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A person with an addiction uses a substance, or engages in a behavior, for which the rewarding effects provide a compelling incentive to repeat the activity, despite detrimental consequences. Addiction may involve the use of substances such as alcohol, inhalants, opioids, cocaine, and nicotine, or behaviors such as gambling.

There is evidence that addictive behaviors share key neurobiological features: They intensely involve brain pathways of reward and reinforcement, which involve the neurotransmitter dopamine. And, in keeping with other highly motivated states, they lead to the pruning of synapses in the prefrontal cortex, home of the brain's highest functions, so that attention is highly focused on cues related to the target substance or activity. It is important to know that such brain changes are reversible after the substance use or behavior is discontinued.

Both substance use disorders and gambling behaviors have an increased likelihood of being accompanied by mental health conditions such as depression and anxiety, or other pre-existing problems. Substance use and gambling disorders not only engage the same brain mechanisms, they respond to many of the same treatment approaches.

Substance use and gambling disorders are complex conditions that affect the reward, reinforcement, motivation, and memory systems of the brain. They are characterized by impaired control over usage; social impairment, involving the disruption of everyday activities and relationships; and craving. Continuing use is typically harmful to relationships as well as to obligations at work or school.

Another distinguishing feature of addictions is that individuals continue to pursue the activity despite the physical or psychological harm it incurs, even if it the harm is exacerbated by repeated use. Typically, one's tolerance to a substance increases as the body adapts to its presence.

Because addiction affects the brain's executive functions, centered in the prefrontal cortex, individuals who develop an addiction may not be aware that their behavior is causing problems for themselves and others. Over time, pursuit of the pleasurable effects of the substance or behavior may dominate an individual's activities.

All addictions have the capacity to induce a sense of hopelessness and feelings of failure, as well as shame and guilt, but research documents that recovery is the rule rather than the exception. There are many routes to recovery. Individuals can achieve improved physical, psychological, and social functioning on their own-so-called natural recovery. Others benefit from the support of community or peer-based networks. And still others opt for clinical-based recovery through the services of credentialed professionals.

The road to recovery is seldom straight: Relapse, or recurrence of substance use, is common-but definitely not the end of the road. For those who achieve remission of an addiction disorder for five years, researchers report, the likelihood of relapse is no greater than that among the general population. Neuroscientists report that synaptic density is gradually restored.

Myths About Addiction

The processes that give rise to addictive behavior resist a simplistic explanation. There is not just one cause: Although genetic or other biological factors can contribute to a person's vulnerability to the condition, many social, psychological, and environmental factors also have a powerful influence on substance use.

Some characteristics, such as a lack of ability to tolerate distress or other strong feelings, have been associated with addiction, but there is no one "addictive personality " type that clearly predicts whether a person will face problems with addiction.

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Symptoms of Addiction

Recurrent use of a substance, or engagement with an activity, that leads to impairment or distress, is the core of addictive disorders. The clinical diagnosis of an addiction is based on the presence of at least two of a number of features:

The substance or activity is used in larger amounts or for a longer period of time than was intended.

There is a desire to cut down on use or unsuccessful efforts to do so.

Pursuit of the substance or activity, or recovery from its use, consumes a significant amount of time.

There is a craving or strong desire to use the substance or engage in the activity.

Use of the substance or activity disrupts obligations at work, school, or home.

Use of the substance or activity continues despite the social or interpersonal problems it causes.

Participation in important social, work, or recreational activities drops or stops.

Use occurs in situations where it is physically risky.

Use continues despite knowing it is causing or exacerbating physical or psychological problems.

Tolerance occurs, indicated either by need for markedly increased amounts of the substance to achieve the desired effect or markedly diminished effect of the same amount of substance.

Withdrawal occurs, manifest either in the presence of physiological withdrawal symptoms or the taking of a related substance to block them.

The severity of the condition is gauged by the number of symptoms present. The presence of two to three symptoms generally indicates a mild condition; four to five symptoms indicate a moderate disorder. When six or more symptoms are present, the condition is considered severe.

Causes of Addiction

Research makes it clear: There is no way to predict who will develop compulsive substance use or gambling behavior.

Addiction is a multi-faceted condition, arising from the confluence of many elements-including, of course, exposure to an addictive agent. It is more accurate to think of risk factors for the development of substance abuse disorders, rather than direct causes. (There are also factors that protect individuals against addiction.)

