The emergence of Exercise Addiction, Body Dysmorphic Disorder, and other image-related psychopathological correlates in fitness settings: A cross sectional study

Profiling and assessing the risks of image- and performance-enhancing drugs use during the COVID-19 lockdown

Background

Image and Performance-Enhancing Drugs (IPEDs) can enhance mental and physical capabilities and impact one's overall health. Initially confined in sport environments, IPEDs use has become increasingly widespread in a high-performing society. The present study was aimed at profiling IPEDs use during the COVID-19 lockdown among an international sample of young adults.

Methods

A cross-sectional observational study was carried out in eight countries (United Kingdom, Italy, Lithuania, Hungary, Portugal, Spain, Brazil, and Japan) between April and May 2020. The survey questionnaire included validated measurements such as Exercise Addiction Inventory (EAI), Appearance Anxiety Inventory (AAI), and Self-Compassion Scale (SCS) as well as questions about the type of IPEDs, purchasing methods and socio-demographic information.

Results

A total of 736 IPEDs users were included in the survey. Their mean age was 33.05 years (±SD = 10.06), and 64.2% were female participants. Overall, 6.8% were found at risk of exercise addiction (EAI >24), 27.6% presented high levels of appearance anxiety, and 24.9% revealed low levels of emotional regulation's self-compassion. Most participants (55.6%) purchased IPEDs through pharmacies/specialized shops, while 41.3% purchased IPEDs on the Internet. Online IPEDs buyers were mainly men who had higher scores on the Exercise Addiction Inventory. One or more IPEDs classifiable as "potentially risky" were used by 66.3% of the sample. Users of "potentially risky IPEDs" were younger and primarily men. They showed higher scores both on the Exercise Addiction Inventory and Appearance Anxiety Inventory.

Conclusion

This study profiled users of IPEDs when the most restrictive COVID-19 lockdown policies were implemented in all the participating countries. More targeted post-COVID 19 prevention strategies should be implemented according to the emerged socio-demographic and psychopathological traits and cross-cultural differences emerged. Longitudinal studies will also be needed to determine the long-term effect of the COVID-19 lockdown on IPEDs consumption.

Factors associated with the use of benzodiazepine and opioid prescription drug in the student population: a cross-sectional study

The misuse of benzodiazepines and opioid medications is frequent in students. To improve our understanding of this behavior, we aimed to identify factors associated with separate and concomitant use of these substances. Anonymous self-reported questionnaires were e-mailed to students enrolled at a French university between March and July 2021, covering: sociodemographic characteristics, academics, psychoactive substance use, ADHD symptomatology (adulthood and childhood), and psychiatric/psychological or addiction follow-up. Factors associated with the use of benzodiazepines and opioid medications included female sex (OR = 1.41 [1.08; 1.86]) and OR = 1.38 [1.06; 1.79], respectively), older age (OR = 1.65 [1.04; 2.6] and OR = 2.17 [1.4; 3.36], respectively), current psychiatric/psychological follow-up (OR = 6.53 [5.18; 8.24] and OR= 1.5 [1.12; 2.0], respectively), ADHD symptomatology (OR= 2.33 [1.71;3.16] and OR= 1.61 [1.15; 2.24], respectively), polyconsumption (tobacco use for benzodiazepine users, OR = 1.38 [1.04; 1.82]; alcohol use OR = 1.67 [1.17; 2.39] and tobacco use OR = 1.62 [1.23; 2.14] for opioid users). These factors were even more strongly associated with the concomitant use of benzodiazepines and opioid medications: older age (OR = 3.64 [2.22; 5.99]), female sex (OR = 1.54 [1.1; 2.14]), grade repetition (OR = 1.7 [1.14; 2.54]), psychiatric/psychological follow-up (OR = 4.51 [3.35;6.06]), ADHD symptomatology (OR = 5.3 [3.69; 7.63]), polyconsumption (tobacco use OR = 2.05 [1.39; 3] and cannabis use, OR = 2.07 [1.97; 4.16]. The factors associated with the use of benzodiazepines and prescription opioids identified in this study could lead to the development of targeted prevention methods.

Effect of Social Media on Diet, Lifestyle, and Performance of Athletes: A Review of Current Evidence

PURPOSE OF REVIEW

Social media (SM) plays an important role in providing diet and health advice to athletes, but it also carries with it a risk of credibility in the information sought for and received. The objective of this review is to assess the knowledge gap on how SM influences dietary and lifestyle practices in athletes.

RECENT FINDINGS

For this, relevant literature was searched in three leading databases with appropriate keywords, which were subjected to proper scrutiny that led to inclusion of 22 articles (original research papers, reviews, viewpoints, and commentaries). The current era of digitalization has seen an over-reliance on internet and SM for nutrition and lifestyle advice for an athlete. SM has become a powerful tool in athlete's choice of food, nutrition information, healthy living, and performance, with merits and demerits. Their role in choosing dietary supplements and particular food types (e.g., ketogenic diet), body image, self-esteem and eating disorders, and in lifestyle and performance are discussed. SM should be used with caution and should not be used alone as a source of information for nutrition related pieces of advise by athletes. Any food type and supplements trending in SM should be discussed with a sports nutritionist before consumption. SM influencers having a big follower base may not always be disseminating the right knowledge on food and nutrition, thus caution should be exercised. For optimal benefit to the athlete, SM information should be in alignment with recommendations provided by sports nutrition and coaches.

Exercise Addiction and Intimate Partner Violence: The Role of Impulsivity, Self-Esteem, and Emotional Dependence

Given the scarcity of studies linking exercise addiction to intimate partner violence, the present study aims to analyze the relationship between these variables and examine the potential mediating roles of emotional dependence, impulsivity, and self-esteem. This is a non-experimental, cross-sectional correlational design study. The sample comprised 887 university students (86% women, mean age 20.82 years, SD = 3.63). Elevated levels of exercise addiction were associated with increased impulsivity, emotional dependence, and exerted violence, as well as decreased self-esteem and perceived violence. Mediation models were tested, explaining 7% of the variance in received violence, 13% of the variance in exerted violence, and 6% of the variance in perceived violence. Higher levels of exercise addiction were linked to increased received and exerted violence and decreased perceived violence, attributed to the positive impact of exercise addiction on emotional dependence. This study highlights the mediating roles of self-esteem and impulsivity in the relationship between exercise addiction and partner violence. Identifying risk or vulnerability factors such as emotional dependence, impulsivity, and self-esteem related to exercise addiction and interpersonal partner violence is especially relevant for designing and implementing preventive interventions in the general young population.

Exploring the association between suicidal thoughts, self-injury, and GLP-1 receptor agonists in weight loss treatments: Insights from pharmacovigilance measures and unmasking analysis

INTRODUCTION

The study addresses concerns about potential psychiatric side effects of Glucagon-like peptide-1 receptor agonists (GLP-1 RA).

AIM

The aim of this work was to analyse adverse drug reports (ADRs) from the Food and Drug Administration Adverse Events Reporting System (FAERS) using metformin and orlistat as comparators.

METHODS

Descriptive and pharmacovigilance disproportionality analyses was performed.

RESULTS

A total of 209,354 ADRs were reported, including 59,300 serious cases. Of those, a total of 5378 psychiatric disorder cases, including 383 'serious' cases related to selected ADRs were registered during 2005-2023. After unmasking, 271 cases where individual GLP-1 RA were implicated showing liraglutide (n = 90; Reported Odds Ratio (ROR) = 1.64), exenatide (n = 67; ROR = 0.80), semaglutide (n = 61; ROR = 2.03), dulaglutide (n = 45; ROR = 0.84), tirzepatide (n = 5; ROR = 1.76) and albiglutide (n = 2; ROR = 0.04). A greater association between these ADRs with metformin was observed, but not orlistat. With regards to selected preferred terms (PTs), 42 deaths including 13 completed suicides were recorded. Suicidal ideation was recorded in n = 236 cases for 6/7 GLP-1 RA (excluding lixisenatide).

DISCUSSION

Suicide/self-injury reports pertaining to semaglutide; tirzepatide; and liraglutide were characterised, although lower than metformin. It is postulated that rapid weight loss achieved with GLP-1 RA can trigger significant emotional, biological, and psychological responses, hence possibly impacting on suicidal and self-injurious ideations.

