Exercise Compulsion: Often the Hardest Habit to Kick in Recovery from an Eating Disorder
Eating disorders wreak havoc on the lives of sufferers. An individual’s relationship to food, to body image and to exercise become distorted and the voice of the eating disorder begins to determine what is best for the individual. When it comes to exercise, the eating disorder will consistently yell, “More is better.” In western culture regular exercise is seen as a virtue and the lack of exercise makes a person feel unworthy, lazy, or even sinful. For the individual suffering with an eating disorder, well-intended public health recommendations encouraging exercise become highly rigid, unbending rules. Instead of generic suggestions for maximizing health, these messages become strict moral codes by which a client will determine if they have been “good or bad.” Maintaining the rigid exercise routine becomes the focal point of the day or the week creating undue anxiety in the sufferer.
Exercise Compulsion Defined
Many people think the only problem with exercise is in extreme cases of severely underweight patients who insist on 3 hours of gym time each day. But this is not the case. It is important to distinguish over exercise from exercise compulsion as both can be present in those suffering with eating disorders. In exercise compulsion, the amount of daily exercise may not be excessive, but it is the drive to exercise that is problematic. Exercise compulsion leaves no room for injury, illness, busyness or other responsibilities. Exercise compulsion is a cruel taskmaster that demands a certain type and amount of movement before it gives permission for an individual to eat or rest. In this way, exercise compulsion not only demonizes eating, but also demonizes rest.
Here are a few examples of the sort of internal dialogue that drives compulsive exercise: :
“ I did not run this morning, so I can’t have half and half in my coffee.”
“ Even though I have been told by my doctor not to put weight on my ankle, I will just do some housework in order to burn a few calories.”
“I have an extra busy day. I will set my alarm at 5am to make sure I get in a run before my day starts at 630am.”
“I have not exercised for 3 days.I better get on the scale and check my weight. No matter what happens tomorrow, I will make time for the gym.”
“My kids stayed home sick from school and I can’t go to the gym. I will squeeze in a workout at 730pm after my partner gets home.”
“I am eating out for my birthday tomorrow. I will workout extra today and tomorrow to make up for the extra calories.”
“I have been sitting all day so I will just have a light snack for lunch. I have not been active enough to need a whole meal.”
“ I just have to exercise today. I will feel so much better after I do. There is no other way to calm myself down besides exercising.”
How Does Exercise Compulsion Relate to Eating Disorders?
Most, but not all, cases of eating disorders contain some sort of distorted relationship with movement. For some, it involves over exercise (the burning of too many calories) and for others it is exercise compulsion (the inability to eat or rest without some form of exercise). In both cases, the exercise distortion will be tangled up with the idea of “calories in and calories out.” This outdated adage is an overly simplistic way to describe the bodies energy turnover system, (ie. metabolism.) While there is some crude truth to this concept, it nowhere near explains the complexities of what determine a person’s body weight. When someone is undernourished from restricting calories, his or her brain will latch on to the “calories in/ calories out” concept with rigid, black and white thinking. This, in part, is what fuels the distorted relationship with exercise. A rest day, an injury or competing responsibilities will pose a “threat” to the individual with exercise compulsion. The individual will insist that their calories are out of balance (black and white thinking} and if they don’t exercise, they will gain weight. The result is intense fear, panic and anxiety surrounding every decision about exercise and the sufferer will lose the ability to read what his or her body needs.
Assessing Exercise Compulsion
Exercise compulsion and the inability to rest often flies under the radar for many clinicians and family members who are supporting people with eating disorders. “Healthy, disciplined, and fit” will be words used to describe a person’s behaviors when in reality, they are driven by fear and intense anxiety. Exercise compulsion can be a habit in someone’s life for years after the clinical aspects of the eating disorder are under control and weight has been fully restored. Exercise compulsion can not be determined by looking at someone’s labs or body weight. A person’s thoughts and attitudes toward exercise and rest must be examined in order to determine the type of relationship they have with movement.
Clinical research has shown that compulsive exercise is highly correlated with anxiety, depression, and disordered eating behaviors. Compulsive exercise tests can be used to determine the intensity of the attitudes one might experience should their exercise routine be threatened. Jenni Schaefer, eating disorder advocate, survivor and author, offers a free compulsive exercise test on her website https://jennischaefer.com/cet/. While this does not take the place of clinical assessment with a therapist, it is a helpful tool to determine an individual’s need for care.
Treatment for Exercise Compulsion
Exercise, like eating, is required at regular intervals for the body to be healthy. But in the case of an eating disorder, the natural rhythms of eating and exercising can be “high-jacked.”. The result is someone misattuned to their bodies cues for movement and fuel. For some, complete abstinence from exercise is required for a season in order to give the body needed rest and a chance to reestablish the ability to hear and respond to their body cues. This is typically recommended for a very short time as exercise is crucial in the recovery or an eating disorder. Remember, movement and food are crucial for health. Both are required. On the other hand, most suffering with exercise compulsion do not need complete abstinence from exercise. Instead, a season of dis-engaging with the types of exercise that have been used to abuse the body is recommended while new activities are encouraged. Below is a clinical example to illustrate this point:
“Lisa has been recovered from an eating disorder for 3 years and is maintaining a healthy weight. While she was in recovery, she was forced to stop running. As soon as her weight was restored, her treatment team allowed her to begin running again. Within 2 months she was running 12-15 miles per week. Her weight has not fluctuated and she weighs herself every morning. She is terrified of becoming “fat” which in her mind, means anything over the weight her treatment team set 3 years ago. She believes that her rigid running routine is what maintains her weight.”
Recommendation: Lisa needs to stop running and switch to different forms of movement. Variety is key in Lisa’s case and she needs to experience her body and appetite without running. Lisa could also benefit from a type of group exercise in order to add some play and connection into her exercise routine.
Relationship to exercise, along with weight and eating attitudes, needs to be a measure of recovery from an eating disorder. This is especially true given the high moral value placed upon regular exercise in western culture. An individual should be free to rest and eat regardless of how many calories they have burned in a given day. With good support, these goals are achievable even for those who have suffered under the weight of exercise compulsion for many years. Reach out to a therapist or mental health specialist if you or a loved one are struggling.