Eating Disorders in Athletes: The Truth About Compulsive Exercise

Compulsive exercise—also known as excessive exercise —is “characterized by a significant amount of physical activity combined with a compulsive need to do the activity” (Bewell-Weiss & Carter, 2010). Compulsive exercise is often done to manage emotional distress, cope with difficult thoughts, or compensate for eating (a form of purging). To be clear, the term “exercise” for most individuals who are compulsively exercising consists of:

• Moderate to vigorous cardiovascular exercise (individual cardiovascular exercise, group fitness, CrossFit, cardio boxing, cardio kickboxing, circuit classes, etc.).
• Resistance training (HIIT training, Tabata, Circuit training, etc.)

Why Do People Compulsively Exercise?

Some individuals over exercise as a compensatory behavior. It may follow a session of binge eating or it may serve as a way for them to give themselves “permission” to binge eat afterwards. Others may start overexercising following treatment for an eating disorder. They may start to use compulsive exercise behaviors instead of other eating disorder behaviors to manage their anxiety in recovery. 

Many compulsive exercisers believe that exercise is not worth doing if they are not hyperventilating (breathing heavy) and/or sweating significantly. They often believe that if they are not having any physical consequences (pain and suffering), then they are not working hard enough.

Athletic Goals

Some athletes are driven to engage in compulsive exercise to improve performance, reach a goal or to achieve success in sports and athletic competitions.

Genetics

Starvation activates certain genes through epigenetics. When a certain weight is reached, the body becomes unfazed by starvation and commences searching for food as a survival technique in times of famine. A foraging behavior of sorts begins and is often accompanied by hoarding. (Baird ’06; Gusinger ’03, Kersting ’04).

Weight Control or Physical Appearance

Commonly, especially in people with eating disorders, many people exercise excessively to lose weight, to maintain weight loss or prevent weight gain. Excessive or compulsive exercise is frequently a symptom of an eating disorder and can even promote the development of the illness. Physical activity, in this sense, can become too much of a good thing.

Are you concerned that you, or someone you care about, may over exercise? See how many questions you answer “yes” to:

• Your commitment to exercise and/or training takes precedence over all other activities, including work, school and spending time with friends and family.
• You exercise excessively “just because” (as opposed to intentional exercise in preparation for a competition)
• You refuse to miss a workout, regardless of weather or injury
• You feel heightened anxiety and/or agitation if unable to engage in exercise
• You are underweight or severely underweight
• You are frequently tired
• Your exercise routine interferes with (or has replaced) your social life
• You experience injuries and muscle soreness and continue to exercise
• You get sick frequently and have many respiratory tract infections
• You experience GI symptoms (bloating, cramps, diarrhea)
• You notice hair loss or have pale skin
• You notice an increasing number of medical complications including racing heart, dizziness, fainting, hypotension and others
• You spend what most people agree is an excessive amount of time and energy doing physical activities
• You have an inflexible exercise schedule; “I must work out today; nothing will stop me.”
• You experience withdrawal symptoms when exercise is stopped (insomnia, mood or appetite changes)
• You deny overexercising or downplay your exercise routine when someone brings it up
• You’ve become obsessed over the number of minutes you exercise daily. (If your workout doesn’t go as planned, you will make sure to complete the remaining minutes or exercises by the end of the day).
• Males: You notice changes in your sex drive or experience low testosterone.
• Females: You notice changes in your menstrual cycles (or your periods stop completely).

Which Athletes Might Be at Risk for Eating Disorders?

Interestingly, there is a temperament associated with athletes that closely mirrors the traits of those with eating disorders. These traits include:

• Perfectionists
• High achievers
• People-pleasers

Research by Craig Johnson, PhD, CEDS, FAED, senior clinical advisor at Eating Recovery Center, shows that at least one-third of female college athletes have some type of disordered eating behaviors. And one study found that 40 percent of patients with anorexia nervosa engaged in compulsive exercise.

Participation in endurance sports is a risk factor for, not a cause of, an eating disorder. This risk for developing an eating disorder particularly affects those with an underlying genetic predisposition influenced by biological, psychological and social factors (Thompson and Sherman, 2010).

Compare it to the genetic vulnerability a person may have when alcoholism runs in their family. Consuming alcohol creates a higher risk of developing the disorder, just as engaging in diet manipulation and intensive exercise is a risk factor for someone who is vulnerable to eating disorders.

Eating Disorders Often Go Unnoticed in Sports

“To be elite or at world level — you have to have intense focus. Eating disorders for these athletes is often misguided focus — intense focus, detail, excellence and perfection. But when that becomes misdirected, ‘eating well’ doesn’t equal success — it equals disordered eating,” says Danny Gerow, age 25.

Gerow was an elite cyclist who competed at the world level in Belgium and went on to coach cycling at the collegiate level. Gerow saw athletes struggling with obsessive thoughts around food and training. These habits are fear-based — a fear of eating too much or too little, and a fear about how this might affect performance. Gerow urges the community to look beyond eating disordered behaviors to understand the function of the disorder:

“There’s a lot of people to be helped and freed… if the athlete has disordered eating, it’s the outward expression of something inward gone awry.”

Elite and endurance athletics will continue to be a risk factor for eating disorders. Thankfully, health and recovery from eating disorders are possible. Of course, it depends on a combination of factors including the support of coaches, teams, families, medical and mental health professionals.

Here’s what an individualized treatment plan at our eating disorder treatment center typically looks like:

• A thorough psychiatric assessment to determine if medicine may be necessary to treat anxiety or depression
• Therapy using ACT (acceptance and commitment therapy), DBT (dialectical behavior therapy) and CBT (cognitive behavioral therapy) to increase awareness of the underlying causes of the behaviors and to introduce coping tools and strategies for managing symptoms such as guilt, shame, or intrusive thoughts about body image or weight
• Customized meal plans to help restore nutritional balance
• Yoga/movement therapy for relaxation, improved body image and improving one’s relationship with movement and exercise
• Recreational activities including gardening, crafts, music to help develop coping tools and alternatives to exercise

Let Go of Old Beliefs

Many people with eating disorder histories associate exercise with weight loss and control. They have pushed themselves to either excessively exercise or refused to exercise at all. Find peace by having a willingness to challenge previous beliefs about exercise. Open your mind to building a new relationship with it. Whenever your mind goes to calories or time frames associated with the eating disorder, gently ask it to "let go."

Bring Curiosity to Exercise

Find balance with exercise by inviting curiosity in and trying new activities that are fun. People with eating disorder histories may be so used to associating exercise with improved performance or focusing on "have to's" and “should’s” that they don't know what movement activities they truly find enjoyable. Be willing to try new activities, starting with activities you are curious about and trying one new activity a week.

Listen to Your Body

Find balance with exercise by stopping when your body says it's tired. And, if you are still struggling with an eating disorder or are early on in your recovery, set a timer, but only if you have agreed on an amount of exercise with your treatment team. If you are not used to exercising, start with a slow, twenty-minute walk with a friend. Better yet, practice mindful walking out in nature with supportive friends and family.