Do You Have Exercise Bulimia?

OK, so you love to exercise. And duh, you love to eat.

Do we now have a diagnosis for this? Well, to answer your question... Kind of.

Related - Male Eating Disorders and Body Dysmorphia

Let's talk about the differences between binging and overeating first, though. I know that we kind of use these synonymously, but they are actually on different ends of the spectrum.

Bingeing and Overeating Defined

Wikipedia's definition of binge eating is this: "A type of disordered eating which consists of episodes of uncontrollable eating. Typically the eating is done fast, and the person will feel emotionally numb and just can’t stop."

This is very different than overeating, which is defined as eating too much or to excess. Basically, we are aware of it and we have some control over it. Typically, there are no feelings of guilt, embarrassment or concealing behavior.

Think of it like this - you go to a buffet. If you are a binge eater, you are likely going to experience some significant emotions - extreme stress about what you will be ingesting, and extreme excitement as well.

You will likely put a great amount of food on your plate, and feel totally out of control, and you will likely eat very fast. You may even try to conceal how much you are eating.

If you overeat, you may get more than you needed, but you do not experience a lack of control. You don’t experience complete guilt or disgust with yourself and you don’t try and conceal what you are eating.

So now that we can differentiate the differences between binge eating and overeating, let's talk about the DSM.

What In the Heck Does DSM Stand For?

The DSM is how clinicians diagnose a myriad of mental disorders. The new Diagnostic and Statistical Manual of Mental Disorders, 5th ed. is the latest and greatest on how your physician or psychiatrist can look at symptomology and come up with a diagnosis.

So let's talk about exercise bulimia.

Bulimia nervosa is characterized by binge eating with compensatory behaviors (excessive exercise being a non-purge type of bulimia along with laxatives, etc) once a week for three months.

We have likely heard of binge eating and likely heard of bulimia, but we usually we don’t think of exercise bulimia as a thing. Or at least I didn’t until I heard a physician talk about a patient who had “exercise bulimia.” I had no idea that it was even a descriptive diagnostic term.

Bulimia Nervosa

I am sure you have all associated bulimia nervosa (OK just bulimia) with bingeing and purging. This eating disorder occurs mostly in women and may be due to a compulsion to be thin.

Bulimia as mainstream America knows it is bingeing and barfing. It’s eating great amounts of food in a small window of time (usually two hours or less) and then purging it out.

However, the purge part can be any compensatory behavior like the inappropriate use of laxatives, diuretics, or other medication and even excessive exercise.

Exercise Bulimia

This used to be a subset of bulimia in the DSM 4th ed, but changes were made and now it is just under bulimia nervosa.

This “type” of bulimia if you will, is harder to recognize. There are no trips to the bathroom, no problem with swelling of the salivary glands and face due to excessive vomiting, and none of your teeth rotting out of your head.

This can be overlooked very easily, especially if the person is good at hiding their bingeing habits from others. Some things to look for in someone with this type of exercise purging:

• Working out even through injury and sickness
• Exercising for hours on end
• Excessive depression if they cannot exercise for any reason
• Defining self-worth by what they can do at the gym
• Missing work or other important events to workout
• Exercising in secret; not telling family members how often they are exercising
• Difficulty sleeping
• No interest in hanging out with friends/loved ones
• Amenorrhea

Now, don’t get all weirded out with the above. Some of us have done bodybuilding competitions and would classify most of these as true for us.

When I am in the throws of getting dialed in for a competition, almost all of these apply... Well except for the last one, I am in full blown menopause, so there’s that.

This is one of the reasons it is so hard to really diagnosis this kind of bulimia. A lot of us that love the gym may find this die-hard gym goer admirable and want to emulate his or her drive.

How to Treat Exercise Bulimia

Obviously, an exercise bulimic needs to recognize they have a problem. That truly is half the battle to any issue anyone has that is interfering with their lifestyle in such a way as to be destructive.

There are two types of treatment - traditional and non-traditional. Let's go over the traditional first - I mean, age before beauty, right?

The Traditional Route

The traditional route is just that - since this is a psychology-driven disorder, it stands to reason to speak with a psychologist or therapist about this behavior.

