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.
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.
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)
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 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)
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:
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.