Eating Disorders in Athletes: The Truth About Compulsive Exercise

What is compulsive exercise? Is it possible to exercise too much? And what are the signs that someone is struggling with excessive exercise or an eating disorder? Eating disorder expert Dr. Amy Gooding explains all of these facts and discusses eating disorders in athletes here in our comprehensive guide.

What is 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.

    Symptoms of Over Exercising

    A person who over exercises can experience a number of serious negative physical health outcomes, including:

    • Joint injuries
    • Stress fractures
    • Muscle tears
    • Tendonitis
    • Fatigue
    • Dehydration
    • Anxiety
    • Depression
    • Decreased immune system response
    • Increased resting heart rate
    • Increased blood pressure
    • Orthopedic overuse injuries
    • Overreaching
    • Overtraining syndrome

    People who compulsively exercise and those with eating disorders often struggle with food-, body- or weight-related issues. These issues tend to drive excessive physical activity. In fact, a study by Brewerton found that nearly 40 percent of patients with anorexia nervosa engage in compulsive exercise behaviors (Brewerton et al, 1995). 

    Can You Get Too Much Exercise?

    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 look at your behaviors.

    For individuals who are restricting their food intake (a potential warning sign of anorexia) — over exercise could lead to serious medical complications or even death. Electrolyte imbalances can occur even if the individual is drinking a lot of water since food is necessary for hydration.

    exercise running

    When is Too Much Exercise a Problem?

    Compulsive exercise has been defined as a craving for physical training, resulting in uncontrollable excessive exercise behavior with harmful consequences, such as injuries and impaired social relations.[1] Over exercising can be a major health concern when done by someone who has a history of eating disorder behaviors (restricting, purging, binge eating, or body image issues).
    It is important to understand the difference between compulsive exercise (a form of purging) in someone with an eating disorder history and overtraining, which we discuss later in this piece.

    Why Do People Over Exercise?

    Compulsive exercise often starts in a seemingly harmless way. People start to overexercise for many reasons. Here are some examples.

    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.


    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.

    Activity Level

    Some people exercise compulsively because they are hyperactive; their nature is to always be moving.


    Some people over exercise to control their mood, particularly anxiety issues; intense activity calms them down. Exercise can have an antidepressant effect for some people when used in a healthy, balanced manner. Exercise can also cause increased depression in people who over exercise.

    Dependence or Addiction

    Some people are even conditioned to a dopamine or endorphin “high” from exercise. Signaling in the pleasure/reward system is genetically wired to increase the likelihood of being physically active and sustaining an exercise program (Herring ’14).

    yoga exercise

    Who is at Risk for Compulsive Exercise?

    Really, anyone could be at risk for compulsive exercise, just like anyone could be at risk for an eating disorder. Overexercising symptoms to watch for include the following:

    • They maintain an excessive, rigid exercise regimen – despite weather, fatigue, illness, or injury
    • They experience feelings of intense anxiety, depression, irritability, feelings of guilt, and/or distress if unable to exercise, along with feelings of intense discomfort with rest or inactivity
    • The exercise routine significantly interferes with important activities, occurs at inappropriate times or in inappropriate settings
    • Exercise is used to manage emotions
    • Exercise is used as a means of purging (needing to “get rid of” or “burn off” calories)
    • Exercise is used to give one’s self permission to eat
    • Exercise may be secretive or hidden
    • Frequently feeling that one is not good enough, fast enough or not pushing hard enough during a period of exercise
    • A tendency to overtrain

    Common Warning Signs of Compulsive Exercise Behaviors

    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).

      Parents, healthcare providers, sports medicine and sports performance staff and coaches can play an active role in communicating concern to athletes that show signs of unhealthy exercise or eating behaviors. If you are concerned that someone you love may be exercising too much, consider the following:

      1. Has athletic performance decreased or are there signs of fatigue? Note: fatigue may be noticed in the athletic environment or elsewhere, like in classes, at home or out with friends.
      2. Does a female athlete have irregular or absent periods?
      3. Does the athlete suffer from stress fractures or other injuries caused by overuse? Is the athlete continuing to exercise when they should be resting, leading to injuries that don’t heal?
      man jogging

      How Do I Know if I Need Help for Excessive Exercise?

