A pattern began to emerge of individuals having both disordered eating behaviors and some pathology or pathologized behaviors or attitudes around physical activity.
Studies indicate that between 50 to 80% of individuals with eating disorders have a skewed attitude toward physical activity as a part of the symptomatology of their eating disorder.
For these behaviors to go unaddressed, it just doesn’t make sense. This is true both during treatment and after.
When individuals are discharged from a facility, they are moving from an environment with boundaries and safety constraints back into the life they were living before. They might feel a compulsion to engage in these behaviors again.
Or, they may simply want to break up the rigidity so that they don’t feel like there are not any options for them as far as exercise and movement is concerned.
These previously maintained behaviors have to be addressed so that they do not go right back into engaging in these compulsive behaviors once they return to that environment.
We want to be able to give them options so that exercise does not feel off limits, but they know how to move their body healthily. It was our belief that a group focusing on this movement would be helpful for individuals working toward recovery.
The group grew pretty organically to become a joint movement and nutrition group, as we would have a client and one of us knew the movement piece, the other had the nutrition piece down, so, it became an immersion of the two.
Benefits of Addressing Physical Activity
When clients engage in this compulsive need to excessively exercise before taking care of even their most basic needs such as sleeping or eating, where we start in addressing these behaviors is to get information on “why.”
We ask these individuals, “what does this physical activity do for you? How does it make you feel?”
A lot of individuals report that it makes them feel some kind of control, makes them feel a strong sense of power, and it made her feel strong.
One person that would do upwards of 3,000 crunches every night reported they liked the sagittal movement of it, that it felt almost like rocking, and it was self-soothing.
By looking at this during a dance movement therapy group one day, we were able to bring some flexibility into what movement might look like. With that same individual, we taught her a yoga sequence and worked with her on not needing this compensatory movement in order to meet her needs.
When she finished her stay here, the number of crunches she did each night had gone from about 3,000 to the low hundreds. She started incorporating yoga movement into her daily routine as well.
So, not only did we work to decrease the number of crunch reps she felt she needed to do, we built in some flexibility of what movement might look like, and she started to find some joy in the yoga movement. She said that it felt good, and she could express herself through it.
She also shared that it helped to reduce her feelings of anxiety, and she was able to limit some of the tremors that happened in her body from the anxiety, as well.
We also address the self-worth aspect, looking into how to uncouple that perfectionism that is tied into the exercise. We also want to decrease the need for external validation through exercise.
We want to work on individuals learning about their own movement, what is enough to them what is over and under, what do these things mean to them.
We also look at reducing shame and guilt around exercise behaviors. The more we create flexibility around what physical activity can look like, the more we can break up and change those thought patterns of, “if I don’t engage in this particular kind of exercise, then I’m not good” or “If I don’t engage in a particular kind of exercise, I have something to feel guilty about.”
There is also the benefit of exercise helping a client to restore weight. Bone density can be improved in the practice of physical activity as well as it promoting muscle-building.
All of this can help the individual to feel physically stronger as well as, potentially, mentally stronger.
Risks in Addressing Physical Activity in Treatment
Also to be considered is that we may be moving in ways that could be triggering to individuals.
There is an adult individual we worked with who had a really rigid set of exercises. She had rigid thoughts such as “50 to 60 lunges is what is best” or “50 to 60 push-ups it what has to be done, it is the only way I can stay strong.”
This individual had a trauma history, and it made sense that she was trying to build up physical strength in order to feel protected and feel like she could be a protector for her family.
We talked about other ways she could build that strength but knew, when working with her, we wouldn’t start with lunges or push-ups. This is because those are her exercises of choice that trigger the need to get through it or feel “that is not enough.”
We also want to talk about what exercise looks like post-discharge. We want to address the risk factors that come in right away such as external triggers in social media or pop culture, even family culture around exercise.
We want to encourage the use of language that is not rigid around physical activity so that individuals have that flexibility in the environment to which they are returning.
