Eating Disorder Articles

Compulsive Exercise: The Other Eating Disorder

From the Sunflower Newsletter, May, 2007

Compulsive exercise may be no more than another way to purge. As with all other disordered eating behaviors, the apparent goal is to burn calories and lose weight, but ultimately the exercise provides a temporary sensation of power, control and/or self-respect.

As you all know, I have long contended that eating disorders are chronic stress-related conditions. It's a way to cope with stress, forget about underlying issues, escape inner pain and relieve guilt. Compulsive exercise is as dangerous as restricting, purging or using diet pills and laxatives. Combining restriction and/or binging and purging with compulsive exercise can quickly lead to serious illness (kidney failure, heart attack) or death.

Athletes and Eating Disorders

Athletes may engage in compulsive exercise to please coaches and parents and meet the expectations of others. Eating disorders continue to be on the rise among athletes, especially those involved in sports that emphasize thinness such as gymnastics, figure skating, dancing and synchronized swimming. According to a 1992 American College of Sports Medicine study, eating disorders affect 62 percent of female athletes.

When I was in private practice, I was under contract with the University of Arizona Athletics department, and regularly treated many world class athletes with eating disorders. I was amazed at the number of golfers, swimmers, and soccer players with eating disorders! Often the first treatment intervention was suspending all exercise until the person had begun to achieve solid recovery from the eating disorder.

An athlete with an eating disorder and an exercise addiction risks serious medical consequences. Any heart murmurs or arrhythmias are naturally aggravated and made worse. Because their nutrition is so poor, they also risk bone damage and loss from osteoporosis. They're also more prone to stress fractures and other physical injuries than their teammates, and any injuries may take an abnormally long time to heal.

So What is Healthy Exercise?

To maintain cardiovascular health, 2,000-3,500 calories should be burned each week through aerobic exercise, such as running, dancing, cycling and the like. Thirty to 45 minutes a day, five or six days a week is sufficient to acquire these health benefits. Exercise beyond 3,500 calories per week, however, leads to decreased physical benefits and increased risk of injury. Click here to get more information on muscle dysmorphia, a condition in which a sufferer engages in compulsive weight-bearing exercises.

I could talk about compulsive exercise all day, but I want to leave you with a list of red flags that you can use to assess your personal potential for compulsive exercise. The red flags are taken from the book, Disordered Eating, Food Obsessions and Compulsive Exercise by Nancy Clark. They were posted on NaturalStrength.com on May 10, 2002. I also want to thank the folks from something-fishy.org and the wonderful website, Mirror Mirror.

Do I Have an Exercise Addiction?

Red flags that you may be exercising for the wrong reasons include:

	preoccupation with exercise routine or intrusive thoughts about exercise that interfere with your ability to concentrate or focus
	finding time at any cost to exercise, like cutting school or taking time off from work
	exercise is your social life — you turn down social activities so as not to miss your scheduled workout
	feeling overly anxious, guilty or angry if unable to exercise and you can't tolerate changes or interruptions of your exercise routine
	exercising alone to avoid having your routine disturbed
	exercising is driven primarily by a desire to control your weight, shape and/or body composition
	food choices are based solely on exercise (you exercise as punishment for eating "bad" foods, to purge calories or you overly restrict what you eat if you can't exercise)
	lying about exercise or you always exercise alone
	you can't take rest days or time off from exercise — even if you're injured or ill.
	persistent desire and/or unsuccessful attempts to control or reduce exercise (e.g., can't take a day off during the week or time off periodically throughout the year)
	engaging in non-purposeful or excessive exercise beyond a sensible fitness or training program
	how you feel about yourself on a daily basis is based on how much exercise you perform or how hard you work out
	exercise isn't fun or pleasurable or you're never satisfied with your physical achievements
	amenorrhea (loss of three consecutive menses or failure to begin menstruating by age sixteen) and/or stress fractures

The Female Athlete Triad

Compulsive exercise is often associated with disordered eating habits. Any active female who under-eats, overexercises or both is at risk for the Female Athlete Triad. Also called the "Energy Drain," the Female Athlete Triad refers to three serious interrelated health problems: disordered eating habits, amenorrhea and osteoporosis. It's precipitated by under-fueling (consuming too few calories, usually deliberately in an attempt to lose weight quickly to improve appearance or performance) and aggravated by psychological stress. The ovaries produce less and less estrogen, resulting in menstrual irregularities and often amenorrhea. This low estrogen level also promotes or accelerates the loss of normal bone density, setting the stage for fragile and brittle bones that fracture easily (stress fractures and osteoporosis).

To recover from the Female Athlete Triad, you must correct the energy (caloric) imbalance by consuming enough calories to support your physical activity level. Dietary changes alone, however, are rarely enough to reverse the Triad. You will also need to address your exercise habits and strategies for coping with stress. Seek help from therapists and registered dietitians who specialize in eating disorders. Lastly, amenorrhea should always be evaluated by a qualified physician as soon as possible in order to prevent damaging health consequences.

Healthy Exercise at Mirasol

From the Sunflower Newsletter, May, 2007

At least 80% of Mirasol's clients are compulsive exercisers, and newcomers may be shocked to learn that residential treatment for an eating disorder also means letting go of the exercise addiction.

"The exercise addiction gets a lot of positive feedback because it makes them look better and feel more in control of their lives," notes Mirasol therapist Diane Ryan. "But eventually it takes on a compulsive quality and becomes just another way of restricting calories."

To break the cycle, all Mirasol clients refrain from exercising for the first week of treatment.

"For compulsive exercisers, it's a form of detox," says exercise therapist Jill Sprecher, "and some of them go through an actual withdrawal".

After the first week, based on their BMI and overall progress, they can participate in a carefully monitored program that may include yoga, dance/movement therapy, kickboxing, weights, gentle cardio and morning walks in the desert. The teen program also offers a class combining dance and low-flying trapeze at Zuzi Dance Studio.

All activities are accompanied by plenty of group and individual processing.

"Exercise provides an easy way to check out of their bodies, so I work with them to breathe, feel their muscles and be present in their bodies," says Sprecher.

Mirasol's Family Program also includes an exercise component.

"It's not uncommon to find that the daughter has partnered with the parents in an exercise addiction," says Ryan, "so we provide training on healthy exercise, how to recognize compulsive exercise and how to assess participation in individual and group sports as its relates to eating disorder recovery."

As with healthy eating, healthy exercise is all about balance.

"It's important for parents to recognize that all the things that are wonderful and beneficial about exercise flip and become negative when nutritional status is compromised," says Ryan.

Mirasol's teen exercise program includes, "Flight into Aerial," combining dance with low-flying single point trapeze. In addition to learning aerial skills, clients work on building spatial awareness, trust and cooperation.