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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 signs and symptoms of compulsive exercise, as defined by the National Eating Disorder Association: 
- Exercise interferes with important life activities and occurs in inappropriate settings and times.
- The individual maintains a rigid, excessive exercise regime despite illness, medical complications, injuries, fatigue, or weather.
- If unable to exercise, the individual feels intense distress, anxiety, irritability, guilt, and/or depression.
- The person experiences feelings of discomfort with inactivity or rest.
- They withdraw from family, friends, and social activities to exercise more.
- They use exercise as a way to purge or as permission to eat food (to “burn off” calories).
- They may exercise in secret.
- The individual may continually feel as though they are not good enough, not pushing hard enough, and not going fast enough while exercising.
The Connection Between Anorexia & Compulsive Exercise
While compulsive exercise is a symptom found among all eating disorder diagnoses, it is most common among individuals with anorexia nervosa, with approximately 44.6% to 80% of anorexic individuals suffering from compulsive exercise. 
While it’s easy to assume anorexic individuals engage in compulsive exercise simply 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 restricted their food intake to stimulate anorexia. The researchers were surprised that the starving rats started running on the wheel excessively, even going so far as to ignore the few meals they were offered to keep running. 
Though the researchers assumed the rats would decrease their energy output since they were starving, they 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 make a conscious effort to burn calories or control their body shape or weight with exercise, they still can’t stop running around aimlessly, moving constantly, and fidgeting.
As one researcher explained, though compulsive exercise may, in some anorexic individuals, start as a desire to burn calories and control body weight or shape, the evidence reveals that compulsive exercise eventually becomes “autonomous and controlled more by ‘biology’ than by conscious decision-making.” 
In short, compulsive exercise in anorexic people 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 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: People with eating disorders often have a very slow heartbeat. Athletes have slow heartbeats too, but a healthy heart can speed up when needed. But people with anorexia may strain their hearts to the breaking point with their workouts.  A heart weakened by anorexia is often not up to the task of beating harder and faster during a workout.
- Overuse injuries: People with compulsive exercise issues work out for hours, pushing their bodies hard in each session. Since they’re restricting their meals, they may not have the nutrients needed for tissue repair. As a result, their pulled muscles, sore tendons, and stretched ligaments may worsen with each workout.
- Electrolyte imbalances: Human sweat contains salts. These elements are needed for cell communication, and the body can’t function properly when stores are depleted. People with anorexia already have electrolyte issues due to their eating habits, but exercising excessively can worsen the matter.
- Fractures: Many individuals with anorexia have weak bones. Some forms of workouts put their frail bones at risk. Using weight machines, running on rough roads, and playing contact sports could all result in fractured bones.
Sudden death is an unfortunate consequence of anorexia. While it’s most commonly connected to heart issues, any other complications we’ve mentioned could play a role. 
Poor Treatment Outcomes
Not 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 the 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 anorexic individuals who did not engage in compulsive exercise. 
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. 
Greater Psychological Distress
Finally, an over-exercise disorder among adults with anorexia is directly associated with higher levels of psychological distress, including depression, anxiety, obsessive-compulsiveness, and chronic negative affect. 
Further, it has been shown to increase concerns about:
- Weight and shape
- Body dissatisfaction
- A drive for thinness
This ultimately leads to psychological distress and worsened eating disorder symptomatology. 
An anorexia workout can last for hours, and some people schedule multiple sessions per day. People with anorexia must also set aside time to count calories, research acceptable foods, and prepare meals for others (which they will never eat). As a result, there’s little time left behind for social engagements.
Outsiders may also suspect that people struggling with anorexia nervosa and exercise aren’t healthy. They may ask questions that people with anorexia find insulting.
As isolation deepens, the eating disorder can worsen. Researchers say both social impairment and depression are common in people who exercise compulsively. 
What to Do Next
If you think you or a loved one might have an eating disorder with excessive exercise, seek professional support today. Eating disorders are serious mental health disorders that can cause severe and often life-threatening physical complications, especially when paired with compulsive exercise.
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.
- National Eating Disorders Association. (n.d.). Compulsive Exercise. NationalEatingDisorders.org. Retrieved September 2022.
- Fietz, M., Touyz, S., Hay, P. (2014). A risk profile of compulsive exercise in adolescents with an eating disorder: a systematic review. Advances in Eating Disorders, 2:3, 241-263.
- Scharner, S., Prinz, P., Goebel-Stengel, M., Kobelt, P., Hofmann, T., Rose, M., Stengel, A. (2016). 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. Frontiers in Neuroscience, 10:475.
- Boakes, R.A. (2007). Self-starvation in the rat: running versus eating. Spanish Journal of Psychology, 10(2), 251-7.
- Sardar, M.R., Greway, A., DeAngelis, M., Tysko, E.O., Lehmann, S., Wohlstetter, M., Patel, R. (2015). Cardiovascular Impact of Eating Disorders in Adults: A Single Center Experience and Literature Review. Heart Views, 16(3), 88-92.
- Jáuregui-Garrido, B., Jáuregui-Lobera, I. (2012). Sudden death in eating disorders. Journal of Eating Disorders, 8, 91-8.
- Noetel, M., Miskovic-Wheatley, J., Crosby, R.D., Hay, P., Madden, S., Touyz, S. (2016). A clinical profile of compulsive exercise in adolescent inpatients with anorexia nervosa. Journal of Eating Disorders, 4, 1.
- Stiles-Shields, C., Lock, J., Le Grange, D. (2015). The effect of driven exercise on treatment outcomes for adolescents with anorexia and bulimia nervosa. The International Journal of Eating Disorders, 48(4), 392-6.
- Lichtenstein, M.B., Hinze, C.J., Emborg, B., Thomsen, F., Hemmingsen, S.D. (2017). Compulsive exercise: links, risks and challenges faced. Psychology Research and Behavior Management, 10, 85-95.
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 October 13, 2022, on EatingDisorderHope.com. Reviewed & Approved by Jacquelyn Ekern MS, LPC