What is exercise bulimia?
Exercise bulimia is a subset of bulimia nervosa (BN), an eating disorder characterized by cycles of binging and purging. Those with BN utilize various unhelpful behaviors as a way to "compensate" for the amount of food eaten during a binging episode.
With exercise bulimia, excessive and compulsive exercise is the primary compensatory behavior, with working out used as a means to "purge" calories.1
Warning signs of exercise bulimia
In a world that often glorifies diet and exercise, it can be challenging to see if someone has a problem with exercise bulimia. Some of the common warning signs and symptoms of exercise bulimia include:
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- Prioritizing exercising over other social obligations, such as work, school, and family commitments
- Continuing to exercise despite fatigue, injury, or other mental complications
- Intense anxiety, depression, guilt, or irritability if unable to exercise
- Obsessive calorie counting and closely tracking the amounts of calories burned when working out
- Discomfort with rest and inactivity
- Using exercise as permission to eat
- Exercising in secret
- Exercising at inappropriate times with no effort to suppress the behavior
- Maintaining an excessive and rigid exercise regimen
From the outside, this may look like someone is partaking in too much exercise despite many good reasons to ease up on their workout schedule.
Dangers of exercise bulimia
Although regular exercise is great for your physical and mental health, when exercise becomes a compulsion, it can be just as harmful to you as any other eating disorder.
Exercise bulimia can have many
medical and psychological complications, including, but not limited to:
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- Overuse injuries, like sprains, strains, and even stress fractures
- Fatigue and feeling tired all the time
- Dehydration and electrolyte imbalances
- Tendinitis, which is a painful inflammation of the tendons
- Chronic joint pain and arthritis
- Amenorrhea (loss of periods) due to low body fat
- Infertility and other reproductive issues
- Osteoporosis
- Weakened immune system
- Proneness to respiratory infections
- Heart problems, including arrhythmia
- Mood swings and/or irritability
- Depression, anxiety, and suicidal tendencies
While not all those living with exercise bulimia will engage in frequent binging episodes, those who do are at further risk of gastrointestinal issues, such as esophageal lesions, bloating, nausea, acid reflux, abdominal pain, and nausea.
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In severe cases of exercise bulimia, a person may develop a condition known as rhabdomyolysis. This potentially life-threatening condition occurs when overexercising causes the muscles to break down, releasing enzymes and proteins into the blood, causing kidney damage and even failure.
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How to get help for exercise bulimia
The good news about exercise bulimia is that exercise bulimia treatment does exist.
If you’re concerned about your behaviors surrounding exercise and food, it’s important you seek professional help. The longer you allow these behaviors to rule your life, the worse the potential impact on your physical and mental health.
Treatment for exercise bulimia typically requires a multi-pronged approach, which includes implementing coping strategies, developing healthy eating habits, maintaining healthy self-esteem and body image, and redirecting exercise goals with the gradual incorporation of moderate physical activity. (9)
Treatment for exercise bulimia will depend upon your individual needs, symptomatology, and co-occurring conditions like other eating disorders or mental health conditions.
A biopsychosocial approach
A quality eating disorder treatment program will use a biopsychosocial approach to care—this model understands and aims to address the various biological, psychological, and social factors that influence a person’s body image, exercise, disordered eating, and mental health. When you first enter a program, a treatment provider will perform a biopsychosocial assessment, which evaluates:
- The patient’s perception of their exercise bulimia and how it’s affected them and those around them
- Description of exercise bulimia and any other disordered eating symptoms and triggers
- The duration of their exercise bulimia
- Current patterns of exercise and eating
- Body image dissatisfaction and distortion
- Family history of mental health conditions or eating disorders
- History of trauma
- Effects of exercise bulimia on their life
- Occupational and educational history
- Living situation
- Community relationships
- A sensitive physical assessment of weight, pulse, blood pressure, etc.
- Motivation for change
Treatment modalities
Research has indicated that some people with exercise bulimia or compulsive exercise may need motivational interviewing, a short-term therapeutic modality aimed at resolving ambivalence related to change and entering treatment. (10)
Once someone is ready to enter treatment and heal their relationship with exercise, their individualized treatment plan may include several therapies, such as:
- Cognitive Behavioral Therapy (CBT): Examines the connection between your thoughts, feelings, and behaviors so you can understand how the three influence one another, aiming to change behaviors, emotions, and thought patterns. Also examines and challenges core beliefs that aren’t helpful and influence compulsive exercise.
- Acceptance and Commitment Therapy (ACT): Aims to increase psychological flexibility and encourages you to make choices that align with your values.
- Dialectical Behavior Therapy (DBT): Focuses on mindfulness, emotional regulation, distress tolerance, and communication with others.
- Exposure therapy: Exposes you to your fear, which over time can habituate the stimulus and lead to reduced anxiety. For someone with exercise bulimia, the exposure may include stopping exercise or movement.
- Group therapy: Allows patients to share honestly while still being accepted by others, which can be very validating. Different groups may focus on different modalities, such as CBT groups or DBT groups.
- Nutritional counseling: Debunks myths related to food and your food beliefs. May also involve meal support and planning.
One of the main goals of treatment for exercise bulimia is to restore a healthy relationship with exercise and movement. This may involve movement groups in which you learn to enjoy movement again, focusing on physical activity that brings you joy as opposed to choosing exercise based on how many calories it can burn or how much muscle it can build. Mindful movement can help strengthen your mind-body connection and help you appreciate and care for your body.
While at times it may seem impossible, exercise bulimia recovery is possible. Contact someone you trust who can help you find the support and treatment you need.
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