Biological factors

Genes. Estimates vary but scientists find that genetic factors contribute about half the risk for developing a substance use disorder. For example, one factor linked to vulnerability is variation in a gene that determines the makeup of brain receptors for the neurotransmitter dopamine. Another factor appears to be the nature of the body's hormonal response to stress.

Physiological factors. Variations in liver enzymes that metabolize substances are known to influence one's risk of alcohol use disorder.

Gender. Males are more likely to develop substance use disorder than females, although the so-called gender gap may be narrowing for alcohol use disorder, and females are more subject to intoxication effects at lower doses of alcohol.

Psychological Factors

Personality factors. Both impulsivity and sensation seeking have been linked to substance use and gambling disorders. Impulsivity may be particularly related to the risk of relapse.

Trauma and abuse. Early exposure to significant adverse experience can contribute to the development of substance use disorders by overwhelming an individual's coping ability, perhaps by sensitizing brain pathways of alarm/distress, or by adding to the burden of stress.

Mental health factors. Conditions such as depression, anxiety, attention deficit disorder, and post-traumatic stress disorder (PTSD) increase the risk of addiction. Difficulties managing strong emotions are also linked to substance use.

Environmental Factors

Family factors. While strong family relationships have been shown to protect against substance use disorders, several aspects of family functioning or circumstances can contribute to addiction risk. Having a parent or sibling with an addictive disorder raises the risk, as does a lack of parental supervision or support. Poor-quality or troubled parent-child relations and family disruptions such as divorce also add to one's risk, as does sexual, physical, or emotional abuse. Research shows that marriage and taking on child-raising responsibilities mitigate the risk of addiction.

Accessibility factors. Easy availability of alcohol or other substances in one's home, at school or work, or in one's community increases the risk of repeated use.

Peer group. As profoundly social animals, people are strongly influenced by their peers and, in generally seeking to be liked by them, may adopt many of their behaviors, particularly during adolescence. Positive social relationships, on the other hand, are known to strongly protect against substance use.

Employment status. Having a job, and developing the skills for employment, exerts pressure for stability and provides financial and psychological rewards that mitigate addiction risk.

Treatment of Addiction

Substance use is a treatable condition and complete remission is entirely possible. Recovery, however, is often a long-term process that may involve multiple attempts. Relapse is now regarded as part of the process, and effective treatment regimens address prevention and management of recurrent use.

Since success tends not to occur all at once, any improvements are considered important signs of progress. Increasingly, programs are available to help those who recognize that they have a substance-use problem but are not ready for complete abstinence.

Because addiction affects so many facets of an individual's functioning-from the ability to tolerate frustration to establishing and maintaining a productive role in society-good treatment focuses on many dimensions of life, including family roles and work skills as well as mental health.

Treatment can include any of a number of components, which are often deployed in combination and are likely to change over the course of recovery:

Detoxification, conducted under medical supervision, may be needed but is only the first stage of treatment.

Medications that reduce or counter use of illicit substances are suitable for some individuals, or medications may be used to target co-occurring disorders such as anxiety and depression.

Motivational Interviewing, which is a short-term counseling process to help a person resolve ambivalence about treatment and find and hold onto incentives for change.

Cognitive Behavior Therapy (CBT) can help a person recognize and cope with situations that trigger the desire to use substances.

Group therapy and other peer-support programs leverage the direct experience of many to support individual recovery and prevent the recurrence of substance use.

Family therapy helps individuals repair any damage done to family relationships and to establish more supportive ones.

Life skills training, including employability skills, may be part of an individual's treatment plan.

Good treatment programs also feature the regular monitoring of individual progress.

Treatment is available in a variety of settings, from a doctor's office or outpatient clinic to long-term residential facility. No one way will be right for everyone, and there is evidence that one's commitment to change is more important than the type of treatment program he or she selects. Whatever the treatment under consideration, say independent researchers, there are number of features to look for to identify an effective program:

Patients undergo comprehensive medical and psychiatric screening.

Treatment addresses individual needs, including co-occurring conditions, whether chronic pain, anxiety, or hepatitis.

Families are involved in treatment.

There is continuity of care via active linkages to resources in subsequent phases of recovery.

The facility maintains a respectful environment.

Treatment services are evidence-based and reflect best practices.

Staff members are licensed and certified in the disciplines they practice.

The program is accredited by a nationally recognized monitoring agency.

Patient response to treatment is monitored and the program or facility offers outcome data reflecting treatment performance.

