Help For Excessive Exercise

Is Your Exercise Problematic? And Could It Be A Symptom Of An Eating Disorder?

Are you feeling compelled to exercise? Do you feel guilty for taking a day off? Does your commitment to exercise take precedence over other activities? Do you organize your schedule around getting in your workouts, or schedule all your workouts for the month at one time? Do you feel that you must exercise to justify eating or to burn off enjoyable food? Have you struggled to not exercise even when injured or sick? Does missing a day of exercise cause anxiety?

If so, you may be experiencing symptoms of problematic exercise, which can also be a symptom of an eating disorder or disordered eating. Whether exercise is a problem on its own or as part of an eating disorder, we can help.

The Darker Side of Exercise

Most people view exercise as a positive activity. Therefore, you may wonder how it could be bad for you. For many people, exercise does offer health and mental health benefits. It can boost mood and creativity and reduce stress.

Our culture’s celebration of exercise creates a context in which excessive exercise is often not recognized or taken as seriously as it should be. In our practice, we often see the other side of exercise. For our clients who struggle with an eating disorder or are victims of diet culture, exercise can be detrimental.

You may have internalized messages from our culture that thinness and fitness are virtuous goals. You may believe engagement in certain types or amounts of exercise will make you more worthy. Others may have taught you that exercise is important to “maintaining a healthy weight.”  And if you are in a larger body, you might feel that you only have value if you are engaging in regular intense activity.

What is Excessive Exercise?

Excessive exercise is a common symptom and can play a role in the development and maintenance of the disorder.  The problem is not necessarily the amount of exercise, but more the psychological state that accompanies it. Excessive exercise is driven. The person feels compelled to exercise and has intense distress when they are kept from their planned exercise.

We will describe how to identify excessive exercise and review how it manifests in various eating disorders. We will review the risks of overexercising. Finally, we will share how we can help if you (or a loved one) are engaging in too much exercise.

Whereas most people would understand self-induced vomiting to be a negative eating disorder behavior, they might not think the same of exercise. Those who exercise excessively are often praised for their motivation and self-discipline. But taken to an extreme, this behavior can have serious consequences.

In one of the largest studies on excessive exercise in eating disorders, excessive exercise was defined as any of the following:

1. Exercise that interfered with important activities
2. Exercise that exceeded three hours per day and caused distress if the individual were unable to exercise
3. Frequent exercise at inappropriate times and places and little or no attempt to suppress the behavior
4. Exercising despite more serious injury, illness or medical complication

Excessive Exercise as a Symptom of an Eating Disorder

Excessive or driven exercise is a common component of different types of eating disorders. It may be found among patients with anorexia nervosa, bulimia nervosa, and muscle dysmorphia, as well as other specified feeding and eating disorder (OSFED) and subclinical presentations. In the case of certain eating disorders, such as anorexia, there is even some evidence that increased exercise may be a fundamental biological reaction.

Activity-Based Anorexia in Rats

Animal studies have demonstrated that eating disorders can give rise to excessive exercise behavior, by inducing what is called “Activity Based Anorexia” in rats. When researchers restrict rats’ food intake while giving them unlimited access to a wheel, the rats start running excessively.  Paradoxically, they opt to continue running rather than eat during the short intervals of time food is made available to them. If allowed, they will literally run themselves to death.

These rats display the puzzling behavior of self-starvation exhibited in anorexia nervosa. One would expect that rats (and humans) who are starving would become less, rather than more, active. Yet in young children who develop anorexia nervosa, restricted intake is usually accompanied by increased activity. Children with anorexia often present as hyperactive – they won’t sit still, they fidget, and they often run around aimlessly. They do not express a conscious attempt to burn calories the way older adolescents and adults do. Thus, excessive activity or exercise appears to be a more a basic drive that gets turned on by the energy imbalance of restricted intake.

Exercise in Anorexia Nervosa 

Hyperactivity is a common, intriguing, and well-documented symptom of anorexia nervosa, noted as early as 1873 by the French physician Ernest-Charles Lasègue, one of the earliest writers about the disorder. Lasègue observed that patients with anorexia exhibited high levels of activity seemingly incompatible with their impoverished nutritional state. 

In one study, 37 percent to 54 percent of patients with anorexia nervosa (depending on subtype) engaged in excessive exercise. Patients may underreport the amount of time that they engage in physical activity, making it hard for caregivers and treatment professionals to fully assess.

