicable diseases worldwide: an analysis of burden of disease and life expectancy. Lichtenstein MB, Christiansen E, Elklit A, Bilenberg N, Støving RK.

Exercise addiction: a study of eating disorder symptoms, quality of life, personality traits and attachment styles.

Lukács A, Pálinkás A, Mayer K, Csosz A, Varga B, Túry F. The relationship among exercise frequency, exercise dependence symptoms, and body image attitudes in Hungarian fitness instructors.

J Exerc Rehabil. McKinney J, Lithwick DJ, Morrison BN, Nazzari H. Investigating the motivations of habitual exercisers. J Sport Health Sci. Mikulincer M, Florian V. The impact of death-risk experiences and religiosity on the fear of personal death: the case of Israeli soldiers in Lebanon.

Omega J Death Dying. Mikulincer M, Orbach I. Attachment styles and repressive defensiveness: the accessibility and architecture of affective memories.

Mikulincer M, Florian V, Tolmacz R. Attachment styles and coping with daily political terrorism. Mikulincer M, Shaver PR, Pereg D. Attachment theory and affect regulation: the dynamics, development, and cognitive consequences of attachment-related strategies. Motiv Emot. Monacis L, de Palo V, Griffiths MD, Sinatra M.

Social networking addiction, attachment style, and validation of the Italian version of the Bergen Social Media Addiction Scale. Muthén LK, Muthén BO. Orzolek-Kronner C.

The effects of exercise on self-esteem and depression in overweight and obese women. J Adv Nurs. Pálfi V, Kovacsik R, Szabo A. Symptoms of exercise addiction in aerobic and anaerobic exercises: beyond the components model of addiction. Addict Behav Rep.

Pels F, Kleinert J. Disordered eating and emotion regulation: a qualitative study exploring the role of alexithymia as a potential moderator. J Eat Disord. Penedo FJ, Dahn JR. Exercise and well-being: a review of mental and physical health benefits associated with physical activity.

Curr Opin Psychiatry. Shaver PR, Mikulincer M. Attachment-related psychodynamics. In: Cassidy J, Shaver PR, editors. Handbook of attachment: theory, research, and clinical applications. Shroff H, et al. Features associated with excessive exercise in women with eating disorders.

Smyth JM. Beyond self-report: using observational, physiological, and behavior measures to gauge love in romantic relationships.

Soc Pers Psychol Compass. Strauman TJ. Self-regulation and depression. Self Identity. Strezhnev A, Lucas C, Sundberg R. Dynamic social network modeling and analysis: workshop summary and papers.

USA: National Academies Press; Suldo SM, Sandberg DA. An investigation of resiliency in the academic and social domains: a longitudinal study of high-risk inner-city adolescents. J Sch Psychol. Szabo A, Griffiths MD, Marcos RDLV, Mervó B, Demetrovics Z. Focus: addiction: methodological and conceptual limitations in exercise addiction research.

Yale J Biol Med. Szabo A, De La Vega R, Ruiz-Barquín R, Rivera O.

When people who struggle with exercise addiction are not able to work out, they may experience anxiety, depression, and other forms of emotional distress. The National Eating Disorders Association NEDA has identified the following as among the many potential health consequences of compulsive exercise :.

Although exercise addiction is not included as an official diagnosis in the DSM-5 , this reference manual does contain multiple references to unhealthy exercise-related behaviors in relation to eating disorders. For example, the DSM-5 identifies excessive exercise as a compensatory behavior among individuals who have developed bulimia nervosa.

In the aftermath of binge-eating episodes, people who have bulimia may exercise excessively in an attempt to prevent weight gain. The DSM-5 also notes that some people who develop anorexia nervosa demonstrate excessive levels of physical activity prior to the onset of the restrictive eating behaviors that are symptomatic of anorexia.

As the DSM-5 notes, body dysmorphic disorder can co-occur with eating disorders. Anyone who struggles with an eating disorder needs effective care from a qualified provider. When an eating disorder is accompanied by a compulsion to exercise excessively, it is vital that the individual receives comprehensive treatment from a provider who can identify and address all the concerns that have been preventing them from living a healthier life.

Every 52 min someone dies from complications due to an eating disorder and As with any new website, we are continuing to refine the content. At the end of the session, there will be a survey. If you have any other questions or comments, email us at office medainc.

Blog Posts. Study Links Eating Disorders, Exercise Addiction by Timberline Knolls Staff. Help Us Save More Lives Every 52 min someone dies from complications due to an eating disorder and Donate Now! EA subjects were more likely to have lower levels of overall wellbeing only in amateur competitive athletes , higher anxiety levels, and have greater frontal brain activity.

