March 24, 2016

Compulsive Exercise and Eating Disorders in Athletes - Dr. Stephanie Setliff

man jogging outsideHealth experts often speak out against sedentary lifestyles, but we rarely hear strong warnings regarding compulsive exercise, a harmful practice that affects many who struggle with eating disorder behaviors, including athletes.

To recognize National Athletic Training Month in March, we take a look at compulsive exercise, also known as excessive or obligatory exercise, and its relationship with eating disorders, to help identify at-risk individuals and refer to treatment.

What is compulsive exercise?

Exercise compulsion is “characterized by a significant amount of physical activity combined with a compulsive need to do the activity” (Bewell-Weiss and Carter). In other words, if a patient feels a sense of urgency or agitation when they can’t exercise, there could be a problem.

Are you exercising too much?

Compulsive exercise is exercise that is done to the point that problems start to arise. When exercise makes you ignore friends and family, if it is affecting your schoolwork or career, or causing health problems, it may be time to take a look at your behaviors. If you are concerned that someone you love — male or female — may be exercising too much, consider the following:
  • Has athletic performance actually decreased or are there signs of fatigue?
  • Does a female athlete have irregular or absent periods?
  • Does the athlete suffer from stress fractures or other injuries caused by overuse?
Parents, healthcare providers, coaches and trainers can play an active role in communicating concern to athletes that show signs of unhealthy exercise or eating behaviors.

Is compulsive exercise an eating disorder?

Some people are driven to perform extreme amounts of physical activity due to food, body, or weight-related concerns. In fact, there is a type of bulimia called exercise bulimia. People with bulimia may purge by means of vomiting or laxatives, while exercise bulimics purge through exercise. Exercise bulimia affects people who feel the need to exercise compulsively at a high level in order to burn fat or calories.

Signs of eating disorders in athletes

It can be difficult to spot warning signs of eating disorders in athletes. Athletes may be able to mask signs of disordered behaviors – or just not report them. Experts generally agree that certain athletes (gymnastics, dance, cheerleading, cross country, swimming and wrestling) face a higher risk for anorexia or bulimia.

Learn more about anorexia symptoms and bulimia symptoms in athletes. 

Sports that require revealing clothing or uniforms (dance, swimming) may put participating athletes at risk for body dissatisfaction and competitive thinness. 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 Dr. Craig Johnson, Chief Science Officer and Director of the Family Institute 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.  

How do I know if I need help?

While exercise is a part of a healthy lifestyle, it is possible to have too much of a good thing. It may help to know the signs of compulsive exercise, listed below, and to seek help from a professional, if warranted:
  1. Are you exercising excessively, above and beyond what is necessary to prepare for competition?
  2. Do you prioritize exercise over work, school and time spent with family and friends?
  3. Do you have perfectionistic tendencies or heightened strictness when it comes to your exercise regimen?
  4. Does your anxiety increase if you can’t exercise?
  5. Do you refuse to miss workouts, even if you are injured or the weather is bad?
While exercise is a healthy behavior, it can also be a slippery slope for patients that are in treatment for, or recovering from, an eating disorder.

Help for compulsive exercise

Thankfully, effective treatment for compulsive exercise and eating disorder behaviors exist. At Eating Recovery Center, we offer specialized treatment to meet athletes’ distinctive needs. We evaluate all of our patients’ physical and psychological health needs to provide the necessary tools to achieve lasting behavioral change — and to help our patients find their way to recovery.

Resources Int J Eat Disord. 1995 May;17(4):413-6. Comparison of eating disorder patients with and without compulsive exercising. Brewerton TD1, Stellefson EJ, Hibbs N, Hodges EL, Cochrane CE.


Medically reviewed by Stephanie Setliff, MD, Medical Director of Eating Recovery Center, Dallas. Written by Britt Berg for Eating Recovery Center.
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