This article originally appeared on Trail Runner

As interest in endurance events grows, it's crucial to understand the psychological drivers behind the determination of runners. A recent study in the International Journal of Sport and Exercise Psychology delves into the link between severe complications in ultra-marathons leading to Intensive Care Unit admissions, exercise addiction, and athlete personality traits. The study reveals that while trail and ultrarunning is a healthy pursuit for many, some athletes take it to its extremity in ways that have severe physiological consequences.

The study focused on 12 hospitalized ultra-runners, brought in for several reasons ranging from rhabdomyolysis with acute kidney injury, severe hyponatremia, hyperthermia, and gastric ulcer. Researchers dispensed the Exercise Addiction Inventory to examine various aspects of behavior and its impact on well-being. This addiction is characterized by a compulsive pattern of exercise habits, leading to loss of control and adverse effects on health and personal life. Symptoms include an overwhelming urge to exercise, even when experiencing fatigue, injuries, or conflicts with other responsibilities.

The criteria used to evaluate exercise addiction include Salience, which refers to prioritizing exercise over other obligations; Conflict, which arises between exercise and responsibilities; Mood Modification, using exercise to enhance emotional well-being; Tolerance, requiring more exercise to achieve the same mental benefits; Withdrawal, leading to negative emotions when unable to exercise; and Relapse, returning to excessive exercise after reducing activity.

Researchers found most in the study were "at risk" and exhibited symptoms of exercise addiction, though only one was considered at risk for exercise addiction. Their scores neared the threshold of "problematic" and thus should be guarded. "Mood modification" emerged as a significant criterion, suggesting exercise is a coping strategy for handling negative emotions.

"People with a high mood modification report experiences related to a subjective experience that may be the consequence of engaging in a particular activity to develop a coping strategy for dealing with negative emotions," said the authors. Those individuals may report engaging in ultra-running as a coping strategy for dealing with negative emotions and as a way to "Change my mood," "to get a buzz," and "to escape." This means that people are considered dependent on or "addicted" to exercise when it becomes their primary or only coping mechanism for navigating challenging emotions like sadness, anxiety, and uncertainty.

Regarding personality traits, ultra-runners scored high in emotional stability, indicating a calm and even-tempered demeanor, even in challenging situations. The researchers found that these personality components may be risk factors for persisting in exercise despite negative consequences while also serving as levers for psychotherapeutic intervention.

"Compared to the general population, ultrarunners have high scores in emotional stability," the authors explained. "People who score high in emotional stability tend to be calm and even-tempered, even when encountering difficulty or an unexpected situation."

While high emotional stability is generally viewed as positive, it may be a coping mechanism for ultra-runners with elevated anxiety levels. This coping mechanism could lead to extreme physical activity to alleviate tensions, potentially bordering on compulsion or dependency.

This research sheds some light on the psychological aspects of ultra-marathon running and can aid in developing preventive measures and tailored interventions for extreme endurance athletes. With their high emotional stability, ultra-runners can face challenges more calmly, making it essential to consider their psychological well-being in such demanding events.

Individuals who engage in ultrarunning may be more likely to exhibit signs of exercise dependence, which can result in serious harm. As a precaution, coaches, athletes, and mental health professionals should evaluate addiction tendencies and personalities of individuals experiencing difficulties after participating in ultra-marathons. Even if they do not meet the criteria for exercise addiction, those with severe issues should be offered psychological support. Interventions should focus on mood modification, a crucial factor for ultrarunners experiencing complications. Prevention strategies should be tailored to individuals' psychological profiles, emphasizing the physical risks associated with extreme endurance events.

RELATED: How Brittany Peterson Balances Pro Running With Her Work As A Mental Health Educator

Note from Allie Ostrander, NNormal Athlete and Mental Health Advocate

Allie Ostrander's passion for running was evident from an early age. The three-time collegiate steeplechase champion had a wildly successful career. However, beneath her competitive drive laid an unseen struggle--a compulsive need for exercise that had evolved into an addiction.

"When I was with coaches in the past, I wasn't open about my compulsive need for exercise, which made it easy for me to classify my excessive exercise as 'training,' even when it wasn't productive," said Ostrander.

To address this issue, Ostrander decided to seek professional guidance. She enlisted the help of a coach who provided structure and direction and encouraged open communication about her recovery from exercise addiction and her experience with eating disorders. By sharing her struggles candidly with her coach, and working with a team of experienced healthcare providers, Ostrander found her support to navigate the challenging path toward a healthier relationship with exercise.

"For about a year, I coached myself," she explained. "But I realized I needed someone to give me structure and guidance to ensure that my training was intentional and goal-oriented, not just meaningless exercise." This marked a turning point in her journey, with her coach providing the essential balance between pushing her limits and respecting her body's needs. "So that leads me to my current coach, who I am very open with about eating disorder recovery and exercise addiction."

As Ostrander embarked on her path to recovery, she learned to recognize the warning signs and red flags she had previously overlooked.

"I think a couple of the biggest warning signs are being unwilling to take breaks from exercise (even when it makes sense, like between seasons), exercising past the prescribed amount, exercising through injury and fatigue, and being incredibly rigid around an exercise routine," she said.

This newfound self-awareness allowed her to differentiate between beneficial training practices and those that pushed her to the brink. As an elite athlete, she needed to balance challenging her limits and ensuring her overall well-being. "All of these can be taken too far--to the point where they’re no longer beneficial for fitness or reaching one’s goals," she cautioned.

In elite athletics, Ostrander's courage to speak out about her battle with exercise addiction sheds light on a significant issue that often remains hidden.

"My biggest advice to someone struggling with exercise addiction would be to find people you can confide in and hold you accountable," said Ostrander. "It's easy to continue participating in harmful behaviors when no one realizes they are harmful, but once you’re open about it, people can help you progress away from those behaviors."

She stressed the significance of opening up about the issue, as this would enable others to provide the necessary support and guidance. "I would recommend checking the intention behind every training session and making sure that all exercise is aligned with your goals."

If you're concerned about your relationship with exercise, contact a trusted mental health professional, or get in touch with Bigger Than The Trail. This non-profit provides counseling free of charge to folks with financial barriers to healthcare access.

RELATED: Allie Ostrander's Radical Transparency

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