Conclusions: EA is prevalent in the absence of indicated eating disorders across populations but varies depending on measurement tool.

Further research is needed to explore EA without indicated eating disorders in different populations using homogenous measurement tools, further determine psychological correlates, and examine which measures of EA without indicated eating disorders predict poor health outcomes.

Abstract Background: Exercise addiction EA can be debilitating and can be a symptom of an eating disorder. Publication types Meta-Analysis Systematic Review.

Prevalence rates differed largely according to eating disorder status, with participants with indicated eating disorders yielding more than double the prevalence rates than those with no indicated eating disorders. These results are broadly in agreement with a recent meta-analysis that showed subjects with indicated eating disorders are over 3.

One potential reason could be because of the recruitment strategy and specific population group; this study used social media as a means of recruitment and was restricted to health club users, which is unique in this area of research.

This is supported by our finding that using social media for social integration and emotional connection was a significant predictor for higher exercise addiction scores. Social media use has been shown to elicit feelings of negative body image Perloff, ; Fardouly and Vartanian, , which has been shown to be associated with exercise addiction.

Social media is an appropriate platform to recruit from, however, primarily due to the number of people who routinely engage in social media. Recent data suggests that 2.

The role of social media's influence in the etiology of exercise addiction warrants further exploration. This study had several limitations. Firstly, due to the cross-sectional nature of the study design, the direction of correlation and therefore causality is impossible to determine.

Further longitudinal analysis is required to determine the direction of the observed correlations. Secondly, it has been reported that the EAI can yield false-positive results in elite athletes Szabo et al.

Further validation of this questionnaire in this sub-population is warranted. Thirdly, the variables accounted for a low percentage of the total variation. Moreover, the sample was restricted to health club users who were recruited via social media, making the generalization of the findings across populations difficult.

Despite these limitations, the large sample size, novelty of measured correlates, and our findings that significant variables of EA vary according to eating disorder status mean that this study adds significant knowledge to the current EA literature.

The key findings from this study suggest a direct link between exercise motivations and EA, especially if the reason for exercising is to modify mood state. It is suggested that exercising to modify mood state, eating disorder status, and BDD status be included in the intolerable life-stress section of the Interactional Model of EA.

Furthermore, this study shows that the etiology of EA differs according to eating disorder status, with variables including social media use, exercise motivation, and ethnicity being uniquely correlated with EA only in populations with indicated eating disorders.

Furthermore, BDD is also highly prevalent in subjects without indicated eating disorders and could be a primary condition in which exercise addiction is a symptom.

It is recommended that clinicians and practitioners working with patients who present with symptoms of EA should be screened for eating disorders and BDD before treatments are considered, as both eating disorders and BDD have considerably higher co-morbid outcomes than EA, and therefore need to be treated as a primary condition.

Furthermore, treatment programs already exist for these two primary conditions and therefore can be implemented easier. The development of screening tools that are able to stratify these populations would be beneficial to both researchers and practitioners.

The datasets generated for this study are available on request to the corresponding author. The studies involving human participants were reviewed and approved by Anglia Ruskin University Sport and Exercise Sciences Departmental Ethics Panel ESPGR MT and LS: study design, data collection, data analysis, and write up.

BS, JF, SJ, and LY: study design, data analysis, and write up. CG: study design and write up. All authors contributed to the article and approved the submitted version. The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Abraham, S. Eating Disorders: The Facts, 7th Edn. Hampshire: Oxford University Press. Google Scholar. Adams, J. Exercise dependence: diagnostic and therapeutic issues for patients in psychotherapy.

doi: CrossRef Full Text Google Scholar. Allegre, B. Health Addict. American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders, 4th Edn.

Washington, DC: American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders DSM-5®. Ashdown-Franks, G. The evidence for physical activity in the management of major mental illnesses: a concise overview to inform busy clinicians' practice and guide policy.

Psychiatry 32, — PubMed Abstract CrossRef Full Text Google Scholar. Becker, A. Ethnicity and differential access to care for eating disorder symptoms.

Brohede, S. Validation of the body dysmorphic disorder questionnaire in a community sample of Swedish women. Psychiatry Res. Brown, R. Eadington and J. Cornelius Nevada: Commercial Gaming, University of Nevada, — Buhlmann, U. The meaning of beauty: implicit and explicit self-esteem and attractiveness beliefs in body dysmorphic disorder.