CONCLUSIONS

With the current pharmacovigilance approach, no causality link between suicidal ideation and use of any GLP-1 RA can be inferred. There is a need for further research and vigilance in GLP-1 RA prescribing, particularly in patients with co-existing psychiatric disorders.

Performance-enhancing substances in sport: A scientometric review of 75 years of research

The use of performance-enhancing substances not only undermines the core values of sports but also poses significant health risks to athletes. In a fast-evolving doping environment, where sport professionals are constantly seeking novel and illegal means to bypass doping tests, and new substances are regularly detected on the drug market, it is crucial to inform authorities with updated evidence emerging from scientific research. The current study aims to (i) outline the structure of knowledge in the literature on performance enhancers in sports (i.e., most active countries, main sources, most productive authors, and most frequently used keywords); (ii) identify the most impactful documents in the field; and (iii) uncover the main domains of research in the literature. To do so, we conducted a comprehensive scientometric analysis of the literature on doping, sourcing our data from Scopus. Our research involved a document co-citation analysis of 193,076 references, leading to the identification of the 51 most influential documents and seven key thematic areas within the doping literature. Our results indicate that the scientific community has extensively studied the most prevalent doping classes, such as anabolic agents and peptide hormones, and little is still known about the use of contaminated supplements or other types of enhancers identified as emergent trends. Concurrently, technological advancements contributed to the development of more sophisticated doping detection techniques, using blood or urine samples. More recently, the focus has shifted towards the athlete biological passport, with research efforts aimed at identifying biomarkers indicative of doping. The dynamic nature of doping methods underlines the necessity for more robust educational campaigns, aiming at raising awareness among sports professionals and their entourage about the dangers of doping and the intricacies of its control mechanisms.

Family Functioning Styles and Exercise Addiction: Disengaged, Enmeshed, and Rigid Family Patterns Are Associated with Exercise Addiction

Physical exercise is a widely recommended practice for promoting health, but for some individuals, this activity can result in pathological and morbid behaviour. Therefore, the study of the factors contributing to the onset, development, and progression of exercise addiction is particularly relevant. Within this framework, the present study assessed the effect of family functioning, body image concerns, age, and gender on exercise addiction. A sample of 300 regular exercisers (Mage = 30.3 years, SD = 11.6; 69.7% females, 30.3% males) participated in the study and completed the Family Adaptability and Cohesion Evaluation Scales-IV, Body Image Concern Inventory, and Exercise Addiction Inventory. Data were analysed by implementing a series of moderated moderated-mediations. Results showed that three significant models were relevant. First, positive associations of disengaged (p < 0.05), enmeshed (p < 0.05), and rigid (p < 0.01) family functioning with exercise addiction were found. Furthermore, body image concerns mediated all these relationships, and the interaction between gender and age significantly moderated the effects of body image concerns on exercise addiction (p < 0.05). Such data may be useful for a deeper understanding of the variables associated with the development of exercise addiction, suggesting key elements on which it might be useful to focus in clinical and/or preventive activity.

Global Self-Esteem, Body Composition, and Physical Activity in Polish University Students

Global self-esteem is a psychological concept that refers to the overall assessment of oneself as a person of value. Body composition is measured by indices such as BMI, BF, and LBM, which have implications for health and self-esteem. Physical activity is associated with numerous health and self-esteem benefits. The purpose of this study focuses on assessing the relationship between global self-esteem, body composition, and physical activity among Polish students. The study was conducted on a group of 305 students between the ages of 19 and 26. The participants were divided into groups according to their level of physical activity. The SES scale by M. Rosenberg assessed the subjects' global self-esteem. The results showed a negative correlation between body weight and BMI and global self-esteem, that is, the higher the body weight, the lower the self-esteem. On the other hand, higher levels of physical activity were associated with higher global self-esteem. The study suggests that maintaining healthy physical activity and body composition can help improve global self-esteem. The study highlights the importance of physical activity for mental health and self-esteem. It is worth encouraging and promoting physical activity among students to support an individual's physical and emotional health. Ultimately, this study may have implications for health policy, education, and intervention for students to emphasize the importance of physical activity for self-esteem and overall health.

Mediating Roles of Psychological Distress, Insomnia, and Body Image Concerns in the Association Between Exercise Addiction and Eating Disorders

Purpose

Exercising can promote good health. However, excessive exercising may have downsides. This study examined the association between exercise addiction and eating disorders and whether the identified association was mediated by psychological distress, insomnia (including sleep quality), and body image concern.

Methods

A total of 2088 adolescents (mean age of 15.3 years) participated in this cross-sectional study by questions assessing exercise addiction, eating disorders, psychological distress, insomnia, sleep quality, and body image concern.

Results

There were significantly positive relationships between the variables (r=0.12-0.54, p<0.01) with effect sizes from small to large. The four potential mediators (ie, insomnia, sleep quality, psychological distress, and body image concern), individually and in total, significantly mediated the association between exercise addiction and eating disorders.

Conclusion

The findings suggest that exercise addiction in adolescents may influence eating disorders through multiple pathways, such as insomnia, psychological distress, and body image concerns. Future research should examine these relationships longitudinally and use gathered information to inform intervention development. Clinicians and healthcare workers are encouraged to assess exercise addiction when treating individuals with eating disorders.

Investigating anabolic-androgenic steroid dependence and muscle dysmorphia with network analysis among male weightlifters

BACKGROUND

Anabolic-androgenic steroid (AAS) dependence has numerous adverse health consequences, and may be driven in part by body image concerns, primarily muscle dysmorphia. This study aims to further understand and identify potential clinical targets using network analyses of AAS dependence and muscle dysmorphia symptoms in males who used AAS and weightlifting controls.

METHODS

A sample of 153 men who currently or previously used AAS and 88 weight-lifting controls were recruited through social media and relevant online forums, and via posters and flyers distributed in select gyms in Oslo, Norway. Symptoms of AAS dependence and muscle dysmorphia were assessed using clinical interviews and standardized questionnaires. Severity of muscle dysmorphia symptoms were compared between the groups using independent samples t-tests. The following symptom networks were computed using Gaussian graphical modeling or mixed graphical modeling: (1) AAS dependence symptoms among men with AAS use (2) muscle dysmorphia symptoms among men with AAS use and weight-lifting controls in two separate networks, which were compared using a network comparison test, and (3) AAS dependence and muscle dysmorphia symptoms among men with AAS use.

RESULTS

In a network of AAS dependence symptoms, continuing use despite physical and mental side effects, using longer than planned, tolerance, and work/life interference were the most central symptoms. When comparing symptom structures of muscle dysmorphia between those who used AAS and controls, the most central symptoms in each group were exercise dependence and size/symmetry concerns, respectively. Men with AAS use demonstrated elevated muscle dysmorphia symptoms compared to controls, indicating that both the severity and structure of symptoms differ between these groups. In a network including both AAS dependence and muscle dysmorphia symptoms, no significant connections between symptom groups were identified.

CONCLUSIONS

AAS dependence is complex, with correlated somatic and psychological challenges driving the symptom network, indicating that alleviating physical and mental health concerns during both AAS use and cessation is an important clinical target. Muscle dysmorphia symptoms related to taking action (diet, exercise, and supplement use) appear to cluster together more for those who use AAS than those who do not.

Knowledge and Beliefs about Herb/Supplement Consumption and Herb/Supplement-Drug Interactions among the General Population, including Healthcare Professionals and Pharmacists: A Systematic Review and Guidelines for a Smart Decision System

The increased consumption of a variety of herbs/supplements has been raising serious health concerns. Owing to an inadequate understanding of herb/supplement-drug interactions, the simultaneous consumption of these products may result in deleterious effects and, in extreme cases, even fatal outcomes. This systematic review is aimed at understanding the knowledge and beliefs about the consumption of herbs/supplements and herb/drug-supplement interactions (HDIs). The study follows the PRISMA guidelines. Four online databases (Web of Science; PubMed; Cochrane; and EBSCOhost) were searched, and a total of 44 studies were included, encompassing 16,929 participants. Herb and supplement consumption is explained mostly by the reported benefits across multiple conditions and ease of use. Regarding HDIs, most people take both herbs/supplements and prescription drugs simultaneously. Only a small percentage of participants have knowledge about their interaction effects, and many reported adverse interactions or side effects. Nevertheless, the main reason for stopping the prescribed drug intake is the perceived lack of its effect, and not due to interactions. Therefore, it is important to increase the knowledge about supplement use so that further strategies can be elaborated to better detect or be alert for whenever a potentially dangerous reaction and/or interaction may occur. This paper raises awareness regarding the need for developing a decision support system and ends with some considerations about the development of a technological solution capable of detecting HDIs and, thereby, aiding in the improvement of pharmacy services.

