Sociocultural theories of body image propose that different societies have different conceptions of the ideal body shape. Within contemporary Westernized cultures, advertisements, the Internet, and social media networks promote particular assumptions about what constitutes the ‘ideal’ body, and thus exert a strong social pressure to achieve such a body shape. Individuals go to great lengths to achieve and maintain a body image that corresponds to these archetypes of ‘beauty’, which are reinforced as having a superior social value. Such social ideals of beauty are often entirely unrealistic, and can result in body dissatisfaction, appearance anxiety, body image disorder, low self-esteem, and depressive symptoms. Attempts to attain the ideal body can lead to excessive behaviours, such as compulsive exercising, the use of image- and performance-enhancing drugs (IPEDs), and eating disorders. This chapter focuses on excessive exercising and the use of IPEDs, and how these behaviours relate to distress about body image.

Exercise addiction (AE), which can be defined as engaging in excessive and problematic physical exercise, is still not officially included in the psychiatric nosography, although this disorder can be identified as linked to addictive behaviours. Many different etiopathogenetic hypotheses have been proposed to account for the epidemiological distribution of EA in the general population. However, a clear phenomenological concept of the disorder and shared diagnostic tools are still lacking. It is frequently comorbid with eating disorders and body dysmorphic disorder, which can both trigger EA and develop secondary to it. In recent times it has been proposed that the lockdowns and other restrictions which were imposed during the COVID-19 pandemic could have been possible risk factors for the development or worsening of EA, as physical exercise was widely recommended as a strategy for coping with these restrictions. The initial evidence about the emergence of EA during the COVID-19 pandemic is presented.