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Mindful Movement, Exercise, and Bulimia Nervosa Recovery

Movement may often be overlooked as an effective component of bulimia nervosa recovery programs. Although it is not universal, many people with bulimia nervosa and other eating disorders feel compulsions to exercise excessively. In fact, some cases of bulimia nervosa involve exercising excessively instead of vomiting as the purging mechanism following a binge eating episode. Excessive exercise goes beyond healthy movement patterns; people who suffer an exercise addiction, whether in conjunction with an eating disorder or not, might suffer injuries or develop stress conditions. A compulsion to exercise also frequently interferes with the individual’s social life and mental health – they will skip social engagements to exercise, and their relationships can suffer because of that.

Because of the frequent connection between eating disorders and compulsive exercise, eating disorder treatment centers often include a mindful movement program as part of their treatment plans. These programs are centered on low-impact, mindful movement. They help individuals repair their relationship with movement and exercise in a way that is self-affirming and positive. They also introduce a way for people in recovery to remain active without falling into the physical and mental health pitfalls that can come with exercise addiction.

While recommending movement to someone in treatment for bulimia nervosa seems counterintuitive, increasing evidence indicates that when nutritionally supported movement is closely monitored by eating disorder therapists, individuals benefit physically and mentally from the health advantages. In fact, research shows that people in eating disorder recovery who participate in mindful movement exercises experience reduced signs and symptoms of bulimia nervosa and other eating disorders. Controlled exercise programs may also reverse heart abnormalities in people with long-term anorexia nervosa, increase muscle strength and improve the overall quality of life.

What is the Difference Between Mindful Movement and Exercise?

Exercise is defined as a repetitive, structured physical activity intended to condition specific parts of the body. When most people exercise, they concentrate on maintaining endurance and exercising for as long as they feel like they can continue.

Mindful movement does not emphasize endurance, burning calories, and increasing muscle strength. Instead, mindful movement practiced by clients at a residential bulimia nervosa treatment center involves stretching and moving in mindful ways that promote a meditative state. Mindful movement encourages bulimia nervosa recovery by facilitating awareness of emotions and thoughts arising from the adoption of different poses. Stretching the body slowly not only prepares people for extended meditation therapy but also substitutes as a type of formal meditation for exploring strong emotions that contribute to signs and symptoms of bulimia nervosa.

Practicing mindful movement also helps people in recovery explore what it feels like to be on the edge of feeling a bit uncomfortable. Unlike exercise, which is often meant to drive a person through a rigorous exercise plan, mindful movement therapy is not intended to compel patients in bulimia nervosa recovery to push themselves but instead to connect with their bodies through movement. Mindful movement offers the opportunity for people to explore their mind’s reactions to what it perceives as physical movement. Approaching the boundary dividing a “comfort” zone from a “discomfort” zone helps people learn to deal with unpleasant thoughts and emotions productively.

Mindfulness, Meditation, and Movement

“Mindfulness” is a bit of a buzzword in recovery circles. It can be easy to dismiss as a New Age talking point, but mindfulness exercises have become a central facet of virtually every kind of psychiatric and mental health treatment program, eating disorders included. Mindfulness is a state of “living in the moment” that allows people to gain a clearer understanding of their thoughts and emotions. Mindfulness practices teach people how to focus their awareness on how they feel and what they’re experiencing at that moment. Concerns about the future or regrets about the past are ignored, and current thoughts and feelings are acknowledged. It’s important for people practicing mindfulness to calmy and nonjudgmentally experience these emotions without acting on them.

Mindfulness helps people in eating disorder treatment recognize that their feelings, thoughts, and especially urges to engage in disordered behaviors are distorted. Identifying these emotions that act as triggers for eating disorder behaviors is the first step in replacing them with healthier options. It also provides a sense of control over these disordered thoughts and feelings. Considering that a sense of losing control over a person’s eating, exercise, and body image is often a major part of eating disorders, mindfulness practices can be a foundation for increased self-awareness and self-understanding as well as a sense of regaining control.