Global and appearance-contingent self-esteem: Associations with health and attractiveness exercise reasons

Whilst some individuals exercise for health-related reasons, others appear to exercise to bolster physical attractiveness. For the latter, this is often attributed to dissatisfaction with appearance. Few studies, however, have explored if differences in self-esteem may relate to diverse exercise reasons. The present study investigated whether global self-esteem, appearance-contingent self-worth, and appearance satisfaction may be differentially associated with health and attractiveness exercise reasons. It was further sought to explore whether these relations coincided with different motivational regulations. Adults from the east midlands of the United Kingdom (N = 209; 75% female, 25% male; mean age = 29.77 years) completed measures relating to their global and appearance-contingent self-esteem, appearance satisfaction, exercise intentions, and motivations. Structural equation modelling revealed that global self-esteem was positively associated with appearance satisfaction and health reasons for exercise, whereas appearance-contingent self-esteem related to lower appearance satisfaction and attractiveness reasons. Appearance satisfaction had no association with either exercise reason but was associated with intrinsic motivation and lower controlled exercise motivations. Health exercise reasons were positively associated with intrinsic, identified, and introjected motivation, whereas attractiveness reasons were exclusively related to external motivation. The findings highlight the conceptual importance of differentiating the level and contingency of exercisers' self-esteem. The findings may also have substantive value for exercise practitioners in understanding different reasons for exercise.

Personality Traits Associated with the Risk of Exercise Dependence in Ultraendurance Athletes: A Cross-Sectional Study

Exercise dependence (ED) is common in endurance athletes and can lead to physical and psychological distress with various health effects. We designed a prospective cross-sectional study to investigate the personality traits associated with ED among ultraendurance athletes. A total of 507 participants (41.6 (9.8) years, men: 73.7%) completed (1) a screening questionnaire about sociodemographic data, sporting habits, and healthcare data, (2) the Exercise Dependence Scale-Revised (EDS-R, 21 items scored from 1 (never) to 6 (always), 7 subscales), (3) the Big Five Inventory (BFI), and (4) 2 items of the SCOFF (Sick-Control-One Stone-Fat-Food) questionnaire regarding possible eating disorders. Based on the EDS-R scores, 37 (7.3%) participants were at risk for ED (scores ≥ 5/6 on ≥3 subscales), 366 (72.2%) were nondependent but symptomatic (scores ≥ 3/6 on ≥3 subscales), and 104 (20.5%) were asymptomatic. Participants with ED had a greater training volume and a higher prevalence of possible eating disorders. A higher level of neuroticism was associated with increased EDS-R scores (r = 0.294; p < 0.001), with significantly higher scores in the ED group (F = 14.50, p < 0.001). The association between neuroticism and ED was not moderated by the presence of eating disorders. These findings will help to screen ultraendurance athletes at risk for ED and optimize their care.

Appearance between professionalism and work-related stress among marketing employees

BACKGROUND

Appearance and body language are key components of non-verbal communication and play an important role in the service and marketing sector.

OBJECTIVE

The aim was to explore experiences and perceptions of appearance issues related to work among employees in the marketing sector in Sweden.

METHODS

Interviews were conducted with 15 marketing and communication employees (five males, ten females), at multinational companies and a university. Thematic analyses were conducted, and content was organised in two themes with sub-themes: 1. Appearance from a resource perspective (Appearance benefits; Physical activity resources; Age benefits). 2. Appearance from a demand perspective (Adaptation to gender roles; Investment in appearance; Adaptation to situation and culture).

RESULTS

The findings showed that appearance was perceived as a resource for professionalism, work engagement and career in various ways. Appearance-related issues were not considered on organisational work level, but employees perceived unspoken demands to look good and appropriate to represent the company brand. The employees spent a considerable amount of time, money, and effort on appearance.

CONCLUSION

Appearance creates dualistic questions and points out several dilemmas that the individual struggle to solve, which creates stress in work. The character of unspoken demands on appearance and absent communication on organisational level make the stress-coping strategies complicated and the stress coping is mostly left for the individual to handle. A gender difference shows that compared to men, women more often experience negative stress generated by appearance-related issues in work. Education and actions at the managerial level of companies are needed.

Relationship between Attention to Body Shape, Social Physique Anxiety, and Personal Characteristics of Brazilians: A Structural Equation Model

People can develop eating disorders due to excessive body image concerns. The primary objective of this study was to examine the relationship between attention to body shape, social physique anxiety, and personal characteristics in a sample of Brazilians. The secondary objective was to evaluate the correlation of the constructs with the participants' body composition. First, 1795 individuals (70% female; M_age = 25.5 ± 6.6 years) completed the Attention to Body Shape Scale, the Social Physique Anxiety Scale, and a sociodemographic questionnaire. Then, 286 participants (58% female; M_age = 25.3 ± 5.7 years) underwent a bioimpedance exam to identify body composition. Structural equation modeling was used to estimate the relationship between the variables. The greater the attention to body shape, the greater the expectations of negative physical evaluation and the less comfort with physical presentation. Younger age, female gender, consumption of supplements/substances for body change, restrictive diets, physical inactivity, poor self-assessment of food quality, and overweight/obesity were related to negative body concerns. An expectation of negative physical evaluation was positively correlated with body fat and negatively with muscle mass. Comfort with physical presentation was negatively correlated with fat and positively with muscle. These results can support preventive strategies aimed at reducing eating disorders resulting from body image concerns.

Sports Supplements User Profile Based on Demographic, Sports, and Psychological Variables: A Cross-Sectional Study

Despite the high prevalence of sports supplement (SS) use, efforts to profile users have not been conclusive. Studies report that 30–95% of recreational exercisers and elite athletes use SS. Research found has mostly focused on demographic and sports variables to profile SS users, but little research has studied the psychological factors that may influence the use of SS. The purpose of this investigation was to classify, describe, and differentiate the profile of users and non-users of SS, considering demographic, sports, and psychological variables. A total of 554 participants completed the questionnaire. Overall, 45% of recreational exercisers and elite athletes reported using supplements. There were significant differences found regarding the use of SS between men and women (51% vs. 49%, p = 0.002; OR = 1.799), and when training 4 or more days per week (p ≤ 0.001; OR = 1.526). Findings regarding the psychological variables have been found in the Adonis Complex. These results indicate that participants with greater concerns regarding physical appearance, tend to be SS users (p = 0.001; OR = 1.200). The results of this study fill a gap in previous research, and provide an approximate profile, including demographic, sports, and psychological variables of SS users.

Advances in problematic usage of the internet research - A narrative review by experts from the European network for problematic usage of the internet

Global concern about problematic usage of the internet (PUI), and its public health and societal costs, continues to grow, sharpened in focus under the privations of the COVID-19 pandemic. This narrative review reports the expert opinions of members of the largest international network of researchers on PUI in the framework of the European Cooperation in Science and Technology (COST) Action (CA 16207), on the scientific progress made and the critical knowledge gaps remaining to be filled as the term of the Action reaches its conclusion. A key advance has been achieving consensus on the clinical definition of various forms of PUI. Based on the overarching public health principles of protecting individuals and the public from harm and promoting the highest attainable standard of health, the World Health Organisation has introduced several new structured diagnoses into the ICD-11, including gambling disorder, gaming disorder, compulsive sexual behaviour disorder, and other unspecified or specified disorders due to addictive behaviours, alongside naming online activity as a diagnostic specifier. These definitions provide for the first time a sound platform for developing systematic networked research into various forms of PUI at global scale. Progress has also been made in areas such as refining and simplifying some of the available assessment instruments, clarifying the underpinning brain-based and social determinants, and building more empirically based etiological models, as a basis for therapeutic intervention, alongside public engagement initiatives. However, important gaps in our knowledge remain to be tackled. Principal among these include a better understanding of the course and evolution of the PUI-related problems, across different age groups, genders and other specific vulnerable groups, reliable methods for early identification of individuals at risk (before PUI becomes disordered), efficacious preventative and therapeutic interventions and ethical health and social policy changes that adequately safeguard human digital rights. The paper concludes with recommendations for achievable research goals, based on longitudinal analysis of a large multinational cohort co-designed with public stakeholders.

