What is Exercise Bulimia?
Compulsive or excessive exercise may be used as a compensatory behavior, meaning some people use it as a way to compensate for the calories they consume (1), and this is a condition known as exercise bulimia.
Exercise bulimia has some characteristics similar to bulimia nervosa, an eating disorder that involves binge eating followed by purging or other compensatory behaviors, typically by self-induced vomiting, fasting, excessive exercise, or use of diuretics and/or laxatives (2).
Those with exercise bulimia only use excessive exercise as a compensatory behavior after binging episodes, or even just after eating. Essentially, exercise is being used as a way to attempt to control body shape or body weight.
Medical professionals once classified excessive exercise as a form of bulimia nervosa, but it has become recognized as a separate condition. Exercise bulimia is not currently recognized in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders), which can make it hard to classify and diagnose. That being said, this doesn’t make it any less serious than a recognized eating disorder. It can appear to fall into other categories, such as an obsessive-compulsive disorder or a body dysmorphic disorder.
Diagnosis of exercise bulimia is further complicated by the harmful cultural belief that a person who is focused on fitness must be healthy, particularly in a culture that celebrates thinness and dedication to training, no matter how obsessive. Furthermore, those living with exercise bulimia may not be in a low weight body as genetic differences significantly impact how different people’s bodies respond to disordered behaviors like compulsive exercise.
Who is at Risk of Exercise Bulimia?
Exercise bulimia is common across genders and it’s estimated that about 4% of Americans are living with the condition (4). Exercise bulimia may develop in individuals who find it difficult to purge via vomiting or laxative use, including people with a fear of vomiting or health anxiety.
4% of Americans have exercise bulimia.
Certain populations may be at an increased risk of exercise bulimia. These increased risk groups include those with an interest in health and fitness and people who have body-focused careers, such as personal trainers or athletes (5).
Furthermore, as eating disorders and compulsive exercise have a lot of characteristics in common, those already showing disordered eating behaviors are at more risk of exercise bulimia. Studies show that compulsive exercise is four times more common in people showing signs of an eating disorder, compared to the general population (6).
Signs and Symptoms of Exercise Bulimia
Within diet culture, exercise is considered healthy and virtuous, no matter what,, which can make it difficult to notice when someone is overexercising. One key indication that a person is suffering from exercise bulimia is that they schedule their lives around exercise, just as those with other eating disorders may schedule their lives around food rules and rituals.
Other signs and symptoms of exercise bulimia include (1,2,4):
- Obsessive calorie counting and closely tracking how many calories are burned when working out
- Nutrient deficiencies or malnutrition
- Refusal to eat if unable to exercise soon afterward
- Exercising despite injury, illness, or other medical complications
- Prioritizing exercise over social, family, school, or work commitments.
- Not taking any rest or recovery days
- Exercising for hours each day and feeling intense distress and/or guilt if unable to exercise
- Frequent exercise at inappropriate times with no attempt to suppress the behavior
- Being defensive if someone suggests exercise might be excessive
- Constant body checking and weighing and feeling the need to work out more to reach a desired weight
- Intense fear in states of rest
- Inflexibility when it comes to mode of exercise and time of day to work out
- Self-esteem is dependent on perceived physical fitness, body size, and body weight.
Underlying Causes of Exercise Bulimia
Exercise bulimia often has to do with control. These disordered eating and exercise behaviors develop in part as a way to take control of one’s life and cope with negative thoughts and emotions. There is no single cause of exercise bulimia, rather its onset is due to a myriad of biological, psychological, behavioral, and social factors.
Exercising causes the release of feel-good neurotransmitters, such as dopamine, which stimulates a reward response, helping to relieve stress, boost mood, and reduce the symptoms of depression and anxiety.
When an individual stops exercising the good feelings wear off, and in individuals who exercise a lot, this can result in withdrawal-like symptoms. This can lead a person to work out once again, to the detriment of adequate rest, to chase the “high” of chemical release, and the cycle continues (7).
People who exercise compulsively are more likely to exhibit certain personality traits, which researchers believe play an important role in developing and maintaining the condition. They include (8):
- Perfectionism or behavioral inflexibility: Causes a person to have a lower tolerance for perceived flaws and therefore never be satisfied with performance and appearance.
- Neuroticism: Increases emotional instability, which may lead a person to focus on exercise as a coping mechanism for negative thoughts and emotions.