Anxiety Disord. Cachelin, F. Barriers to treatment for eating disorders among ethnically diverse women. Cash, T. Why do women exercise? Factor analysis and further validation of the reasons for exercise inventory.

Skills 78, — Coffino, J. Mayo Clin. Colledge, F. Responses of fitness center employees to cases of suspected eating disorders or excessive exercise. Conner, M. Gender, sexuality, body image and eating behaviours.

Health Psychol. Costa, S. The role of age, gender, mood states and exercise frequency on exercise dependence.

de Coverley Veale, D. Exercise dependence. Di Lodovico, L. Which sports are more at risk of physical exercise addiction: a systematic review. Doninger, G. Validity evidence for eating attitudes test scores in a sample of female college athletes.

Egorov, A. The exercise paradox: an interactional model for a clearer conceptualization of exercise addiction. Ertl, M. Running on empty: high self-esteem as a risk factor for exercise addiction.

Theory 26, — Facebook Facebook Reports Third Quarter Results. Menlo Park, CA. Fardouly, J. Social media and body image concerns: current research and future directions. Fietz, M. A risk profile of compulsive exercise in adolescents with an eating disorder: a systematic review.

Freimuth, M. Clarifying exercise addiction: differential diagnosis, co-occurring disorders, and phases of addiction. Health 8, — Garber, C. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise.

Sports Exerc. Garner, D. The eating attitudes test: psychometric features and clinical correlates. Grandi, S. Personality characteristics and psychological distress associated with primary exercise dependence: an exploratory study.

Griffiths, M. A cross-cultural re-evaluation of the exercise addiction inventory EAI in five countries. Sports Med. Open Hamer, M. Psychobiological mechanisms of exercise dependence.

Hausenblas, H. How much is too much? The development and validation of the exercise dependence scale. Health 17, — IBM Corp. SPSS for Macintosh Version Chicago, IL. Jenkins-Guarnieri, M. Development and validation of a social media use integration scale. Media Cult.

Jisc Online Surveys Klein, D. CNS Spectr. Kovacsik, R. The role of passion in exercise addiction, exercise volume, and exercise intensity in long-term exercisers. Leuenberger, A. Endorphins, exercise, and addictions: a review of exercise dependence.

Lichtenstein, M. Exercise addiction in crossfit: prevalence and psychometric properties of the exercise addiction inventory.

Little, R. A test of missing completely at random for multivariate data with missing values. Macfarlane, L. Identifying the features of an exercise addiction: a delphi study. Maree, T. The social media use integration scale: toward reliability and validity.

Marques, A. Prevalence of risk for exercise dependence: a systematic review. McNamara, J. Striving for success or addiction?

Exercise dependence among elite Australian athletes. Sports Sci. O'Brien, C. The mosaic of addiction. Psychiatry , — Perloff, R. Social media effects on young women's body image concerns: theoretical perspectives and an agenda for research.

Sex Roles 71, — Phillips, K. The Broken Mirror: Understanding and Treating Body Dysmorphic Disorder. Oxford: Oxford University Press.

Pope, Z. Validity and reliability of eating disorder assessments used with athletes: a review. Sport Health Sci. Powell, K. The scientific foundation for the physical activity guidelines for americans, 2nd edition.

Health 16, 1— Serier, K. Obligatory exercise and coping in treatment-seeking women with poor body image. Weight Disord. Silberstein, L. Behavioral and psychological implications of body dissatisfaction: do men and women differ?

Sex Roles 19, — Symons Downs, D. Exercise Psychology , eds M. Anshel, S. Petruzzello, and E. Labbe Washington, DC: American Psychiatric Association , — EA has been described using different terms such as exercise dependence, compulsive exercise, and obligatory exercise.

For the purposes of this study, we use the term EA as it encompasses both features of dependence and compulsion [ 72 ]. Hausenblas and Symons Downs [ 39 ] developed a set of criteria for EA based on modifications of the Diagnostic and Statistical Manual of Mental Disorders, 4th edition DSM-IV; American Psychiatric Association [ 5 ] , criteria for substance dependence.

These criteria include six symptoms of EA, with the presence of some or all these symptoms indicating a likelihood of having become addicted. The six symptoms are: 1 salience, where exercise becomes the most important thing in people's lives, consuming most of their time and dominating their thinking; 2 mood modification, where exercise is used to facilitate a distinct and consistent change in mood state; 3 tolerance, where individuals require longer and more intense periods of exercise to achieve previously acquired effects; 4 withdrawal symptoms, where unpleasant physiological and psychological effects occur when people cannot maintain their regular level of activity or stop altogether; 5 conflict, where people experience inter- and intrapersonal conflicts because of a high level of engagement in the behavior; and 6 relapse, where addictive patterns of behavior tend to reemerge [ 39 ].

