Running is My ... Life

The long winter months take a heavy toll on the recreational athlete. Many let their running shoes gather dust in closets or allow their bicycles to lean dejectedly against cellar walls. They resign themselves to watching their sleek lines grow softer, and some may even be grateful for the rest.

There are others, however, who brave the slush-locked streets or the grinding tedium of laps on an indoor track rather than miss their daily dose of exercise. For them, a day off is an irritant, a missed week is a severe trial and a month off is a life crisis of catastrophic proportions. They are people such as Richard, an executive in his early 30s, who found himself unable to give up his daily seven-to eight-mile run, even though it interfered with his job and made strangers of his children.

"When I run, I feel very energized, proud of myself and have more confidence," Richard says. "If I don't run, I feel like a slob: lazy, heavy and tired. I won't last long at my job if I don't spend the necessary hours there, but if I don't run I won't be very good at it either. . . . Running is my life. It makes me feel like a complete person, and I need to do it every day." Richard is addicted to exercise.

Researchers have known of the addictive qualities of running and other aerobic sports for some time. At first, exercise addiction seemed harmless, and many believed that it was beneficial. Psychiatrist William Glasser, who popularized the concept in his 1976 book "Positive Addiction," contrasted compulsive running with the use of alcohol or drugs to cope with life's problems; running neither destroyed the mind nor pickled the liver, he argued, but instead strengthened both body and soul.

Soon, however, the focus shifted to the darker side of exercise addiction. In 1979, psychologist William Morgan found that addicted runners continued to run even when it put their jobs, their family relationships and their health in jeopardy.

This reinforced an observation made by many physicians and sports-medicine specialists. Some "recreational" athletes push themselves to the point of injuries such as shin splints or stress fractures, then refuse to rest and recuperate, causing greater and perhaps permanent damage.

The reason exercise addicts keep punishing themselves probably lies in what happens when they don't run, swim, bicycle or work out. Connie Chan, a psychologist at the University of Massachusetts at Boston, has studied the psychological consequences of being unable to exercise. Chan and psychologist Hildy Y. Grossman compared 30 male and female runners who had been laid low by minor injuries for at least two weeks with a similar group who continued to run. Those who could not run displayed more signs of depression, anxiety and confusion than did those who could, and they were far less happy with themselves and their bodies. Like other addictions, exercise appears to have withdrawal symptoms.

Chan has treated dozens of running addicts and has learned that they have some common characteristics. Addicts must run daily to function normally, and they become irritable, tense and anxious if unable to exercise for a few days. These are the short-term symptoms of exercise withdrawal.

When unable to run for longer periods of time, addicts can experience more drastic symptoms, including depression, lack of energy, loss of interest in eating, sex and other activities, decreased self-confidence and self-esteem, insomnia and weight loss or gain. They continue to run while injured and organize their lives around exercise and related activities, ignoring their families and careers.

Edward Colt, an endocrinologist and former medical director of the New York City marathon, believes that exercise addiction is very widespread: "I think that all - 100 percent - of the people who exercise regularly are addicted to some extent."

But not everyone agrees that the problem is so extensive; some, including Morgan, now question its very existence. Morgan no longer studies the issue: He feels that the concept of exercise addiction is extremely murky, and no one has ever confirmed that exercise is addictive in the same way that drugs and alcohol are.

One popular - but unproved - theory is that athletes become hooked on endorphins, the body's natural pain-killers, which surge into the brain and the bloodstream during strenuous exercise. Colt and his colleagues have done studies that show runners do have elevated endorphin levels after exercise, but no one has demonstrated that these substances actually have physiologically addictive effects. It's more likely that the "runner's high" is a feeling of well-being that comes with release of pent-up stress.

Endorphins might contribute to exercise addiction, perhaps by dulling the pain of aching muscles or battered bones that would otherwise tell people that they are overdoing it, but Chan thinks that the roots of the problem run much deeper: For the addict, exercise fulfills profound psychological needs.

The typical addict is usually not a world-class athlete; more likely, he or she is one of millions who have taken up aerobic sport in adulthood as a way of getting in shape or losing weight. People who stick to an aerobic exercise regimen usually find themselves not only slimming down and firming up but also feeling more relaxed and better able to cope with stress.

Potential addicts develop a heady sense of control over their bodies and feel invincible when running. They are intense individuals whose jobs often do not produce quantifiable results, and in their increasing mileage and other "personal bests" they discover a source of measurable achievement. For many, these results are a revelation, a self-affirmation that helps to overcome deeply buried fears of powerlessness and personal inadequacy. Eventually, exercise becomes much more than a form of recreation or a path to physical fitness. It is the root of their psychological well-being, the touchstone of their identities.

