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Recognize exercise bulimia signs and symptoms

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Exercise bulimia is perhaps a lesser-known eating disorder than anorexia nervosa (AN) or bulimia nervosa (BN), but it can be just as dangerous. Engaging in excessive exercise can be harmful to a person’s physical and mental health and often requires professional treatment to overcome.

5
 minute read
Last updated on 
May 25, 2022
April 4, 2024
The signs and effects of exercise bulimia on the body
In this article

What is exercise bulimia?

Exercise bulimia is characterized by excessive and pathological exercise. It is similar to bulimia nervosa in that instead of “purging” by self-induced vomiting or diarrhea, a person exercises excessively to burn calories in order to compensate for food consumption.

Exercise bulimia is not a formal diagnosis in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), a diagnostic tool published by the American Psychiatric Association (APA). However, excessive exercise as a compensatory behavior is listed as a symptom of bulimia nervosa. (1) 

As such, exercise bulimia may exist on its own, as a symptom of bulimia nervosa, or in conjunction with co-occurring anorexia nervosa. Since exercise bulimia isn’t a formal clinical term, you may hear it called many other things, such as “exercise addiction,” “compulsive exercise,” or “excessive exercise.”

Exercise bulimia signs

While movement is healthy for our minds and bodies, too much exercise can indicate a problem. Countless people make exercise a part of their daily routine, but the problem comes in when that exercise becomes compulsive or pathological. Compulsive exercise may include the following criterion: (2)

  • Exercising with the goal of compensating after overeating (for example, having a binge on food and then going to the gym for multiple hours afterward to compensate)
  • Exercising according to rigid self-imposed rules and in response to an obsession
  • Exercising is time-consuming, interferes with the person’s life and responsibilities, and is continued regardless of negative consequences

Symptoms of exercise bulimia may include: (3,4)

  • Experiencing a preoccupation with exercise and weight management
  • Missing important events or neglecting hobbies in order to exercise
  • Feeling ashamed or guilty if you miss a workout
  • Excessively tracking how many calories you burn during a workout
  • Becoming defensive if someone points out how much you exercise
  • Having distorted body image
  • Exercising for multiple hours a day, way longer than the average work out of a half hour to an hour at a time
  • Continuing to work out even if you are sick or injured
  • Deriving little to no joy from exercise, even activities that were once fun
  • Experiencing cravings to work out
  • Stopping menstruation (in those who menstruate)

People with exercise bulimia are typically very rigid with their workout routines, so much so that they are unable to skip a workout or cut one short without feeling guilty. This can occur in people who are attempting to lose weight via exercise as well as attempting to gain muscle via excessive weightlifting. 

Much like other eating disorders, exercise bulimia is accompanied by a sense of shame, which can only perpetuate the cycle of compulsive exercise.

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Traits linked to compulsive exercise

A review of literature revealed that compulsive exercise is associated with the following: (4)

  • Eating disorder pathology and symptoms
  • Neuroticism: A tendency toward negative affect or emotional state, including irritability, anger, depression, anxiety, and emotional instability
  • Perfectionism: Desiring flawlessness, setting extremely high standards, and being overly critical of oneself
  • Narcissism: A sense of entitlement and inflated sense of self-importance 
  • Obsessive compulsive traits: Obsessive thoughts and repetitive, uncontrollable behaviors

Complications of exercise bulimia

Exercise bulimia and excessive exercise can lead to many different psychological and medical complications, including: (3,5,6)

  • Increased risk of arrhythmias (abnormal heart rhythm)
  • Extreme fatigue
  • Weakened immune system leading to more frequent illnesses
  • Overuse injuries, such as stress fractures or osteoarthritis
  • Mood swings or irritability
  • Depression and anxiety
  • Sleep disturbances
  • Extreme soreness
  • Dangerous weight loss
  • Increased suicidality

Over-exercising can also lead to rhabdomyolysis, a serious and potentially life-threatening condition in which an individual’s muscles break down, releasing proteins and muscle enzymes into the bloodstream, which can lead to kidney failure. (7) 

Do you have exercise bulimia?

Not all exercise is bad, which can make it particularly tricky to parcel out who has exercise bulimia and who is simply a gym enthusiast.