"Eat clean, train mean, get lean": Body image and health behaviours of women who engage with fitspiration and clean eating imagery on Instagram

The present study examined the relationship between posting or viewing fitspiration and clean eating imagery in relation to body image, disordered eating, and compulsive exercise among women. Participants (269 women aged 18-30 years) who posted and/or viewed fitspiration, clean eating or travel imagery on Instagram completed an online cross-sectional questionnaire. Results showed engaging with fitspiration and clean eating material (either posting or viewing) was significantly positively associated with increased levels of compulsive exercise and athletic-ideal internalization. However, only viewing (not posting) fitspiration and clean eating content was significantly related to thin-ideal internalization and disordered eating symptomatology. Athletic-ideal internalization mediated the relationships between posting fitspiration/clean eating and disordered eating symptomatology and compulsive exercise. Both thin-ideal internalization and athletic-ideal internalization mediated the relationship between viewing fitspiration/clean eating material and disordered eating and compulsive exercise. Overall, the findings suggest that viewing fitspiration and clean eating content on Instagram is negatively associated with thin-ideal internalization and disordered eating symptomatology, however the same relationships do not exist for people who frequently post these types of material. The mediational pathways provide a nuanced understanding of how engaging with fitspiration and clean eating material on social media influences female users' body image and health behaviour.

Why do we climb mountains? An exploration of features of behavioural addiction in mountaineering and the association with stress-related psychiatric disorders

Common knowledge implies that individuals engaging in outdoor sports and especially in regular and extreme mountaineering are exceptionally healthy and hardened. Physical activity in outdoor environments has a positive effect on physical and mental health. However, regular and/or extreme mountaineering might share similarities with behavioural addictions and could thus also have a negative impact on health. In this cross-sectional web-based questionnaire study, we collected data on exercise and mountaineering addiction (Exercise Addiction Inventory; original and adapted version for mountaineering; Exercise Dependence Scale adapted version for mountaineering). Further surveyed parameters included mountaineering habits, Risk-Taking Inventory, Sensation-Seeking/Emotion Regulation/Agency Scale (SEAS), resilience, self-perceived stress, physical activity in metabolic units and mental health. Comparisons were performed between individuals with symptoms of addiction to mountaineering (MA) and individuals without symptoms of addiction to mountaineering or sports in general (CO) using non-parametric analyses. We analysed data from 335 participants, n = 88 thereof with addiction to mountaineering (MA) and n = 247 control participants (CO). The MA group scored significantly higher with regards to self-perceived stress (p < 0.001) and included a significantly higher number of individuals affected by symptoms of depression (p < 0.001), symptoms of anxiety (p < 0.001), symptoms of eating disorders (p < 0.001), alcohol abuse or dependence (p < 0.001), illicit drug abuse (p = 0.050), or current and history of psychiatric disorders (p < 0.001). Individuals with MA showed higher values in all SEAS subscales as well as increased risk-taking (p < 0.001). Regular and extreme mountaineering can display features of a behavioural addiction and is associated with psychiatric disorders. Behavioural addiction in mountaineering is associated with higher levels of sensation-seeking, emotion regulation, and agency, as well as increased risk-taking.

Orthorexia nervosa and its association with narcissism in fitness center users

PURPOSE

Orthorexia nervosa (ON) is an eating behavior where patients obsessively try to reach health through "purity" of food. Narcissism is a personality trait characterized with the self-belief of grandiosity, importance and need of appreciation. Both of these conditions are connected through self-image in way of reaching perfection through health and body image, whereas one of the ways for reaching it is exercising. This cross-sectional study aimed to investigate ON and its possible association with narcissism in fitness center users.

METHODS

The study included 1017 fitness center users and three questionnaires were used for the assessment: general information, ORTO-R and Narcissistic personality inventory-13 (NPI-13).

RESULTS

There was a significant negative correlation (r = - 0.467, p < 0.001) between the ORTO-R score and the NPI-13 score. Comparison of the ORTO-R score between different durations of using a fitness center showed statistically significant differences (H = 134.72, p < 0.001). The subjects who are using the fitness center for less than 1 year have the highest ORTO-R score, while those who are using it 1-3 years have the lowest ORTO-R score. Moreover, multiple linear regression showed that ORTO-R score retained significant association with NPI-13 (β ± SE, - 0.416 ± 0.026, p < 0.001) and the duration of using a fitness center (0.576 ± 0.068, p < 0.001) after model adjustment for age and BMI.

CONCLUSION

These results are implying that fitness center users could possibly be vulnerable of developing ON and that there is a strong association between ON and narcissism in this population. However, future larger-scale longitudinal studies are needed to address these findings.

LEVEL OF EVIDENCE

Level V, cross-sectional survey-based study.

Online Behaviours during the COVID-19 Pandemic and Their Associations with Psychological Factors: An International Exploratory Study

This cross-sectional study aimed to explore specific online behaviours and their association with a range of underlying psychological and other behavioural factors during the COVID-19 pandemic. Eight countries (Italy, Spain, the United Kingdom, Lithuania, Portugal, Japan, Hungary, and Brazil) participated in an international investigation involving 2223 participants (M = 33 years old; SD = 11), 70% of whom were females. Participants were surveyed for specific type of Internet use severity, appearance anxiety, self-compassion, and image and use of performance-enhancing drugs (IPEDs). Results were compared cross-culturally. The mean time spent online was 5 h (SD = ±3) of daily browsing during the pandemic. The most commonly performed activities included social networking, streaming, and general surfing. A strong association between these online behaviours and appearance anxiety, self-compassion, and IPEDs use was found after adjustment for possible confounders, with higher scores being associated with specific online activities. Significant cross-cultural differences also emerged in terms of the amount of time spent online during the initial stages of the COVID-19 pandemic.

The Thin Ideal and Attitudes towards Appearance as Correlates of Exercise Addiction among Sporty People during the COVID-19 Pandemic

The stress and anxiety caused by the coronavirus pandemic (COVID-19) have exacerbated body image concerns. A society that perpetuates the attempt for a perfect and thin appearance represents a fertile ground for the development of exercise addiction (EA). This cross-sectional study aims to explore EA during the second wave of the pandemic (October−December 2020) and to examine the independent influence of both time spent on moderate and vigorous physical activities and body image variables (i.e., drive for leanness and sociocultural attitudes toward appearance) on EA. A sample of Italian sporty people (N = 194; 48.5% females; Mage = 25.91 ± 6.32) was surveyed using the Exercise Addiction Inventory, the Drive for Leanness Scale, the Sociocultural Attitudes Towards Appearance Questionnaire, and the Global Physical Activity Questionnaire. A total of 82% of the sample were symptomatic of and 11.3% were at risk of EA. Hierarchical regressions revealed an association between the time spent on vigorous physical activities and levels of EA (p < 0.05). Moreover, body image variables were positively related to EA, explaining an additional 11% of variance (p < 0.05). Results showed the importance of considering and addressing body image factors to investigate and dampen the risk of EA among sporty people.

Physical Activity and Exercise Addiction During the Covid-19 Pandemic in Italy

Severe restrictive measures were implemented globally to limit the spread of the Covid-19 pandemic leading to significant lifestyle changes and impacting on both the physical and the mental health of citizens. Caught by the fear of getting sick, some individuals have adopted behaviors which favored the development of exercise addiction (EA). Our aim was to evaluate physical activity habits and the risk of EA in the general Italian population during phase 1 of the lockdown. The role of appearance anxiety (AA), self-compassion, and use of performance and image enhancing drugs (PIEDs) as predictors of EA development were investigated. A comparison between physically active subjects with the inactive ones was also included. Between April and May 2020, an online survey was conducted across Italy. Nine hundred thirty-six answers were collected. The rate of EA in the physically active sample (782 subjects) was 4.1%. The physically active group showed higher SCS scores and a greater use of PIEDs. Of the physically active participants, 84.2% reported variations in their fitness routine. Perceived benefit of exercising resulted significantly higher in those with EA. Subjects with EA reported stronger motivation in engaging in physical activity as for "physical wellness," "psychological well-being," and "sexual attractiveness and confidence in relationship." A higher level of AA, a lower level of self-compassion, and a higher perceived benefit of exercising during lockdown were all significant predictors for the presence of EA. Our findings suggest that the fear of getting sick from Covid-19, combined with radical changes in the lifestyles induced by the lockdown and individual personological characteristics, can favor the development of EA and related phenomena in the general population.

