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Many people know at least a little bit about eating disorders like anorexia nervosa (AN) and bulimia nervosa (BN). However, these mental health conditions can manifest in several different ways, and sometimes, those presentations are considered their own form of the disorder.
This is the case when it comes to exercise bulimia and anorexia athletica.
The two conditions are similar, both involving excessive exercise as a primary coping mechanism for emotional discomfort and disturbed thoughts, but each presents a little differently. Knowing the difference can be helpful when determining the type of treatment that may be most suitable for you or your loved one.
Exercise bulimia (EB) is a subtype of bulimia nervosa. It involves the same cycle of binging and purging that characterizes BN, but exercise is the primary purging behavior.1 This behavior is often compulsive, with people becoming fixated on working out to control weight or "make up for" caloric intake to the point where it disrupts their everyday lives.1
Additionally, those with exercise bulimia may have difficulty controlling their urge to exercise and do so even when feeling sick, fatigued, or while injured, which can lead to adverse physical and psychological consequences.2,4
Exercise bulimia can be centered around a fixation on weight loss or around a desire to maximize muscle mass. After an episode of binge eating, someone with exercise bulimia may feel obligated to complete a certain amount of exercise to “undo” the episode.
The feeling that the person needs to “compensate” for eating by exercising feeds into the binge/purge cycle, and someone may feel tremendous guilt if they miss a workout, leading them to prioritize exercise over many or most other obligations.5
Prioritizing exercise over other essential activities
Feeling guilty or anxious when unable to exercise
Exercising despite illness or injury
Other symptoms of exercise bulimia may include closely tracking the number of calories burned during exercise, constantly increasing the intensity or duration of workouts, and experiencing withdrawal symptoms such as anxiety, irritability, or sleep problems when unable to exercise.3
What is anorexia athletica?
Anorexia athletica (AA) is a set of disordered thoughts and behaviors that resemble anorexia nervosa but primarily affect athletes.6 The condition combines compulsive exercise and extreme caloric restriction to lose weight or achieve a specific body shape or size thought to be advantageous for certain sports.6
Certain sports are particularly connected to this type of behavior, especially those that prioritize certain body types or weights. For example, wrestling, gymnastics, and ballet tend to encourage thinness, leanness, or maintaining a certain body weight. Athletes in these sports and others may restrict their calories and exercise excessively to achieve these weights and shapes, sometimes even being coached to do so.6
How anorexia athletica differs from healthy athleticism
It can be tricky to tell the difference between a dedicated athlete and someone struggling with anorexia athletica, especially in a culture that prizes people "pushing themselves" for the sake of sport.
The most significant difference between someone with AA and a hard training athlete is the state of mind behind the actions. While anorexia athletica may manifest in a very physical way, the condition is, at its core, a mental health disorder.
Some unhelpful thoughts someone struggling with AA may experience include:6
Intense body dissatisfaction
An obsession about being thin for their athletic performance
Guilt around eating
Body shame
On the other hand, while an athlete may occasionally feel self-conscious about their body or worry about their performance, they will not take as extreme of measures to achieve their athletic goals. Instead, they'll work out and train for the love of the sport and focus more on the general idea of improvement rather than zeroing in on a specific weight, shape, or other body-related goal.
Exercise bulimia vs anorexia athletica: Key differences
Just as EB and AA resemble BN and AN, the conditions also closely resemble each other. However, there are some key differences between how the two disorders manifest and are maintained.
Exercise bulimia arises as a maladaptive coping mechanism connected to the cycle of binging and purging that characterizes bulimia nervosa. Disordered eating behaviors will look like those involved in BN, including regular binge eating episodes. When someone has EB, they tend to compensate for those binge sessions with excessive exercise, and this behavior can eventually become compulsive and disruptive to everyday life.1
Whether you have exercise bulimia or anorexia athletica, help is available. Learn about Within's remote treatment program and what to expect from your personalized schedule and dedicated care team.
Anorexia athletica primarily develops in athletes or people who are already intensely focused on physical activity. The eating disorder symptoms involved in the disorder resemble those in AN, including distorted body image and severely limited caloric intake. But the driving force behind these thoughts and behaviors is the desire to fit a particular body shape, size, or weight to achieve a perceived advantage in their sport.6
Both conditions can result in injuries, and people frequently push through workouts and drills despite illness, fatigue, injury, or prior obligations or social responsibilities. The essential difference is that anorexia athletica stems from a desire to be thin and competitive athletically, while exercise bulimia develops as a result of needing to “undo” eating.5
Finding help for an eating disorder
If you or someone you know is experiencing signs and symptoms of exercise bulimia, anorexia athletica, or other eating disorders, it may be time to seek help from a mental health professional.
These conditions and others can take an immense mental, physical, and emotional toll and often require personalized treatment to help address the various underlying factors in play. But the good news is recovery is entirely possible.
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.
Exercise bulimia is a subset of bulimia nervosa, where people primarily use excessive exercise as a way to "compensate" for binge eating behavior. People with exercise bulimia may focus on weight loss or muscle gain, but it is always underscored by feeling a compulsion to exercise.
What are the symptoms of anorexia athletica?
The symptoms of anorexia athletica include having a low body weight, feeling distressed about exercising or not exercising enough, missing periods, a reduced heart rate, hair loss, frequent sprains or stress fractures, and fatigue.6
Can you exercise too much?
It may sound counterintuitive, but it is possible to exercise too much. The body requires adequate amounts of rest, stretching, and fuel (food) to recover after every workout. Pushing too hard or too frequently can result in injuries and exhaustion.