- Addictive personalities: Those with addictive personalities are more likely to engage in compulsive exercise, perhaps to fill the void left by a previous addiction. (9)
Other Contributing Factors
Additional biological, psychological, and sociocultural factors that can contribute to the onset of an eating disorder, like in exercise bulimia, including:
- Family history of eating disorders and/or other mental illness
- History of dieting
- Poor self-esteem concerning appearance
- Body dysmorphia and/or muscle dysmorphia
- Personal history of an anxiety disorder, such as panic disorder or obsessive-compulsive disorder
- Weight stigma i.e. believing that being thinner or more muscular is better
- Being bullied, particularly about weight or body type
- Limited social networks
- Major and/or stressful life changes
- Family and/or relationship conflicts
- The use of fitness trackers, which can encourage competition
Health Complications of Exercise Bulimia
Thanks to the widely-held public belief that exercise is always good for you, exercise bulimia may be perceived as ‘healthy’. However, this couldn’t be further from the truth and the physical and psychological effects of excessive exercise should not be underestimated.
The physical complications of exercise bulimia include, but are not limited to:
- Overuse injuries, such as stress fractures, sprains, and strains
- Tendinitis, painful inflammation of the tendons
- exercise amenorrhea – loss of periods due to excessive exercise which may cause irreversible bone loss
- Infertility and other reproductive issues
- Fatigue, constantly feeling tired, and reduced performance when exercising
- Arthritis or chronic joint pain
- Weakened immune system and proneness to respiratory infections
- Heart problems, including arrhythmia
- Electrolyte imbalances
Although not everyone with exercise bulimia will engage in binging episodes, those that do may also experience gastrointestinal issues, such as bloating, abdominal pain, acid reflux, and nausea.
Exercise bulimia can also have a significant impact on a person’s mental health. Common psychological consequences of the condition include depression and anxiety, social isolation, perfectionism, withdrawal from relationships, low self-esteem, and more.
Exercise Bulimia: In Summary
Exercise bulimia is a mental disorder that although not currently recognized in the DSM-5, can still have a serious impact on mental and physical wellbeing.
A person with exercise bulimia will exercise compulsively to compensate for binging or just eating and to attempt to control body shape and weight. Unlike bulimia nervosa, individuals with exercise bulimia may not engage in any other purging behaviors, such as self-induced vomiting or medication use.
People of all gender identities are almost at equal risk of developing the condition, with those in body-focused careers being most at risk. The onset of exercise bulimia is complex and believed to develop as a response to several biological, psychological, and sociocultural factors.
If left untreated, people with exercise bulimia are at increased risk of injury, as well as dehydration, malnutrition, reproductive problems, and cardiovascular issues, therefore intervention must be as swift as possible to prevent permanent consequences.
- Waehner, P. (2020, November 17). Exercise bulimia is a new kind of eating disorder. Verywell Fit. Retrieved June 24, 2022, from https://www.verywellfit.com/exercise-eating-disorders-1229634
- Team, T. H. E. (2017, July 26). Exercise bulimia: Symptoms, treatments, and more. Healthline. Retrieved June 24, 2022, from https://www.healthline.com/health/exercise-bulimia-symptoms-treatments-and-more
- MedicineNet. (2005, January 30). Exercise bulimia information on Medicinenet.com. MedicineNet. Retrieved June 24, 2022, from https://www.medicinenet.com/script/main/art.asp?articlekey=50963
- Lauren Muhlheim, P. D. (2021, October 20). Excessive exercise: Could it be a symptom of an eating disorder? Verywell Mind. Retrieved June 24, 2022, from https://www.verywellmind.com/excessive-exercise-eating-disorder-symptom-4062773
- Freimuth, M., Moniz, S., & Kim, S. R. (2011, October 21). Clarifying exercise addiction: Differential diagnosis, co-occurring disorders, and phases of addiction. MDPI. Retrieved June 24, 2022, from https://www.mdpi.com/1660-4601/8/10/4069
- Di Lodovico, L., Poulnais, S., & Gorwood, P. (2019). Which sports are more at risk of physical exercise addiction: A systematic review. Addictive Behaviors, 93, 257–262. https://doi.org/10.1016/j.addbeh.2018.12.030
- Saanijoki, T., Tuominen, L., Tuulari, J. J., Nummenmaa, L., Arponen, E., Kalliokoski, K., & Hirvonen, J. (2017). Opioid release after high-intensity interval training in healthy human subjects. Neuropsychopharmacology, 43(2), 246–254. https://doi.org/10.1038/npp.2017.148
- Lichtenstein, M. B., Hinze, C. J., Emborg, B., Thomsen, F., & Hemmingsen, S. D. (2017). Compulsive exercise: Links, risks and challenges faced. Psychology Research and Behavior Management, Volume 10, 85–95. https://doi.org/10.2147/prbm.s113093
- Sussman, S., Lisha, N., & Griffiths, M. (2010). Prevalence of the addictions: A problem of the majority or the minority? Evaluation & the Health Professions, 34(1), 3–56. https://doi.org/10.1177/0163278710380124