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How Exercise Addiction Relates to Eating Disorders

In the world of mental health treatment and diagnosis, the most recent Diagnostic and Statistical Manual of Mental Disorders, which was the fifth edition, added many new types of illness to their records. The DSM-V added several previously excluded mental illnesses such as hoarding disorder and rapid eye movement sleep behavior disorder. There was also a focus on the greater classification of eating disorders, with official classifications of binge eating disorder and OSFED, which can include many disparate types of disordered eating behaviors.

The DSM-V also began to include some behavioral addiction disorders – hoarding disorder is one of them, as is gambling addiction. These disorders are based on the continued, compulsive repetition of certain behaviors that cause the brain to release certain mood-elevating chemicals, especially serotonin and dopamine. So other examples that were not included in the current DSM are video game addiction or sex addiction – and especially exercise addiction. Although exercise addiction is closely linked with both eating disorders and compulsive disorders like OCD, it is not yet listed as a separate disorder in the DSM-V.

What Is Exercise Addiction?

One of the reasons exercise addiction is not classified as a standalone disorder is that its diagnosis is somewhat dependent on the personal circumstances of the individual. For example, many professional athletes work out for hours every day, beyond the point of pain or through an injury. This person may fit many of the behavioral criteria, but without an internal, compulsive need to do so. Although their health is a concern (and for weight-dependent sports like boxing or gymnastics, weight control is also a reason for excessive exercise), their exercise patterns are driven by their profession.

In a 2011 study, released shortly before the DSM-V, the authors modified the traditional criteria for defining substance addiction to apply to exercise addiction. It’s not a perfect comparison, but it highlights the difference between excessive exercise and compulsive exercise; the former may be part of a larger mental health disorder such as anorexia nervosa, but might not be considered an addiction, whereas the latter may be classified as a behavioral addiction in future editions of the DSM. The authors, Marilyn Freimuth, Sandy Moniz, and Shari R. Kim, included these factors in their description:

  • Tolerance: increasing the amount of exercise to feel the desired effect, be it a” buzz” or sense of accomplishment;
  • Withdrawal: in the absence of exercise the person experiences negative effects such as anxiety, irritability, restlessness, and sleep problems;
  • Lack of control: unsuccessful at attempts to reduce exercise level or cease exercising for a certain period;
  • Intention effects: unable to stick to one’s intended routine as evidenced by exceeding the amount of time devoted to exercise or consistently going beyond the intended amount;
  • Time: a great deal of time is spent preparing for, engaging in, and recovering from exercise;
  • Reduction in other activities: as a direct result of exercise social, occupational, and/or recreational activities occur less often or are stopped;
  • Continuance: continuing to exercise despite knowing that this activity is creating or exacerbating physical, psychological, and/or interpersonal problems.

Exercise most likely goes undiagnosed or underdiagnosed because of the positive connotations people hold about working out. Many doctors, without the benefit of knowing their patient’s compulsive patterns, would applaud extensive working out, and most people outside the medical and mental health professions claim they want to exercise more. After all, drug and alcohol addiction and gambling addiction have easily noted negative effects. In fact, some studies indicate that a person who experiences exercise addiction is more likely to develop other behavioral addictions like internet or video game addiction, as well as substances. These are “negative” behaviors that most people don’t see as advantageous in the way they view exercise. However, exercise addiction can wreak havoc on a person’s physical and psychosocial health.

Mental and Physical Health Problems Caused by Excessive Exercise

Notably, exercise addiction can cause various physical ailments related to repetitive stresses, such as problems with the joints in the knees and ankles from running, problems with the spine and shoulders from weight lifting, and others. Because the person generally works out even after suffering an injury, they can become exacerbated and become chronic injuries. In people with cardiovascular conditions (cause by excessive exercise or not), exercise addiction can trigger or worsen dangerous symptoms like arrhythmia.

In terms of behavioral health, exercise addiction interferes with a person’s social life, relationships, and sometimes work. As an example, people with exercise addiction often cancel social engagements or skip them entirely to get more exercise in. Of course, if someone schedules time to go running, it’s usually perfectly normal, but when they begin to miss important appointments, it’s a cause for concern. As with any addiction, it also tends to take more and more exercise to attain the same feeling, so more time needs to be devoted to it, interfering with social lives and hurting relationships. Other signs that there may be an exercise addiction might be exercising at unusual times, interrupting sleep, or exercising in bad weather like a thunderstorm or blizzard, despite the risks and discomfort.

