What gym addiction says of self-esteem

Q “What is the best therapy of fighting addiction to fitness and physical workouts in the gym? I feel I am overdoing it and it even eats up my quality time with family?”

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The generally recommended level of physical exercise for an adult is about five hours of mild to moderate exercise a week or half that for more intense exercise.

This number is an approximation and must not be taken as the only guide to exercise. Secondly, and to get some facts out of the way, it is indeed possible to get addicted to exercise in part because training leads to release of hormones called endorphins that gives one the high one gets after ‘a good round of exercise’.

These hormones are similar to the drug morphine but are released by the body.

Again, and in the spirit of getting the boring facts out of the way, addiction can be defined generally as ‘the fact or condition of being addicted to a particular substance or activity’. The technical definition is more rigorous and recognises addiction as a brain disease that manifests as compulsive use of substances in a way that leads to harm and an inability to stop in spite of the harm done. There is also the increased use of the substance, called tolerance. To a lay person, this boring story is summarised by the four C’s of addiction. Compulsion, Craving, Consequences (bad or harmful) and Control (loss of).

So, the simple answer to your question is yes, one can become addicted to physical exercise when he has the compulsion to do so, has a craving for it, suffers the consequences, for example injury and loses control of the need to stop. (As in your case where you neglect the family).

Addiction to all manner of drugs is well understood and alcohol and drugs abuse are common reasons for this type of discussion in lay circles.

Less known are addictions that are due to certain types of behaviour. Some years ago, celebrated then number one golfer Tiger Woods was reported to have gone to a clinic in the USA for the treatment of addiction to sex.

Whether the diagnosis was correct in the technical sense or not, it raised the profile of this condition to a new level and in particular the conversation about compulsive sexual behaviour.

The term (compulsive) has been in use in the various classification systems for many years. In this regard, and perhaps to give a glimpse of what the future holds, the latest classification of diseases released recently, does include excessive gambling as a disorder of the mind!

The point that we are making here is that medical classification systems are dynamic and respond to changing evidence and your compulsion to physical exercise could one day qualify as a formal disorder. Now time for two stories.

A few years ago we published a paper on a study that compared Kenyan female elite runners and British female elite athletes. We were able to show that Kenyan girls did not show features of Anorexia nervosa (an eating disorder characterised by the desire to be thin), while many British girls who were elite runners had feature of the condition.

It was postulated that some girls run long distances to lose weight in the context of AN. Indeed, it is a well-known fact that people with diseases of body image sometimes do get to do too much exercise. Men with low self-esteem spend many hours trying to achieve the perfect body shape.

Similarly, teenage boys who have body image issues could also be involved in too much physical activity such as body building to increase body mass in the context of low self-esteem sometimes associated with depression.

Many years ago, we saw a man whose right arm was much bigger than his left. The explanation was easy. He was right handed and played squash for an hour twice daily. He was physically as fit as any man we had examined, but emotionally he was as fragile as an eggshell.

He cried easily, slept badly and was sad most of the time. The only time he felt a little better was after a game of squash, and as he put it, after hitting that black ball against the wall as hard as he could.

In therapy, it became clear that he would also have liked to smash the head of his wife in the same way against the wall, but feared the consequences.

Since he found her in bed with the shamba man a few years earlier, he had become the best squash player in his group. For at least two hours a day he smashed the ball (her head) and felt better in the process.

This revelation led to couple therapy which ended in the mutual decision to dissolve the marriage. Both later found happiness apart.