Regular exercise is healthy – but obsessive-compulsive exercise is frequently driven by an underlying eating disorder, requiring specific mental health interventions and treatments such as cognitive behavioural therapy.
The warning comes from a prominent Australian psychiatrist who has co-authored 15 published peer-reviewed papers on the topic and has been part of an international team leading new approaches in the treatment of compulsive exercise.
Dr. Phillipa Hay, a renowned eating disorders academic and psychiatrist, and Director of Wesley Eating Disorders Centre, at Wesley Hospital in Ashfield, claims a compulsive drive to exercise excessively may often stem from underlying weight- or food-related issues. Together, they can be detrimental to physical and psychological health.
According to Dr. Hay, studies have shown that compulsive exercise occurs in half of all patients with an eating disorder, up to 80 per cent of anorexia nervosa patients and up to 57 per cent of patients with bulimia.
“The combination of the two disorders is associated with poorer outcomes and longer hospitalisations, and is a predictor of relapse,” Dr. Hay said. “Obsessive-compulsive exercise also causes higher levels of psychological distress, including depression and anxiety, in people with an eating disorder, and in some studies, it has also been related to increased rates of suicide and self-harm.
“For this reason, it’s important to get help if you or a loved one is showing symptoms, which often include increased anxiety and mood changes if unable to exercise, rigid and unrealistic exercise rules or goals and the drive to exercise even when ill or injured.”
To treat obsessive-compulsive exercise symptoms and establish a healthy relationship with physical activity, body image, and diet, Dr. Hay recommends cognitive behavioural therapy (CBT).
“CBT can help change a person’s attitude, beliefs, and behaviours towards a difficult-to-manage behaviour such as physical activity, to promote exercise that is ‘healthy’,” Dr. Hay said. “This therapy also equips people with more effective coping strategies and the skills to prevent relapse. While exercise therapy is not often included in the treatment of eating disorders, studies have found that ‘healthy’ exercise for patients with anorexia can reduce eating disorder symptoms, facilitate weight gain and improve body perception, mood, and quality of life. ‘Healthy’ exercise is exactly that – exercise for health and well-being – like joining a local sports team – versus solitary weightlifting at midnight driven by fear.
“Exercise has many benefits for health, both physically and psychologically. Just 20 minutes of exercise a day is known to be anti-depressive and reduce anxiety. However, over-exercising can become an addiction that has negative consequences on health. Specialised clinics such as Wesley Eating Disorders Centre can help in the recovery, management, and prevention of obsessive-compulsive exercise in people with eating disorders.”
Dr. Phillipa Hay’s six signs and symptoms of obsessive-compulsive exercise:
1. Mood changes. Exercise becomes ‘unhealthy’ when the inability to exercise causes mood changes. Feelings of guilt, anger or irritability may arise when a person is unable to engage in physical activity.
2. Fear of stopping or reducing exercise. People may have an overwhelming fear of the negative consequences that may result if they stop or reduce exercise; such has becoming fat, or a feeling as of an inability to cope. Not being able to exercise may cause heightened levels of anxiety.
3. Strict exercise rules. A common sign of obsessive-compulsive exercise is following rigid exercise rules to avoid negative consequences. These are often linked with food consumption. For instance, a person might decide they should spend extra time exercising if they ate something unhealthy, or miss a meal if they do not exercise.
4. Setting difficult exercise goals. A fitness goal such as losing excess weight, training for a race or gaining muscle is healthy. Exercise goals become unhealthy when they are unrealistic and inflexible. Failure to meet high standards often leads to self-criticism, heightened anxiety and negative feelings.
5. Skipping other engagements. Exercise becomes compulsive when physical activity becomes the central focus of a person’s thoughts to such an extent that it takes precedence over other responsibilities. People may spend too much time thinking about, planning and engaging in exercise that they miss social engagements, or it gets in the way of work or study.
6. Exercising in poor health or circumstances. While an injury or illness may cause a healthy exercising person to rest and recover, an obsessive-compulsive exerciser will continue to workout even when it is detrimental to their physical health. The compulsion will motivate them to exercise even in bad weather despite the increased risk of other infections or ailments.