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Exercise bulimia: What it is and how it’s treated

Bulimia nervosa (BN) is an eating disorder that affects about three percent of women and one percent of men, and most are diagnosed between the ages of fifteen and twenty-nine, according to available data. Unfortunately, research also shows the mortality rate for bulimia is high. In some cases, it is five times higher than in control groups. (1) 

Bulimia most commonly presents as vomiting after eating or using laxatives to rid the body of food. But exercising excessively is another way people with bulimia purge food. This is called exercise bulimia. It’s important to be aware of the signs and possible negative side effects, because exercise is often taken to the extreme in the name of health in our society and can cause serious injury.

Last updated on 
December 26, 2022
In this article

What is exercise bulimia?

As its name suggests, exercise bulimia is a condition centered on excessive exercise. Over-exercising isn’t an eating disorder in and of itself, but when it occurs alongside other behaviors, compulsive exercise can be part of an eating disorder. (2)

For example, individuals who live with bulimia have episodes of binge eating. After a binge, they may engage in some form of purging to prevent weight gain from overeating. (2) While vomiting or using laxatives to purge unwanted calories might be what most of us think of, excessive exercise is also a form of purging. Someone with exercise bulimia may spend hours exercising in an attempt to burn off excess calories, and, in many cases, a person exercises to the point of injury or exhaustion.

Symptoms of exercise bulimia

Exercise bulimia symptoms are based upon diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which is the reference guide mental health professionals use to diagnose eating disorders. According to this manual, a person must have repeated episodes of binge eating to be diagnosed with bulimia. During these periods, they consume significantly more food than the typical person would during a given time period, and, afterwards, they purge the excess food. (2) 

In the case of exercise bulimia, a person purges through exercise. Some specific signs and symptoms of exercise bulimia include: (3)

  • Consuming large amounts of food and feeling out of control when eating
  • Discomfort eating in front of other people
  • Preoccupation with weight loss, dieting, and controlling the size of their body
  • Maintaining a strict exercise routine, even when sick or injured
  • Exercising in secret
  • Being unable to complete other activities, such as working or caring for a family, because of the fixation on food and exercising
  • Feeling extremely anxious when unable to exercise
  • Isolating from friends and family because so much time is spent exercising
  • Exercising specifically to burn off extra calories or to have permission to eat 
  • Frequently trying new diets or restricting calories, while also engaging in binges at least once a week 
  • Evaluating self-worth almost entirely based on weight and body shape

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Exercise bulimia treatment

Symptoms of exercise bulimia can be distressing and make it difficult to function in daily life. Some individuals may even develop health problems related to exercise bulimia. These can include chronic fatigue, loss of bone mineral density, stress fractures, chronic pain, heart problems, electrolyte imbalances, and digestive problems.

Fortunately, treatment can improve symptoms of exercise bulimia and address related health problems. Since exercise bulimia can cause damage to the body, treatment often includes a medical evaluation. Some individuals with exercise bulimia may require inpatient treatment, where they receive around-the-clock care and medical support. While receiving inpatient care, patients also undergo psychological treatments, including group and individual counseling. Together, these treatments help individuals cultivate a healthier relationship with food, eating, movement, and their bodies.

One type of psychotherapy that has been found to be effective for some people living with bulimia is cognitive behavioral therapy, or CBT. This form of therapy can be tailored to meet the needs of individuals with eating disorders. (4) During CBT, a licensed mental health professional will help you to evaluate thoughts and behaviors related to your eating disorder and replace them with healthier ways of thinking and behaving. For example, you may believe that your entire worth and happiness is based upon having a certain body type. In CBT, you become aware of faulty beliefs connected to worthiness and can learn to think differently and apply new coping mechanisms.

