Compulsive Exercise: Causes, Diagnosis, and Treatment Options

We live in a culture that values movement and exercise. While this is not inherently negative, our culture also validates excessive movement and exercise. When individuals work out excessive lengths of time regardless of weather or injury, they are often lauded for their commitment and perseverance. Rarely are any questions asked about why the individual finds it necessary to put their body through this. Because of this, individuals struggling with compulsive exercise addiction often go undetected by their loved ones and may not even know their behaviors are concerning, let alone that they are potentially dangerous.

Identifying Compulsive Exercise in Eating Disorder Patients

It is not uncommon for individuals with an eating disorder to engage in excessive and/or compulsive exercise behaviors as a facet of their disorder.

While there is no definitive diagnostic criteria for compulsive exercise, there are behaviors professionals and loved ones can identify. The Journal of Eating Disorders proposed the following criteria for a clinical definition of compulsive exercise:

1. Compulsive exercise as defined by 1 and 2:

1. Excessive exercise that the patient feels driven to perform in response to an obsession or according to rules that must be applied rigidly.
2. The exercise is aimed at preventing some dreaded consequence or at preventing or reducing distress, often based on distorted beliefs about exercise.

1. The compulsive exercise is time-consuming (takes more than one-hour a day), significantly interferes with the person’s daily routine, occupational functioning or social relationships, or is continued despite medical injuries, illness, or lack of enjoyment.
2. At some point during the course of the disorder, the patient has recognized that the compulsive exercising is excessive or unreasonable [1].

Causes of Excessive Exercise in Eating Disorder Patients

There can be many reasons an individual engage in excessive exercise as a facet of their eating disorder.

Some will use exercise as a compensatory behavior, basing their exercise schedule, level-of-intensity, etc. on their caloric intake that day. They might also exercise prior to a meal in order to “earn” that meal. Both behaviors are related to beliefs these individuals may have that they cannot simply eat food to nourish their bodies and that they must burn off or tone any calories they take in for eating to be acceptable.

Individuals with eating disorders commonly struggle with mood dysregulation and co-occurring mood and/or trauma disorder, therefore, they may also use excessive movement to alleviate or prevent aversive emotion-states.

The above-mentioned study also noted that individuals with eating disorders often also have perfectionist traits and that many individuals that engage in compulsive exercise report doing so to feel in-control or reach a desired level of achievement [1] . They often put great pressure on themselves to achieve “perfection” whether in their bodily appearance or fitness performance.

Finally, those that struggle with disordered eating often have a distorted sense-of-self and cognitions related to this. They may hold beliefs that connect their worth to their fitness or exercise such as “if I don’t work out, I am lazy, bad, and worthless.” The fear that their commitment to exercise is tied to their “good-ness” motivates them to excessively exercise even when it is causing harm.

Evaluating Someone for Over-Exercise

To evaluate someone for over-exercise, a great deal of questions need to be asked regarding the individual’s exercise history, current behaviors, impact of their exercise on their daily life, etc. One must also consider their lab results and vitals as these can indicate if a person’s body is being negatively impacted by too much exercise.

There is no current approved assessment for compulsive exercise behaviors, however, considering the questions above can be a great indicator of an individual is excessively and/or compulsively exercising.

Be sure to ask not only about their exercise behaviors but how these behaviors fit into their job, relationships, nourishment, and self-image.

Treatment of Compulsive Exercise

Treatment of compulsive exercise is similar to the treatment of eating disorders.

Individuals that are struggling with severe eating disorder and/or exercise behaviors and are severely malnourished and underweight will need their movement to be strictly limited. Any movement in a depleted body is medically dangerous. Individuals healing their malnourished bodies need to retain all nutrients and calories that they take in, therefore, there is no wiggle-room for expending calories via exercise or even common daily movement such as walking up-and-down stairs, taking daily walks or standing for too long.

Individuals that struggle with compulsive exercise are likely to find this very challenging. They might begin to hide their movement, taking “the long way” to walk places, taking the stairs more often, pacing excessively, or hiding movement while in their bedroom at night or in the privacy of a bathroom.

It is important that treatment professionals explore the deeper urges, sensations, and cognitions surrounding these behaviors. Similar to other eating disorder behaviors, simply encouraging them to “stop” is not effective. When exercise behaviors become so intense to be considered compulsive, what is beneath the behaviors is much deeper and must be explored to help the individual work toward long-term recovery.

When individuals become more nourished, it is also important to reintegrate movement into their life with the support of the members of their team. An individual recovering from compulsive exercise cannot jump back into intense movement. Instead, they should be encouraged to start slowly, engaging in mindful and minimal movement that considers their current cognitions and the sensations in their body. Individuals should be taught to listen intuitively to their body’s needs while moving and making choices about continued movement accordingly.

This reintroduction of movement should not include cardio movement. Excessive exercisers will likely want to begin these types of movement right away, however, it is not medically safe nor clinically effective for them to do so.

It can take a year or more for an individual recovering from an eating disorder and compulsive exercise to even be in a place where reintegrating movement is safe and appropriate.

Recovering from compulsive exercise is a huge undertaking, especially if it occurs alongside an eating disorder. Treatment professionals should be careful in moving patients toward this process and should let their patients know that it will be very slow and why that is most beneficial to them.

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References

[1] Dittmer, N., Jacobi, C., Voderholtzer, U. (2018). Compulsive exercise in eating disorders: a proposal for a definition and clinical assessment. Journal of Eating Disorders, 6:42.

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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 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.

Author: Margot Rittenhouse, MS, NCCC

Published on July 28, 2022
Reviewed & Approved on Aug 1, 2022, by Jacquelyn Ekern MS, LPC
Published on EatingDisorderHope.com