These factors are critical in selecting participants for research examining EA. Previous studies have suggested that exercising at least four times a week i. These criteria ensure that participants have a high level of exercise engagement and are likely to be at greater risk of developing EA, thus enabling researchers to examine the phenomenon more closely.

The relationship between EA and EDs has also been the focus of research. EA symptomatology often co-occurs with symptoms of other disorders, where EDs are most commonly associated with EA [ 11 ].

EDs are mental health conditions characterized by abnormal or disturbed eating behaviors, thoughts, and emotions, which could result in negative physical and psychological consequences [ 6 ].

Various studies have shown that EA is three-and-a-half times more prevalent among people with an ED than among those without an ED [ 75 ]. The co-occurrence of EA and EDs is frequently observed among athletes participating in various types of professional and amateur sports.

In a recent study by Godoy-Izquierdo and colleagues [ 37 ], the need for further quantitative research investigating the characteristics and correlates of this comorbidity was highlighted. One mechanism that may underly the occurrence of both psychological conditions is an insecure attachment IA style, which was previously associated with several other psychological pathologies e.

The IA style has also been linked to EDs, but results were conflicting [ 23 ]. For example, several studies have shown a relationship between attachment styles and EDs [ 19 , 82 ], while others have shown mixed findings [ 62 ] or non-significant relationships [ 71 ]. Moreover, only one study has tested the association between attachment and EA, with no significant results [ 53 ].

Attachment theory suggests that individuals acquire coping mechanisms for negative emotions and distress through their experiences with attachment figures [ 59 ]. Central to this theory is the concept of attachment styles, which encompass an individual's cognitive and emotional perceptions of themselves and others in intimate relationships.

These styles are shaped by repeated interactions with attachment figures and involve security levels, coping strategies for negative experiences, and frameworks for regulating affect and expressing attachment needs [ 2 , 40 ]. As mentioned earlier, IA styles have been identified as correlating with a range of addictions and disorders, including exercise addiction EA and eating disorders EDs [ 21 , 47 ].

A comprehensive meta-analysis of 34 studies revealed that IA precedes the development of substance abuse problems, regardless of the specific psychoactive substance involved [ 29 ]. Furthermore, IA has been associated with behavioral dependencies such as video game addiction and gambling disorder [ 27 ], as well as anxiety and borderline personality disorders [ 15 ].

These connections are believed to be mediated by deficits in emotion regulation, as individuals with IA often employ non-constructive methods to regulate their emotions and underutilize social support [ 29 , 58 ].

Moreover, IA has been found to have a positive correlation with stress, increasing vulnerability to the development of pathological and addictive disorders [ 3 ].

Individuals with IA may exhibit dysfunctional emotion regulation, leading to a greater inclination to rely on maladaptive resources to fulfill their attachment needs [ 7 , 15 ]. These findings align with predisposition models that propose vulnerability factors play a causal role in the development of various psychological pathologies [ 77 ].

Additionally, self-regulation SR theory suggests that deficiencies in emotional self-regulation mechanisms contribute to the increased prevalence of psychological disorders [ 4 ].

Building on the idea of vulnerability factors and SR deficiencies, different types of attachment styles have been identified that may contribute to these issues. Ainsworth and colleagues [ 2 ] originally defined three attachment styles: secure attachment and two insecure attachment styles—anxious and avoidant.

The anxiety dimension reflects the extent to which an individual seeks intimacy with others, whereas the avoidance dimension encompasses a fear of intimacy and difficulty in trusting others.

Individuals with low levels of one or both dimensions are assumed to have an IA style. The two-dimensional model four-categories of adult attachment.

Each one represents different attachment patterns. People implement different SR strategies based on their attachment style [ 19 ]. For example, individuals with avoidant attachment have negative attitudes towards others, mistrust others, and have a propensity for isolation and loneliness.

Consequently, they may suppress or deactivate emotional reactions to interpersonal threats [ 66 ]. In other words, they use maladaptive SR strategies that suppress emotions, repudiate stress, or divert attention away from emotion-eliciting stimuli [ 18 ]. Conversely, individuals with anxious attachment style who crave close relationships may engage in strategies that sustain or even aggravate their distress [ 66 ].

Since these individuals are extremely afraid of rejection, they tend to hold their anger in and re-direct it towards themselves.

