Identifying Causes & Treatment Options of Compulsive Exercise

Movement is a beautiful privilege and part of the human experience. Whether through dance, sports, daily activities, or providing hugs to loved ones, the ability to move our bodies plays an integral role in our lives.

However, like many aspects of the human experience, what starts as a meaningful relationship can become complicated by societal expectations and life challenges. And what begins as natural and intuitive can become something dark and harmful, with dangerous or even deadly consequences.

As such, it is critical to be aware of what it looks like when an individual’s relationship with exercise takes a harmful turn, and understand how to interfere and support someone if this change takes place.

What is Compulsive Exercise?

The term “compulsive exercise” (sometimes called “exercise addiction”) is often used to describe an unhealthy relationship or fixation with the concept or action of working out.

One common understanding of exercise compulsion explains it as uncontrollable excessive exercise behavior. In other words, people struggling with compulsive exercise don’t necessarily have the power to stop themselves. This holds true even when they’re aware of potential negative consequences of their actions. [3]

Another way to define exercise compulsion is considering the degree of “self-insight” someone has about their relationship to working out. [2] Compulsive behaviors of all sorts are generally thought of as those that happen almost automatically, so someone may think very little, or not at all, about whether they want to work out before jumping into the action.

In any case, the benchmark of this type of behavior is usually when exercise becomes disruptive to everyday life. That could mean when schedules are arranged (or re-arranged) around workouts; when exercise starts outweighing other priorities or responsibilities; or when people regularly find themselves working out longer or harder than expected. [5]

Compulsive Exercise vs. Avid Exercise

It can be tricky to discern compulsive exercise from healthy yet avid exercise routines. Often, it looks very similar to exercise compulsively or physically push oneself in a healthy way, especially for elite athletes. But there is one key difference that separates these types of behaviors.

The motivation behind working out is perhaps the biggest indication of whether someone is exercising in a healthy way or not.

Aside from often being understood as behavior performed outside of someone’s direct control, compulsive exercise is also explained as behavior performed to avoid any discomfort or negative feelings associated with not exercising. [1] This contrasts with exercising in order to feel good or receive the benefits of the movement.

And there are a few other characteristics that might make an individual more likely to develop compulsive exercise issues, including concerns about their body size, shape, or weight, and personality traits like perfectionism or rigid thinking. [1]

When Excessive Exercise Becomes a Problem

Another complication that makes it difficult to detect exercise compulsion is the widespread tenets of diet culture, which often glorify working out to the extreme as a way to control or lose weight.

It is not uncommon to hear phrases such as, “I’m going to have to work this meal off at the gym,” or “I can’t eat that, I didn’t work out today,” in casual conversation. In fact, when these statements occur, others will often nod, understanding, or contribute their own daily food-to-fitness status.

Indeed, many of the symptoms of compulsive exercise are actually lauded by our culture. Even so, these are some warning signs that an individual’s relationship with exercise has become problematic: [5]

• Choosing food types/amounts based on daily movement
• Exercising despite fatigue and/or injury, such as stress fractures
• Exercising even at inappropriate times, such as when it’s unsafe or when weather would deter the average person
• Expressing guilt/shame when not exercising
• Exercising for long durations of time that interfere with other aspects of daily responsibility like work, relationships, sleep, and hygiene
• Hyperfixation on when the next opportunity for movement will be

It’s also important to remember that the phrase “excessive exercise” can be subjective within itself. What is generally considered “excessive” may depend on a number of individual factors, including someone’s age, health status, and fitness abilities. [2]

Is Compulsive Exercise an Eating Disorder?

Compulsive exercise is not an official mental illness defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), however, it is mentioned in the Feeding & Eating Disorders section.

Instead, compulsive exercise is sometimes considered an unhealthy compensatory behavior used by people with bulimia nervosa (BN) or purging-type anorexia nervosa (AN).

Compulsive exercise is also sometimes considered a tenet of exercise addiction. There are several schools of thought on the idea, with some believing that “addiction” is defined by compulsive behavior, and others arguing that compulsive behaviors describe types of actions that are merely part of an addiction. [7]

In cases when it’s considered one in the same with exercise addiction, compulsive exercise may also be found under the umbrella of behavioral addictions. Like internet addiction or gambling addiction, these conditions describe an addiction to a feeling brought on by certain behaviors, as opposed to a physical addiction to a substance. [8]

How Common is Compulsive Exercise?