Psychometric investigation of the Attention to Body Shape Scale in Brazilian adults

The objectives of the study were to develop a Portuguese version of Attention to Body Shape Scale (ABS), estimate the psychometric properties of the ABS for Brazilian data, and compare the ABS scores between the sexes and the different sample characteristics. The Portuguese version was developed following a standardized protocol. The factorial and convergent validity were evaluated using goodness-of-fit parameters and average variance extracted. Composite reliability and ordinal coefficient alpha were calculated. The invariance of the fitted model was investigated across independent subsamples using multigroup analysis. The scores were compared between variables using two-way ANOVA. A total of 1,056 individuals (71% female) with a mean age of 26.1 (SD=6.4) years participated in the study. Item 3 was removed due to low factor loading. The refined model presented good psychometric properties for the data. Different characteristics contributed to greater attention to body shape. The Portuguese version of the ABS will be useful to investigate attention to body shape in Brazil. The validity and reliability of the data supported the adequacy of the refined model. Specific characteristics influenced attention to body shape, and therefore, should be considered in future protocols.

An international cross-sectional investigation on social media, fitspiration content exposure, and related risks during the COVID-19 self-isolation period

With the global COVID-19 pandemic, governments from many countries in the world implemented various restrictions to prevent the SARS-Cov-2 virus's spread, including social distancing measures, quarantine, in-home lockdown, and the closure of services and public spaces. This led to an in-creased use of social media platforms to make people feel more connected, but also to maintain physical activity while self-isolating. Concerns about physical appearance and the desire to keep or reach a muscular and toned ideal body, might have further reinforced the engagement in fitness-related social media activities, like sharing progresses in training achievements or following more fitness contents on popular profiles. To better understand the underlying relation among these factors, the present study investigates 729 responses to the Exercise Addiction Inventory (EAI), the Appearance Anxiety Inventory (AAI), the Self-Compassion Scale (SCS) and their association to social media usage and compares the results cross-culturally in five countries (Spain, Lithuania, United Kingdom, Japan, and Hungary). Findings highlight significant differences between males and females, espe-cially in regard to the time spent online (U = 477.5, p = 0.036). Greater levels of appearance anxiety were associated with the exposure to fitness-related contents on social media. These results strongly confirm the previously highlighted association between fitspiration media and body image anxiety predominantly in females. Clinical implications and future considerations in terms of prevention and treatment in a situation of global emergency are also discussed.

On the pitfalls of conceptualizing excessive physical exercise as an addictive disorder: Commentary on Dinardi et al. (2021)

This commentary challenges some of the proposals made in the opinion paper entitled "The expanded interactional model of exercise addiction" by Dinardi, Egorov, and Szabo (2021). We first question the usefulness of the (expanded) interactional model of exercise addiction to determine the psychological processes underlying distress and functional impairment in excessive physical exercise. We then consider the authors' use of the Self-Determination Theory to model exercise addiction, which risks the misclassification of strenuous, but adaptive, patterns of physical exercise as exercise addiction. We finally address broader concerns regarding the idea that maladaptive exercising could be conceptualized as an addictive disorder.

Characteristics of Gym-Goers Performance-Enhancing Substance Use

The use of prohibited performance-enhancing substances (PES) in fitness and gym settings is a public health concern as knowledge concerning its short-term and long-term adverse health consequences is emerging. Understanding the underlying psychosocial mechanisms of PES use and the characteristics of the gym-goers who use PES could help identify those who are most vulnerable to PES use. The aim of this study was to investigate the profile (e.g., sociodemographic factors, exercise profile, gym modalities, peers, and social influence) and psychosocial determinants (e.g., attitudes, subjective norms, beliefs, and intentions) of PES users in gym and fitness contexts. In total, 453 gym-goers (mean age = 35.64 years; SD = 13.08) completed an online survey. Neural networks showed a global profile of PES users characterized by a desire to increase muscle mass, shape their body, and improve physical condition; being advised by friends, training colleagues and coaches or on the Internet; less formal education, and more positive beliefs for PES use. These results may support public health and clinical interventions to prevent abusive use of PES and improve the health and well-being of gym-goers.

Life Habits and Mental Health: Behavioural Addiction, Health Benefits of Daily Habits, and the Reward System

In this review, the underlying mechanisms of health benefits and the risk of habitual behaviours such as internet use and media multitasking were explored, considering their associations with the reward/motivation system. The review highlights that several routines that are beneficial when undertaken normally may evolve into excessive behaviour and have a negative impact, as represented by "the inverted U-curve model". This is especially critical in the current era, where technology like the internet has become mainstream despite the enormous addictive risk. The understanding of underlying mechanisms of behavioural addiction and optimal level of habitual behaviours for mental health benefits are deepened by shedding light on some findings of neuroimaging studies to have hints to facilitate better management and prevention strategies of addictive problems. With the evolution of the world, and the inevitable use of some technologies that carry the risk of addiction, more effective strategies for preventing and managing addiction are in more demand than before, and the insights of this study are also valuable foundations for future research.

Symptoms of exercise addiction in aerobic and anaerobic exercises: Beyond the components model of addiction

Background

Above the six symptoms in the components model of exercise addiction, other symptoms may also reflect the risk of exercise addiction (REA). Based on past research, these additional symptoms (AS) include training when injured, missing social engagements, disordered eating, staleness, and distorted perception of the exercise volume. The manifestation of these AS, along with the REA, may vary in different exercise forms. Since research shows that aerobic exercise is associated with greater well-being and stress reduction than anaerobic exercise, based on the interactional model of exercise addiction, the prevalence of the REA may be higher in aerobic than anaerobic exercisers.

Methods

This cross-sectional investigation examined the REA and AS in regular exercisers performing aerobic and anaerobic activities. Adults (n = 176), exercising at least three times per week for at least one year, were tested. The between-groups and gender differences, along with the connection between AS and REA in the two exercise forms, were studied.

Results

Aerobic and anaerobic exercisers did not differ in the dependent measures. Women in the anaerobic group reported eating more disorderly than men. The REA groups (asymptomatic, symptomatic, and at-risk) differed in all AS. A consistent but weak connection was disclosed between the RAE and AS.

Conclusions

The REA and the studied AS do not differ between aerobic and anaerobic groups, but women in the latter group reported eating more disorderly when exercise is not possible. Expanding the components model with other pertinent symptoms could yield a more thorough picture about the REA.

Social Media, Body Image and Resistance Training: Creating the Perfect 'Me' with Dietary Supplements, Anabolic Steroids and SARM's

BACKGROUND

Few studies have assessed the use of dietary supplements, anabolic androgenic steroids (AAS) and selective androgen receptor modulators (SARM) in male gym users. The comparison of physical appearance with others on social media and the exposure to fitness-related content on social media (i.e., image-centric social media use) may have a profound role in using these compounds due to its role in creating negative body images in male gym users.

OBJECTIVE

Provide contemporary data on the use of dietary supplements, AAS and SARM among young male gym users, and test the hypothesis that social media is associated with the use of dietary supplements, AAS and SARM, as a result of a negative body image.

METHODS

In this cross-sectional study, conducted in the Netherlands, male gym users (N = 2269; 24 ± 6 years) completed an online questionnaire including self-reported measures regarding resistance training participation, image-centric social media use, dietary supplement intake, and body image. The prevalence of AAS and SARM use was assessed with randomized response, a technique to ask sensitive questions indirectly.

RESULTS

Of all participants, 83% used ergogenic dietary supplements (mainly protein and creatine), and an estimated 9 versus 2.7% had ever used AAS versus SARM. Image-centric social media use was positively associated with the use of dietary supplements (r = .26; p < 0.01) and AAS (p < 0.05), but not SARM. Image-centric social media use was associated with a more dissatisfied body image (r = .34; p < 0.01). Body image did not mediate the relationship between image-centric social media use and the use of doping compounds.