Substance Use Disorders

The medical world currently views substance use disorders according to the class of drug that is used. As a result, it defines 10 distinct disorders. All share the defining features of addiction: They directly and intensely involve reward and reinforcement systems of the brain, stimulating compulsive use that typically leads to the neglect of normal activities and negative consequences. With some variation, they also share common symptoms, although withdrawal symptoms differ significantly among them and do not occur for some classes of drug such as hallucinogens and inhalants.

Alcohol Use Disorder: Alcohol is a brain depressant and alcohol use disorder is common, although more so among adult men (12.4 percent) than women (4.9 percent), although rates are rising among women. It affects men and women differently; women seem to be more susceptible to some of the detrimental effects of alcohol, researchers find. Most commonly, the disorder develops well before age 40.

Caffeine Intoxication: The consequence of very high doses of caffeine consumption, caffeine intoxication is marked by symptoms including restlessness, nervousness, insomnia, flushed face, gastrointestinal disturbance, muscle twitching, rambling thoughts and speech, cardiac rhythm disturbances, periods of inexhaustibility, and psychomotor agitation.

Cannabis Use Disorder: Cannabis use disorder is highest among 18-to29-year-olds (4.8 percent) and prevalence of the disorder decreases with age.

Phencyclidine and Other Hallucinogen Use Disorder: These substances alter perception. Phencyclidine is commonly called "angel dust" or PCP and produces feelings of separation of mind from body.

Inhalant Use Disorder: Inhalant substances are volatile hydrocarbons-toxic gases that are released from glues, fuels, paints, and other volatile compounds and have psychoactive effects. The disorder occurs primarily among those ages 12 to 17.

Opioid Use Disorder: Opioid drugs include the illicit drug heroin and prescription pain-relievers such as oxycodone, codeine, morphine, and fentanyl, among others. According to the American Society of Addiction Medicine, in 2015, 2 million people had a substance use disorder involving prescription pain relievers and 591,000 had a substance use disorder involving heroin. Opioid-related overdoses are now the leading cause of death in Americans under 50 years of age. Prescribed opioids are the "overwhelming initial source" of addiction, according to ASAM.

Sedative, Hypnotic, or Anxiolytic Use Disorder: Addiction to sleeping pills and anti-anxiety medications falls into this category. Like alcohol, these agents are brain depressants. Rates of the disorder are highest among 18-to-29-year-olds.

Stimulant Use Disorder: Substances in this group include amphetamines; methylphenidate, best known as the prescription drug Ritalin; and cocaine. Stimulant drugs are commonly prescribed for the treatment of attention-deficit/hyperactivity disorder (ADHD) and narcolepsy. In the U.S., cocaine use is highest among those aged 18 to 25.

Tobacco Use Disorder: The nicotine in tobacco acts as a central nervous system stimulant. Studies show that 68 percent of adult smokers want to quit, and 50 percent have made attempts to quit.

Other (or Unknown) Substance Use Disorder: Substances ranging from antihistamines, betel nut, and cortisol to steroids may also have effects on the central nervous system that lead to compulsive use causing serious problems.

Gambling and Other Compulsions or Addictions

Addiction is not limited to biochemical substances such as cocaine, alcohol, inhalants, or nicotine. It can involve behaviors that provide opportunities for immediate reward. Because of the fast feedback that occurs from such activities, they can quickly turn a pastime into a compulsive pursuit of reward that may lead to the neglect of other life goals and create harmful consequences, from the loss of large sums of money to the disruption of important relationships.

Behaviors indicative of gambling disorder include:

The need to gamble with increasing amounts of money to achieve the desired excitement.

Restlessness or irritability when attempting to cut down or stop gambling.

Repeated unsuccessful efforts to cut back or stop gambling.

Preoccupation with gambling.

Feelings of emotional distress leading to gambling.

Gambling losses followed by attempts to make up for them.

Lying to conceal the extent of one's gambling.

Gambling that jeopardizes important relationships or work, school, or other obligations.

Financial desperation leading to borrowing money from others.

In June 2018, the World Health Organization included Gaming Disorder, involving digital gaming or video gaming to such a degree that it takes priority over other interests and daily activities despite negative consequences, in its newest edition of the International Classification of Diseases. This inclusion reflects a consensus of experts from different disciplines and geographical regions around the world. They point out that only a tiny proportion of those who engage in digital or video gaming activities-notably those who have impaired control over the activity and spend excessive amounts of time at it-are at risk for the diagnosis.

