Exercise Bulimia

What is exercise bulimia?

Exercise bulimia is a term sometimes used to describe a form of bulimia where the purging behavior used to offset the calories consumed in binge-eating, is excessive exercising.

Exercise bulimia is not recognized as a separate condition in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) ^[1], which is the manual used by mental health professionals in the USA to diagnose mental health problems. Instead, it is merely one way the purging behaviors in bulimia can manifest.

The DSM-5 considers bulimia to be one condition and lists excessive exercise as one of the possible ways an individual struggle can compensate for binging. However the term ‘exercise bulimia’ has been in use for at least 20 years ^[2] and may help some people to distinguish their experience from the perhaps better-understood forms of purging such as vomiting and laxative use.

If you have exercise bulimia, you will experience episodes of excessive eating, where you consume a large number of calories in a short time. You will then seek to burn off those calories by exercising excessively.

Exercise bulimia can have a huge impact on your life but with the right support you can recover.

Symptoms of exercise bulimia

Common symptoms of bulimia are:^[1]

• Periods of excessive eating – known as bingeing – where a large amount of food is consumed in a relatively short space of time (usually less than two hours). ‘Excessive’ is defined as ‘an amount of food that is definitely larger than most individuals would eat in a similar period of time under similar circumstances’^[1]. It does not, for example, include the large meals most of us eat during holidays such as Thanksgiving. Someone with bulimia will typically feel out of control during these binges, unable to stop themselves from eating, and may feel dissociated or in a daze. They may also feel ashamed of their behavior; binge eating often happens in secret or is done discreetly.
• Engaging in purging behaviors that compensates for the large number of calories consumed. To offset the bingeing, someone with bulimia will do something to expel or burn off the calories they have consumed, such as vomiting or using laxatives. In the case of exercise bulimia, the main behavior will be excessive or compulsive exercise. ‘Excessive’ is defined as exercising at inappropriate times or in appropriate places, where it takes precedence over other important tasks or when a person carries on exercising despite injury or illness.
• Poor self-image, based on weight and/or body shape. A person with bulimia will typically worry about how they look and have a fear of weight gain. People with bulimia tend to have a body weight that is within the normal range. They may be overweight but they are rarely obese. Between binges, people with bulimia usually follow a low-calorie diet.

The symptoms must have been present for at least three months to qualify for a diagnosis of bulimia. A doctor or mental health professional making a diagnosis will also want to rule out anorexia, another eating disorder, first.

In some people the condition may be relatively mild, with ‘compensatory behaviors’ such as excessive exercise happening perhaps a couple of times a week. For others, it will be extreme and happen more than once a day.

Causes of exercise bulimia

Bulimia, including exercise bulimia, often starts in adolescence. It is rare that it starts before puberty or after the age of around 40.^[1] It seems to affect more women than men, though it is likely that prevalence in men is underestimated.

There are a number of possible causes for bulimia, and triggers for individual episodes, including:^[1]

• Low mood or another mental health problem such as depression or anxiety
• Stress
• Following a restrictive diet
• Poor body image
• Trauma, abuse, and adverse experiences
• Problems in childhood including abuse, bullying for their weight, and early onset of puberty
• Having a family member with bulimia

Diagnosing exercise bulimia

An individual experiencing exercise bulimia would be diagnoses with bulimia. As with other mental health problems, there are a series of criteria that determine a diagnosis.

The nature of the condition means that some people may show physical signs of illness because of vomiting, laxative use or excessive exercise. These symptoms may include low blood pressure, electrolyte imbalances, dental problems, and fatigue.

Diagnosis will be done by a doctor or mental health professional following a psychological evaluation, which includes discussion of signs and symptoms, a review of medical history and sometimes questionnaires.

Treatment for exercise bulimia

The main treatment for exercise bulimia is mental health therapy. Suitable therapies include:^[3][4]

• Cognitive behavioral therapy (CBT), which explores how we think and act and can help us find ways to cope with difficult emotions. There is a particular kind of CBT that has been developed specifically for eating disorder patients.
• Other therapies such as Interpersonal Therapy (IPT), which can help you address any poor relationships that might be causing or triggering exercise bulimia.
• Family therapy, which can help you and your family understand your condition and how best they can support you.

There is no medication for eating disorders but you may be prescribed medication to treat an underlying or associated mental health problem, such as an an.

Complications of exercise bulimia

There are a number of medical complications associated with exercise bulimia that can occur if it is not treated. These include:^[1][4]

• Injuries resulting from excessive exercise.
• Short term problems from vigorous exercise such as tiredness, dehydration and injuries.
• Longer term problems from over exercise such as osteoporosis, arthritis and heart problems.
• Problems with menstruation, such as an irregular cycle or periods stopping altogether.

People with eating disorders are also at an increased risk of suicide. However, early recognition of symptoms and commitment to treatment can help patients to successfully manage their symptoms and live a full life.