      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:

      • Are you exercising excessively, above and beyond what is necessary to prepare for competition?
      • Do you prioritize exercise over work, school and time spent with family and friends?
      • Do you have perfectionistic tendencies or heightened strictness when it comes to your exercise regimen?
      • Does your anxiety increase if you can’t exercise?
      • 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.

      If you’re wondering if you have a problem, check out the link to the Compulsive Exercise Test, shared below. As you read the test questions, be honest with yourself. Try not to minimize or downplay your exercise habits.


      Is Over Exercising 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 those with exercise bulimia purge through exercise. Exercise bulimia affects people who feel the need to exercise compulsively at a high level to burn fat or calories.

      In addition, many individuals seeking treatment for anorexia also have anxiety, depression or obsessive-compulsive disorder. Studies have shown that the combination of food restriction and excessive exercise temporarily reduces these symptoms. It can become a form of self-medication and a pattern that some liken to an addiction.


      What Are the Signs of Eating Disorders in Athletes?

      It can be difficult to spot signs of compulsive exercise and eating disorders in athletes. Athletes can often mask signs of their disorder – 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.

      Sports that require revealing clothing or uniforms (dance, swimming) may put participating athletes at risk for body dissatisfaction and competitive thinness. However, any athlete, in any sport, can develop an eating disorder. Endurance athletes can be at risk for eating disorders if they aren’t eating enough to fuel their intense training regimens and competitions.

      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.

      Signs of Over Exercise and Eating Disorders in Athletes

      • Bone density loss (osteopenia or osteoporosis) 
      • Loss of menstrual cycle (in women)
      • Female Athlete Triad (in women)
      • Low sex drive or low testosterone in men
      • Relative Energy Deficiency in Sport (RED-S)
      • Persistent muscle soreness
      • Chronic bone & joint pain
      • Increased incidence of injury (overuse injuries, stress fractures, etc.)
      • Persistent fatigue and sluggishness
      • Altered resting heart rate
      • Increased frequency of illness & upper respiratory infections[9]

      Elite Athletes and the Risk for Eating Disorders

      To be an “elite” endurance athlete, you must rank within the top 10 to 15 percent of the competition. The next level of competition is competing at the world level. Some elite endurance athletes often say that the culture offers mixed messaging: Athletes should live healthy and normal lives — but they must also do what they must, to win.

      Endurance athletic culture is centered upon discipline regarding training regimens, weight, sleep and food. For these individuals, their eating and weighing habits aren’t necessarily about a certain body image — rather, they are about performance. Consider these quotes from some of the group’s most competitive athletes:

      "You’re willing to do anything to lose time. Saving four to six seconds could make a difference of how you place, or if you win money.” Regarding the omission of food groups like gluten, dairy, and alcohol, “I don’t think it’s a disorder to not do those things, I think it’s smart and healthy.”

      Brett Rindt, age 34, Pro 1-2 level cyclist

      “It’s a whole lot easier to change your weight than [it is] to change your power in order to climb hills. I would guess most elite endurance athletes have some form of an eating disorder. We weigh ourselves every day.”

      Kyle Thomas, age 33, Pro 1-2 level cyclist

      “I’m 6’3”, 195 lbs. I’d have to lose 20 to 30 pounds to be in the range of a world class Iron Man. I have no interest in doing that. For me, it’s about maintaining my weight and finishing.”

      Jon Slinger, age 35, triathlete

      Can Endurance Sports Cause Eating Disorders?

      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.

      Can Being an Athlete Actually be Unhealthy?

