This chapter begins by discussing the challenges of distinguishing between two very distinct concepts, namely passion and addiction, and goes on to consider some of the reasons why people may exercise. The common features that are shared by neurobiology of exercise and of addiction are then examined. The phenomenon of exercise addiction (EA), which may be regarded as belonging to the cluster of behavioural addictions, is discussed, and a number of different conceptualized models of the development of EA are described. Finally, several possible treatments that are more commonly used for other behavioural addictions are suggested as potentially being suitable for use in the management of EA. The need to focus on prevention strategies is highlighted, as is the importance of promoting a balanced way of life, by focusing on the importance of understanding and shaping the environment in which we live.

We are living in an era in which appearance and body image can become the main focus of thoughts and behaviours, resulting in physical, psychological, and social suffering, about which patients, health professionals, and organizations may or may not have insight. This chapter presents the case of a 32-year-old man with body dysmorphic disorder (BDD) who presented for a psychiatric consultation because he believed that his current psychotropic medication was preventing him from achieving his desired body shape. Exercise had become such an overwhelming preoccupation that it was having negative effects on the other areas of his life, and thus required intervention. Possible etiological and maintenance factors, in particular excessive and dysfunctional exercise behaviours (exercise addiction), were explored. Remission of symptoms only occurred after psychotherapy was included as part of the intervention, demonstrating the positive effects of a treatment plan that combines pharmacology with other therapeutic approaches.

Exercise addiction (EA) is probably the most ‘hidden’ of the behavioural addictions. In a society in which a fit body is normally considered to be a symptom of a healthy lifestyle and success, the assessment and treatment of a maladaptive and health-threatening pattern of exercise may be challenging for healthcare professionals. Furthermore, the lack of guidance and literature on the topic may represent an additional complication on the diagnostic and therapeutic pathway. Although EA is not included in the DSM-5, it is mandatory to inform clinicians about it, as well as other healthcare providers (e.g., psychotherapists, physiotherapists), in order to better identify early signs of such an addiction and prevent injuries or other serious effects on physical or mental health. This chapter provides information on the aetiological basis of EA as well as a compendium of psychological and pharmacological interventions.