Eating disorders are generally hidden diseases with symptoms that sufferers go to great lengths to conceal. But those who struggle with one type of eating disorder – exercise bulimia – might actually be congratulated by friends and family for prioritizing fitness and maintaining an ultra-thin physique, unaware of the damage being done on the inside.
While bulimia is characterized by binging and purging, typically by vomiting or abusing laxatives, exercise bulimia involves purging by exercising excessively. Individuals suffering from exercise bulimia aren’t merely working out to stay healthy, have fun or train for an event; they are compulsively exercising to purge calories from their bodies.
Exercise bulimia falls under the diagnosis of “Eating Disorder Not Otherwise Specified,” and is common in both men and women. Although it may be hard to recognize, exercise bulimia is a very real disorder with devastating consequences, including fatigue, dehydration, osteoporosis, arthritis, reproductive problems, depression, anxiety, heart arrhythmias, and injuries such as stress fractures, strains and sprains.
“Eating disorders are used as coping mechanisms, a way to ‘numb out’ or avoid dealing with uncomfortable emotions,” says Kelly Hinds, the registered dietician at Montecatini, an eating disorder treatment program for women in Southern California. “Exercising provides that same result with the added bonus of activating the reward system in our brain by releasing endorphins and dopamine.”
When most people think about eating disorders, they think of starving, vomiting or laxative abuse. They don’t always think of compulsive exercising. But, according to Hinds, roughly 90 percent of the patients at Montecatini abuse exercise in some way.
Healthy Passion for Fitness or Eating Disorder?
Exercise bulimics tend to feel a sense of loneliness or isolation, are anxious when not exercising, and are heavily focused on their appearance. They exercise several hours a day and push themselves to keep working out even when they are sick, fatigued or injured.
But if you go to the gym every day and count calories, does that mean you have an eating disorder? How is one to know if they have a healthy passion for fitness or have crossed the line into a life-threatening mental illness? Here are a few questions Hinds recommends that you ask yourself to determine if exercise has become a problem for you:
- Do you feel guilty, depressed, irritable or anxious if you miss a workout?
- Do you have to exercise every day or “freak out” if you miss a workout?
- Do you still exercise when you are sick or injured?
- Do your responsibilities and relationships suffer, or do your friends, family and work take a backseat to exercise?
- Do you calculate how much to exercise based on how much you eat, or vice versa?
Treating Exercise Bulimia
Some experts believe it is more difficult to get exercise bulimics to recognize their eating disorder and seek treatment because they aren’t vomiting or engaging in other well-recognized disordered behaviors. But exercise bulimia is a serious disorder with effects that can be just as damaging as other eating disorders like anorexia and bulimia.
Montecatini takes a multifaceted approach to eating disorder treatment. Patients participate in cognitive-behavioral therapy, dialectical behavior therapy and other forms of therapy in order to change negative thought patterns and learn new coping skills. Group therapy helps women with exercise bulimia recognize that they have a problem and that they aren’t alone in their struggles. Montecatini also provides family therapy, restaurant outings, nutrition counseling, fitness classes and yoga to their patients.
According to Hinds, treatment often begins with education about the physical consequences of compulsive exercise. At the residential level of care, patients at Montecatini are required to refrain from exercise for at least 10 days.
“What we see during that time period is heightened anxiety, anger, sadness, depression or whatever emotion the patient has been suppressing with exercise,” explains Hinds. “This is rich soil for the therapists to begin working.”
When exercise privileges are reinstituted, patients participate in walking, dancing, yoga and weight training classes. Patients are not allowed to return to their exercise bulimia activity of choice (often running). From that point forward, the dietitian and therapist encourage patients to explore various forms of exercise that could provide health benefits and meet their needs without returning to the “addiction.” It also requires challenging the patient’s belief that they aren’t really exercising if they aren’t running, going to the gym or engaging in their preferred exercise behavior.
Residential treatment is preferable to outpatient therapy for people struggling with exercise bulimia, says Hinds. It is more difficult to treat exercise bulimia at an outpatient level of care because the patient is never forced to stop the behavior and typically cannot contain it. It then becomes a much longer process, as the therapeutic groundwork has to be laid and the patient has to learn new coping skills to deal with their emotions before they are able to change the exercise behavior.
“The latest research shows that patients who abuse exercise will never be able to return to their activity of choice without relapse,” notes Hinds. “As with alcoholics, the key to recovery is complete abstinence from the behavior. Perhaps the most challenging aspect of treating exercise bulimia is convincing the patient that compulsive exercise could actually be more harmful to their health than leading a sedentary lifestyle.”
How Can I Help?
If you’re concerned that a loved one is addicted to exercise, approach them in a non-judgmental way, gently discuss the negative impact their exercise behaviors are having and suggest that they get help. “Ultimately, the patient must decide that the behavior is problematic and choose to seek help,” says Hinds.
Recovery is only as far away as admitting you have a problem and seeking help. Over time, you can learn to stop relying on exercise as a coping mechanism and find healthier ways to deal with your emotions. The reward is being able to enjoy exercise for what it was meant to be: a fun way to stay healthy in mind, body and spirit.
By Mckayla Arnold