Meditation is a key practice for mindfulness and even mindful movement – although a person remains still while meditating, the sense of experiencing one’s body in a state of self-awareness can be applied to movement. As an example, a person who has completed bulimia nervosa treatment and is ready to start exercising again can use mindfulness techniques they’ve learned through meditation to understand when they are pushing their body too hard or exercising out of a sense of compulsion rather than for pleasure. (Please note this kind of decision should be made after discussions with their therapist or eating disorder counselor, as exercise can be a trigger for relapse.)

Mindfulness meditation asks participants to clear their minds and experience what they are feeling at the moment. The individual might be taught to start by sitting calmly and focusing on their breathing – simply feeling the breath going in and out. It’s normal for the mind to wander, especially when first trying this out. If that happens, the person can simply return to focusing on their breathing. Eventually, simply experiencing one’s sensations and emotions without judgment becomes second nature. At this point, they can start to mindfully experience their disordered thoughts without a compulsion to act on them.

Any discussion of mindful movement would be remiss without mentioning yoga, which is a feature of virtually every eating disorder treatment program. Yoga combines mindful meditation and movement in a way that makes it ideal for people looking to reconnect their healthy selves with their body awareness. Just as a person using mindfulness mediation might put their focus on their breathing, a person doing yoga might focus entirely on the sensation of their muscles and tendons stretching, or the feeling of calm strength a particular pose brings to them. Yoga is also especially useful in cases of bulimia nervosa where exercise compulsions were present. It introduces a form of movement that foregrounds mindfulness of how the body feels, without being high-impact or likely to cause pain or injury.

Signs and Symptoms of Bulimia Nervosa

In addition to outwards signs of bulimia nervosa (disappearing after meals to purge, weight loss, recurring illnesses, abusing laxatives and diuretics), people with bulimia nervosa also suffer from fears, phobias, and compulsive behaviors. An extreme preoccupation with appearance (constantly inspecting themselves in mirrors), phobic fear of gaining weight, feeling as if they cannot control their eating during binging episodes, and giving in to the compulsion to vomit after eating are all psychological symptoms that mindful movement can positively negate.

If you’re looking for signs of bulimia nervosa in a loved one, it might be easiest to look for behavioral cues, since the binge and purge cycle is usually secretive. Look out for complaints about their body or weight, frequent and extreme dieting, wearing baggy clothes that disguise the body’s shape, and other body image issues. Other things to note are frequent bathroom trips, especially after eating, always keeping mints or perfume to hide the odors of vomiting, stashes of food (or finding evidence of a binge eating episode, such as lots of food wrappers suddenly found in the trash), and abuse of laxatives.

It’s important to note that while the stereotype of people with eating disorders is that of a severely underweight, usually white girl or woman, bulimia nervosa is known to affect people of all ages, ethnicities, and genders. Additionally, many people with bulimia nervosa (and other eating disorders) are of “normal” weight or even overweight. Eating disorder counseling generally encourages weight restoration, but the focus is on changing behavior, not weight. Mindfulness is key here as well since a person in recovery normally has to overcome distorted thoughts and feelings about their body so they can get back to eating intuitively and healthily.

Most of all, mindful movement helps reduce bulimia nervosa symptoms by improving self-esteem, recognizing negative thought patterns as soon as they emerge, and stopping these thoughts from controlling unwanted eating disorder behaviors.

When to Seek Help at an Eating Disorder Treatment Center

Frequent, repetitive purging and binge eating episodes associated with bulimia nervosa present a very real and serious health risk demanding professional, caring treatment by eating disorder therapists. In addition to cognitive behavioral therapy, dialectical behavior therapy, nutritional counseling, and group/individual therapy, a bulimia nervosa recovery plan may include meditation techniques and mindful movement exercises designed to support the restoration of physical and psychological health processes.

Mindful movement therapy will also help patients cope with depression, anxiety, and deeply entrenched beliefs about their desire to always be “perfect”. As an integral component of any eating disorder recovery program, mindful movement represents a newer wave of holistic therapies proving to be both successful and enjoyable by people recovering from bulimia nervosa, anorexia nervosa, binge eating disorder, and other eating disorders.

 

Melissa Orshan Spann, PhD, LMHC, RTY 200, is Chief Clinical Officer at Monte Nido, 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.