This unhealthy SR strategy can trigger feelings of resent towards a partner, as well as self-criticism, sadness, and depression [ 69 ]. Differences in SR strategies may also be related to the use of various substances and maladaptive behaviors to alleviate high levels of stress [ 10 ].

Research has suggested that there is a positive relationship between EDs and anxious attachment. However, results regarding the link between EDs and avoidance attachment have been inconsistent.

For instance, some studies have found a positive association between avoidance attachment and EDs [ 46 ], while others have not found a significant relationship [ 78 ].

In the case of EA, a systematic review examining the relationship between exercise and loneliness, a pivotal component of avoidance attachment, yielded ambiguous results [ 64 ].

While exercise has been found to decrease loneliness, physical inactivity may over time lead to feelings of loneliness. Lukács and colleagues [ 54 ] also found that lonely individuals are more likely to report exercise withdrawal and uncontrolled exercise behaviors.

Furthermore, in a study examining exercise habits based on adult attachment, individuals with an avoidant attachment style reported exercising significantly more frequently and for longer durations than those with an anxious attachment style [ 20 ].

There is some evidence suggesting a positive link between anxious attachment and an increased risk for developing EDs. However, further research is needed to confirm this relationship and to explore the potential association between attachment style and EA.

Given the serious consequences and growing prevalence of these pathologies, it is critical to understand the underlying mechanisms and risk factors. Ongoing investigation into the relationship between attachment style and pathological and addictive disorders is essential for advancing our understanding and improving prevention and treatment efforts.

Based on the available evidence, we hypothesized the following:. To increase the likelihood of sampling individuals with EA, we implemented stricter criteria for exercise duration and frequency.

We used the criterion suggested by Huang and colleagues [ 43 ] of exercising for at least one year as a measure of exercise duration. Research has shown that exercise is a habit that requires significant effort to establish and can take several months to become a routine behavior [ 32 , 50 ].

Regarding exercise frequency, McKinney et al. The first group comprised individuals who engage in at least 2. The World Health Organization WHO recommends a minimum of min of moderate-intensity aerobic activity per week, along with muscle-strengthening activities on at least two days per week.

Our study aimed to identify individuals who engage in even more physical activity than the recommended minimum by selecting recreational exercisers who engage in a minimum of 4 h of exercise per week. Participants were recruited between May and September by the first and second authors of this paper through social media groups e.

Demographics Demographic data were collected age, gender, marital status, income level, and education level. In addition, participants were asked to select their main form of exercise from a list of options running, swimming, biking, triathlon, gym workouts, other , the number of hours they exercised per week, and the length of time they had been exercising regularly 1—2 years, 2—5 years, 5—10 years, more than 10 years.

Participants reported devoting an average of 7. Exercise addiction inventory Exercise addiction was assessed using the Hebrew version of the Exercise Addiction Inventory EAI; Weihrauch [ 81 ]. The EAI, which was developed in [ 74 ] from a theoretical model of behavioral addictions [ 17 ], is a six-item self-report survey.

Participants respond by means of a five-point Likert-type scale. A total score of 24—30 indicates a high risk of addiction. Eating attitudes Eating attitudes were measured using the Hebrew version of the Eating Attitudes Test EAT; [ 9 ], which was designed to screen for ED symptoms [ 33 ].

The EAT contains 26 items that participants answer on a 4-point Likert-type scale. Scores of 20 or higher on this measure indicate a tendency towards maladaptive eating behaviors.

Attachment Adult attachment was evaluated using the Experiences in Close Relationship Scale ECR; [ 14 ]. We used the Israeli version that was translated and validated by Mikulincer and Florian [ 56 ] into Hebrew.

The ECR is a item self-report measure scored on a 7-point Likert type scale. It includes two subscales designed to assess the avoidance 18 items and anxiety 18 items dimensions of adult attachment. Higher scores on the avoidance and anxiety subscales indicate higher levels of attachment anxiety and attachment avoidance, respectively.

The participants completed the questionnaires mentioned above using the Qualtrics platform [ 70 ], which can be accessed via any computer or mobile phone connected to the internet. Once participants' inclusion criteria were verified, the collected data were analyzed using SPSS Statistical Package for Social Sciences, V.

The associations between attachment anxiety and avoidance and ED symptoms and EA symptoms were analyzed using a path analysis in Mplus version 8. Attachment anxiety and avoidance were treated as independent variables predicting ED symptoms and EA symptoms measured using EAT and EAI sum scores, respectively , which were entered into the analysis as two parallel dependent variables.

