RESUMO
Background and Aims: While a number of studies have reported on individuals who exercise excessively, and feel unable to stop despite negative consequences, there is still insufficient evidence to categorize exercise as an addictive disorder. The aim of this meta-review is to summarize the published articles and to compile a list of symptoms reported in the qualitative literature in conjunction with excessive exercise. This list is compared with the DSM-5 criteria for gambling disorder, and initial diagnostic criteria for exercise addiction are suggested. Methods: The databases MEDLINE, Web of Science and PsycInfo were searched for qualitative studies or case reports, in which excessive exercise was the main focus. All symptoms reported in conjunction with excessive exercise were extracted from each study and documented. Symptoms were also compared to the diagnostic criteria for gambling disorder. Results: Seventeen studies were included in the review, yielding 56 distinct symptoms. The Critical Appraisal Skills Program tool showed that the majority of the studies were of acceptable quality. Exercise-related symptoms corresponded with seven of the nine DSM-5 criteria for gambling disorder. The ten suggested criteria for exercise addiction are: increasing volume, negative affect, inability to reduce, preoccupation, exercise as coping, continuation despite illness/injury, minimization, jeopardized relationships, continuation despite recognizing consequences, guilt when exercise is missed. Discussion: Our results suggest that excessive exercise may constitute a behavioral addiction, based on the criteria of the DSM-5. Conclusions: Subsequent studies should aim to systematically classify symptoms of excessive exercise; in addition, it should be noted that basic questionnaires may be need to be supplemented with detailed clinical examinations.
RESUMO
BACKGROUND: The number of pathological gamblers seeking treatment has risen continuously till the present, and the trend shows no sign of reversal. Estimates of the number of pathological gamblers in Germany range from 103,000 to 290,000, corresponding to 0.2% to 0.6% of the population. Pathological gambling often accompanies other mental disturbances. Doctors who learn that their patients suffer from such disturbances should ask targeted questions about gambling behavior to increase the chance that this problem will be detected early on. METHODS: This article is based on an analysis of secondary data obtained from the German Statutory Pension Insurance Scheme and the Federal Statistical Office and on a selective review of the literature on comorbidities and available interventions. RESULTS: The rate of inpatient treatment for pathological gambling tripled from 2000 to 2010. Most pathological gamblers are men (70%-80%). More than 90% of the patients suffer from more than one mental disturbance; 40% of them carry five different psychiatric diagnoses. Simple screening instruments for pathological gambling are easy to use in routine practice and facilitate the diagnosis. CONCLUSION: As with alcoholics, only a small fraction of pathological gamblers receives the appropriate support and treatment. Educational seminars to raise awareness among physicians and targeted measures for early detection might result in more of the affected persons getting suitable help.
