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Compulsive Exercise & Eating Disorders

Exercise and body movement can be highly beneficial to one’s health. However, as with everything, moderation is key, and there are many times that exercise can become dangerous when coupled with disordered eating thoughts, beliefs, and behaviors.

While compulsive exercise is not an official diagnosis in the Diagnostic and Statistical Manual of Mental Illness, Fifth Edition (DSM-5), many individuals struggle with the symptoms and behaviors related to it.

Compulsive Exercise, Defined
The term has been used since the 1970s and is officially defined as, “a craving for physical training, resulting in uncontrollable excessive exercise behavior with harmful consequences, such as injuries and impaired social relations [1].”

A simpler definition would be to break down the term itself – it is to exercise in a compulsory manner. Individuals that engage in these behaviors often feel a mental, physical, and emotional compulsion to exercise excessively.

A big red flag is if an individual has a rigid, strict, and sometimes secretive, exercise regimen. The rigidity of the regimen is often a result of the individual feeling intense shame, guilt, stress, or anxiety when they do not engage in their chosen exercise in precisely the way they feel they “need” to.

Often, the secretive aspect comes into play down the road, when the individual recognizes, or has been confronted, with the dangerousness of their behaviors and feels they must then hide them, as stopping them does not feel like an option.

Individuals engaging in compulsive exercise often have a specific view of what this exercise does, using it as a way of managing negative emotions, numbing themselves from uncomfortable experiences, “purging” calories that they have consumed or compensating for eating food.

With these symptoms, it is not surprising that research indicates compulsive exercise behaviors are most commonly associated with eating disorder pathology as well as perfectionism, neuroticism, narcissism, and obsessive-compulsive symptoms [1].

Consequences
It should come as no surprise that running one’s body into the ground at alarming rates regardless of physical exhaustion is harmful. Physically, compulsive exercise can cause significant harm to the body, especially when paired with insufficient nutritional intake to fuel the activity level.

Loss of bone density and menstrual cycle, muscle soreness, bone, and joint pain, overuse injuries, and fractures, and altered resting heart rate can all occur with compulsive exercise behaviors [2].

However, the harmful impacts don’t end there, as individuals often cannot help but prioritize their exercise behaviors above all else (hence the “compulsive” aspect). This means meetings, celebrations, holidays, social events, self-care, etc. all take a backseat to the exercise regimen, resulting in social impairment [1].

Finally, exercising so intensely does not only alter one’s physical makeup but their chemical and hormonal makeup as well.

This change, in addition to the social impairment, might explain why depression is associated with compulsive exercise, although it becomes a chicken-or-the-egg situation, as who knows which came first?

Treatment
Therapist Discussing Nutrition With PatientWithout being a formal diagnosis, research is limited as to how to treat compulsive exercise behaviors. However, many eating disorder treatment centers and mental health professionals are recognizing these symptoms as harmful and worthy of attention.

One study found that Cognitive Behavioral Therapy, the most widely-accepted, evidence-based therapy used now, is effective in treating compulsive exercise [3]. The same study also found that physical exercise and dietary therapy (PED-t) to be effective [3].

There is absolutely more work to be done, however, for now, it is enough to remain alert to the symptoms of compulsive exercise and recognize the undeniable role they may play in eating disorder pathology and treatment.