Why it's so difficult to spot—and how it can be treated.

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Gisela Bouvier was in high school when she discovered the "magic" of dieting. "I started to lose weight and people started to notice and compliment me-which I loved," she says. "Shortly after I started restricting [food], I signed up for a membership at my local gym."

Working out quickly became an obsession says Bouvier, who majored in dietetics and nutrition in college and became a registered dietitian nutritionist at a local hospital after graduation. After nine-hour work days, she would spend two and a half to three hours exercising. If something got in the way of completing her very specific workout routine, she says her mood would go haywire.

"If I didn't exercise, my anxiety would be through the roof," she says. "I would compensate by restricting my meals more or exercising longer the next day. When my friends and family would try to make plans with me, I would cancel or postpone just to ensure I worked out."

Bouvier knew that she had a problem. "Fearing food and feeling the obligation to overexercise was not healthy and was emotionally, physically, and mentally draining," she says.

What Is Exercise Addiction?

Eventually, her compulsions couldn't be masked as healthy habits any longer. Bouvier was suffering from exercise addiction. The condition is defined as excessive physical activity that results in physical, social, and psychological issues, says Heather Hausenblas, Ph.D., a professor in the department of kinesiology at Jacksonville University in Florida, and coauthor of The Truth About Exercise Addiction.

First, know that exercise addiction is not extremely common, affecting less than 1 percent of the population, says Hausenblas. "From a health standpoint, we think more exercise is always better. But there is that tipping point where more exercise can become detrimental."

It's not necessarily the quantity of exercise someone does that is the issue. Putting in long hours training for a marathon or doing two-a-day workout classes doesn't automatically constitute an addiction, says Hausenblas. Instead, someone who is addicted to exercise will become anxious or depressed when they are unable to work out, she says. They will cancel social obligations, schedule their life around their workouts, or work out at inappropriate times and places if need be (like doing pull-ups in an airport bathroom). If they become injured, they are likely to "push through" the pain against doctor's orders, because the thought of taking time off to heal is unbearable.

Exercise addiction can be divided into types, according to research. A primary exercise addiction "occurs in the absence of an eating disorder"-so weight loss is not a major concern. Conversely, someone who suffers from secondary exercise addiction also has an eating disorder. (Related: Orthorexia Is the Eating Disorder You've Never Heard Of)

Exercise Addiction Treatment

"Compulsive exercising is another way to really purge calories, and it's often wrapped up into an eating disorder like anorexia or bulimia," says Amy Edelstein, L.C.S.W., site director of the Renfrew Center, an eating disorder recovery center in New York. She says that both exercise addiction and secondary eating disorders can be a way to manage underlying distressing behaviors or events.

The appropriate treatment for exercise addiction depends on whether the addiction is primary or secondary. Hausenblas says that cognitive behavioral therapy (CBT) can be useful for some people, helping to reframe thinking about exercise. In cases of secondary exercise addiction, treatment for the concurrent eating disorder is crucial.

Treatment focus should be on "giving people healthy coping skills so they understand what the function of these [exercise addiction] behaviors are," says Edelstein.

For Bouvier, she ultimately chose a 10-week inpatient treatment at an eating disorder treatment center, followed by 12 weeks of intensive outpatient treatment, in an effort to heal from her exercise addiction. "It was the longest six months of my entire life, but it gave me the tools to finally find food freedom and joyful and intuitive movement," she says. (Related: Why You Should Give Up Restrictive Dieting Once and for All)

Signs of Exercise Addiction

From a distance, someone with an exercise addiction may just appear to be diligent about their health. Exercise is a healthy habit, and staying active is widely encouraged. For someone with a problem, they might even think society and the medical community are actually encouraging their harmful behavior.

Melinda Parrish, a plus-size model who also served in the military, struggled with exercise addiction and an eating disorder for 11 years. "My need to exercise as a compensatory behavior for my eating was such that it interfered with my social life, my studies, and my health," she says. "I was actually sick, but surrounded by a culture that was validating my unhealthy behavior."

Parrish, now 33, injured her back by overexercising and kept working out despite her extreme pain. She was on active duty in the military and an NCAA Division I athlete on the United States Naval Academy rowing team-staying active was not just encouraged, but expected. Eventually, she required two different back surgeries as a result of her injury and was honorably medically discharged from the Navy. (Related: Exercises to Relieve Your Back Pain)

"I think it's really hard to recover completely in a culture like ours that encourages diet, exercise, and any behavior designed to reduce our weight under the mantle of health," says Parrish. "But when your behavior is actually causing self-harm, it's not healthy. It's very unhealthy. Yet, you'll find validation all over the place for treating your body so poorly. I can't tell you how many people were praising me for continuously pushing my body to extremes in exercise. Inside, I was suffering and wanted someone to tell me to stop."

Through conversations with her husband, Parrish says she began to understand that her behavior was unhealthy. "He was vulnerable in sharing his concern, and that created the space for me to share what I was going through, and over time that led us to a diagnosis and the beginning of recovery," she says.

Injuries from overexercise are not uncommon in people who are addicted to exercise, says Bryant Walrod, M.D., a sports medicine physician at The Ohio State University Wexner Medical Center. Too much exercise can cause issues like stress fractures and tendinitis. Plus, "you can train so hard that your performance actually gets worse," he says.

Exercise Addiction Recovery

It is possible to recover from an exercise addiction and maintain a nonaddictive relationship with exercise. Bouvier, who now runs B Nutrition & Wellness, aimed at helping people create positive relationships with food and exercise, didn't stop exercising entirely-but she now focuses on intuitive movement.

"Exercise is no longer done because I 'need to burn calories,'" she says. "Rather, I exercise because I enjoy it. I also change my exercise routine based on what my body needs. There are days I want an intense workout with heavy lifting, and there are days I do yoga or simply rest. My physical activity is just as intuitive as my nourishment." (Related: 7 Signs You Seriously Need a Rest Day)

But recovery isn't always linear. Parrish admits that she still struggles with some exercise addiction tendencies or thoughts, and Bouvier still regularly uses different tools to ensure she doesn't fall back into addictive behaviors. "It's important that I give myself time blocks when I am at the gym," says Bouvier. "I know that by a certain time I need to be done to be able to get back to work, pick up my daughter, or complete other tasks in my day. Time-blocking is important to me for exercise because it ensures I give myself time to be active but also ensures that I stay focused to not overdo it."

Both Bouvier and Parrish say that the support of their family and loved ones throughout their recovery has been incredibly important. If you know someone who you suspect is addicted to exercise, Edelstein recommends that you address the issue head-on. "If you have an inkling that someone you love is struggling, I would bring it to them in a nonjudgmental, respectful way," she says. Express your worries, show that you are there for them, and offer to help them get help. If they aren't receptive to your comments, let them know you're still here for them whenever they might need you.