In the United States, excessive behavior patterns-involving smartphone use, Internet gambling, gaming, pornography, even eating and shopping-are being studied as possible behavioral addiction. While such activities may provide the opportunity for ample immediate reward, it has not yet been determined that they meet all of the criteria for addictive behavior.

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A person with an addiction uses a substance, or engages in a behavior, for which the rewarding effects provide a compelling incentive to repeat the activity, despite detrimental consequences. Addiction may involve the use of substances such as alcohol, inhalants, opioids, cocaine, and nicotine, or behaviors such as gambling.

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Overview

There is a commonly held misconception that eating disorders are a lifestyle choice. Eating disorders are actually serious and often fatal illnesses that are associated with severe disturbances in people's eating behaviors and related thoughts and emotions. Preoccupation with food, body weight, and shape may also signal an eating disorder. Common eating disorders include anorexia nervosa, bulimia nervosa, and binge-eating disorder.

Signs and Symptoms

Risk Factors

Treatments and Therapies

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There is a commonly held misconception that eating disorders are a lifestyle choice. Eating disorders are actually serious and often fatal illnesses that are associated with severe disturbances in people's eating behaviors and related thoughts and emotions. Preoccupation with food, body weight, and shape may also signal an eating disorder.

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https://www.everydayhealth.com/addiction/hooked-on-caffeine.aspx

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While exercise addiction is not currently included in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-5), there is a growing body of anecdotal, professional, and scientific evidence to show that it is a real and serious condition.

What is Exercise Addiction?

Exercise addiction is a compulsive disorder in which a person feels the uncontrollable need to exercise excessively. It goes beyond simple enjoyment of exercise and often results in injury or illness. Like other behavioral addictions, a person must demonstrate most of the following symptoms to be considered as suffering from exercise addiction: ¹

Loss of control: inability to control the urge to exercise or to stop exercising for a significant time, especially in the presence of an injury that requires time to heal.

Continuance: continuing to exercise even in the presence of injuries, physical problems, psychological issues, or interpersonal problems.

Intention effects: going beyond the original intended duration, frequency, or intensity of exercise without meaning to do so.

Time: spending a great deal of time engaging in, planning for, thinking about, or recovering from exercise.

Reduction in other activities: spending less time in social, occupational, or other situations as a direct result of exercise.

Tolerance: needing to exercise more often, for longer durations, or at higher intensity to feel the desired effect than you originally did.

Withdrawal: feelings of irritability, restlessness, or anxiety after a period without exercise.

Exercise addiction can occur independently or in conjunction with another disorder, such as anorexia nervosa or bulimia nervosa. ² There is some disagreement about what constitutes exercise addiction, which makes it difficult to determine how common the condition is. Some research studies equate exercise addiction with the commitment demonstrated by marathon runners. However, in more thoughtful and statistically sound research studies, excessive exercise is only considered an addiction when people report that they feel compelled to exercise and they have suffered serious physical, social, or occupational problems because of their exercise. ² These research studies agree that approximately 3% of people who exercise regularly are addicted to it; the condition is much more common in people in their late teens or early 20s. ² Other estimates have found that upward of 42% of regular gym-goers meet the criteria for exercise addiction; ¹ however, these are concentrated samples taken from locations with frequent or committed exercisers.

Has Your Exercise Become An Addiction?

While behavioral health and mental health tend to overlap, and many organizations substitute one term for the other, distinct differences do exist between the two. Many mental health disorders have neurological or biological causes, meaning that simply changing a person's behavior may not cure them of that illness. Read More

How Does Exercise Addiction Develop?

There are two types of exercise addiction: primary exercise addiction and secondary exercise addiction. In each case, exercise addiction develops differently.

Primary Exercise Addiction

Primary exercise addiction is more common in males and usually develops in the response to endorphins.

Primary exercise addiction occurs as a form of behavioral addiction, but these people do not have any other psychological or behavioral conditions-exercise addiction is the main problem. ² Primary exercise addiction is more common in males and usually develops in response to the pleasurable effects of endorphins that are released during and after exercise. ² This is how exercise makes the body produce its own high, which is what primary exercise addicts become addicted to.

Secondary Exercise Addiction

Secondary exercise addiction occurs in conjunction with another disorder, most commonly eating disorders such as anorexia nervosa and bulimia nervosa. ² Secondary exercise addiction is more common in females and usually develops due to body image issues. ²

Anorexia is an eating disorder involving self-starvation that leads to excessive weight loss. Even when people with this disorder are dangerously thin, they still believe they need to lose weight. Risk factors for anorexia include: ³

A preoccupation with weight and body shape.

