How Eating Disorders And Exercise Intersect: What You Need To Know
Exercise is often celebrated as a cornerstone of a healthy lifestyle, but when exercise becomes compulsive or intertwined with eating disorders, serious physical and mental health challenges can arise. The line between healthy exercise and harmful behavior can be thin, particularly in environments that emphasize body image or performance.
Understanding the signs of compulsive exercise and its connection to eating disorders may help individuals recognize when to seek help. Below, explore the concept of exercise addiction and how problematic exercise behaviors can manifest in individuals with eating disorders. In addition, explore ways to recognize unhealthy exercise behaviors and find support.
Eating disorders and exercise: Binge eating disorder, anorexia, and bulimia
While physical activity is often promoted as part of a healthy lifestyle, exercise can exacerbate the symptoms of eating disorders like anorexia nervosa and bulimia nervosa. In binge eating disorder, exercise may be sporadic, often used as a form of compensation. Understanding how exercise and other eating disorders intersect may help individuals recognize and address unhealthy exercise patterns.
Anorexia nervosa
Individuals with anorexia nervosa may engage in excessive exercise to control or lose weight, often pushing themselves to dangerous limits despite severe malnutrition. Without sufficient nourishment, however, this exercise can lead to severe physical complications, including but not limited to muscle wasting, bone density loss, and cardiovascular issues.
Bulimia nervosa
For those with bulimia nervosa, exercise can be a way of purging, as individuals may use exercise as a compensatory behavior to offset calories consumed during binge eating episodes. They may exercise to an extreme degree, resulting in physical exhaustion, dehydration, and a heightened risk of injury.
Binge eating disorder
While less commonly associated with compulsive exercise, individuals with binge eating disorder (BED) may engage in sporadic bouts of intense exercise as a form of compensation or to cope with feelings of guilt after a binge. Unlike with other eating disorders, regular exercise can help individuals manage both physical and mental symptoms of the eating disorder.
What is exercise addiction?
Exercise addiction is a behavioral addiction involving compulsive or excessive exercise. Individuals living with exercise addiction may be compelled to exercise to the point of physical pain and exhaustion, often resulting in injury and other health complications. This addiction frequently occurs alongside eating disorders, appearing 3.5 times more often in individuals with an eating disorder than in those without.
Eating disorders in athletes
While eating disorders affect around 9% of Americans, up to 19% of male athletes and 45% of female athletes live with eating disorders and disordered eating. EDs are most common among athletes in sports where leanness or weight control is emphasized, such as ballet, wrestling, and gymnastics.
A focus on physical appearance in athletics can lead to restrictive eating, over-exercising, or purging. Additionally, the culture within some sports can normalize or encourage disordered eating behaviors, making recognizing symptoms and seeking help more difficult for athletes. The physical demands of their sport can further increase the toll on their bodies, leading to fatigue, increased injury risk, and long-term health complications.
Because of these unique challenges, treating athletes with eating disorders often involves a multidisciplinary approach with coaches, trainers, and administrators. In addition, temporary adjustments may be made to an athlete’s schedule, including resistance training, competition, team responsibilities, and, in the case of student-athletes, academics.
Weight loss and compulsive behavior: Recognizing unhealthy exercise patterns
Unhealthy exercise patterns often emerge when the desire for weight loss becomes an obsession, leading to compulsive behaviors that can be harmful. Often, compulsive exercise behavior appears alongside restrictive eating behaviors. Recognizing these patterns may help individuals prevent physical and mental health deterioration.
Overemphasis on weight loss
While physical activity can contribute to maintaining a healthy body composition, an unhealthy attitude toward exercise often manifests as an overemphasis on using activity to control body weight. Whereas a balanced and mindful approach to fitness generally focuses on enjoyment and overall well-being, focusing on body weight and partaking in too much exercise may be a sign of a deeper issue.
Frequent, excessive, or compulsive exercise
Engaging in frequent or excessive exercise beyond what is considered healthy is another sign that a person may be struggling with an eating disorder or exercise addiction. Individuals might work out multiple times a day for hours, often focusing on high-intensity or cardio exercises. To learn more about their exercise habits, a person can take a compulsive exercise test.
Exercising despite injury or illness
Continuing to exercise despite injury or illness is a dangerous sign of compulsive exercise. This relentless drive to maintain one’s exercise routine can prevent the body from healing correctly, which may exacerbate existing conditions. Ignoring the body’s need for rest and recovery can lead to worsening injuries, prolonged recovery times, and long-term health consequences.
Using exercise to compensate for food intake
Those living with EDs or exercise addiction may use exercise as a means to "earn" or compensate for food intake, often driven by guilt or fear of weight gain. This behavior may be significantly pronounced when combined with binge eating. Exercise can become part of a broader fixation on calorie counting and restriction, where the focus shifts from health to rigid control over food intake and energy expenditure.
Feeling anxious or guilty about missing a workout
Feeling emotional distress about missing a workout can indicate an unhealthy relationship with exercise. Eating disorders and exercise dependence can cause a person to feel anxious or guilty about losing progress or gaining weight, which may drive them to push themselves beyond healthy limits.
Is it safe to exercise during eating disorder treatment?
Whether it's safe to exercise during ED treatment depends on the individual’s health, the nature of their eating disorder, and the stage of their recovery. Often, exercise may be temporarily restricted or carefully monitored by one’s care team to ensure it supports recovery and does not exacerbate the eating disorder.
Once significant progress in eating disorder recovery has been achieved, such as weight restoration, healthcare professionals can guide the client in safely reintroducing physical activity, emphasizing healing and joyful movement rather than weight control. This process generally occurs after the individual has reached a healthy body weight and compulsive urges to exercise have diminished.