Some exercise fanatics are single professionals who would rather hit the streets or the gym after work than confront an empty house. For some, workouts meet their needs for social contact; for others, exercising is a way to avoid thinking about an empty social calendar. For all, this heightens their sense of dependence on exercise.

Chan and Colt have found that many exercise addicts show a history of compulsive behavior. "In my experience, many (running addicts) are simply replacing one addiction with another," Colt says. "I've seen many former workaholics, alcoholics, gamblers and smokers.

True to form, these addicts do not seek help willingly. "There's only one thing they want," says Colt, "and that is to find a doctor who will provide the magic cure that will allow them to keep running." Chan agrees, saying, "As long as they're able to run, (addicts) don't see a problem." Many of the exercise addicts whom Chan treats are referred to her by physicians, frustrated when their patients will not stop running long enough to let over-training injuries heal. By the time disabled runners reach her door, most are already deep in the throes of withdrawal and are more than a little bewildered by their symptoms.

"It's one thing to expect physical changes when you're not allowed to run, but exercise addicts are not prepared for the psychological repercussions," Chan says. "One of the things I offer them is reassurance that withdrawal is common and that they can get through it and get back in shape."

Chan knows the pangs of going without only too well. Eight years ago, while still in graduate school, stress fractures brought her 60-mile-per-week running regimen to an agonizing halt. At first, she tried to run through the pain. When she finally took her physician's advice and stopped running for several weeks, she found herself growing anxious and unable to concentrate.

"I felt like I was falling apart," Chan says. "I was really preoccupied with the idea of running and racing, and with the thought that I'd never get back into competitive form. Of course, I knew it was irrational - you just don't get that out of shape in a few weeks." This extreme reaction was quite disturbing, she says, and came as a shock "to someone who thought she had a pretty balanced sense of herself."

Chan helps patients identify how they benefit from running psychologically, in terms of self-esteem and stress control, and explores with them other activities that might offer similar rewards.

She often suggests joining a hiking club or pursuing educational interests. If an injury does not preclude all exercise, she encourages patients to walk, swim or participate in whatever physical activity possible to minimize withdrawal and maintain some conditioning. To help patients cope with stress, Chan often tells them to relive a favorite run in their minds.

Once addicted athletes are physically well enough to start exercising again, Chan advises them to take it slow at first and diversify their physical activities, perhaps by taking up a sport that stresses a different set of muscles, tendons and ligaments. They also need to become more involved with activities and people who are not connected to the exercise ritual.

Chan does not try to get people to give up exercise altogether: "I love to run. I would never tell anyone not to run." But with any exercise program, she says, moderation is the key to gaining the greatest benefits, both physical and psychological. Those who depend exclusively on one activity for a sense of well-being are flirting with addiction. in the long run, it doesn't work.

CAN'T EAT, GOTTA RUN

The psychological needs that keep the addicted athlete on the run echo those that keep the anorexic on the road to starvation, according to psychiatrist Alayne Yates of the University of Arizona.

Yates and her colleagues studied male compulsive runners and found some striking similarities to female anorexics. Both groups are unusually introverted and unable to express anger. They tend to come from fairly affluent, achievement-oriented families and are extremely demanding of themselves.

For both, the commitment to diet or exercise is an integral part of their identities, and they are unable to see that there is anything wrong or extreme in their activities.

Anorexics and exercise addicts are both susceptible to body-image distortions: The emaciated anorexic may see saddlebags where there is only skin and bones; a running addict in peak physical condition may feel weighed down by nonexistent body fat.

"Anorexics can never be thin enough and compulsive runners can never be fast enough," explains psychologist Catherine Shisslak, one of the study's authors.

Connie Chan, who worked with anorexics during her internship in graduate school, agrees that there are parallels between the two groups, but she sees important differences in the extent of their disturbances.

"They may be on the same spectrum," she says, "but in very different places." Take, for example, their body-image distortion. "Addicted runners have some grasp of reality when it comes to body image," Chan says. "But anorexics have gone completely over the edge, and there is no reality in how they see themselves."

She agrees, however, that the issues of achievement, control and fear of powerlessness are central to both anorexia and exercise addiction, and she notes that there is much crossover between the two groups: Compulsive runners often obsess about their weight, and many anorexics exercise religiously.