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diagnostic criteria for eating disorders
Exercise Addiction or Activity Disorder

In our society, exercise is increasingly being sought, less for the pursuit of fitness or pleasure and more for the means to a thinner body or sense of control and accomplishment. In the climate of thinness mania, female exercisers are particularly vulnerable to problems arising when restriction of food intake is combined with intense physical activity. A female who loses too much body fat will stop menstruating and ovulating and will become increasingly susceptible to stress fractures and osteoporosis. Yet, similar to individuals with eating disorders, those with an activity disorder are not deterred from their behaviors by medical complications and consequences. People who continue to over exercise in spite of medical and/or other consequences feel as if they can't stop and that participating in their activity is no longer an option. These people have been referred to as obligatory or compulsive exercisers because they seem unable to "not exercise," even when injured, exhausted or begged by others to stop. The terms pathogenic exercise and exercise addiction have also been used when describing these individuals who are consumed by the need for physical activity to the exclusion of everything else and to the point of damage or danger to their lives.

Signs and Symptoms of Activity Disorder
The signs and symptoms of activity disorder often, but not always, include those seen in anorexia nervosa and bulimia nervosa. Obsessive concerns about being fat, body dissatisfaction, binge eating and a whole variety of dieting and purging behaviors are often present in activity disordered individuals. Furthermore, it is well established that obsessive exercise is a common feature seen in anorexics and bulimics, in fact, some studies have reported that as many as 75 percent use excessive exercise as a method of purging and/or reducing anxiety. Therefore, activity disorder can be found as a component of anorexia nervosa or bulimia nervosa or, although there is yet no DSM diagnosis for it, as a separate disorder altogether. There are many individuals with the salient features of an activity disorder whom do not meet the diagnostic criteria for anorexia nervosa or bulimia nervosa. The overriding feature of an activity disorder is the presence of excessive, purposeless, physical activity which, even if the person is an athlete, goes beyond any usual training regimen and ends up being a detriment rather than an asset to their health and well being.

Features of an Activity Disorder*

  1. The person maintains a high level of activity and is uncomfortable with states of rest or relaxation.
  2. The individual depends upon the activity for self definition and mood stabilization.
  3. There is an intense, driven quality to the activity which becomes self-perpetuating and resistant to change, compelling the person to continue while feeling the lack of ability to control or stop their behavior.
  4. Only the overuse of the body can produce the physiologic effects of deprivation, (secondary to exposure to the elements, extreme exertion, and rigid dietary restriction) which are an important component perpetuating the disorder.
  5. Although activity disordered individuals may have coexisting personality disorder, there is no particular personality profile or disorder which underlies an activity disorder. These persons are apt to be physically healthy, high functioning individuals.
  6. Activity disordered persons will use rationalizations and other defense mechanisms to protect their involvement in the activity. This may represent a preexisting personality disorder and/or be secondary to the physical deprivation.
  7. Although there is not particular personality profile or disorder, the activity disordered person's achievement orientation, independence, self control, perfectionism, persistence, and well-developed mental strategies can foster significant academic and vocational accomplishments such that they are generally viewed as healthy, high functioning individuals.

* Alayne Yates, M.D., Compulsive Exercise And The Eating Disorders (Routledge Press, 1991)

Activity disorders and the eating disorders are expressions of and defenses against affect and are used to soothe, organize, and maintain self esteem. Individuals with eating disorders and those with activity disorder are similar to one another in many respects. Both groups attempt to control the body through exercise and/or diet and are overly conscious of input vs. output equations. They are extremely committed individuals and pride themselves at putting mind over matter, valuing self discipline, self sacrifice and the ability to persevere. They are generally hard working, task oriented, high achieving individuals who have a tendency to be dissatisfied with themselves. The emotional investment these individuals place on exercise and/or diet becomes more intense and significant than work, family, relationships and ironically even health. Those with activity disorder lose control over exercise just as those with eating disorders lose control over dieting and both experience withdrawal when prevented from engaging in their behaviors.

Physical Symptoms of Activity Disorder

A key in determining if a person is developing an activity disorder is if they have symptoms of over training yet persist with exercise anyway.

Symptoms of Overtraining
Fatigue Loss of emotional vigor
Reduction in performance Decreased concentration
Decreased blood lactate Soreness, Stiffness
Autonomic sympathetic insufficiency Inhibited lactic acid response
Immunosuppression "acute phase" response Increased compulsivity
Decreased anabolic (testosterone) response Decreased maximum oxygen uptake
Increased catabolic (cortisol) response (muscle wasting) Hypothalamic dysfunction
Increased central serotonin & GABA Adrenal exhaustion
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