Q&A: Exercise Compulsion and Eating Disorders - Jennifer Lombardi

Eating Recovery Center of California’s Executive Director, Jennifer Lombardi, MFT answers important questions about exercise compulsion and its treatment.

Eating Recovery Center of California’s Executive Director, Jennifer Lombardi, MFT answers important questions about exercise compulsion and its treatment.

How is exercise compulsion defined?

Compulsive, excessive and obligatory exercise are used interchangeably—there is no universal terminology. Exercise compulsion is generally defined as being “characterized by a significant amount of physical activity combined with a compulsive need to do the activity.” (Bewell-Weiss and Carter) In other words, the exercise is obligatory in nature and it doesn’t have to be a certain type of exercise or performed for a minimum duration. We really need to look at intention —if a patient indicates a sense of urgency or agitation when she/he can’t engage in the exercise behavior, there is likely an issue.

How do cultural perceptions about exercise complicate the identification and treatment of exercise compulsion?

In recent years, there has been a major cultural shift around the idea that exercise is going to help you—not only in supporting general health and maintenance of a healthy weight during an obesity “epidemic,” but also as a tool to manage anxiety and stave off depression. Exercise also makes us “feel good,” and interestingly, compulsive over-exercisers often present with higher self-esteem despite having lower body-esteem. This paradox makes total sense if you consider the temperament of those suffering from an eating disorder—they are high achievers, tend to have low reward dependence and novelty seeking traits, and may live in a rigid, “black-and-white” world. But exercise is one of those behaviors that mean something different to eating disorders patients when considering their temperament and brain chemistry.

What role do families play in the issue of exercise compulsion, both in identification and treatment?

The family unit is where we often see this exercise compulsion dynamic play out with young patients. Parents have rallied around their son or daughter’s sport participation, and their objections to stopping the exercise behavior is often “When they’re playing their sport, they feel the best/most confident about themselves.” When the clinician tries to explain the self-esteem paradox and that exercise means something different to their loved one, parents will often cite the positive cultural notions around exercise as a healthy tool to help us overcome obesity and anxiety/depression. Because exercise has the general impression of being healthy and part of a balanced lifestyle, it is critical that families are educated about the slippery slope that exercise represents for individuals struggling with and recoveringfrom an eating disorder.

What factors must be considered when evaluating excessive exercise?

Thorough assessment is critical when evaluating exercise compulsion. Clinicians and patients need to explore with regards to the patient’s relationship to exercise particularly because patients and families will often minimize thoughts and behaviors. It is important to explore the anxiety, rigidity and perfectionism and identify how these hallmark traits of individuals with eating disorders relate to their exercise behaviors. Looking at individual’s support systems and their involvement with the individual’s exercise behaviors,  as well as athletic endeavors, is key to understanding what, when, and how support is needed.

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