Another professional that the exercise bulimic should consult is with dietitians so that they can work on a healthy diet; however, I have never seen that actually happen on an outpatient basis unless this is specifically for an eating disorder clinic that has a dietician on site.

Talk therapy can help flesh out the root cause for people with exercise bulimia. This could stem from anxiety or depression or a trauma in their past.

Psychotherapy

Psychotherapy attempts to address underlying issues that are affecting one's bulimia. This is done usually with a good deal of time and financial investment as well.

This is basically talk therapy which gives you constructive ways of dealing with problems or relationship issues.

Cognitive Behavioral Therapy

This type of therapy focuses on identifying the dysfunctional thought patterns and beliefs that perpetuate their behavior and tries to get a person to understand and identify their irrational thought process. It is usually time-limited and can go hand in hand with medication.

Unfortunately, bulimia, in general, is difficult to treat. With exercise bulimia, it's even harder to detect, as we often associate these exercise behaviors with health.

Chances of relapse are high. It stands to reason that maybe counseling and in-patient treatment may not be the end all be all. This is where the non-traditional route comes in.

The Non-Traditional Route

I have found that talk therapy can leave a client in victim mode. Yes, I said it. Someone else is in the driver's seat, talking about how you should do things.

Now, this is also my own opinion since I get to write this article; but I do know a thing or two about suffering from true binge eating disorder, but we will likely not get into that too much here.

Habit Hypothesis

One non-traditional route that is being utilized more often is the “habit hypothesis” that is described in Scientific America’s article on Anorexia Nervosa. In individual psychotherapy sessions, they found a number of cues that went along with the habits that contributed to the subjects continued anorexia.

Once they were able to redirect the subjects cues, new habits replaced habits that were detrimental in the client's recovery. Little by little, behaviors were changed. New habits formed.

These positive habits of recovery are like little wins, and success is easier, bringing about positive reinforcement. Although this scenario was done with a client with anorexia, this stands to reason this would also work for most diagnosed eating disorders.

Acupuncture

Acupuncture is a form of Chinese medicine. An acupuncturist inserts needles into specified meridians of the body to improve symptoms of depression, physical health, and mental health. This is used for different forms of disease processes and has been found to also have some effect on eating disorders.

Relaxation Therapy

I know that massage makes you a little nicer, but as a therapy it can increase levels of serotonin and dopamine. This aids in decreasing levels of depression.

Do I think this therapy should be used alone? No, I believe this therapy would work in conjunction with other therapies but certainly not as a stand-alone therapy.

How to Get the Exercise Bulimic to Slow Down?

• Plan changes in your exercise routine to be less strenuous.
• Write down changes you plan to make and journal how you are feeling. This helps you become more aware of your feelings and patterns in your behavior.
• Make exercise fun - the exercise bulimic is usually so hyper-focused on purging the food, that they are intent at making exercise as intense as possible; making it fun can stop that focus.
• Make yourself have a rest day. It will be miserable—at first. Your body has likely been whipped like a horse and needs some downtime.

This is all good, but now what about the bingeing part?

You have to treat exercise bulimia as bulimia, and as such know that exercise is the purge part, but the bingeing part is intrinsic to bulimia. You should go with what works for you.

In my own opinion, I have seen the best results with habit change. Now, I know that I do not have exercise bulimia; however, that does not mean I have not been treated for an eating disorder - binge eating disorder to be more precise.

I have done talk therapy, scream therapy (and it really was a scream... Pun intended), I have crawled on my belly (oh, because I missed that part of my creeping stage as a 1-year-old), I have been to neurologists, psychotherapists and have taken medication.

You name it I have done it. What worked for me was habit change. The cue and response to that behavior was life-changing for me, however, others it may be cognitive therapy or psychotherapy or a blending of any of the above therapies.

Conclusion

Eating disorders are extremely difficult to treat. Not only does the person who has exercise bulimia have to acknowledge there is an issue, but then they have to find the right therapy for them. The difficulty in all eating disorders is that there is a payoff somehow.

The client gets some sort of pleasure from the bulimia. There is also extreme pain involved as well. Doing talk therapy and cognitive therapy may help a person with exercise bulimia really look inward and figure out why the really want to stop.

A combination of psychotherapy and the “habit hypothesis” can be the winning combination for some; however, many go untreated as exercise bulimia is extremely difficult to diagnose.