During the analysis, the error distributions of the dependent variables were examined to check for any violations of assumptions. It was found that there was a slight positive skew in the EAT scores. To address this issue, a log10 transformation was applied to the EAT score, and the analysis was repeated.

The results of the analysis with the transformed EAT scores were consistent with the original analysis. Therefore, the results reported in the study are based on the original EAT scores.

Descriptive statistics and bivariate correlations between the main study variables are provided in Table 1. The variables were positively intercorrelated, with greater attachment anxiety and avoidance related to greater EA and ED symptoms.

A path analysis was specified to examine the unique associations of attachment anxiety and avoidance with ED and EA symptoms. Standardized maximum likelihood estimates for this model are presented see Fig. As predicted, attachment anxiety was positively associated with ED symptoms, but its association with EA symptoms failed to reach significance.

In contrast, attachment avoidance was positively associated with EA symptoms, but not with ED symptoms. Path Analysis model for maximum likelihood estimates for attachment anxiety and avoidance predicting ED and EA.

To examine whether the associations between attachment orientations and each type of symptoms are confounded by the other type of symptoms, we conducted two additional regressions, each one regressing one symptom type on attachment anxiety and avoidance, while controlling for the other symptom type.

As seen in Table 2 , attachment anxiety was positively associated with ED symptoms, even after controlling for EA symptoms.

At the same time, attachment avoidance was positively associated with EA symptoms, even after controlling for ED symptoms. The association between attachment anxiety and EA symptoms, was almost completely nullified once ED symptoms were controlled for.

Controlling for age and gender did not change these results. In sum, the results support our hypotheses, indicating that attachment anxiety is uniquely related to ED symptoms but not to EA symptoms, whereas attachment avoidance is uniquely related to EA symptoms but not to ED symptoms.

In this study, we investigated the relationship between two closely related psychological pathologies, ED and EA, and their independent associations with IA via distinct IA styles. We surveyed individuals meeting the criteria for recreational exercisers and found that an anxious attachment style was linked to ED but not to EA supporting H1 , whereas an avoidant attachment style showed an association with EA supporting H2.

These results have two main implications: firstly, they provide further evidence for the existence of EA as a distinct pathology that is related to but independent of ED [ 37 , 73 ]. Secondly, they suggest that IA dimensions may have different trajectories that can potentially lead to the development of different pathological and addictive disorders [ 41 ].

Regarding the first implication, differentiating between ED and EA has both practical and theoretical inferences. From a practical perspective, the comorbidity of these two psychological pathologies involves the risk that only one problem be treated [ 37 ]. In most cases, ED is treated as it is the better-known of the two disorders and is easier to recognize and identify, potentially neglecting EA and its severe consequences [ 73 ].

Theoretical implications suggest that ED and EA may have different underlying mechanisms despite their frequent co-occurrence. While both are associated with attachment styles and emotion regulation deficits, EA has been linked to difficulties in regulating positive emotions, while EDs are more strongly related to difficulties in regulating negative emotions [ 51 ].

The emphasis on physical appearance in EDs may also be related to issues pertaining to self-esteem and social approval, while the motivation for exercise in EA may be more related to achieving a sense of control and mastery [ 39 ]. These differences highlight the need for different treatment approaches and the importance of distinguishing between the two psychological pathologies.

The second implication is that IA may serve as a significant dispositional risk factor for the development of psychological pathologies, including ED and EA [ 31 ]. Given the cross-sectional nature of our study, causality cannot be inferred, however, it suggests a potential association between IA and these pathologies.

Furthermore, attachment should not only be dichotomized as secure or insecure but should also be evaluated based on the various dimensions of IA. Despite anxiety and avoidance styles having distinct regulation strategies and exhibiting diverse patterns in relation to disorders, they are frequently treated as interchangeable.

Our research findings indicate that an individual's unique rankings on attachment dimensions may give rise to various psychological pathologies and addictions. This highlights the need for further research to explore the specific links between IA styles and different disorders [ 30 , 42 , 57 , 60 , 80 ].

Regarding individuals with an anxious attachment style, our results suggest that they may be more likely to engage in excessive exercise as a means of addressing body-image concerns.

On the other hand, individuals with an avoidant attachment style may exhibit a higher tendency to develop exercise addiction as a coping mechanism for emotional difficulties. However, it is important to note that these interpretations should be made cautiously, considering the limitations of our study and the need for further research to establish the causal nature of these relationships.

