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The Body in the Mind. Exercise Addiction, Body Image & the Use of Enhancements Drugs

edited by Ornella Corazza and Artemisia Rocha Dores

28 aprile 2023
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In a society that strives for appearance, fitness is increasingly viewed as a means to reach a certain aesthetic ideal, rather than a way to improve health and physical performance. Every day millions of posts appear on social media promoting a visual representation of apparently fit, healthy and ‘perfect’ bodies.

Combining personal accounts, clinical cases, and scientific research, this book explores how such new trends in society can lead to the development of exercise addiction and body image disorders. It explains how such a concern with physical appearance can act as a precursor or be symptomatic of other conditions, such as eating disorders, mood disorders, and the use of performance and image enhancing drugs. It highlights throughout the importance of raising awareness amongst health professionals, including psychiatrists, psychologists, mental health nurses, social workers and primary care physicians, of this growing challenge to prevent harm and improve treatment.

Ornella Corazza is professor at the Department of Psychology and Cognitive Science of the University of Trento 
Artemisa Rocha Dores,
is a Coordinator Professor of Psychology at the School of Health, Polytechnic of Porto, Portugal.

From Editorial introduction

We live in an image focused society that perpetuates the strive for perfection. Individuals are constantly exposed to pressures regarding appearance, through both the beauty and fitness industry, and social media. In this context, fitness is increasingly viewed as a means to get in shape, look good and reach a certain aesthetic ideal, rather than a way to improve health and performance. “Train. Eat. Sleep. Repeat”, “Don’t stop until you’re proud”, “The pain you feel today will be the strength you feel tomorrow”, “No pain, no gain” are only a few examples of ‘fitspirational’ quotes that are used to inspire a healthy lifestyle through exercise.

In parallel, technological development has brought a new set of values, behaviours and means for sharing advice on products, specialist diets and other techniques designed to enhance physical appearance. Everyday millions of texts and selfies are posted on social media, promoting a visual representation of ostensibly fit and healthy bodies. This context of ‘aesthetic idealisation’ constitutes a fertile ground for the development of exercise addiction alongside other disorders, such as Body Dysmorphic Disorder (BDD), Eating Disorders (ED), and related psychopathologies.

            Through a combination of personal accounts, clinical cases and exploration of the dominant scientific explanations, we present in this book a contemporary perspective on exercise addiction, one designed to shed new light on these rapidly emerging trends in society, which are strongly interlinked with the desire to appear and to have a ‘perfect’ body. We prioritise here the identification and analysis of behaviours of those at risk of addiction, who rarely come to the attention of health professionals, in part because they don’t consider themselves ‘addicted’ in a traditional sense and additionally due to the normalisation of their behaviour by society. Often, if care is sought, primary care doctors, or fitness coaches and others are consulted, as opposed to psychiatrists or psychologists. 

In this book, we explore how such a concern with physical appearance could act as a precursor to, or be symptomatic of not only exercise addiction, but also of other underlying and potentially underdiagnosed clinical conditions and mood disorders, as well as the use of Image and Performance Enhancing Drugs (IPEDs), with potentially damaging consequences for health and wellbeing. The term ‘IPED’ is intended here as an umbrella term, including a wide new range of drugs that can alter the functions of the body and enhance muscle growth, reduce body fat and promote weight loss (Bates & McVeigh, 2016; Corazza et al 2019). Although IPEDs have been in circulation for some years, particularly Anabolic Androgenic Steroid (AAS) which are often used among athletes and body builders (Evans‐Brown et al 2012), their availability on the Internet has made their consumption even more diffuse in society (Coomber et al., 2014). Often advertised via social media platforms as “natural” “healthier”, and “safer” alternatives to medicines, IPEDs attract the attention of vulnerable individuals attempting to enhance their bodies more quickly than can be naturally achieved, in order to look stronger, younger, and more beautiful. Driven by the false perception that natural equals healthy might be unaware that some ingredients (listed or otherwise) could contain undisclosed biologically active ingredients, they might expose themselves to various health risks, such as allergic reactions, liver damage, mercury poisoning, brain damage and sometimes death. Vulnerable individuals, especially those who are unhappy with their bodies or abilities, are prime customers for such substances, and their hazardous behaviour might be symptomatic of BDD, characterised by distressing and disabling preoccupation with perceived appearance flaws that are not observable to others, and other psychopathologies, such as exercise addiction and poor mental health (Veale et al, 2016).

            While addressing major knowledge gaps, this book identifies and facilitates the development of future interventions in the field, in order to improve the mental health and the wellbeing of those affected and their families. It is designed primarily for clinicians, researchers, practitioners and graduate students with an interest in the fields of addiction, body-image and substance misuse, in order to aid the better understanding of the conceptual underpinnings, aetiologies, prevention methods and treatments available. This book presents an unprecedented collection of case studies of those who are most affected, including frequent exercisers, psychiatric patients, and subjects with eating disorders. By highlighting their patterns of consumption, and underlying psychopathological conditions, we aim to facilitate a better understanding of the underlying risks, whilst contributing to the improvement of the clinical practice, and encouraging innovative prevention responses on behaviours where the boundaries between normal and pathological behaviors are hard to define. For each contribution, we also include references to the latest scientific literature in terms of typical symptoms, classifications, aetiology and assessment, making this book a valuable resource for the professional development of those involved in medical research, sport psychology, health promotion, public health, social work and health education.

For clarity reasons, the book has been divided into three core Parts.

Part One, From exercise to addiction: an introduction to the phenomenon, hosts a variety of chapters on the ‘dark’ side of exercise. Although physical exercise has a variety of well-recognised health benefits (e.g. enhanced quality of life, body functioning, muscular strength and endurance, decreased fatigue, and lower incidence of cardiovascular disease, Type 2 Diabetes and risk of depression), this Part explores how exercise can also became an addiction. While reflecting on the underlying neurobiological mechanism, it explains how the emergence of problematic exercising is strongly linked to other behavioural addictions (e.g. pathological gambling, compulsive shopping, and Internet and social media addiction). It highlights how such potentially highly addictive behaviours have not yet been covered in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which at present only includes gambling as a ‘Non-Substance-Related Disorder’. It argues that a new DSM-5 classification would reflect the increasing interest around this topic and the shift towards a new perspective in which the presence of a psychoactive substance is not a prerequisite to addictive disorders.

The second Part, Reaching the extreme with exercise: A collection of clinical case studies, contains chapters devoted to presenting clinical case studies of people affected by exercise addiction. It emphasises the previously unexplored links with other psychopathologies, such as BDD and EDs as well as the use of IPEDs to improve physical appearance and/or boost performance in a faster way, and the often-unknown undelaying risks associated with these behaviours (e.g. contamination, safety, injuries). The case studies are written by leading authorities in the field of behavioural addiction and front-line clinicians.

Part three, Exploring the motivations behind exercise addiction, presents a selected number of personal accounts of people who have been actively involved in the sporting environment, and have agreed to share their views and experiences on problematic exercise. Their testimonies provide a unique subjective perspective which will help to shed new lights on the personal motivations behind compulsive exercising, as well as a deeper understanding of the boundaries between positive and problematic aspects of exercise, which are often hard to define.

We strongly believe that this book is a prime example of effective collaboration amongst individuals from a variety of disciplines and perspectives, who decided to dedicate their time to collectively address these complex issues, during a globally challenging time for humanity, the Covid-19 pandemic.

We hope you will find it a useful and informative resource. Healthy bodies and minds really do matter to us, so let us do our best to benefit society, and improve lives.

Courtesy by Cambridge University Press