Having an anxiety disorder as a child.

Negative self-image.

Having eating problems during infancy or early childhood.

Holding strong or extreme social or cultural ideas about beauty, appearance, and health.

A preoccupation with being perfect.

Being overly concerned with rules.

When exercise addiction is accompanied by anorexia and the primary motivation for the individual is to lose weight, this condition is called anorexia athletica. ¹

Another cause for secondary exercise addiction is bulimia, which is a serious eating disorder that involves a cycle of binging and purging. ⁴ Binging refers to eating a very large amount of food in a specific period of time (typically within 2 hours), often to the point of feeling sick. To compensate for the high intake of calories, some people will exercise excessively, which, over time, can develop into exercise addiction. ⁴ The cause of bulimia is unknown, but it is thought to be caused by a combination of genetic, psychological, and cultural factors. ⁴

Physical Side Effects

Exercise addiction is associated with a number of physical and psychological side effects, including: ⁵

Detrimental social consequences.

Disturbed psychological functioning.

Exercising despite medical contraindications.

Interference with relationships or work.

Withdrawal symptoms such as agitation, anxiety, or restlessness after not exercising for a time.

One of the most serious physical consequences of compulsive exercise is an increased risk for injury or an increased number of exercise-related injuries. ² While regular exercise strengthens the muscles and bones, too much exercise increases the risk for stress fractures. Those who have existing injuries may aggravate their injuries and lengthen the amount of time needed to recover completely. Some examples of injuries caused by excessive exercise include: ⁵

Joint inflammation/ damage.

Loss of muscle mass.

Sprained ligaments.

Strained or torn muscles or tendons.

Another physical risk associated with exercise addiction is menstrual disturbance in women. ⁵ Due to an unhealthy body mass, the female body stops releasing eggs and the woman misses one or multiple periods. ⁵ This is most common in females who have secondary exercise addiction accompanied by an eating disorder, but it can happen with primary exercise addiction as well. ⁵

Exercise addiction is also commonly associated with substance abuse. Research suggests that 15%-20% of exercise addicts are also addicted to either nicotine, alcohol, or illicit drugs. ¹ Not only can these substances have adverse effects on the body on their own, but if you are already weakened by excessive exercise, a substance abuse problem could pose increased risks for harm.

Social and Psychological Side Effects

Due to the amount of time that exercise-addicted people spend exercising and obsessing about exercising, many suffer from dysfunctional relationships. Family and friends often feel left out, unable to approach the person, or upset about the way the exercise-addicted person chooses to spend their time. Even when friends and family members have the best intentions, approaching someone about compulsive exercise can also create relationship conflict.

Some people with this disorder skip classes or take unpaid time off from work to exercise, which interferes with their education and reduces their income. Exercise addiction can make it difficult to carry on a satisfying social life, since people with this disorder often skip special events and activities to exercise. Even exercising with other people is difficult, since compulsive exercisers do not like to have their routines disturbed. They would rather exercise on their own so they can control the components and timing of the exercise session.

Going 6 hours without exercising may provoke anxiety for someone addicted to exercise.

Exercise addiction can cause emotional distress, especially when accompanied by negative body image or a lack of self-esteem. In particular, people suffering from exercise addiction often experience symptoms of anxiety after a period without exercise. ² The length of time between exercise sessions is subjective: though going 24-48 hours without exercising may seem normal for most people, going 6 hours without exercising may provoke anxiety for someone addicted to exercise. If the person is prevented from exercising or is forced to reduce the frequency of exercise, they will likely experience irritability, guilt, anxiousness, and sluggishness. ² These feelings may also occur when a compulsive exerciser experiences a disruption in their exercise routine.

When someone has developed a primary exercise addiction, it is common for that person to suffer depression-like symptoms when forced to stop or reduce exercising. ² For people with primary exercise addiction, exercise is often used as a coping mechanism to deal with stress, so when that coping mechanism is taken away, they don't know how to deal with the stress of daily life. These feelings of depression are often worsened by withdrawal from the exerciser's regular endorphin fix. ²

Treatment Options for Exercise Addiction

Exercise addiction is serious, but there are treatment options available. The first step in choosing a treatment option is figuring out whether you have a primary or secondary exercise addiction. Treatment will be most effective if the root cause of the problem is addressed first. If the underlying condition is anorexia nervosa, for example, then treatment should focus on the eating disorder.

Exercise addiction is challenging to treat because exercise is a healthy habit that should be incorporated into each person's daily life.