Exercise in anorexia nervosa is commonly described by patients as driven or compulsive. Physical signs of fatigue are ignored as patients continue to train despite being physically ill and having low energy. One patient in a study about exercise reported:

“Before I attended treatment, I only sat down during meal times, or else I felt I did not deserve to sit still. I was incredibly restless, so it was difficult to relax…I feel like I am being compelled to exercise….”

Excessive exercise in anorexia nervosa is associated with a younger age and higher rates of anxious/obsessional and perfectionistic traits.

Exercise in Bulimia Nervosa 

Excessive exercise has been included in the diagnostic criteria for bulimia nervosa since the publication of DSM-III-R in 1987. The current diagnostic criteria (DSM-5) for bulimia nervosa specify that there is compensatory behavior for binge eating which can include self-induced vomiting, but also intermittent fasting, laxative use, diuretics, and exercise.

Excessive exercise is a common compensatory behavior in individuals with bulimia nervosa. In one study, 20 percent to 24 percent of patients with bulimia nervosa engaged in excessive exercise. Among patients with bulimia nervosa, excessive exercise is associated with greater baseline eating disorder severity as well as poorer treatment outcomes.

Exercise in Muscle Dysmorphia 

Excessive exercise is a common symptom of muscle dysmorphia, an emerging condition which affects primarily bodybuilders. Some researchers believe it to be a variation of anorexia nervosa characteristic of patients with a more traditional masculine gender identity. Currently, this disorder is classified diagnostically as a type of body dysmorphic disorder versus an eating disorder.

Muscle dysmorphia is characterized by the persistent belief that one is not muscular enough and associated behaviors related to increasing musculature including an extreme exercise program and dietary intake designed to build bulk (often with a focus on protein). Supplements and steroids are sometimes used in the pursuit of muscle. Among men with muscle dysmorphia, approximately 71 percent lift weights excessively, and 64 percent exercise excessively.

Excessive Exercise in OSFED and Subclinical Disordered Eating

Little research has been conducted on excessive exercise in OSFED. In subclinical samples, the relationship between compulsive exercise and elevated scores on measures of eating psychopathology is well established. Behaviors such as dieting and exercise often coexist and reinforce one another. Excessive exercise in the absence of disordered eating or disordered eating attitudes may be less clinically significant and less impairing, but it is still not without risks.

Risks of Excessive Exercise

Exercise in patients with eating disorders and disordered eating can be especially dangerous. Patients may exercise and not fuel properly, putting themselves at risk for a variety of serious medical complications.  These complications can include electrolyte imbalances, heart problems, muscle wasting, injuries, and sudden death. Patients with anorexia often have weak bones and so may generally be more likely to experience fractures; the physical strain associated with over-exercising exacerbates this risk.

The presence of excessive exercise among patients with anorexia nervosa is associated with longer inpatient treatment duration and a shorter time to relapse. Excessive exercise among individuals with disordered eating is also associated with a greater risk of suicidality.

Exercise and Eating Disorder Recovery

Excessive exercise immediately following hospital discharge is a significant predictor of relapse. Exercise can both maintain the beliefs that keep one caught in an eating disorder and be physically counterproductive when weight gain is a goal of treatment.

How We Address Excessive Exercise

If you are engaging in excessive exercise, regardless of whether you are also experiencing symptoms of an eating disorder, we can help.

Our therapists take an individualized approach to addressing exercise in eating disorder recovery. We will help you identify your values and goals and develop a treatment plan that may involve reducing or pausing exercise until further along in recovery. We teach skills such as distress tolerance and management of perfectionism that can help with reducing urges to exercise and encourage moderation. Finally, we help you work towards the incorporation of more joyful movement.

Sometimes medical providers may require restrictions on exercise due to safety risks.

How Do I Know If My Exercise Is Problematic?

Excessive exercise may be difficult to distinguish, especially among athletes. The key feature that determines whether the exercise is problematic lies less in the quantity of activity than it does in the motivations and attitudes behind it: feeling exercise as a compulsion; exercising primarily to influence shape and weight; and feelings of guilt after missing an exercise session. An elite athlete may engage in more total time exercising than a person with an eating disorder, but we could define the eating disorder person’s exercise as excessive, while the elite athlete might not have the attitudes about exercise that would qualify it as excessive or problematic.

We also want to emphasize that your exercise may be problematic even if you are in a larger body and have been told by others that your level of exercise is okay. Often people with larger bodies have been allowed to continue to engage in excessive exercise when thinner peers have been told to stop.

