Beyond primary and secondary addiction: A qualitative study examining the instrumentalization of problematic exercise

The present study investigated problematic exercise from a qualitative perspective. It critically examined the conventional primary-secondary addiction dichotomy’s conceptual validity and proposes alternative frameworks for a more nuanced understanding. Within the framework of critical realism, the objective was to examine the forms of instrumentalization of exercise behavior contained in the narratives of problematic exercise experiences. The participants were 22 individuals (13 men and 9 women) who had previously reported negative experiences with exercise. An in-depth interview was conducted with each participant, and their narratives were subjected to reflexive thematic analysis. Through a systematic and recursive coding process, four main themes were generated that captured the prevalent forms of instrumentalization of problematic exercise behavior: (i) as an anesthetic and mechanism of escape; (ii) as a control mechanism for reported mental health disorders; (iii) as compensatory behavior and body image; and (iv) as a basis for the construction of identity, ego, and status. The findings suggest that exercise addiction is defined by its subjective meaning and the persistent use of the practice to regulate affect and identity tensions. It is concluded that the dichotomy between primary and secondary addiction may be clinically insufficient because the problematic nature of exercise does not seem to depend necessarily on the presence of a prior disorder, but rather on its persistent instrumental use to regulate identity and emotional distress.