When sport tips into obsession

For some enthusiasts, intensive sport can in fact mask a little-known but destructive mental health disorder: bigorexia. It is an addiction that needs to be treated to limit its physical, psychological and social consequences. MonacoSanté keeps you informed.

A toxic illness

Sport is normally beneficial for those who practise it. During each session, the body releases endorphins, dopamine and serotonin, a trio of chemical messengers that produce positive sensations. Dopamine is associated with reward and pleasure, while serotonin, linked to happiness, plays a role in regulating mood. Endorphins, meanwhile, help reduce the sensation of pain by releasing thousands of anti-inflammatory molecules into the body, contributing to that feeling of well-being after exercise. This is a virtuous circle, until sport becomes, for some people, a genuine addiction. So how can we tell the difference between intensive practice and a toxic illness? "Sport addiction can be defined as an obsessive disorder characterised by a number of criteria", explains Dr Tommy Burté, a private psychiatrist in Monaco. Bigorexia then transforms the well-being associated with sport into a pathological dependence. Someone who exercises every day is obviously not necessarily bigorexic. The disorder appears when the person can no longer stop of their own accord, even in the face of injury, pain or fatigue. The psychiatrist points to the notion of control: what begins as a free choice gradually becomes an overwhelming need to train. This addiction is also often associated with other difficulties, such as eating disorders (anorexia, for example), anxiety, depression or intense pressure linked to body image and performance.

The spiral of three anxieties

The first studies on bigorexia date back to the 1980s, alongside the rise of gyms and the mass broadcasting of body ideals on television. Today, social media and certain influencers specialising in endurance running, fitness or bodybuilding also fuel this quest for the perfect body sharing images that are sometimes retouched, or even generated by artificial intelligence. This alone, however, is not enough to trigger the illness. "This disorder is often rooted in a narcissistic vulnerability, in other words a lack of self-esteem and self-confidence. To compensate for this distress, those affected multiply their training sessions, follow very strict diets, take food supplements, and may even resort to performance-enhancing substances", explains Dr Tommy Burté. Recognised by the World Health Organization (WHO) since 2011, this behavioural addiction affects between 0.5% and 1% of the general population. Nearly 90% of those affected are men, mainly aged between 18 and 35. People who take up particularly demanding disciplines such as marathon running, triathlon or bodybuilding are significantly more at risk of crossing the line from a simple passion to a genuine addiction. People with bigorexia can find themselves trapped in a vicious circle fuelled by three forms of anxiety. The first is appearance-related anxiety: the fear of not being muscular enough or, conversely, not being slim enough. Next comes performance anxiety, the pressure to reach ever higher and often unattainable physical goals. Finally, there is withdrawal, or "craving", an overwhelming need to train, failing which the person experiences physical panic, guilt or stress that is hard to bear.

Sometimes serious health consequences

Dependence therefore takes hold gradually in the brain. After intense exercise, the body can release up to five times its normal dose of endorphins. This can produce, in some athletes, a state of euphoria that they then seek to reproduce compulsively. Little by little, an addictive mechanism can take hold: the more the person trains, the greater their need to keep going. Sport eventually disrupts everyday life, not least because the constant pursuit of this sense of well-being provides only temporary relief from anxiety. "It generally takes a psychological, and sometimes even genetic, vulnerability for this disorder to take hold", the psychiatrist notes. This is when the health risks increase. "Any mental health condition, whatever the symptoms involved, is considered a disorder or illness from the moment those symptoms have a social or professional impact", stresses Dr Burté. In other words, the problem arises when sport gradually takes over the patient's entire life. The person may then neglect their loved ones, give up their hobbies, become less effective at work, or think of nothing but their next training session. "In the most severe cases, depression can also develop", the specialist adds. "Physically, excessive training puts strain on the muscles, joints and bones. Unbalanced diets can cause nutritional deficiencies, while the misuse of food supplements or performance-enhancing substances exposes the liver, kidneys and cardiovascular system to damage". Withdrawal symptoms may also appear during periods of rest, such as marked irritability or significant anxiety.

Overcoming denial and recovering

The main challenge in treating bigorexia lies in the patient's denial. The very positive image associated with sport and the culture of effort can indeed delay recognition of the addiction. "It is often those close to the person who notice it first, as the individual concerned usually plays down or denies their difficulties". Fortunately, bigorexia can be treated. Several complementary approaches may be offered, including psychoeducation, cognitive behavioural therapy (CBT) and, in some cases, medication. The aim is to break down the obsessive mechanisms and change the patient's relationship with physical effort and their own body image. "Antidepressants can be prescribed as a first-line treatment. By regulating serotonin in the brain, they calm physical anxiety and help turn the obsession into a passing thought, giving the patient back their freedom of concentration", explains Tommy Burté. With appropriate care, most patients gradually regain a more peaceful relationship with their bodies. "Self-esteem means accepting your flaws and shortcomings just as much as recognising your strengths, without trying at all costs to make them disappear", concludes Dr Burté. Beyond private psychiatrists, those affected can also consult, in the Principality, the specialists at the Monaco Addiction Treatment, Support and Prevention Centre (CSAPAM). Its role is to support people aged 15 or over, whether resident, working or attending school in the Principality, who are dealing with an addiction-related problem.

Practical information:
Opening hours: Monday to Friday, 9 am to 4.30 pm. With or without an appointment. Free and confidential. 

Contact :
Centre de soins, d’accompagnement et de prévention en addictologie de Monaco 
(Monaco Addiction Treatment, Support and Prevention Centre)
7, bis avenue des Ligures - 1st floor. 
Espace Fontvieille in Monaco. 
Phone: 00 377 98 98 27 97

Sport in extreme heat: precautions to take
When training has become an unshakeable habit, it can be hard to accept easing off, even when conditions demand it. In periods of extreme heat, however, this rigidity can expose you to serious risks.
• Avoid the hottest part of the day and opt for early morning or late evening instead
• Reduce the intensity and duration of your effort, even if you are very fit
• Stay hydrated regularly before, during and after your session
• Adapt your activity: choose an air-conditioned venue or postpone your training if necessary
• Listen to warning signs: unusual fatigue, dizziness, headaches, nausea or confusion should lead you to stop exercising immediately and cool down

And remember, in extreme heat, skipping a session is not a lack of willpower: it is a health decision.