Eating disorders treatment center identifies common warning signs and reveals challenges to identifying compulsive exercise behaviors
Professionals specializing in the treatment of men, women and children with eating disorders are observing a growing trend among their patients, who are increasingly engaging in compulsive exercise. According to Eating Recovery Center, an international center providing comprehensive treatment for eating disorders, the connection between excessive exercise and eating disorders
generally stems from food-, body- or weight-related issues that drive the excessive physical activity. In fact, a study by Brewerton
found that nearly 40 percent of patients with anorexia nervosa engaged in compulsive exercise behaviors.
“Compulsive exercise is obligatory in nature, and it doesn’t have to be a certain type of exercise or be performed for a minimum duration,” explains Jennifer Lombardi, MFT, executive director of Summit Eating Disorders and Outreach Program, a partner program of Eating Recovery Center. “When evaluating if exercise is compulsive in nature, it’s important to look at the intention behind the movement, if there is a sense of urgency or agitation when individuals can’t engage in the exercise behavior, there is likely an issue. It’s also important to consider exercise in the larger context of an individual’s eating and body image history; exercise is one of those behaviors that means something different to people struggling with eating disorders due to their temperament and brain chemistry.”
Lombardi and the eating disorders experts at Eating Recovery Center explain that individuals engaging in compulsive exercise generally fall into one of two categories: those exhibiting significant exercise compulsion as part of their eating disorder; or individuals that did not initially exhibit excessive exercise behaviors, but began to do so as their eating disorders improved.
In other words, some eating disordered individuals abuse exercise as a compensatory behavior following a bingeing session or to give themselves “permission” to eat. Others may begin to engage in excessive exercise as what they believe to be a “healthy” part of eating disorders recovery. What these individuals do not realize, is that the frequency and volume of their exercise has taken the place of other eating disordered behaviors as an anxiety management tool and poses significant health complications, including joint injuries, stress fractures, muscle tears, tendonitis, fatigue and dehydration.
Eating Recovery Center encourages families, friends and healthcare professionals to be mindful of five common warning signs of compulsive exercise behaviors, including:
1. Exercising excessively “just because” as opposed to intentional exercise in preparation for a competition.
2. Refusing to miss a workout, regardless of weather or injury.
3. Exercising takes precedence over all other activities, including work, school and spending time with friends and family.
4. Experiencing a heightened level of anxiety if unable to engage in exercise.
5. Displaying an elevated rigidity and perfectionism with regard to exercise behaviors.
However, it is important to note that popular cultural narratives around exercise in the United States can pose significant challenges to identifying compulsive exercise—alone or occurring alongside an eating disorder.
•Exercise is healthy. There has been a major cultural shift around the notion that exercise helps us, not only in supporting general health and maintenance of a healthy weight during an obesity “epidemic,” but also as a tool to manage anxiety and stave off depression. This idea, and myriad variations of encouraged and acceptable frequencies of exercise (30 minutes each day; five days a week; etc.) can challenge the identification of dangerous patterns and/or normalize compulsivity, even during assessment by medical professionals.
•I am a competitive athlete. Overreaching is a common method of competitive athletes, and it is based on a principle of training that encourages the athlete to push beyond the body’s current ability to improve stamina and performance. Overreaching should not be confused with overtraining, which involves excessive intensity and duration, inadequate recovery time, unhealthy psychological state and malnutrition. Athletes that are overreaching are usually taking in sufficient nutrients and “fuel” to support their purposeful training activities, whereas athletes that are overtraining are nutritionally depleted and are exercising at extreme levels “just because.”
•I feel most confident when I am exercising and/or competing in my sport. Endorphins released during exercise make us “feel good.” Interestingly, compulsive exercisers often present with higher self-esteem despite having lower body-esteem. This paradox makes complete sense considering the temperament of those suffering from an eating disorder. These individuals are high achievers, see the world in a rigid, “black and white” way and tend to have low reward dependence. Due to the cultural reinforcement around exercise, patients feel good about themselves because they are excelling at something considered to be a “healthy” behavior. Additionally, exercise is concrete, measurable and accepted, and individuals with low reward dependence can do it well and push themselves privately.
•There is no official diagnosis; exercise compulsion must not be a real disorder. The treatment community and the American Psychiatric Association agree that more research is necessary to validate a formal diagnostic category for exercise compulsion in the Diagnostic and Statistical Manual. However, exercise compulsion is a very real compensatory behavior for many individuals struggling with disordered eating.
Treatment is available to address compulsive exercise—occurring either alone or alongside a diagnosed eating disorder.
“A thorough medical evaluation is also a critical component of assessment, as exercise relates very directly to physical health and medical status,” continues Lombardi. “However, it’s critical that an eating disorders specialist is part of the multidisciplinary treatment team – including a therapist, dietitian, primary care and/or sports medicine physician – to help facilitate patient assessments and assist in the identification of dangerous patterns of behavior despite the common challenges imposed by our cultural beliefs about exercise.”
Running on Empty: Exercise Compulsion and Eating Disorders is available for complimentary viewing through Eating Recovery Center’s On Demand Professional Development Series. In this video, Lombardi explores current research examining the addictive nature of exercise, exercise in eating disorders recovery and interventions for compulsive exercising.
For more information about compulsive exercise, eating disorders and effective treatment, visit EatingRecoveryCenter.com.