The effectiveness of incorporating self-regulation strategies into treatment plans for individuals with IA has been proposed in recent research [ 34 ]. Additionally, cognitive-behavioral therapy CBT has shown promise in modifying maladaptive beliefs and expectations related to attachment in relationships and reducing cognitive and emotional reactivity [ 49 ].

Further research should investigate the efficacy of such treatments specifically for individuals with ED and EA. One major limitation of this study is the restricted sample that was included.

The criteria for participant selection focused on individuals with an exercise history longer than one year, potentially excluding those who engage in intense exercise behaviors within a shorter timeframe but still demonstrate symptoms of EA.

This exclusion of individuals with a shorter exercise history might have led to an underrepresentation of individuals who could potentially score highly for EA. While this limitation does not compromise the validity of the findings within the selected sample, it is important to acknowledge the potential impact on the generalizability of the results.

Future research should consider including a broader range of participants with varying exercise histories to obtain a more comprehensive understanding of the relationship between attachment styles, EA, and EDs.

Additionally, this study relied on self-administered questionnaires, which may have introduced social desirability and recall biases. The evaluation tools used were screening tools with no diagnostic validity [ 7 ].

To address these issues, future studies could incorporate objective measures of attachment styles during physical activity, such as measuring cortisol levels in the hypothalamic—pituitary—adrenal HPA system [ 68 ]. An alternative indirect assessment method is the use of narrative techniques, such as the Adult Attachment Interview AAI [ 36 ], and the Adult Attachment Projective Picture System AAP,[ 35 ].

These narrative interviews emphasize mental representations and could provide insight into unconscious defensive processes, a dimension that is neglected by self-report measures.

Future research should also explore how the type of human interaction in exercise affects EA symptoms [ 25 ]. Previous research has found that endurance sports, such as running and triathlon, have the highest prevalence of EA symptoms [ 25 ].

Moreover, EA symptoms differ among those who participate in team sports and those who exercise individually [ 48 , 73 ]. Therefore, it is crucial for future research to consider these factors to develop a more comprehensive understanding of the relationship between exercise and attachment styles.

Furthermore, in the context of ED, future research should explore the bidirectional relationship between IA and ED. While previous studies have demonstrated a relationship between IA and ED, the nature of this relationship is not yet fully understood [ 8 , 24 ].

Therefore, it would be valuable for future research to investigate the directionality and underlying mechanisms of the relationship between IA and ED. This study contributes to the growing literature on the associations between attachment styles, EDs, and EA. Our findings indicate a positive association between attachment anxiety and ED symptoms, while the association with EA symptoms was not found to be significant.

Conversely, attachment avoidance showed a positive association with EA symptoms but not with ED symptoms. These results suggest a potential link between individuals with an anxious attachment style and a higher likelihood of engaging in excessive exercise to manage body-image concerns.

Similarly, individuals with an avoidant attachment style may be more prone to developing EA as a coping mechanism for emotional difficulties. These findings have practical implications for recognizing dispositional risk factors for EA and ED. Data and materials are available upon request and with permission of Dr.

Dalit Lev Arey at dalitlev mta. Exercise adherence rates. American Council on Exercise. Ainsworth MS, Blehar MC, Waters E, Wall S. Patterns of attachment: a psychological study of the strange situation. New Jersey: Lawrence Erlbaum Associates; Google Scholar.

Stress and addiction: when a robust stress response indicates resiliency. Psychosom Med. Article PubMed PubMed Central Google Scholar. Aldao A, Nolen-Hoeksema S. The influence of context on the implementation of emotional regulation strategies.

Behav Res Ther. Article PubMed Google Scholar. American Psychiatric Association. Diagnostic and statistical manual of mental disorders, text revision DSM-IV-TR. Washington, DC: American psychiatric association; Book Google Scholar.

American Psychiatric Association, D. Diagnostic and statistical manual of mental disorders: DSM-5 Vol. Washington, DC: American psychiatric association. Andreassen CS, Griffiths MD, Hetland J, Pallesen S. Development of a work addiction scale. Scand J Psychol. Article Google Scholar.

Andreassen CS, Pallesen S, Griffiths MD. The relationship between addictive use of social media and video games and symptoms of psychiatric disorders: a large-scale cross-sectional study.

Psychol Addict Behav. Apter MJ, Yanko V. The eating attitudes test: psychometric features and clinical correlates. Psychol Med. Buckholdt KE, Parra GR, Anestis MD, Lavender JM, Jobe-Shields LE, Tull MT, Gratz KL.

Emotion regulation difficulties and maladaptive behaviors: examination of deliberate self-harm, disordered eating, and substance misuse in two samples.