CONCLUSIONS

The use of dietary supplements in young male gym users is exorbitant, with the use of AAS and SARM being substantial. Image-centric social media use is positively associated with the use of dietary supplements and AAS.

The Relationship between Alexithymia, Dysmorphic Concern, and Exercise Addiction: The Moderating Effect of Self-Esteem

As with other addictions, exercise addiction can severely impact individuals' lives and have significant psychophysical consequences. Consequently, the study of the mechanisms involved in this psychopathological condition has great clinical and practical relevance. Therefore, the goal of the present study was to explore the risk factors and protective factors for exercise addiction, with a particular focus on the roles of alexithymia, body image concerns, and self-esteem. A sample of 288 regular exercisers (mean age = 28.35 years, SD = 8.26; 72% females, 18% males) completed the Exercise Addiction Inventory, 20-Item Toronto Alexithymia Scale, Body Image Concern Inventory, and Rosenberg Self-Esteem Scale. Data were analyzed by implementing a moderated mediation model. Results showed a significant and positive association between alexithymia and exercise addiction, totally mediated by body image concerns. Furthermore, self-esteem showed a relevant moderating effect, such that at high levels of self-esteem the effect of alexithymia on body image concerns became insignificant. Such data have important implications, highlighting some core variables on which it might be useful to keep a focus in order to elaborate tailored interventions, from both preventive and treatment perspectives.

Association of body dysmorphic disorder with anxiety, depression, and stress among university students

Objectives

This study aims to estimate the prevalence of body dysmorphic disorder (BDD) and identify its association with depression, anxiety, and stress.

Method

We conducted a cross-sectional study in Jeddah, KSA. In 2019, a validated questionnaire with items on sociodemographic characteristics and body dysmorphic disorder, as well as the Depression, Anxiety, and Stress Scale – 21 items (DASS 21) was distributed to 1,112 students of King Abdulaziz University. SPSS version 23 was used for data analysis, which included descriptive statistics, chi-square tests, and binary logistic regression models. The association was presented as an odds ratio (OR) along with its 95% confidence Interval (CI).

Results

The overall prevalence of BDD was 13.9% (95% CI of 11.8–16.2.) with the highest reported sites being the skin (81.6%) and waist (68.8%). BDD was found to be a significant predictor of depression with an OR of 4.2 (95% CI 2.9–6.1), anxiety OR of 2.2 (95%1.6–3.2), and stress OR of 3.2 (2.2–4.7). Females were significantly associated with anxiety, OR of 1.4 (95% CI 1.1–1.9) and stress, OR of 1.5 (1.1–2). Affiliation to the administration, arts, humanities, and social colleges was also a significant predictor of anxiety as reflected by an OR of 1.4 (95% CI 1.1–1.8).

Conclusions

Our study shows that BDD is relatively common among university students in Jeddah and associated with depression, anxiety, and stress.

•

BDD is common among university students.

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Skin and Waist circumference were the most reported sites among students.

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BDD is a significant predictor of depression, anxiety, and stress affecting both male and female university student.

Generating evidence on the use of Image and performance enhancing drugs in the UK: results from a scoping review and expert consultation by the Anabolic Steroid UK network

BACKGROUND

The use of anabolic androgenic steroids (AAS) and associated image and performance enhancing drugs (IPEDs) is now a global phenomenon. There is a need to develop evidence to support the development of interventions to prevent the commencement of use, to minimise the potential harms or to support those in their cessation of use. While the United Kingdom (UK) is no exception to this issue, its public health and legislative response to the phenomenon differs to other countries and requires the examination of research specific to the UK. Therefore, a scoping review has been conducted to examine the recent relevant literature to help inform the development and evaluation of effective interventions to reduce the harmful use of IPEDs.

METHODS

A comprehensive search strategy was developed for multiple bibliographic databases, supported by and iterative citation searching process and complimented by expert input from the Anabolic Steroid UK Network. Research conducted by or UK academics or within the UK were eligible, if published in the previous five years.

RESULTS

In total 87 eligible outputs were identified, including 26 review articles, 25 qualitative papers and 24 quantitative papers. together with small numbers of clinical studies/case reports (6) and commentaries/correspondence (6). The most common topics of research were public health, treatment and harm reduction (41), followed by studies focusing on epidemiology, sub-groups of people using IPEDs and motivations for use (34). The studies illustrated the diverse populations of people who use a range of enhancement drugs including concomitant psychoactive drug use. A number of papers focused on blood borne viruses and associated issues, while others reported on the uptake of needle and syringe programmes. No effectiveness evaluations related to any aspect of treatment, harm reduction or other intervention were published during study period.

CONCLUSION

There is a need for the development of effectiveness evaluations of current interventions and any future service provision for people using image and performance enhancing drugs. While there have been no studies of this nature to date, this review illustrates the rich data that has been gathered through diverse methodologies, that will assist in the development of future effectiveness evaluations.

When Much Is Too Much-Compared to Light Exercisers, Heavy Exercisers Report More Mental Health Issues and Stress, but Less Sleep Complaints

BACKGROUND

Physical inactivity has become a global somatic and mental health issue. To counterbalance, promoting regular physical activity appears plausible, above all among adults, where physical inactivity is particularly high. However, some, but sparse, research also indicates that excessive exercising might be associated with unfavorable mental health dimensions. Here, we tested the hypothesis that excessive exercising was associated with more mental health issues. To this end, we assessed mental health issues, stress, mental toughness, and sleep disturbances among heavy and light adult exercisers.

METHODS

A total of 200 adults (mean age: 35 years; 62% females) took part in the study. Of those, 100 were heavy exercisers (18-22 h/week), and 100 were light exercisers (1-6 h/week). Participants completed questionnaires covering sociodemographic information, mental health issues, perceived stress, mental toughness, and sleep disturbances.

RESULTS

Compared with light exercisers, heavy exercisers reported higher mental health issues, more stress, but also higher mental toughness scores and less sleep disturbances. Higher age, lower mental toughness scores, heavy exerciser-status, and more sleep disturbances predicted higher mental health complaints.

CONCLUSIONS

Compared with light exercising, heavy exercising might be associated with more mental health issues. As such, it appears that the association between exercise frequency, intensity, and duration and psychological well-being might be related to an optimum point, but not to a maximum point. In a similar vein, heavily exercising athletes, their coaches, parents, and representatives of sports associations should get sensitized to possible adverse psychological effects of excessive physical activity patterns.

Protective and Risk Factors in Exercise Addiction: A Series of Moderated Mediation Analyses

For a minority of individuals, exercise may become excessive and lead to an addictive behaviour. To better understand the processes by which exercise could become an addiction, the present study examined the risk and protective factors of exercise addiction among regular exercisers, by investigating the role of drive for thinness, bulimia, body dissatisfaction, body image concerns, and self-esteem. A sample of 319 Italian regular exercisers (M_age = 30.78 years, SD = 11.98) completed the Italian versions of the Exercise Addiction Inventory, Eating Disorder Inventory-3 Referral Form, Body Image Concern Inventory, and Rosenberg Self-Esteem Scale. Data were analyzed by implementing a series of moderated mediations. Drive for thinness, bulimia, and body dissatisfaction were positively associated with exercise addiction. An indirect path was found in each of these relationships, which included the mediation of body image concerns, as well as a significant moderation of self-esteem in the associations between drive for thinness, bulimia, body dissatisfaction, and the mediator. High self-esteem appeared to be a protective factor. The higher the level of self-esteem, the less indirect the effects of thinness drive, bulimia, body dissatisfaction, and body image concerns were on exercise addiction. Such findings contribute to a better understanding concerning the risk and protective factors of excessive exercise, and may have important practical implications in structuring interventions to reduce risk of developing exercise addiction, as well as orienting future research.

The expanded interactional model of exercise addiction

BACKGROUND AND AIMS

Cited in over 100 articles, the interactional model of exercise addiction (Egorov & Szabo, 2013) forms the theoretical foundation of many studies on the risk of exercise addiction. Still, the inclusion of previously omitted determinants could make it more useful. Therefore, this review presents the expanded version of the original model.

METHOD

We added 'self-concept' as another determinant in the 'personal factors' domain and 'attractive alternatives' to the 'situational factors' domain. Further, we doubled the reasons for exercise in the 'incentives for exercise domain.' Last, we added a new domain, the 'exercise-related stressors,' to illustrate that exercise itself might be a source of stress.

