Sociocultural theories of body image propose that different societies have different conceptions of the ideal body shape. Within contemporary Westernized cultures, advertisements, the Internet, and social media networks promote particular assumptions about what constitutes the ‘ideal’ body, and thus exert a strong social pressure to achieve such a body shape. Individuals go to great lengths to achieve and maintain a body image that corresponds to these archetypes of ‘beauty’, which are reinforced as having a superior social value. Such social ideals of beauty are often entirely unrealistic, and can result in body dissatisfaction, appearance anxiety, body image disorder, low self-esteem, and depressive symptoms. Attempts to attain the ideal body can lead to excessive behaviours, such as compulsive exercising, the use of image- and performance-enhancing drugs (IPEDs), and eating disorders. This chapter focuses on excessive exercising and the use of IPEDs, and how these behaviours relate to distress about body image.

One of the most challenging aspects of exercise addiction (EA) is that it is a behaviour that is positively reinforced in the community. Moreover, accompanying non-adaptive eating behaviours make this problem more complicated. Evidence has shown that people with EA are mostly ambivalent and can be resistant to change. Therefore an understanding of individual differences and comorbidity factors may be important when choosing the most appropriate disorder-specific treatment. This chapter presents the case of a 38-year-old woman who exhibited excessive exercise and binge-eating behaviours. In addition to 12 sessions of online cognitive–behavioural therapy, some mindfulness-based techniques were used to elicit emotional awareness in this patient throughout her treatment. At the end of the intervention, her mood was improved, and she began to use more effective ways of coping with negative emotions. This case may also shed light on the importance of limitations and barriers to treatment adherence.

Following the exponential increase in Internet use over recent decades, social networking sites have become a major source of information and inspiration. These networks have a crucial role in defining beauty standards and sharing new trends and ideas, especially among adolescents and young adults. The concept of ‘fitspiration’ (a combination of the words ‘fitness’ and ‘inspiration’) encourages people to engage in physical activity and adopt a healthy lifestyle. This chapter discusses how fitspiration’s emphasis on well-being, having a fit body, and healthy lifestyle has made potentially pathological behaviours, such as dietary restriction, substance misuse, and overexercising, socially acceptable. The potential physical and psychological risks to fitspiration users, including unsupervised supplement intake, body image disturbances, eating disorders, physical and mental burnout, social isolation, and feelings of weakness and worthlessness, are analysed. The need to further elucidate the potentially harmful effects of social network content and develop preventive mental health strategies is highlighted.

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.

In this chapter, Dr Roisin Mooney, an academic researcher and fitness model, interviews James Hollingshead, a professional bodybuilder, about his experiences and perceptions of the bodybuilding industry in relation to exercise addiction. Many people engage in weightlifting and bodybuilding as a hobby, or as part of a healthy lifestyle, and then make the transition to semi-professional or professional status. The popularity of bodybuilding is continually growing, offering an opportunity to combine an activity one is passionate about with a seemingly glamorous lifestyle, company sponsorship, and the opportunity to inspire others. The rise of social media has further increased its appeal, and has the potential to positively reinforce engagement with unhealthy extremes of behaviour. In a fast-paced society, people frequently look for short cuts to professional status, including the use of steroids and/or excessive exercising. Better governance is needed to enable amateur and professional bodybuilders to maintain a balanced and healthy lifestyle.

The potential negative effects of exercise addiction (EA) were first reported over 50 years ago, but it has only recently been formally recognized as a disorder in the leading clinical manuals. The inclusion of exercise behaviour as a potentially addictive behaviour will require greater consensus on how to define this disorder, with diagnostic criteria and course descriptions clearly supported by scientific evidence, and on how to categorize it in relation to other mental disorders. This chapter presents an overview of attempts to identify the defining features of EA, the development of instruments to measure it, estimates of its prevalence, and the main strategies for treating it. The diverse terminology used to describe this disorder reflects both the range of perspectives from which it has been examined, and the different manifestations of EA. The chapter concludes by recognizing that the development and validation of specific diagnostic criteria for EA pose many challenges.

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.

Exercise addiction (AE), which can be defined as engaging in excessive and problematic physical exercise, is still not officially included in the psychiatric nosography, although this disorder can be identified as linked to addictive behaviours. Many different etiopathogenetic hypotheses have been proposed to account for the epidemiological distribution of EA in the general population. However, a clear phenomenological concept of the disorder and shared diagnostic tools are still lacking. It is frequently comorbid with eating disorders and body dysmorphic disorder, which can both trigger EA and develop secondary to it. In recent times it has been proposed that the lockdowns and other restrictions which were imposed during the COVID-19 pandemic could have been possible risk factors for the development or worsening of EA, as physical exercise was widely recommended as a strategy for coping with these restrictions. The initial evidence about the emergence of EA during the COVID-19 pandemic is presented.