Anorexia & Compulsive Exercise: A Dangerous Combination

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Anorexia and compulsive exercise often go hand in hand. Tragically, they can be a dangerous (or even deadly) combination. But what is the driving motivator behind compulsive exercise in anorexics, and how does compulsive exercise specifically impact the physical and mental health of individuals with anorexia?

What Is Compulsive Exercise?

Before we look at the connection between anorexia and compulsive exercise, let’s first uncover some of the signs and symptoms of compulsive exercise, as defined by the National Eating Disorder Association [1].

  • Exercise that interferes with important life activities and occurs in inappropriate settings and times
  • The individual maintains a rigid, excessive exercise regime in spite of illness, medical complications, injuries, fatigue, or weather
  • If unable to exercise, the individual feels intense distress, anxiety, irritability, guilt, and/or depression
  • Feelings of discomfort with inactivity or rest
  • Withdrawing from family, friends, and social activities to exercise more
  • Using exercise as a way to purge or as permission to eat food (i.e. “burn off” calories)
  • Exercising in secret
  • Constantly feeling as though you are not good enough, not pushing hard enough, and not going fast enough while exercising

The Connection Between Anorexia & Compulsive Exercise

Woman with an eating disorder doing compulsive exerciseWhile compulsive exercise is a symptom found among all eating disorder diagnosis, it is most common among individuals with anorexia nervosa, with approximately 44.6 to 80 percent of anorexics suffering from compulsive exercise [2]. While it’s easy to assume anorexics intentionally engage in compulsive exercise simply as a way to control their weight and body shape, research shows something deeper may be driving the exercise.

In one famous study, researchers gave lab rats access to a wheel and then restricted their food intake to stimulate anorexia. The researchers were surprised to find that the starving rats started running on the wheel excessively, even going so far as to ignore the few meals they were offered, just so they could keep on running [3].

Though the researchers assumed the rats would decrease their energy output since they were starving, they actually started expending more and more energy, even to an excessive, self-harming degree.

The same anomaly is seen among young children with anorexia. Though many young children with anorexia do not yet display a conscious effort to burn calories or control their body shape/weight with exercise, they still can’t seem to stop running around aimlessly, moving constantly, and fidgeting [4].

As one researcher explained, though compulsive exercise may, in some anorexics, start out as a desire to burn calories and control body weight/shape, the evidence reveals that compulsive exercise eventually becomes “autonomous and controlled more by ‘biology’ than by conscious decision-making” [5].

In short, compulsive exercise in anorexics is often an intrinsic drive switched on by the energy imbalance caused by food restriction.

Why Anorexia & Compulsive Exercise are a Dangerous Combination

As we know, compulsive exercise and anorexia often go hand in hand, with the former (compulsive exercise) often being fueled by the latter (energy imbalances from caloric restriction). But what kind of impact does compulsive exercise have on individuals with anorexia nervosa?

Increased Risk of Medical Complications

Excessive exercise (and often exercise of any kind) among individuals with anorexia nervosa can be dangerous. Compulsive exercise in anorexics can lead to heart problems, overuse injuries, muscle wasting, electrolyte imbalances, and even sudden death. Further, since many individuals with anorexia have weak bones, the risk of exercise-induced bone fractures is high, with compulsive exercise greatly increasing this risk [6].

Worsened Treatment Outcomes

Woman Compulsively ExercisingNot only can compulsive exercise cause severe medical complications among individuals with anorexia, but it’s also associated with poor treatment outcomes. One study found that adult anorexia patients who engaged in compulsive exercise had to be hospitalized longer, were at a greater risk of relapse, and required more energy input and weight gain during re-feeding than anorexics who did not engage in compulsive exercise [7].

Additionally, an adolescent-specific review of eating disorder literature found that when compulsive exercise was present at the start of treatment, adolescents displayed significantly worse eating disorder symptoms and preoccupations compared to adolescents who did not compulsively exercise [8].

Greater Psychological Distress

Finally, compulsive exercise among adults with anorexia is directly associated with higher levels of psychological distress, including depression, anxiety, obsessive-compulsiveness, and chronic negative affect [9]. Further, it has been shown to increase concerns about weight and shape, body dissatisfaction, perfectionism, and a drive for thinness, ultimately leading to psychological distress and worsened eating disorder symptomatology [10].

If you think you or a loved one might have an eating disorder, seek professional support today. Eating disorders are serious mental illnesses that can cause severe and often life-threatening physical complications, especially when paired with compulsive exercise.

So take the first step today and seek professional help or simply start by talking to your doctor, therapist, counselor, parent, or someone else you trust about your struggles with eating or exercise.

[1] Compulsive Exercise. National Eating Disorders Association. (2018, February 22).

[2] Fietz M, Touyz S, Hay P. A risk profile of compulsive exercise in adolescents with an eating disorder: a systematic review. Adv Eat Disord. 2014;2:241–63

[3] Scharner S, Prinz P, Goebel-stengel M, et al. Activity-Based Anorexia Reduces Body Weight without Inducing a Separate Food Intake Microstructure or Activity Phenotype in Female Rats-Mediation via an Activation of Distinct Brain Nuclei. Front Neurosci. 2016;10:475. doi:10.3389/fnins.2016.00475

[4] Lauren Muhlheim, P. D. (2020, March 23). Excessive Exercise: Could It Be a Symptom of an Eating Disorder? Verywell Mind.

[5] Boakes, R. A. (2007). Self-Starvation in the Rat: Running versus Eating.

[6] Jáuregui-garrido B, Jáuregui-lobera I. Sudden death in eating disorders. Vasc Health Risk Manag. 2012;8:91-8. doi:10.2147/VHRM.S28652

[7] JI. Hudson, E. H., L. Scott, S. B., RH. Striegel-Moore, C. M. B., L. Tremblay, M. L., M. Fietz, S. T., C. Meyer, L. T., … R. Gümmer, K. E. G. (1970, January 1). A clinical profile of compulsive exercise in adolescent inpatients with anorexia nervosa. Journal of Eating Disorders.

[8] Stiles-Shields C, Bamford B, Lock J, Le Grange D. The effect of driven exercise on treatment outcomes for adolescents with anorexia and bulimia nervosa. Int J Eat Disord. 2015;48:392–6

[9] JI. Hudson, E. H., L. Scott, S. B., RH. Striegel-Moore, C. M. B., L. Tremblay, M. L., M. Fietz, S. T., C. Meyer, L. T., … R. Gümmer, K. E. G. (1970, January 1). A clinical profile of compulsive exercise in adolescent inpatients with anorexia nervosa. Journal of Eating Disorders.

[10] ibid.

About the Author:

Sarah Musick PhotoSarah Musick is a freelance writer who specializes in eating disorder awareness and education. After battling with a 4-years long eating disorder, she made it her mission to help others find hope and healing in recovery.

Her work has been featured on numerous eating disorder blogs and websites. When she’s not writing, Sarah is off traveling the world with her husband.

The opinions and views of our guest contributors are shared to provide a broad perspective on eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer a discussion of various issues by different concerned individuals.

We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.

Published September 24, 2020, on
Reviewed & Approved on September 24, 2020, by Jacquelyn Ekern MS, LPC

About Baxter Ekern

Baxter is the Vice President of Ekern Enterprises, Inc. He is responsible for the operations of Eating Disorder Hope and ensuring that the website is functioning smoothly.