      While eating disorder professionals have different criterion for “red flags”, athletes shared these turning points in which they noticed unhealthy habits start to occur:

      • Overtraining
      • An increase in injuries
      • Continual food group restriction post-race day
      • Continual focus on weight loss post-race day
      • Feeling guilty about food choices
      • Focusing so much on “healthy” food that it was limiting happiness
      • Obsessive thoughts about food and exercise
      • Neglecting other enjoyable activities due to the need to exercise or avoid the food that is present

      What is Overtraining Syndrome?

      Unfortunately, no agreed upon definition exists regarding overtraining syndrome, but research done by Halson and Jeukendrup defines overtraining as: “An accumulation of training and/or non-training stress resulting in long-term decrement of performance capacity with or without related physiological and psychological signs and symptoms of overtraining in which restoration of performance capacity may take several weeks or months.”[2]

      Put more simply, overtraining has some negative physical consequences — from lack of adequate recovery time between exercise/activity sessions. Overtraining may or may not also have psychological signs and symptoms like guilt[3] or withdrawal from friends and family[4]

      Athletes at any level, from amateur to professional or elite athletes, can experience overtraining syndrome. However, adults who are not professional or amateur athletes are rarely diagnosed with overtraining syndrome. The average person will most likely quit the activity or exercise they have begun before they get to the point of overtraining syndrome.

      Compulsive Exercise or Overtraining?

      The major difference between compulsive exercise and overtraining syndrome/overreaching is that compulsive exercise does NOT always have negative physical consequences, whereas overtraining syndrome will always see some type of negative physical consequence.
      Let’s define a few terms.

      1. Overload: A planned, systematic, and progressive increase in training to improve performance.[5]
      2. Overreaching: Unplanned, excessive overload with inadequate rest. Poor performance is observed in training and competition. Successful recovery should result from a short term (a few days to a couple weeks) rest period. [6]
      3. Overtraining Syndrome: Untreated overreaching that produces long-term decreased performance and impaired ability to train.[7,8]

      How to Overcome Excessive Exercise in Eating Disorder Treatment

      When an individual begins treatment at Eating Recovery Center, we do a thorough assessment of their relationship with exercise to determine whether or not it is a symptom of the eating disorder. The assessment includes the following:

      • History of individual exercise activities
      • When physical activity became out of control and possible reasons why
      • Record of athletics, including types of sports and for how long
      • Family history of excessive/compulsive exercise, eating disorders or related symptoms
      • Personal history of stress, trauma or anxiety
      • Feelings of shame or guilt when not exercising
      • Using exercise as a form of self-punishment

      We also do a thorough medical history including taking a history of stress fractures and other injuries that aren’t healing, along with bloodwork.

      Statements such as “I am going to get fat if I don’t exercise today,” “I’m worthless if I don’t run ten miles,” “I’m lazy and not accomplishing anything if I can’t exercise” or “my girlfriend won’t think I’m attractive if I don’t work out three hours a day” indicate an unhealthy relationship with exercise. These components are important to address and will be jointly considered in treatment, along with any other mental health and physical symptoms.

      Treatment for Compulsive Exercise

      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

      We also use some of these techniques when helping to re-integrate exercise into someone’s life. Individuals who follow the recommendations of the treatment team and stay the course can develop a healthier relationship with exercise. Individuals who are ready to reintegrate exercise should be medically stable, able to follow their meal plan and be in therapy. Some example goals in treatment include:

      • Learning to listen to their bodies while providing the fuel that they need to be active
      • Discovering ways to incorporate exercise into their lives while maintaining relationships with friends and family
      • Finding out that by putting excessive/compulsive exercise behind them, they find more enjoyment in physical activity and feel more connected with what they truly value in life

      Creating a Treatment Plan for Excessive Exercise

      If it is determined that the individual’s relationship with exercise is disordered, they could be asked to temporarily refrain from all forms of physical activity other than gentle yoga or movement therapy. This can be extremely challenging for the individual who has become physiologically and psychologically dependent on exercise.

