How Does Excessive Exercise Influence the Anorexic Patient: What research shows

When anorexia presents with excessive exercise, the case is more difficult to treat; and this combination of symptoms may actually be a variant of obsessive-compulsive disorder, research shows.

Overexercise has a clear relationship to poor treatment outcomes in anorexia, in other words, people with anorexia who over-exercise are more likely to never recover or to relapse1. Research finds many reasons why. The most basic cause is that of people with anorexia, the excessive exercisers are more depressed, anxious, and treatment-resistant2.

fitness class

The Connection Between Overexercise and Anxiety

In fact, many studies show anorexics who overexercise are very anxious and obsessive-compulsive. Some researchers have even posited that anorexia with excessive exercise is a strain of obsessive-compulsive disorder, perhaps a culture-bound variant3. Other research links hyperactive anorexia to obsessive-compulsive-personality disorder (OCPD), which may seem like splitting hairs from OCD but OCPD differs because it blankets a person’s life with the need for organization of everything.

This isn’t surprising. The stereotypical profile of anorexia is a type-A personality, the perfectionist; and these are similar qualities of OCPD and OCD. The relationship also shows up in the brain with both OCD and anorexia sharing an altered serotonergic function4.

Both OCPD and OCD are also risk factors for anorexia, which affects up to 4% of American women. Studies vary on the mortality rate of anorexia from 5-20%, and it’s believed less than half fully recover5.

Activity Anorexia and OCD

There is some intrinsic relationship between starvation, exercise, and obsessive-compulsivity that researchers have called activity anorexia. This condition was first noted in rats. When rats have access to both food and the exercise wheel, they self-regulate a healthy balance between food intake and exercise, but when food intake is restricted, the rats exercise more and more.

Researchers W. David Pierce and W. Frank Epling found these to be the same behaviors present in anorexia and overexercise, which account for 38-75% of those with anorexia.[6] The two went on to write a book in which they describe a dangerous, reciprocal cycle in which obsessive-compulsiveness, overexercise, and food restriction mutually reinforce the other to create a very resistant eating disorder7.

man with weights in hand

There Is No Hard Data on the Connection Between the Two

While the relationship is clear, the reasons are murky as to why obsessive-compulsiveness and overexercise in anorexia are closely linked. It may be that someone overexercises to relieve anxiety or weight- and/or food-related obsessions, so the OCD behaviors lead to the element of excessive exercise in an eating disorder8.

Regardless, over-exercise makes recovery from an eating disorder even more challenging. Although the effects of obsessive-compulsivity on treatment outcomes are unknown, these personality traits certainly add another layer of complexity to individual cases of eating disorders and may make people more resistant to treatment8.


  1. Dalle Grave, R., Calugi, S., Marchesini, G. (2008). Compulsive exercise to control shape or weight in eating disorders: prevalence, associated features and treatment outcome. Comprehensive Psychiatry, 49:346–352.
  2. Peñas-Lledo, E., Vaz Leal, F., & Waller, G. (2002). Excessive exercise in anorexia nervosa and bulimia nervosa: Relation to eating characteristics and general psychopathology. International Journal of Eating Disorders, 31(4), 370-375.
  3. Davis, C., Kaptein, S. (2006). Anorexia nervosa with excessive exercise: A phenotype with close links to obsessive-compulsive disorder. Psychiatry Research, 142(2-3), 209-217.
  4. Jarry, J., Vaccarino, F., (1996). Eating disorder and obsessive-compulsive disorder:
    neurochemical and phenomenological commonalities. Journal of Psychiatry & Neuroscience, 21(1), 36-48.
  5. Le Grange, D. (2005) The Maudsley family-based treatment for adolescent anorexia nervosa. World Psychiatry, 4(3), 142-146.
  6. Epling, W.F. Pierce, W.D., Stefan, L. (1983). A theory of activity-based anorexia International Journal of Eating Disorders, 3(1), 27-46.
  7. Epling, W., & Pierce, W. (1996). Activity anorexia: Theory, research, and treatment. Mahwah, N.J.: Lawrence Erlbaum Associates.
  8. Davis, C., Blackmore, E., Katzman, D.K., Fox, J. (2005) Female adolescents with anorexia nervosa and their parents: A case control study of exercise attitudes and behaviors. Psychological Medicine, 35(3), 377-386.
  9. Young, S., Rhodes, P., Touyz, S., & Hay, P. (2013). The relationship between obsessive-compulsive personality disorder traits, obsessive-compulsive disorder and excessive exercise in patients with anorexia nervosa: A systematic review. Journal of Eating Disorders, 1, 1-16.

Contributor: Leigh Bell, BA,

About the Author:

Leigh Bell holds a Bachelor of Arts in English with minors in Creative Writing and French from Loyola Marymount University in Los Angeles. She is a published author, a journalist with 15 years of experience, and a recipient of the Rosalynn Carter Fellowship for Mental Health Journalism. Leigh is recovered from a near-fatal, decade-long battle with anorexia and is the mother of three young, rambunctious children.

Last Updated & Reviewed By: Jacquelyn Ekern, MS, LPC on July 31st, 2015
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