Exercise Bulimia – What’s Healthy When It Used to Be a Problem?

Whether someone’s eating disorder involved excessive exercise behaviors or not, treatment programs almost always recommend ceasing workout routines while the body is healing and being renourished.

For those in recovery, this can be difficult. Too much exercise may be used as a maladaptive coping mechanism or develop in tandem with disordered eating behaviors, but some movement also is and can feel good for the body, making it difficult to let go of the hobby all together or know how to balance the amount of exercise one partakes in.

If you’re recovering from exercise bulimia or other eating disorders, it’s important to remember that putting an end to working out is not a permanent recommendation. The reintegration of some exercise routines will be allowed and encouraged as the body continues to grow stronger and heal.

Still, this reintegration process brings about its own questions around how to safely integrate a workout routine into your recovery efforts while avoiding the pitfalls that can lead to a relapse. But there are some recommendations that may help ease the uncertainty of this time, and help you develop and maintain healthy routines around exercise moving forward.

What is Exercise Bulimia?

While many types of eating disorders can be impacted by compulsive exercise, exercise bulimia is most closely tied to exercise addiction.

Sometimes also referred to as “exercise anorexia” or “anorexia athletica,” this condition is not explicitly defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the primary diagnostic tool used for mental illness diagnoses. It is, however, identified as a purging behavior utilized in bulimia nervosa.

Essentially, exercise bulimia refers to the act of pathological or compulsive exercising, which can look like exercising despite illness, injury, or exhaustion, or prioritizing workouts over most other aspects of life. Individuals who engage in this behavior use excessive exercise as a compensatory behavior, often engaging in extreme amounts of movement as a way to purge calories consumed during binging episodes.

Compulsive exercise behaviors are generally considered the most frequent compensatory behavior in children and adolescents with eating disorders. These behaviors are also sometimes seen as “gateway behaviors,” which can lead to other compensatory behaviors, such as self-induced vomiting and the misuse of laxatives. [1]

Is Movement Safe After an Eating Disorder?

Individuals in eating disorder treatment often fear they will be unable to exercise for the rest of their recovery journey. But this is not the case. Healthy types of movement are not only possible in eating disorder recovery, but often encouraged.

Research indicates that incorporating exercise and movement into eating disorder treatment actually leads to numerous benefits, including a reduced drive for thinness, reduced eating disorder symptoms, decreased levels of bodily dissatisfaction, and a generally improved quality of life. It’s possible for exercise to even reverse some physical effects of eating disorders. [2]

While not advised in the beginning of treatment due to the body’s need to retain all calories being consumed, exercise can eventually be reintroduced into someone’s regular routine. The pace of this transition is unique to each individual, with that person’s treatment team members generally guiding them through this process.

But paramount to safely reintroducing exercise to someone’s regular routine is realigning their perspective on physical movement itself.

Re-Learning How to Exercise

When used as a maladaptive coping mechanism or compensatory behavior, exercise is often joyless, seen simply as a means to an end. But there are many ways to move the body that are not only healthier and more gentle, but genuinely enjoyable to participate in.

Treatment programs will often work with patients to build a more positive and intuitive relationship with movement. That means encouraging exercise or other types of movement that supports a closer connection to their body, or aligns more closely with their bodily queues and needs.

At the same time, patients are taught new coping skills to help them deal with intense anxiety or other issues that may have led to exercise addiction. This can help them find more support through other outlets, allowing them to view exercise in a healthier and more balanced way.

When to Incorporate Movement

While there is always risk involved in re-engaging in physical movement, it should be possible to pursue a healthy workout routine so long as someone maintains a mindful, healthful, and positive mindset. But since it can take some time before someone feels confident in their recovery, exercise reintegration generally isn’t recommended until later on in someone’s journey.

By this point, patients generally have practice using new coping skills to combat unhelpful urges, and have had time to develop a more positive mindset around the idea of body image.

But eating disorder recovery is not a straight path, and each person’s journey is different. As such, when and how exercise is reintroduced to someone’s routine will vary, based on that person’s particular case and the recommendations of their treatment team.

Key Skills for Reintegrating Movement

Most treatment programs will teach patients new and effective coping skills that can help them safely and sustainably reintroduce physical activity into their life.

Mindfulness

Mindfulness refers to an individual’s ability to be fully-present in the moment with where they are and what they are doing. Mindfulness involves an ability to check-in with one’s mental, emotional, and physical experience as it is.

For those reintegrating movement, it is critically important that the individual be capable of using mindfulness skills to engage with their experience of movement, exist with their bodies, and accept what is occurring for them.

Somatic Awareness

Somatic awareness involves directing a patient’s attention to the physical sensations occurring in their body. In eating disorder treatment, this can help them connect to their physical experiences, listen to their bodies, and attend to the body’s needs without using disordered behaviors. [3]

Doing this also often fosters a new, more positive and connected relationship to the body. This can have a positive domino effect, encouraging and reinforcing actions that are healing and comforting.

When reengaging in physical movement, the individual can use this connection and awareness to recognize how the exercises are making them feel, emotionally and physically, and they can alter their choices accordingly.

Cognitive Reframing

Integral in most types of eating disorder treatment is teaching a patient to recognize and identify unhelpful thought and behavioral patterns associated with their eating disorder. Cognitive reframing goes one step further, helping them learn how to not only recognize these patterns, but change them, to serve the person in a more positive way.

In the earlier stages of recovery, physical movement may trigger previous unhelpful thoughts and urges, which can make someone feel conflicted, distressed, or drawn back to their disordered behaviors.

Having the ability to identify those unhelpful thoughts, however, can help someone make the choice not to engage with them. Instead, they can actively choose recovery-focused thinking, which is designed to help combat these urges.

Finding Help for Exercise Bulimia

Excessive exercise can have concerning consequences, including exacerbated physical symptoms of eating disorders and, unfortunately, even suicidal behavior. [1] But it is possible to overcome these unhelpful thoughts and behaviors.

Your primary care physician, therapist, psychologist, or other trusted medical professional can help you evaluate the situation and determine your next best steps. These experts are generally versed in eating disorders, and may be able to recommend programs or treatments.

If you’d rather not discuss these sensitive topics with another person face-to-face, there are a number of eating disorder and mental health hotlines you can utilize. These programs allow callers to remain anonymous, while handing out resources and information on eating disorders and recovery options.

If you or a loved one are struggling with exercise bulimia or any type of eating disorder, it’s important to seek out help. But it’s even more important to remember that recovery—and a healthier, happier future—is always possible.

Resources

1. 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.
2.  Cook B, et al. (2016). Exercise in eating disorders treatment: systematic review and proposal of guidelines. Medicine & Science in Sports Exercise; 48:7.
3. Bakal D, Coll P, Schaefer J. (2008). Somatic awareness in the clinical care of patients with body distress symptoms. BioPsychoSocial Medicine; 2:8.

Published on January 4th, 2024 on EatingDisorderHope.com