Hooked on the mirror: the emergence of exercise addiction, body dysmorphic disorder, and other image-related psychopathological correlates in fitness settings

In a society that perpetuates the strive for a perfect appearance, a fit body has become synonymous with success, but simultaneously hard to achieve. This represents a fertile ground for the development of Exercise Addiction (EA) alongside other disorders, such as Body Dysmorphic Disorder (BDD). This study aims to explore the diffusion of EA in fitness settings and related psychopathologies in the United Kingdom, Italy, Netherlands, Hungary. Methods: A cross-sectional sample (N = 1711) was surveyed in gyms using the Exercise Addiction Inventory (EAI), Appearance Anxiety Inventory (AAI) and Rosenberg’s Self Esteem Scale (RSE) in addition to questions on use of fitness supplements. Results: Compulsive exercise, appearance anxiety and low self-esteem were reported. 11.7% scored over the cut off for EA. 5% was found above the clinical cut off for BDD. 39.8% used enhancing supplements without medical consultation (95.5%). The latter group scored higher in both EAI and AAI. The regression model revealed a strong association between the consumption of supplements and the level of EA across the sample. Conclusions: This study identified a high risk of EA, appearance anxiety and BDD amongst participants. The previously- unexplored association between these disorders highlights the need for informed and integrated responses targeting such vulnerable individuals.