The aim of this study was to assess the risk of exercise addiction (EA) in fitness clubs and to identify possible factors in the development of the disorder. The Exercise Addiction Inventory (EAI), the Narcissistic Personality Inventory (NPI), and the Coopersmith Self-Esteem Inventory (SEI) were administered to a sample of 150 consecutive gym attenders recruited in fitness centers. Based on EAI total score, high EA risk group (HEA ) and a low EA risk group (LEA ) were identified. HEA reported significantly higher total score (mean = 20.2 versus 14.6) on the NPI scale and lower total score (mean = 32.2 versus 36.4) on the SEI scale than LEA. A stepwise regression analysis indicated that only narcissism and self-esteem total scores ( were good predictors of days per week exercise. The present study confirms the direct and combined role of both labile self-esteem and high narcissism in the development of exercise addiction as predictive factors towards the risk of addiction. Multidisciplinary trained health care providers (physiatrists, psychologists, and psychiatrists) should carefully identify potential overexercise conditions in order to prevent the potential risk of exercise addiction. 1. Introduction In the Substance-Related Disorders section, the Diagnostic and Statistical Manual of Mental Disorders, fifth edition, DSM-5 [1], includes only gambling disorder as form of addiction that does not involve ingestion of substance, reflecting evidence that this repetitive behavior activates reward systems as well as drugs of abuse [2, 3]. It is noteworthy that in clinical practice we observe a clustering of different excessive and repetitive behaviors, with symptoms that appear comparable to those produced by gambling, involving hedonistic (e.g., “sex addiction”) or nurturant motives (e.g., “exercise addiction,” “shopping addiction,” and “internet addiction”) [4]. Actually, these addictive behaviors, although showing strong neural similarities to substance addiction, are not included in any official recognized medical or psychological frameworks because there is not enough peer-reviewed evidence to establish diagnostic criteria [5]. Regular and moderate physical activity plays a lead role in the maintenance of health and in disease prevention. For instance, it can reduce the risk of cardiovascular diseases [6], diabetes [7], colon and breast cancer [8–10], and depression and anxiety [11, 12]. Moreover, adequate levels of physical activity will decrease the risk of a hip or vertebral fracture and help in weight control [13]. Exercise is a subcategory of
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