Professional mental health support for eating disorders
If you’re struggling with an eating disorder or exercise addiction, consider seeking the guidance of a mental health professional. A licensed therapist or counselor can help you identify underlying issues, build healthier coping mechanisms, and develop a comprehensive treatment plan.
If you’re concerned about not being able to attend sessions in your area, you might also try online therapy through a platform like BetterHelp, allowing you to connect with a qualified ED specialist for weekly therapy sessions from your home. Online therapy is as effective as in-person therapy and may be preferable for those in need of a convenient, flexible, low-cost alternative to traditional therapy. With additional tools and features like guided journaling, digital therapy worksheets, and group sessions, you can make meaningful progress toward long-term recovery in each session.
Takeaway
Is exercise addiction a recognized mental health condition?
Excessive exercise, sometimes called exercise addiction or dysfunctional exercise, is when a person feels the need to compulsively exercise—even when it disrupts their life or causes overuse injuries like stress fractures or other complications. Excessive exercise is not a diagnosable disorder as listed in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR), and it's not a required component of diagnostic criteria for any one disorder. However, it can be a possible symptom of several different recognized mental health conditions, such as anorexia nervosa, bulimia nervosa, body dysmorphic disorder, or obsessive-compulsive disorder.
How does social pressure contribute to compulsive exercise behavior?
Social pressure may make a person more likely to engage in compulsive exercise behavior, whether it's societal pressures to be thin that lead a person to compulsively exercise for weight loss or social pressures in a particular gym environment, industry, or social group. While social encouragement to exercise can be a positive thing, pressure to over-exercise can lead to health problems.
What’s the connection between eating disorders, exercise habits, and mental health?
Eating disorder symptoms can sometimes include unhealthy exercise habits. For example, restrictive eating disorders—where a person has an intense fear of gaining weight and severely limits their food intake as a result, like anorexia nervosa or bulimia nervosa—can involve compulsive participation in an exercise program. A person with anorexia may exercise excessively to try and avoid weight gain, while a person with bulimia may exercise excessively as a compensatory behavior after binging.
Instead of having health benefits, this over-exercising can lead to electrolyte imbalances, increased risk of medical complications, menstrual dysfunction or other disruption to the menstrual cycle, weak bones, and even sudden death. In terms of mental health, it may increase stress and anxiety, disrupt mood and sleep, and increase the chances of developing a co-occuring disorder like depression.
Is dialectical behavior therapy an effective eating disorder treatment?
Dialectical behavior therapy (DBT) is a type of talk therapy that's often recommended for individuals with eating disorders. Research suggests that it can be effective in many cases. A 2020 systematic review of research on the topic reports that “the primary goal of DBT for EDs is to eliminate maladaptive ED behaviors (eg, binge eating, purging), and to work toward building a more fulfilling life.” To that end, DBT providers usually work with eating disorder patients to build and practice healthy and effective coping skills for compulsions and psychological distress to improve their mental state.
What type of eating disorder is most likely to include compulsive exercise for weight loss?
Compulsive exercisers—those whose exercise duration and frequency are excessive and interfere with health and functioning—are often associated with anorexia nervosa and bulimia nervosa. Individuals with either of these eating disorders (EDs) typically fear gaining weight and may engage in what feels like obligatory exercise to try and reach or maintain a low body weight.
According to doctors, sports medicine experts, and physical therapy professionals, this practice can cause many a medical complication, from negatively affecting bone health and muscle strength to causing electrolyte imbalance and high blood pressure and increasing the likelihood of injuries. It can also make ED recovery more complicated. That said, excessive exercise is a relatively common symptom that can affect anyone, whether they are elite athletes or not, and whether they have an eating disorder or not.
How does exercise affect eating disorders?
In general, healthy and safe exercise can help promote physical and mental well-being. However, to exercise daily without rest and despite injury—in other words, in an excessive or compulsive way—can sometimes be one of the behavioral or physical symptoms of an eating disorder. For example, a meta-analysis on the topic shows a lifetime prevalence of excessive exercise in 80% of individuals with anorexia nervosa, also reporting that excessive exercise is a key predictor of early relapse in individuals with anorexia.
What not to do when someone is in eating disorder treatment?
If someone you know has an eating disorder and is already in treatment, it's generally recommended that you be as supportive, compassionate, and empathetic as possible. Being an active listener and providing encouragement and material support when needed may also help them in their recovery. It can be helpful to avoid being judgmental or commenting on their appearance or eating habits.
What physical problems are often associated with eating disorders like binge eating disorder?
Eating disorders can cause a variety of physical problems for those who live with them. For example, someone with binge eating disorder may be at increased risk of cardiac problems, digestive problems, acid reflux, diabetes, and other complications. Someone with avoidant/restrictive food intake disorder (ARFID) may be at increased risk of dangerous weight loss due to a lack of adequate nutrition, which can cause many additional complications.
What is the relationship between exercise and appetite?
The relationship between physical exercise and appetite is complex. Exercise of different types can release hormones of different types, which may stimulate or suppress appetite. For example, high-intensity, sustained aerobic exercise may suppress appetite, though typically only for a short period.
What happens if you exercise on an empty stomach?
In general, it's not recommended that an individual exercise on an empty stomach. The most effective kind of therapeutic exercise usually involves eating some time before a workout so that your body has fuel to use. Without it, you may have less stamina and could feel lightheaded or weak. If you have questions or are concerned about your food intake or related habits, you might benefit from nutrition counseling with qualified health professionals or a treatment team.
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