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March 14, 2019

Compulsive Exercise & Eating Disorders

Woman running with Compulsive Exercise and 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.

Woman with PTSD and eating disorder in obstacle course

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.

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Resources
[1] Lichtenschtein, M. B. et al. (2017). Compulsive exercise: links, risks, and challenges faced. Psychological Research & Behavior Management, 10, 85-95.

[2] Unknown (2019). Compulsive Exercise. National Eating Disorder Association, retrieved on 03/06/2019 from https://www.nationaleatingdisorders.org/learn/general-information/compulsive-exercise.

[3] Mathisen, T. F. (2018). Treatment effects on compulsive exercise and physical activity in eating disorders. Journal of Eating Disorders, 6:43.


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Carolina House is a comprehensive eating disorder treatment program that offers a full continuum of care for men and women age 17 and above.

Carolina House provides focused care for individuals whose lives have been impacted by anorexia, bulimia, binge-eating disorder, compulsive overeating, body dysmorphic disorder, orthorexia, and certain co-occurring mental health challenges. Please call us at: 866-690-7240


Image of Margot Rittenhouse.About the Author: 

Margot Rittenhouse, MS, PLPC, NCC is a therapist who is passionate about providing mental health support to all in need and has worked with clients with substance abuse issues, eating disorders, domestic violence victims, and offenders, and severely mentally ill youth.

As a freelance writer for Eating Disorder Hope and Addiction Hope and a mentor with MentorConnect, Margot is a passionate eating disorder advocate, committed to de-stigmatizing these illnesses while showing support for those struggling through mentoring, writing, and volunteering. Margot has a Master’s of Science in Clinical Mental Health Counseling from Johns Hopkins University.


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 on March 14, 2019.
Reviewed & Approved on March 14, 2019, by Jacquelyn Ekern MS, LPC

Published on EatingDisorderHope.com

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