Aside from the common warning signs of exercise bulimia, one significant indication that someone is struggling with a deeper problem would be the concurrent symptoms of bulimia, including body image issues and binge eating episodes that generally trigger excessive exercise.

Another good way to find out if you have exercise bulimia is to take an exercise bulimia test. But remember: These quizzes are not the same as a proper medical evaluation. If you're worried about your behaviors or that of a loved one, it's important to consult your primary care physician, therapist, or another trusted medical professional.

Exercise bulimia test

The Compulsive Exercise Test (CET) is composed of 24 self-report statements that are designed to assess the core emotional, cognitive, and behavioral features of compulsive exercise.8 The exercise bulimia test assesses aspects of compulsive exercise on five subscales:9

  • Avoidance and rule-driven behavior
  • Weight control exercise
  • Mood improvement
  • Lack of exercise enjoyment
  • Exercise rigidity

Each self-report item is rated on a scale from 0 (never true) to 5 (always true). The higher a person scores on the test indicates more significant compulsive exercise pathology.8 Examples of self-report statements on the exercise bulimia test include:8

  • I feel extremely guilty if I miss an exercise session
  • I usually continue to exercise despite injury or illness unless I am very ill or too injured
  • I feel less depressed or low after I exercise
  • If I feel I have eaten too much, I will do more exercise
  • My weekly pattern of exercise is repetitive

You might be interested in

Disclaimer about "overeating": Within Health hesitatingly uses the word "overeating" because it is the term currently associated with this condition in society, however, we believe it inherently overlooks the various psychological aspects of this condition which are often interconnected with internalized diet culture, and a restrictive mindset about food. For the remainder of this piece, we will therefore be putting "overeating" in quotations to recognize that the diagnosis itself pathologizes behavior that is potentially hardwired and adaptive to a restrictive mindset.

Disclaimer about weight loss drugs: Within does not endorse the use of any weight loss drug or behavior and seeks to provide education on the insidious nature of diet culture. We understand the complex nature of disordered eating and eating disorders and strongly encourage anyone engaging in these behaviors to reach out for help as soon as possible. No statement should be taken as healthcare advice. All healthcare decisions should be made with your individual healthcare provider.

Resources

  1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). 
  2. Dittmer, N., Jacobi, C. & Voderholzer, U. (2018). Compulsive exercise in eating disorders: proposal for a definition and a clinical assessment. Journal of Eating Disorders 6(42)
  3. National Library of Medicine. (2022). Are you getting too much exercise?
  4. Lichtenstein, M. B., Hinze, C. J., Emborg, B., Thomsen, F., & Hemmingsen, S. D. (2017). Compulsive exercise: links, risks and challenges faced. Psychology research and behavior management, 10, 85–95.
  5. O’Keefe, J., Patil, H., Lavie, C., et al. (2012, June). Potential adverse cardiovascular effects from excessive endurance exercise. Mayo Clinic Proceedings, 87(6), 587-595
  6. Smith, A. R., Fink, E. L., Anestis, M. D., Ribeiro, J. D., Gordon, K. H., Davis, H., Keel, P. K., Bardone-Cone, A. M., Peterson, C. B., Klein, M. H., Crow, S., Mitchell, J. E., Crosby, R. D., Wonderlich, S. A., le Grange, D., & Joiner, T. E., Jr (2013). Exercise caution: over-exercise is associated with suicidality among individuals with disordered eating. Psychiatry research, 206(2-3), 246–255.
  7. Sunder, A., Mohanty, B., Singh, A., & Yadav, P. (2019). Rhabdomyolysis - Exercise induced nightmare. Journal of family medicine and primary care, 8(1), 305–307.
  8. Meyer, C., Plateau, C. R., Taranis, L., Brewin, N., Wales, J., & Arcelus, J. (2016). The Compulsive Exercise Test: confirmatory factor analysis and links with eating psychopathology among women with clinical eating disorders. Journal of Eating Disorders, 4, 22. 
  9. Schlegl, S., Vierl, L., Kolar, D. R., Dittmer, N., & Voderholzer, U. (2022). Psychometric properties of the Compulsive Exercise Test in a large sample of female adolescent and adult inpatients with anorexia nervosa and bulimia nervosa. International Journal of Eating Disorders, 55(4), 494– 504. 

FAQs

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Further reading

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