It is difficult to pin down exactly how many individuals are engaging in concerning and harmful compulsive exercise behaviors, as they often go unnoticed due to the social acceptance of compulsive, excessive, and compensatory exercise behaviors mentioned above.

Some studies have attempted to track these numbers, with concerning results. According to the study, anywhere from 31%-81% of patients with AN participated in compulsive exercise, and the behaviors were also noted in 20%–66% of patients with BN. [4]

Other results tied the issue more broadly to related concerning behaviors, noting that 17%-59% of fitness instructors in one study qualified for eating disorder or disordered eating behavior. Researchers said this finding indicated a relationship between disordered relationships with food and the body and exercise. [1]

How is Compulsive Exercise Treated?

As compulsive exercising rarely occurs without eating disorder symptomatology, it is often treated in a similar way to eating disorders.

This treatment involves a multidisciplinary team to address the diverse effects of compulsive exercise, such as medical and dietary consequences. As such, an individual would often work with a therapist, physician, dietitian, and likely a physical therapist or recovery-focused and ED-informed fitness specialist.

Overall, there are some approaches that are generally used to help compulsive exercisers recover from their unhelpful behaviors and build a healthy lifestyle. [2]

 

Psychoeducation

The psychoeducation component of treating compulsive exercise involves education in fitness, physiology, and dietetics. The intention is for the individual to gain the understanding of how the body works to motivate them to engage in movement and nourishment in ways that are best for their physical and emotional well-being.

Structured Exercise

It would be ineffective to support someone in building a more positive relationship with movement without allowing them to move. As such, treatment for compulsive exercise also often involves exposure to and engagement with movement in a mindful, intuitive, and more appropriate manner.

During this exercise, the individual works with their treatment team to process any urges that arise and challenges they experience around exercise, movement, or fitness.

Psychotherapy

Compulsive exercise may have many physical consequences, but ultimately, the urge comes from a mental condition, making psychotherapy an essential aspect of treating excessive exercise.

Many individuals engage in compulsive exercise to alter their bodies—though this is not the only reason the behavior develops. Exercise may provide feelings of control or an outlet for escape. What may have begun as an effective coping skill may have become problematic.

Therapy can help someone identify what they are experiencing and develop insight, cognitive skills, and effective coping skills to engage more appropriately with exercise, as well as to more effectively cope with life.

Finding Help for Compulsive Exercise

While not an official DSM-5 diagnosis, compulsive exercise can still lead to harmful consequences and should be taken seriously. If you or a loved one are concerned about the nature of your relationship with movement, it is best to seek support.

Your primary care physician, therapist, or another trusted medical professional may be able to help you identify treatment programs or specialists in your area.

But no matter where you decide to look for help, the most important thing you can do is reach out. It’s often the first step on the road to a healthier and happier future.

References

1. Cjestvang C, Bratland-Sanda S, Mathisen TF. (2021). Compulsive exercise and mental health challenges in fitness instructors; presence and interactions. Journal of Eating Disorders, 107.
2. Martenstyn JA, Jeacocke NA, Pittman J, Touyz S, & Maguire S. (2022). Treatment Considerations for Compulsive Exercise in High-Performance Athletes with an Eating Disorder. Sports Medicine – open; 8(1):30.
3. Young S, et al. (2018). Relationships between compulsive exercise, quality of life, psychological distress, and motivation to change in adults with anorexia nervosa. Journal of Eating Disorders; 6:2.
4. Dittmer N, Jacobi C, Voderholzer U. (2018). Compulsive exercise in eating disorders: proposal for a definition and a clinical assessment. Journal of Eating Disorders; 6:42.
5. Everything to know about compulsive exercise. (n.d.). Medical News Today. Accessed July 2023.
6. Freimuth M, Moniz S, & Kim SR. (2011). Clarifying exercise addiction: differential diagnosis, co-occurring disorders, and phases of addiction. International Journal of Environmental Research and Public Health; 8(10):4069–4081.
7. Heather N. (2017). Is the concept of compulsion useful in the explanation or description of addictive behaviour and experience? Addictive Behaviors Reports; 6:15–38.
8. Alavi SS, Ferdosi M, Jannatifard F, Eslami M, Alaghemandan H, & Setare M. (2012). Behavioral Addiction versus Substance Addiction: Correspondence of Psychiatric and Psychological Views. International Journal of Preventive Medicine; 3(4):290–294.

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The opinions and views of our guest contributors are shared to provide a broad perspective of eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer discussion of various issues by different concerned individuals.

We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.

Published on February 18, 2024 on EatingDisorderHope.com