RESULTS

The expanded model is more inclusive and accounts for a greater combination of interactions playing roles in exercise addiction. Overlooking the eventuality that stress resulting from exercise might also fuel the dysfunction was a significant omission from the original model, rectified in the current update. Finally, the new expansions make the model more applicable to competitive situations too.

CONCLUSION

The expanded interactional model of exercise addiction is more comprehensive than its original version. It also accounts for the exercise or sport-related stress as possible fuel in addictive exercise behavior.

Can Cycling Be Addictive? A Qualitative Interview Study Among Amateur Female Cyclists

Exercise and healthy eating are proposed as a recommended lifestyle by the World Health Organization with several positive outcomes, including a decrease in pathologies such as diabetes and reduction in mortality rates. However, research suggests that there is the potential for exercise behaviour to become addictive among a small minority of individuals, which detrimentally impacts their lives. The risk of exercise addiction increases for endurance sports, of which cycling is considered one, given the intense physical and psychological demands, due to elevation and distance, in amateur cycling events. Understanding the risk factors specific to cycling is worthy of investigation, as it is not clear whether cycling can become an addiction. Using the ‘addiction component model’ as a framework, qualitative analysis was used to determine whether symptoms of addiction were present among a sample of eight female cyclists. Through the use of thematic analysis, the results showed that symptoms of addiction were reported by participants. Three themes were generated from research interviews comprising ‘addiction components’ (i.e. salience, conflict, mood modification, tolerance, withdrawal, and cycling despite health problems), ‘enabling infrastructure’ (i.e. supportive work, supportive family and friends), and ‘striving for excellence’ (i.e. needing to be the best, pushing too far, and having unrealistic expectation), currently measured in the ‘addiction component model’. There were also novel themes including ‘cycling above health’ where the participant continues to cycle against medical advice; ‘enabling infrastructure’ where work, family, and friends are accepting of cycling; and ‘striving for excellence’ where the participants ‘needing to be the best’ when comparing themselves to their peers, ‘pushing too far’ to achieve the goal set, and finally ‘unrealistic expectations’ resulting in negative comparison to peers. These findings suggest that addiction to cycling should be investigated further, and implications may necessitate clinical intervention to find alternative coping mechanisms when exercise is not available to an individual as there is a likelihood that individuals will continue to exercise in spite of injury and against medical advice.

Testosterone, identity and the body: Exploring cultural definitions of disorder

Medically-sanctioned testosterone administration has seen increasingly widespread application in the treatment of gender dysphoria (GD). Yet, by comparison, this approach is not medically accepted for those who are experiencing muscle dysmorphia (MD), a specifier of body dysmorphic disorder (BDD), despite both conditions reflecting incongruences between self-perception, identity and phenotype, and both currently being classified as mental health disorders. Rather, by stark contrast, those with MD are largely treated with psychological intervention to accept themselves as they physically are and the illicit use of testosterone for muscle-related body perception purposes is generally subject to criminal justice enforcement actions. In this commentary, we examine attempts to distinguish between the use of testosterone for gender-affirming hormone therapy in the case of GD and for aesthetic (muscle enhancement) use in the case of MD, as well as explore the implications of this disparity. Moreover, we consider how such disparity in policy and practice may be understood, in part, as an example of a bias reflecting the selective pathologizing of anabolic-androgenic steroid (AAS) use, socio-cultural evolutions in gender identity and expression and, more broadly, the manner in which culture defines disorder and its appropriate response.

Exploring the Relationship Between Mental Well-Being, Exercise Routines, and the Intake of Image and Performance Enhancing Drugs During the Coronavirus Disease 2019 Pandemic: A Comparison Across Sport Disciplines

Introduction: Physical distancing under the coronavirus disease 2019 (COVID-19) pandemic had a significant impact on lifestyles, including exercise routines. In this study, we examined the relationship between mental health and addictive behaviors, such as excessive exercise and the use of image and performance enhancing drugs (IPEDs) across 12 sport disciplines. Materials and methods: A large cross-sectional sample of the adult population (N = 2,295) was surveyed. The mean age was 33.09 (SD = 11.40). The number of male participants was 668 (30.0%). The use of IPEDs was assessed in conjunction with psychometric measures such as the Exercise Addiction Inventory (EAI) and the Appearance Anxiety Inventory (AAI). The participants were grouped into activity group (AG) and non-activity group (NAG) according to the presence or absence of their exercise habits. The results were compared between these groups, as well as across sport disciplines, while taking into account the relationship between different psychological measures and IPEDs consumption. Results: The frequency of IPEDs use was higher among AG (34.6%) than NAG (14.6%), although AG participants reported less history of addictions (7.1%) than NAG (11.8%). The logistic regression analysis revealed that scores equal to or above cutoff points, in both the EAI and AAI, predicted the IPEDs use. Regarding the differences across the various sport disciplines, those who were involved in practicing Weight Lifting and Cross Fit were found to be more at risk of excessive exercising and more inclined to use a wide range of IPEDs. Conclusions: Although exercise could help to increase well-being and prevent addictions during the COVID-19 pandemic, our results show that those in the AG are particularly vulnerable to excessive IPEDs use. Sport disciplines associated with higher EAI and AAI scores have also shown a higher tendency to excessive IPEDs use. Furthermore, the factor of having above the cutoff scores in EAI or AAI in each sport could indicate larger IPEDs consumption regardless of the discipline. In light of the current findings, it is necessary to better define the "non-excessive" levels of exercise in various sport disciplines and an adequate intake of IPEDs to ensure the safety and well-being of people during a pandemic.

Exercise Addiction and Muscle Dysmorphia: The Role of Emotional Dependence and Attachment

Background: Both exercise addiction (EA) and muscle dysmorphia (MD) primarily involve the compulsive practice of physical exercise and are classified as behavioral addictions in different lines of research. These types of addictions are frequently comorbid with other addictive pathologies, such as emotional dependence (ED), which is closely related to childhood attachment. This study is presented to address the scarcity of research relating EA and MD with other behavioral addictions. The aims are to analyze the sex differences found in emotional dependence, attachment dimensions, EA and MD; to analyze the association between EA and MD and other behavioral addictions, such as emotional dependence and attachment dimensions; and to analyze the possible role that childhood attachment plays in mediating the interaction between emotional dependence and EA and MD. Method: The sample comprised 366 participants (54.6% women) aged 17-31 (M = 23.53; SD = 6.48). Results: There are sex differences, with men scoring higher in EA, MD, and ED. The positive relationship between EA and ED (values between 0.16 and 0.28), MD (presenting values between 0.42 and 0.70), and attachment styles based on preoccupation, interference, permissiveness, and value of parental authority (values between 0.11 and 0.14) is highlighted. On the other hand, MD was positively related to ED (values ranging from 0.24 to 0.36) and attachment styles based on the value of parental authority, self-sufficiency, and resentment toward parents (between 0.17 and 0.18), and negatively related to secure attachment (values between -0.13 and -0.18). Likewise, the predictive role of ED and attachment styles in EA and MD was tested. And it was observed how attachment styles mediated the relationship between EA and ED, as well as the relationship between MD and ED. Thus, it has been shown that people with EA and MD present attachment styles that may influence negatively the decision-making process when choosing inappropriate strategies to achieve adequate emotional regulation, even selecting inappropriate goals for physical exercise with negative consequences. Conclusions: The dissemination of the findings among mental health and sports science professionals is necessary to develop prevention and intervention strategies for people affected by EA and MD.

Exercise Addiction Stability and Health Effects. A 6-Month Follow-up Postcompetition Study in Amateur Endurance Cyclists

OBJECTIVE

To study the longitudinal stability of exercise addiction and its health effects in apparently healthy amateur endurance cyclists from pre- to 6-month post-competition.

METHODS

In total, 330 (30 women) adult cyclists were divided into 4 groups based on scores on the Exercise Addiction Inventory at both periods: nonrisk (n = 262, 79.1%), transient (n = 35, 10.6%), emerging (n = 14, 4.2%) and persistent (n = 20, 6.1%).

