EATING DISORDER NEWS & REVIEW
By Columnist Eleni Psillakis – Eating Disorder Educator:
Excessive exercise can be used as a compensatory behaviour for many eating disorders, including anorexia nervosa, bulimia and muscle dysmorphia. Come with us as we explore these concepts further.
The benefits of physical activity for mental illness is well documented. 30-minutes of vigorous exercise, 3-times a week can contribute to improvements in depression and anxiety. 1. However, when the motivation to exercise becomes unhealthy, there are major health consequences. There is a fine line between exercising for health benefits and the compulsion to exercise to the point where high levels of anxiety are experienced if exercise is delayed.
Excessive exercise can be used as a compensatory behaviour for many eating disorders, including anorexia nervosa, bulimia and muscle dysmorphia. Excessive exercise, restricted eating, bingeing or a combination of all of these are common in eating disorders. Eating disorders are mental illnesses and are comorbid with many other conditions such as depression, anxiety, obsessive-compulsive disorder and post-traumatic stress disorder. So if exercise is proven to be beneficial for mental illness, how do we create this balance?
There are three terms to define and consider:
Overtraining occurs when the body cannot keep up with the physiological demand for the exercise, having negative consequences on many physiological systems. Overtraining can often lead to exercise dependence.1
Exercise dependence occurs when a person becomes addicted to exercise, training multiple times a day and can experience withdrawal.1
Excessive Exercise has diagnostic criteria in the DSM IV (The Diagnostic and Statistical Manual of Mental Disorders – 4th Ed) These are the exercises that:
- Significantly interferes with important activities.
- Occurs at inappropriate times or in inappropriate settings.
- Continues despite injury or other medical complications.
Jonathon Mond et al. suggests that excessive exercise occurs if a person experiences intense guilt when planned exercise cannot be undertaken and when it occurs to solely influence weight or shape.2
There are in fact contraindications for exercise for certain physical consequences of extreme diet and exercise behaviours. For example, the Centre for Eating and Dieting Disorders says that exercise is contraindicated for anyone with an eating disorder and a BMI lower than 14. Cardiorespiratory exercise is contraindicated for people that purge, due to cardiac and electrolyte imbalance risks. Osteoporosis is also a consequence of prolonged restrictive eating.
The Compulsion to Exercise
Personally, I would like to see another dot point added to the criteria. This is would be when a person’s sense of worth is dependent on adhering to excessive exercise regimes and attaining a particular body shape or weight.
Unhealthy diet and exercise behaviours are often the means to control other emotions created by so many factors including life circumstances, genetic dispositions, other illnesses and trauma. The reason WHY needs to be dealt with and not just the signs and symptoms. Exercise is not beneficial if more anxiety, shame and guilt occur if the planned exercise does not happen.
I engaged in excessive exercise as a compensatory measure when suffering anorexia during my late teens and early adult life. The type of exercise was running long distance multiple times a day purely for the burning of calories for the little food I ate. At the time this made me feel like I was worth something. So to stop this pattern of thinking difficult. The bottom line is I did not like myself. 26 years later, undergoing treatment for depression, the only routine I had was to make myself get up and go to the gym. My psychologist said the day I stop doing that she would be worried. Sounds ironic, doesn’t it?
Not only did the type of exercise change, but the motivation to exercise changed. As I had the psychological help to address the emotional issues that had nothing to do with food or exercise and to practice liking myself again, my sense of worth did not involve the need to stick to high levels of exercise, to ‘do’ or to seek approval. Resistance training allowed a focus other than racing, depressive thoughts. I enjoy going to the gym to lift weights and feeling my body get stronger, but in doing so I am strengthening my mind and my thoughts. The benefits resistance training it has on the body physically is a bonus. Win- Win only if your sense of worth is healthy.
Balancing Thoughts & Balancing Behaviour
I now exercise no more than one hour a day, 4-5 days a week. I enjoy rest days. I go out with my friends and I drink wine and eat cheese. My sense of worth as a person is not dependant on sticking to unhealthy behaviours that I once hid behind as ‘healthy’. This is such freedom and many people may not understand how a person that has suffered an eating disorder be recovered if they still exercise.
The motivation to exercise has changed. The ugly thoughts I had about myself have changed. It has taken holistic treatment to deal with the cause and not just the signs and symptoms. There needs to be a balance of thoughts before a balance in behaviour can occur. It is this healthy level of exercise that is beneficial to mental illness. And to come alongside someone who does not have the desire to get out of bed due to depression, anxiety and any other mental illness and move with them – for their health sake, is one of the most supportive things you can do.
Please, let’s stop calling eating disorders body image issues. Unless we treat thought patterns, then using unhealthy levels of exercise as an excuse for ‘health’ will add to a problem rather than encouraging recovery.
- Ashish Sharma, et.al. “Exercise for Mental Health” (2006).
- Mond, Jonathan M., et al. “An update on the definition of “excessive exercise” in eating disorders research.” International Journal of Eating Disorders2 (2006): 147-153.
Workshops & Events
Identifying & Managing Eating Disorders in the Fitness Industry
Mental Health First Aid Australia
As an accredited Mental Health First Aid Instructor, Eleni recommends gaining the qualification yourself. Attain a certificate in Mental Health First Aid, by registering below. This qualification enables you to support people in a time of mental illness and crisis until an appropriate professional arrives.
About Our Eating Disorder News and Review Columnist – Eleni Psillakis
Combining over 27-years experience in the fitness industry, education and a lived experience, Eleni Psillakis is raising awareness of eating disorders as serious mental illnesses. In her time as a group fitness instructor, personal trainer, secondary and tertiary educator, Eleni wasn’t aware of the fine-line that crossed from healthy to unhealthy diet and exercise habits.
How Eleni Used Resistance Training
Using resistance training to gain weight to her 39kg frame at age 19, Eleni physically recovered and went on to compete in women’s bodybuilding. However the underlying emotional issues and thought patterns resurfaced 25-years later when her marriage broke down and a diagnosis of clinical depression resulted. Antidepressants and 8-years of psychological counselling, assisted with unlearning of negative thought processes that Eleni had of herself for most of her life. These were nothing to do with body image, but self-worth.
Resistance training again helped the process of stopping her thoughts racing during this time of depression and she stepped back onto the competition stage gaining a top 3 place in her division for each of the 5 competitions since. It was the psychological help that has made the difference this time around.
“An Insight to Anorexia and Other Eating Disorders for Fitness Professionals”, a seminar that Eleni has written, has been approved by Fitness Australia for continuing education.
Disclaimer: The information published in this column are based on the author’s own professional and personal knowledge, and opinion. This information is not a substitute for professional medical advice, diagnosis or treatment of any manner. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding any medical condition and consult a qualified medical professional before beginning any nutritional program or exercise program. Never disregard professional medical advice or delay in seeking it because of something you have read on InShape News.