Finally, we want to look at what is coming up for individuals as they are re-incorporating movement.
I currently have an outpatient individual that had been in inpatient before and described that a couple of years ago in another facility, she did yoga maybe once a week and nothing else.
This individual struggled with compulsive exercise and had a goal to do 100 classes in 100 days, so, one every single day.
Then, she went to treatment and did yoga once a week. Since then, she has not moved and described to me a fear of movement, asking, “how will I move appropriately,” “will I go back to that?”
With this group, our hope is to bridge that gap a little bit more and decrease that scary transition.
Binge Eating & Bulimia & Excessive Exercise
There are some misconceptions of people in larger bodies that their exercise has to be at high intensity and frequency. They have shame about their body image and weight.
This can be true, and it is essential to ask them how they feel about their body, as it can be a barrier to movement. We try to make all bodies feel comfortable in group and dispel any of these myths.
One individual had a trauma history of a physically and verbally abusive mom, and grandma would come and save the person from the abuse and take her out to eat.
As a result, eating became the way that she self-soothed. She developed a binge eating disorder and was in a larger body that with which she was uncomfortable.
We worked on a movement plan where, the first week, she didn’t move outside of her regular daily movement. The second week, we went for a walk once for 10 minutes.
She shared that she had shame in walking because she felt winded in walking. She felt she couldn’t do what her peers could do, so we started with very short walks.
She, eventually, built up her ability to comfortably walk around campus, and it didn’t feel like an obligation. It didn’t feel like what she thought exercise would be.
Instead, it felt comforting to her.
That is what we mean by incorporating movement in a slow and great way.
Virtual Presentation by Maggie Garrity, RD, LDN, Director of Nutrition Services Timberline Knolls and Natalie Breitmeyer, DMT/Yoga Therapist in the December 8, 2018, Eating Disorder Hope Virtual Conference III: Blasting Through Bias: A Deep Dive into Underserved Populations and Global Issues 2018
Please visit the Virtual Conference page for other presentations.
Margaret Garrity, RD, LDN is the Director of Nutrition Services and her job entails many duties. She oversees the dietitians and diet technicians, carries a caseload of adolescents, supervises the menu and meal planning stages and develops nutrition-related protocols. She also implements current nutrition recommendations, participates in community outreach and trains dietitians. Prior to joining Timberline Knolls, Maggie was the Nutrition Manager at Revolution in Chicago. She started with Timberline Knolls as a diet technician and progressed to a Registered Dietitian. Maggie attended Eastern Illinois University for her undergraduate degree in Dietetics and Nutrition and then completed her dietetic internship at Ingalls Memorial Hospital. She is a member of the Academy of Nutrition and Dietetics, Behavioral Health DPG and South Suburban Academy of Nutrition and Dietetics. Learn More About Margaret Garrity, RD, LDN
Natalie Breitmeyer, MA, LPC, R-DMT, RYT is currently working as a licensed professional counselor, dance/movement therapist, and yoga specialist for Timberline Knolls in Lemont, Illinois. She received her MA in Counseling and Dance/Movement Therapy from Columbia College Chicago and trained as a yoga teacher with Yogaview Chicago. Natalie is a faculty member at Hubbard Street Dance Chicago’s Lou Conte Dance Studio where she teaches yoga and modern dance. Natalie engages with clients from a humanistic, culturally and trauma-informed lens, and incorporates somatic psychology, yoga philosophy, play therapy, and creative arts therapies into her clinical counseling work. Prior to becoming a counselor, Natalie worked as a freelance dance and theater artist in Chicago and Seattle. She received her BFA in Theater with an emphasis in playwriting and directing from Cornish College of the Arts in Seattle. Learn More About Natalie Breitmeyer, MA, LPC, R-DMT, RYT
About the Transcript Editor: Margot Rittenhouse, MS, NCC, PLPC 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 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 of 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 February 6, 2019.
Reviewed & Approved on February 6, 2019, by Jacquelyn Ekern MS, LPC
Published on EatingDisorderHope.com