Once the root problem is identified, the next step is to determine if another condition needs to be addressed first for health or safety reasons. For example, though exercise addiction can be extremely harmful, a co-occurring substance abuse problem may be more immediately threatening. In such cases, the substance abuse problem may need to be addressed first. It is important to consult with a medical professional and a mental health professional when seeking treatment for exercise addiction because the condition affects the physical body as much as your mental condition.

With the problems properly identified and prioritized, a behavioral health professional can help you begin treatment. Right now, there are no prescription drugs available for exercise addiction treatment, but research continues to discover if certain drugs can help you control your impulses to engage in harmful behaviors. A medical or mental health professional may prescribe medication to address symptoms that result from exercise addiction and exercise withdrawal, such as anxiety or depression. A medical professional may also prescribe medications to help with any physical injuries caused by excessive exercise.

Exercise addiction is challenging to treat because exercise is a healthy habit that should be incorporated into each person's daily life. Also, what may seem like a challenging workout for one person may be easier for someone in better shape. So it becomes difficult to define what is within the bounds of normal, healthy exercise and what is harmful.

Exercise addiction treatment is further complicated by the fact that abstinence is not usually an option. While some people suffering from exercise addiction may need to take time off from exercise to recover from existing injuries, eventually exercise should be reincorporated into a daily routine.

Recognize dysfunctional thought patterns that lead to excessive exercise.

To get a better understanding of your specific case of exercise addiction, behavioral health professionals may use an assessment tool called the Exercise Dependence Scale. ¹ This tool is used to determine how severe your reliance on exercise is on an emotional and psychological level. As treatment progresses, a counselor or therapist may ask you to complete the assessment again to determine what progress you've made.

With primary exercise addiction, it is likely that you do not have any other coping skills for dealing with stress. In this case, treatment focuses on building healthy coping skills and using cognitive behavioral therapy to recognize dysfunctional thought patterns that lead to excessive exercise. ¹

In cases of secondary exercise addiction, the therapist focuses on self-esteem issues and distorted body image. Medications such as anti-depressants, anti-psychotics, and mood stabilizers are commonly prescribed in the early stages of eating disorder treatment. ⁶ Other therapies include individual therapy, group therapy, nutritional counseling, and medical monitoring. ¹

As many as 35% of people with an eating disorder will relapse, and while exercise addiction further complicates the treatment process, recovery is possible. ⁷ It is often a lifelong battle to establish healthy habits and boundaries that prevent normal eating and exercise patterns from reverting to excessive or overly controlled, but with the right treatment and continued support, you can go on to live a healthy life.

Sources

1. Freimuth, M., Moniz, S., & Kim, S. R. (2011). Clarifying Exercise Addiction: Differential Diagnosis, Co-occurring Disorders, and Phases of Addiction. International Journal of Environmental Research & Public Health, 8(10), 4069-4081.

2. Berczik, K., Szabo, A., Griffiths, M. D, Kurimay, T., Kun, B., Urban, R., & Demetrovics, Z. (2012). Exercise addiction: Symptoms, diagnosis, epidemiology, and etiology. Substance Use & Misuse, 47, 403-417.

3. United States National Library of Medicine. (2016). .

4. United States National Library of Medicine. (2016). .

5. Pinheiro, A. P., Thornton, L. M., Plotonicov, K. H. P., Tozzi, F., Klump, K. L., Berrettini, et al. (2007). Patterns of Menstrual Disturbance in Eating Disorders. International Journal of Eating Disorders, 40, 424-434.

6. National Institute of Mental Health. (2016). Eating Disorders.

7. Carter, J. C., Blackmore, E., Sutandar-Pinnock, K., & Woodside, D. B. (2004). Relapse in anorexia nervosa: A survival analysis. Psychological Medicine, 34(4), 671-9.

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While exercise addiction is not currently included in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-5), there is a growing body of anecdotal, professional, and scientific evidence to show that it is a real and serious condition. Exercise addiction is a compulsive disorder in which a person feels the uncontrollable need to exercise excessively.

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Learn about the effects, signs, and symptoms of cell phone addiction as well as what treatment is available.

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http://www.bbc.com/news/technology-33976695

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Learn how addiction affects your brain and behavior.

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Sometimes people get so addicted that they forget to eat or sleep
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http://metro.co.uk/2016/09/07/15-things-you-only-know-if-youre-addicted-to-memes-6113112/

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Not being able to provide for their family

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Not being able to provide for their family

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anorexia, starving yourself

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Phones
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