      In the early stages of treatment at our eating disorder clinic, an individual may struggle with decreasing their exercise. The combination of eating more and exercising less can increase anxiety, trigger fears about weight gain and increase negative body image. The individual may experience increased depression or anxiety, irritability, and even a sense of a loss of identity. These feelings will improve throughout treatment as they learn how to cope with maladaptive thoughts and emotions.

      The importance of being treated by a multi-disciplinary team of experts cannot be overemphasized. At ERC, the treatment team consists of a physician, psychiatrist, registered dietitian, therapist, psychiatrist, certified eating disorder specialists and movement therapists working together to support each patient’s individual needs during this very difficult phase of treatment.

      How to Find Balance with Exercise in Eating Disorder Recovery

      If you are recovering from an eating disorder, we offer some strategies to help you focus on recovery while integrating movement back into your life.

      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.

      Create a Safety Net

      In recovery, our goal is to ultimately get to a place where we feel like we can honor eating when we are hungry and stopping when we are full — with little judgement towards ourselves. However, there must be a build up to that. There must be a structure. It's the same with exercise. If you have not incorporated a structure (a safety net) around your exercise, do so. Here’s an example: “For the first year, I exercised 20 minutes a day, or no more than an hour three times per week. I stuck to this structure so that I did not have to think about it too much. Later in my recovery, I began to honor my body and it told me when to exercise and when not to.”

      Be Honest with Yourself

      Have you ever noticed that your relationship with exercise is identical to the relationship you have with food? At first it can be a struggle between your eating disorder’s way or your treatment team’s way. The key to finding balance with this struggle is being brutally honest with yourself and your intentions. If exercise is triggering you, speak to your treatment team and start small. Remember: Acting on your eating disorder’s demands is not wellness, it’s part of the illness.


      With Help, You can Make Peace with Exercise

      If you’re asking yourself: do I need help for compulsive exercise? It’s better to be safe than sorry. Maybe you don’t have a problem. But what if you do? Many benefits can come from meeting with a mental health professional to talk about concerns related to exercise, athletics, eating habits or body image.

      Compulsive exercise, particularly when coupled with an eating disorder, can lead to long-term changes that seriously damage the brain and body (Cook ’16; Powers ’08). If you suspect that you have an issue with excessive exercise, know that it’s always better to catch these types of issues early on. Don’t wait too long, thinking that you are going to get better. When we do anything in life that is extreme, the universe will seek balance. It takes time to find balance, but we can achieve it with the following:

      • Practice
      • Gentle reflection
      • Making sure that our authentic self is triumphing overeating disorder beliefs

      Over time, and with support, those who compulsive exercise can integrate moderate exercise into their lives. By creating a different relationship and experience with exercise, they can experience the emotional rewards.

      When we are honest with ourselves and willing to invite curiosity in, we can rebuild our relationship with exercise and bring balance into our lives.

      Read These Next:


      [1] Lichtenstein MB, Hinze CJ, Emborg B, Thomsen F, Hemmingsen SD. Compulsive exercise: links, risks and challenges faced. Psychology Research and Behavior Management. 2017;10:85-95. doi:10.2147/PRBM.S113093.

      [2] Halson, SL, and Jeukendrup, AE. Does overtraining exist? An analysis of overreaching and overtraining research. Sports Medicine 34(14): 967-981, 2004

      [3] Hausenblas HA,Symons Downs D. Exercise dependence: A systematic review. Psychol Sport Exerc 2002; 3: 23–80


      [5] McArdle, W. D., Katch, F. I., & Katch, V. L. (2015). Exercise physiology: Nutrition, energy, and human performance.

      [6] McArdle, W. D., Katch, F. I., & Katch, V. L. (2015). Exercise physiology: Nutrition, energy, and human performance.

      [7] McArdle, W. D., Katch, F. I., & Katch, V. L. (2015). Exercise physiology: Nutrition, energy, and human performance.

      [8] Raglin J, Bardukas A. Overtraining in athletes: the challenge of prevention. A consensus statement. ACSM’s Health Fitness J 1999;3(2):27.


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