RESULTS

The prevalence of high-risk exercise addiction was reduced postcompetition (16.7% vs 10.3%, P = 0.017). Of the cyclists with a high precompetition risk of exercise addiction, 63.6% (35/55) had a transient addiction associated with favorable effects on mental quality of life (effect size [ES] = 0.52, 95% confidence interval: [0.20, 0.86]) and sleep quality (ES = -0.50 [-0.89, -0.12]) and avoided the worsening of depression symptom severity compared to the remaining groups (ES range = 0.51-0.65). The 5.1% (14/275) of cyclists with a precompetition low risk of exercise addiction presented emerging exercise addiction that was associated with a worsened mental quality of life compared to the remaining groups (ES ranged 0.59-0.91), sleep quality compared to the nonrisk (ES = -0.56 [-0.02, -1.10]) and transient (ES = -0.72 [-1.36, -0.08]) groups and anxiety symptom severity compared to the persistent group (ES = 0.51 [1.20, -0.19]).

CONCLUSIONS

Exercise addiction had a marked transitory component at 6-month postcompetition with associated health benefits in amateur endurance cyclists.

Motivation and mental well-being of long-distance hikers: A quantitative and qualitative approach

Hikers performing long distances (1000–5500 kms a year) were analyzed using quantitative and qualitative methods to evaluate their mental well-being and to find their motivation as well as to analyze the excessive physical activity. 112 hikers completed a questionnaire (M_(age) = 40.28, SD = 8.77, 57.1% male) and 25 individuals were interviewed. Distance had association only with perceived health status. There were no differences between males and females, as well as between age groups and educational attainments regarding distance. 33.3% of hikers indicated symptoms of loneliness and 4.5% were involved excessively in hiking that was significantly regressed by distress. Hikers had mainly intrinsic motivations to complete long distances including overcoming new challenges, finding the physical boundaries, experiencing a state outside the comfort zone, belonging to a special group with similar interest and attracted by the beauty of nature. Overcoming all these embodied in a flow experience that took them further to perform the new long-distance trails.

Prevalence and correlates of body dysmorphic disorder in health club users in the presence vs absence of eating disorder symptomology

PURPOSE

Body dysmorphic disorder (BDD) has been consistently linked with eating disorders, however studies that stratify associations between BDD in subjects with and without eating disorder symptomology are sparse. It was, therefore, the aim of this study to assess correlates of BDD (including social media use, motivations for exercise, exercise addiction, and sexuality) stratified by eating disorder symptomology.

METHODS

Cross-sectional study of 1665 health club users recruited online completed a battery of surveys. BDD prevalence rates were calculated and logistic regression models were created in two sub-samples: indicated or no-indicated eating disorder symptomology.

RESULTS

The key findings showed the prevalence of BDD in participants with indicated-eating disorder symptomology was significantly higher than in participants without indicated-eating disorder symptomology, yielding an odds ratio of 12.23. Furthermore, several correlates were associated with BDD only participants with an absence of eating disorder symptomology (gender, BMI, exercise addiction, exercising for mood improvement, attractiveness and tone), with others being significantly associated with BDD in participants in the presence of indicated eating disorders symptomology (exercising for health and enjoyment, relationship status, and ethnicity).

CONCLUSIONS

This study provides more evidence of the complex relationship that exists between BDD and eating disorders. Furthermore, it is recommended that practitioners working with BDD subjects should screen for eating disorders due to the high morbidity associated with eating disorders.

LEVEL OF EVIDENCE

Level III: case-control analytic study.

Problematic usage of the internet and eating disorder and related psychopathology: A multifaceted, systematic review and meta-analysis

Eating disorders are widespread illnesses with significant impact. There is growing concern about how those at risk of eating disorders overuse online resources to their detriment. We conducted a pre-registered systematic review and meta-analysis of studies examining Problematic Usage of the Internet (PUI) and eating disorder and related psychopathology. The meta-analysis comprised n = 32,295 participants, in which PUI was correlated with significant eating disorder general psychopathology Pearson r = 0.22 (s.e. = 0.04, p < 0.001), body dissatisfaction r = 0.16 (s.e. = 0.02, p < 0.001), drive-for-thinness r = 0.16 (s.e. = 0.04, p < 0.001) and dietary restraint r = 0.18 (s.e. = 0.03). Effects were not moderated by gender, PUI facet or study quality. Results are in support of PUI impacting on eating disorder symptoms; males may be equally vulnerable to these potential effects. Prospective and experimental studies in the field suggest that small but significant effects exist and may have accumulative influence over time and across all age groups. Those findings are important to expand our understanding of PUI as a multifaceted concept and its impact on multiple levels of ascertainment of eating disorder and related psychopathology.

Exercise and Use of Enhancement Drugs at the Time of the COVID-19 Pandemic: A Multicultural Study on Coping Strategies During Self-Isolation and Related Risks

Introduction: Little is known about the impact of restrictive measures during the COVID-19 pandemic on self-image and engagement in exercise and other coping strategies alongside the use of image and performance-enhancing drugs (IPEDs) to boost performance and appearance. Objectives: To assess the role of anxiety about appearance and self-compassion on the practice of physical exercise and use of IPEDs during lockdown. Methods: An international online questionnaire was carried out using the Exercise Addiction Inventory (EAI), the Appearance Anxiety Inventory (AAI), and the Self-Compassion Scale (SCS) in addition to questions on the use of IPEDs. Results: The sample consisted of 3,161 (65% female) adults from Italy (41.1%), Spain (15.7%), the United Kingdom (UK) (12.0%), Lithuania (11.6%), Portugal (10.5%), Japan (5.5%), and Hungary (3.5%). The mean age was 35.05 years (SD = 12.10). Overall, 4.3% of the participants were found to engage in excessive or problematic exercise with peaks registered in the UK (11.0%) and Spain (5.4%). The sample reported the use of a wide range of drugs and medicines to boost image and performance (28%) and maintained use during the lockdown, mostly in Hungary (56.6%), Japan (46.8%), and the UK (33.8%), with 6.4% who started to use a new drug. Significant appearance anxiety levels were found across the sample, with 18.1% in Italy, 16.9% in Japan, and 16.7% in Portugal. Logistic regression models revealed a strong association between physical exercise and IPED use. Anxiety about appearance also significantly increased the probability of using IPEDs. However, self-compassion did not significantly predict such behavior. Anxiety about appearance and self-compassion were non-significant predictors associated with engaging in physical exercise. Discussion and Conclusion: This study identified risks of problematic exercising and appearance anxiety among the general population during the COVID-19 lockdown period across all the participating countries with significant gender differences. Such behaviors were positively associated with the unsupervised use of IPEDs, although no interaction between physical exercise and appearance anxiety was observed. Further considerations are needed to explore the impact of socially restrictive measures among vulnerable groups, and the implementation of more targeted responses.

Mental Disorders in Individuals With Exercise Addiction-A Cross-Sectional Study

Background and Aims: Exercise addiction has not yet been designated as an addictive disorder in the DSM-5 due to a lack of detailed research. In particular, associations with other psychiatric diagnoses have received little attention. In this study, individuals with a possible exercise addiction are clinically assessed, in order to establish a profile of co-occurring psychiatric disorders in individuals with exercise addiction. Methods: One hundred and fifty-six individuals who reported exercising more than 10 h a week, and continued to do so despite illness or injury, were recruited for the study. Those who met the cut-off of the Exercise Dependence Scale (n = 32) were invited to participate in a screening with the Structured Clinical Interview for DSM-5 (SCID-5-CV) and personality disorders (SCID-5-PD). Additionally, an interview based on the DSM-5 criteria of non-substance-related addictive disorders was conducted to explore the severity of exercise addiction symptoms. Results: 75% of participants fulfilled the criteria for at least one psychiatric disorder. Depressive disorders (56.3%), personality disorders (46.9%) and obsessive-compulsive disorders (31.3%) were the most common disorders. Moreover, there was a significant positive correlation between the number of psychiatric disorders and the severity of exercise addiction (r = 0.549, p = 0.002). Discussion: The results showed a variety of mental disorders in individuals with exercise addiction and a correlation between the co-occurrence of mental disorders and the severity of exercise addiction. Exercise addiction differs from other addictive und substance use disorders, as obsessive-compulsive (Cluster C), rather than impulsive (Cluster B) personality traits were most commonly identified. Conclusions: Our results underscore the importance of clinical diagnostics, and indicate that treatment options for individuals with exercise addiction are required. However, the natural history and specific challenges of exercise addiction must be studied in more detail.