Cogn Ther Res. Berczik K, Szabó A, Griffiths MD, Kurimay T, Kun B, Urbán R, Demetrovics Z. Exercise addiction: symptoms, diagnosis, epidemiology, and etiology.

Subst Use Misuse. Blasi MD, Giardini A, Colonnello V. Attachment styles and emotion regulation strategies: a systematic review. J Psychol Psychother Res. Brand R, Rüütel J, Hurst P, Sabiston CM.

Exercise addiction and mental health literacy in endurance sport. J Sports Sci. Brennan KA, Clark CL, Shaver PR. Self-report measurement of adult attachment: an integrative overview. In: Simpson JA, Rholes WS, editors. Attachment theory and close relationships.

New York: Guilford Press; Brenning K, Soenens B, Braet C, Bosmans G. Attachment and depressive symptoms in middle childhood and early adolescence: testing the validity of the emotion regulation model of attachment. Pers Relat. Brewerton TD, Stellefson EJ, Hibbs N, Hodges EL, Cochrane CE.

Characteristics of women runners with a history of bulimia nervosa. Int J Eat Disord. Brown RIF. Gambling and problem gambling: aetiology, prevalence and treatment. Brumariu LE. Parent-child attachment and emotion regulation. New Dir Child Adolesc Dev.

Chen LJ. Exercise addiction and its associated mental health factors among college students in Taiwan. J Exerc Sci Fit. Chrisman-Miller K. Examining the role of attachment anxiety and attachment avoidance in somatic symptom severity. J Soc Clin Psychol. Coffey KA. Attachment and emotional regulation: theoretical foundations and clinical applications.

J Clin Psychol. Cook BJ, Hausenblas HA, Tuccitto DE, Giacobbi PR Jr, Kubitz KA. Eating disorder examination questionnaire: norms and psychometric properties among female collegiate athletes. J Sport Exerc Psychol. Cortés-García L, González-Santos J, Salgado-Borges LJ. Exercise addiction: a review.

Int J Psychol Psychol Ther. Davis C, Claridge G, Fox J. Di Lodovico L, Dubertret C, Ameller A. Prevalence of exercise addiction: a systematic review.

Psychol Sport Exerc. Driver HS, Taylor SR. Exercise and sleep. Sleep Med Rev. Estévez A, Jáuregui P, Sánchez-Marcos I, López-González H, Griffiths MD. Attachment and emotion regulation in substance addictions and behavioral addictions.

J Behav Addict. Faber KM, Smit DJ, Brosschot JF, Peeters F. The relationship between eating disorders and anxious attachment: a meta-analysis.

Fairbairn CE, Sayette MA, Aalen OO, Frigessi A. Alcohol and emotional contagion: an examination of the spreading of smiles in male and female drinking groups. Clin Psychol Sci. Feeney JA. Adult attachment and long-term effects of trauma: a review.

Attach Hum Dev. Ferraro FR, Taylor R. The impact of COVID on individuals with addictive disorders. Am J Addict.

Gardner B, Lally P, Wardle J. Br J Gen Pract. Garner DM, Olmsted MP, Bohr Y, Garfinkel PE. The Eating Attitudes Test: psychometric features and clinical correlates. Gassó P, Picouto MD, Cristóbal-Narváez P, Pérez-Navarro M. J Child Fam Stud. George C, West M. The development and preliminary validation of a new measure of adult attachment: the adult attachment projective.

George C, Kaplan N, Main M. Adult attachment interview. Berkeley: University of California; Godoy-Izquierdo D, Ramírez MJ, Díaz I, Lopez-Mora C. A systematic review on exercise addiction and the disordered eating-eating disorders continuum in the competitive sport context. Int J Ment Heal Addict.

Grady MD, Kwapil TR, Pogue-Geile MF. The expression and experience of distress in the offspring of parents with bipolar disorder and parents with major depressive disorder.

J Abnorm Psychol. Hausenblas HA, Symons Downs D. How much is too much? The development and validation of the exercise dependence scale. Psychol Health. Hazan C, Shaver P. Romantic love conceptualized as an attachment process. J Pers Soc Psychol. Hiebler-Ragger M, Unterrainer HF. Personality, quality of life, and coping among the homeless: a cross-sectional survey.

Int J Environ Res Public Health. Holmberg D, Thorell LB, Gardsjö H. Attachment style and self-reported symptoms of psychological ill health among university students. Huang C, Wang J, Chang Y, Huang Y. Associations among exercise motivation, exercise frequency, and unregulated eating behaviors in young adults.

Eat Behav.