It should also be noted that the prevalence of eating disorders is higher among athletes, especially those in sports that emphasize leanness than it is in the general population. Thus, athletes who are exhibiting signs of an eating disorder should be assessed. 

If you (or a loved one) endorse one or more of the following items, consider whether you may benefit from seeking help:

• My exercise interferes with important activities such as work or socializing.
• I exceed three hours of exercise per day.
• I experience stress or guilt when I am unable to exercise.
• I exercise at inappropriate times and places and cannot suppress the behavior.
• I continue to exercise despite injury, illness, or medical complications.

Recovery advocate Jenni Schaefer has made the Compulsive Exercise Test, a measure used to assess excessive exercise, available on her website.

Get Help for Excessive Exercise in California

If you or someone you know is exhibiting signs of excessive exercise and/or an eating disorder, eating disorder treatment, including psychotherapy, can help address both the eating disorder and exercise obsession. Cognitive-behavioral therapy, which helps to modify behaviors as well as underlying beliefs about exercise, can help individuals develop moderation and balance. If you are a parent of a child in treatment, it may be beneficial for you to help limit or restrict their exercise.

Begin Counseling for Excessive Exercise in Los Angeles, CA

You do not have to continue to struggle with an exercise compulsion alone. Therapy can help. Our Los Angeles, California practice has caring therapists who specialize in the treatment of excessive exercise in teens and adults. To begin the counseling process, follow these steps:

1. Contact Eating Disorder Therapy LA
2. Complete our appointment request form and we match you to an eating disorder therapist.
3. Start recovering from excessive exercise.

Counseling Services at Eating Disorder Therapy LA

At Eating Disorder Therapy LA, we provide treatment for all eating disorders. Our therapists treat Anorexia Nervosa, Atypical Anorexia, Avoidant/Restrictive Food Intake Disorder, and Body Image Issues.

Sources

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Kolnes, L.-J. (2016). “Feelings stronger than reason”: conflicting experiences of exercise in women with anorexia nervosa.Journal of Eating Disorders, 4, 6. http://doi.org/10.1186/s40337-016-0100-8

Meyer, C., Taranis, L., Goodwin, H., & Haycraft, E. (2011). Compulsive exercise and eating disorders. European Eating Disorders Review, 19(3), 174–189. http://doi.org/10.1002/erv.1122

Mond, J. M., & Calogero, R. M. (2009). Excessive exercise in eating disorder patients and in healthy women. The Australian and New Zealand Journal of Psychiatry, 43(3), 227–234. http://doi.org/10.1080/00048670802653323

Mond, J. M., Hay, P. J., Rodgers, B., Owen, C., & Beumont, P. J. V. (2004). Relationships between exercise behaviour, eating-disordered behaviour and quality of life in a community sample of women: when is exercise “excessive”? European Eating Disorders Review, 12(4), 265–272. http://doi.org/10.1002/erv.579

Additional Sources

Pope, C. G., Pope, H. G., Menard, W., Fay, C., Olivardia, R., & Phillips, K. A. (2005). Clinical features of muscle dysmorphia among males with body dysmorphic disorder. Body Image,2(4), 395–400. http://doi.org/10.1016/j.bodyim.2005.09.001

Shroff, H., Reba, L., Thornton, L. M., Tozzi, F., Klump, K. L., Berrettini, W. H., … Bulik, C. M. (2006). Features associated with excessive exercise in women with eating disorders.International Journal of Eating Disorders, 39(6), 454–461. http://doi.org/10.1002/eat.20247

Smith, A. R., Fink, E. L., Anestis, M. D., Ribeiro, J. D., Gordon, K. H., Davis, H., Joiner Jr., T. E. (2013). Exercise caution: Over-exercise is associated with suicidality among individuals with disordered eating. Psychiatry Research, 206(2–3), 246–255. http://doi.org/10.1016/j.psychres.2012.11.004

Sundgot-Borgen, J., & Torstveit, M. K. (2004). Prevalence of eating disorders in elite athletes is higher than in the general population.Clinical Journal of Sport Medicine: Official Journal of the Canadian Academy of Sport Medicine, 14(1), 25–32.

Thomas JJ, Schaefer J. Almost Anorexic: Is My (Or My Loved One’s) Relationship with Food a Problem? Center City, MN: Hazelden/Harvard Health Publications; 2013.

Vandereycken, W., & van Deth, R. (1990). A tribute to Lasegue’s description of anorexia nervosa (1873), with completion of its English translation. The British Journal of Psychiatry, 157(6), 902–908. http://doi.org/10.1192/bjp.157.6.902