Exercise Addiction and Obsessive-Compulsive Disorder

The term “addiction” is somewhat controversial among mental health professionals as it relates to exercise. Many mental health experts consider addictions to be more impulsive behavior than compulsive, in that the behavior is driven by an impulse to attain a positive feeling, rather than doing the action because of a compulsive need. Crucially, disorders that feature repetitive, compulsive behaviors like anorexia nervosa or most famously obsessive-compulsive disorder (OCD) are not considered addictions, although the behaviors associated with them are done repeatedly and ritualistically. Many professionals prefer the term “compulsive” or “excessive” exercise to describe this situation.

OCD is a useful comparison to compulsive exercise, and not only because people with OCD have a higher risk of compulsively exercising (as well as developing certain eating disorders). It’s a psychiatric disorder that causes people to engage in repetitive behaviors like hand-washing or obsessively counting objects in order to avoid what they perceive as negative consequences. OCD sufferers suffer obsessive thoughts, compulsive behaviors, and a tendency for perfectionism. All these qualities are common in people who exercise compulsively and are common in eating disorders as well.

A study performed in 2006 showed a strong link between anorexia nervosa, OCD, and excessive exercise. Among the participants, who were all anorexia nervosa patients, those who displayed excessive exercise tendencies also showed a much higher rate of OCD symptoms than those who didn’t. In the context of people with eating disorders, the researchers suggested that OCD and compulsive exercise can be considered as subtypes of the same disorder. Whatever the terminology, the study makes it clear that exercise addiction and OCD share many behavioral qualities.

Exercise Addiction and Eating Disorders

Excessive exercise is extremely common in people with eating disorders that are triggered by body image and weight loss concerns. These include anorexia nervosa, bulimia nervosa, and binge eating disorders. They can also exist on their own, so many eating disorder treatment centers have developed exercise programs specifically to treat compulsive exercise. More often, the two disorders are linked in the same person, which requires co-occurring treatment to address either one effectively. This normally does not include medication as might be prescribed for OCD, but rather progressive behavioral training therapy and other talk therapy methodologies.

Exercise is used as a weight control method for people with many eating disorders. In people with anorexia nervosa, exercise can become as obsessive and compulsive as counting calories and restricting food intake. Many patients with anorexia nervosa are put on a weight-restoration program; this usually also includes a provision limiting exercise time and strenuousness. With bulimia nervosa cases, in which individuals binge eat and then engage in compensatory purges, the classic example of purging is self-induced vomiting. However, other purging methods are sometimes used, simultaneously or alternating. These include abusing laxatives or diet pills, but just as frequently involved excessive exercising.

In a psychosocial sense, having both an eating disorder and exercise addiction can hurt a person’s social life, self-esteem, and personal relationships. Discomfort at mealtimes, or refusal to eat with others, and the aforementioned social challenges caused by compulsive exercise can pile up quickly and cause the person to avoid socializing to fulfill their compulsive tendencies. Combined with the health risks that can come with these disorders, there is also a high risk for these individuals to develop depression or anxiety.

Treatment Is Possible

Although exercise addiction and eating disorders sound grim when the results are described like that, neither is a cause to lose hope for a healthier future in recovery. Treatment programs are widely available to help people recover from these kinds of mental health disorders, and thousands of people have regained their healthy selves with help from those programs. Mindful movement classes, which include low-impact, self-aware practices like yoga, nature walks, and dance classes, can be used to reintroduce exercise into a recovered person’s life without promoting the kind of excessive exercise patterns that caused problems in the past. In conjunction with mental health improvement techniques like group therapy and Cognitive Behavioral Therapy, eating disorders can also be effectively treated. Most programs will be able to coordinate both forms of treatment into an integrated program.

If you or someone you love is struggling with an eating disorder, compulsive exercise, or both, don’t hesitate – effective treatment is available. Reach out today to get started on the path to recovery.

 

Melissa Orshan Spann, PhD, LMHC, RTY 200, is Chief Clinical Officer at Monte Nido & Affiliates, overseeing the clinical operations and programming for over 50 programs across the U.S. Dr. Spann is a Certified Eating Disorder Specialist and clinical supervisor as well as an accomplished presenter and passionate clinician who has spent her career working in the eating disorder field in higher levels of care. She is a member of the Academy for Eating Disorders and the International Association of Eating Disorder Professionals where she serves on the national certification committee, supervision faculty, and is on the board of her local chapter. She received her doctoral degree from Drexel University, master’s degree from the University of Miami, and bachelor’s degree from the University of Florida.