There are other types of psychotherapy that have also been found to be effective. They include: (5,6,7,8,9,10,11)

  • Acceptance and commitment therapy (ACT)
  • Cognitive behavioral therapy (CBT)
  • Cognitive remediation therapy (CRT)
  • Dialectical behavioral therapy (DBT)
  • Emotionally focused therapy (EFT)
  • Exposure therapy
  • Internal family systems (IFS)
  • Interpersonal therapy (IPT)

In addition, there are many other therapies, practices, and activities that can be helpful as part of a comprehensive treatment plan for exercise bulimia, such as:

  • Art therapy
  • Meditation and mindfulness
  • Movement therapy
  • Music therapy
  • Outdoor activities
  • Yoga 

If you are living with exercise bulimia, you may feel as if you are alone. There are treatment programs available, and there is no shame in asking for help. Exercise bulimia is a legitimate medical condition that warrants treatment. You may be anxious about reaching out for help, but once you take that first step, you’ll find that there are caring professionals there to guide you along your journey toward recovery.

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.

Resources

  1. van Eeden, A. E., van Hoeken, D., & Hoek, H. W. (2021). Incidence, prevalence and mortality of anorexia nervosa and bulimia nervosa. Current Opinion in Psychiatry, 34(6), 515–524. https://doi.org/10.1097/yco.0000000000000739
  2. Bulimia nervosa. National Eating Disorders Association. (2018, February 22). Retrieved February 28, 2022, from https://www.nationaleatingdisorders.org/learn/by-eating-disorder/bulimia
  3. Compulsive exercise. National Eating Disorders Association. (2018, February 22). Retrieved February 28, 2022, from https://www.nationaleatingdisorders.org/learn/general-information/compulsive-exercise
  4. Slade, E., Keeney, E., Mavranezouli, I., Dias, S., Fou, L., Stockton, S., Saxon, L., Waller, G., Turner, H., Serpell, L., Fairburn, C. G., & Kendall, T. (2018). Treatments for bulimia nervosa: A network meta-analysis. Psychological Medicine, 48(16), 2629–2636. https://doi.org/10.1017/s0033291718001071
  5. Manlick, C.F., Cochran, S.V. & Koon, J. Acceptance and Commitment Therapy for Eating Disorders: Rationale and Literature Review. Journal of Contemporary Psychotherapy, 43, 115–122 (2013). https://doi.org/10.1007/s10879-012-9223-7
  6. Huurne, E.D.T., de Haan, H.A., Postel, M.G., et al. Long-term effectiveness of web-based cognitive behavioral therapy for patients with eating disorders. Eating & Weight Disorders. 2021 Apr;26(3):911-919. https://pubmed.ncbi.nlm.nih.gov/32449152/
  7. Kass, A. E., Kolko, R. P., & Wilfley, D. E. (2013). Psychological treatments for eating disorders. Current Opinion in Psychiatry, 26(6), 549–555. https://doi.org/10.1097/YCO.0b013e328365a30e
  8. Iryna Ivanova & Jeanne Watson (2014) Emotion-focused therapy for eating disorders: enhancing emotional processing. Person-Centered & Experiential Psychotherapies, 13:4, 278-293, DOI: 10.1080/14779757.2014.910132
  9. Butler, R.M., Heimberg, R.G. (2020). Exposure therapy for eating disorders: A systematic review. Clinical Psychology Review, Volume 78. https://doi.org/10.1016/j.cpr.2020.101851
  10. Lester, R. J. (2017). Self-governance, psychotherapy, and the subject of managed care: Internal Family Systems therapy and the multiple Self in a US eating-disorders treatment center. American Ethnologist, 44(1) 23-35.
  11. Miniati, M., Callari, A., Maglio, A., & Calugi, S. (2018). Interpersonal psychotherapy for eating disorders: Current perspectives. Psychology Research and Behavior Management, 11, 353-369.

FAQs

Further reading

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What is exercise addiction?

Yes, there is such a thing as too much exercise. As important as moving our bodies is...
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Exercise bulimia: What it is and how it’s treated

Bulimia nervosa (BN) is an eating disorder that affects about three percent of women...
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The signs and effects of exercise bulimia on the body

Exercise bulimia is perhaps a lesser-known eating disorder than anorexia...