Over-exercising, Over Activity

By Carolyn Costin, MA, M.Ed., MFCC

Accompanying with the steady increase in the number of people with eating disorders has been a rise in the number of people with exercise disorders: people who are controlling their bodies, altering their moods, and defining themselves through their overinvolvement in exercise activity, to the point where instead of choosing to participate in their activity, they have become "addicted" to it, continuing to engage in it despite adverse consequences. If dieting taken to the extreme becomes an eating disorder, exercise activity taken to the same extreme may be viewed as an activity disorder, a term used by Alayne Yates in her book Compulsive Exercise and the Eating Disorders (1991).

In our society, exercise is increasingly being sought, less for the pursuit of fitness or pleasure and more for the means to a thinner body or sense of control and accomplishment. Female exercisers are particularly vulnerable to problems arising when restriction of food intake is combined with intense physical activity. A female who loses too much weight or body fat will stop menstruating and ovulating and will become increasingly susceptible to stress fractures and osteoporosis. Yet, similar to individuals with eating disorders, those with an activity disorder are not deterred from their behaviors by medical complications and consequences.

People who continue to overexercise in spite of medical and/or other consequences feel as if they can't stop and that participating in their activity is no longer an option. These people have been referred to as obligatory or compulsive exercisers because they seem unable to "not exercise," even when injured, exhausted, and begged or threatened by others to stop. The terms pathogenic exercise and exercise addiction have been used to describe individuals who are consumed by the need for physical activity to the exclusion of everything else and to the point of damage or danger to their lives.

The term anorexia athletica has been used to describe a subclinical eating disorder for athletes who engage in at least one unhealthy method of weight control, including fasting, vomiting, diet pills, laxatives, or diuretics. For the rest of this chapter, the term activity disorder will be used to describe the overexercising syndrome as this term seems most appropriate for comparison with the more traditional eating disorders.

Signs and Symptoms of Activity Disorder

The signs and symptoms of activity disorder often, but not always, include those seen in anorexia nervosa and bulimia nervosa. Obsessive concerns about being fat, body dissatisfaction, binge eating, and a whole variety of dieting and purging behaviors are often present in activity disordered individuals. Furthermore, it is well established that obsessive exercise is a common feature seen in anorexics and bulimics; in fact, some studies have reported that as many as 75 percent use excessive exercise as a method of purging and/or reducing anxiety. Therefore, activity disorder can be found as a component of anorexia nervosa or bulimia nervosa or, although there is yet no DSM diagnosis for it, as a separate disorder altogether.

There are many individuals with the salient features of an activity disorder who do not meet the diagnostic criteria for anorexia nervosa or bulimia nervosa. The overriding feature of an activity disorder is the presence of excessive, purposeless, physical activity that goes beyond any usual training regimen and ends up being a detriment rather than an asset to the individual's health and well-being.

In her book, Compulsive Exercise and the Eating Disorders, Alayne Yates lists the proposed features of an activity disorder, a summary of which is listed below.

Features of an Activity Disorder

• The person maintains a high level of activity and is uncomfortable with states of rest or relaxation.

• The individual depends on the activity for self-definition and mood stabilization.

• There is an intense, driven quality to the activity that becomes self-perpetuating and resistant to change, compelling the person to continue while feeling the lack of ability to control or stop the behavior.

• Only the overuse of the body can produce the physiologic effects of deprivation (secondary to exposure to the elements, extreme exertion, and rigid dietary restriction) that are an important component perpetuating the disorder.

• Although activity disordered individuals may have coexisting personality disorders, there is no particular personality profile or disorder that underlies an activity disorder. These persons are apt to be physically healthy, high-functioning individuals.

• Activity disordered persons will use rationalizations and other defense mechanisms to protect their involvement in the activity. This may represent a preexisting personality disorder and/or be secondary to the physical deprivation.

• Although there is no particular personality profile or disorder, the activity disordered person's achievement orientation, independence, self-control, perfectionism, persistence, and well- developed mental strategies can foster significant academic and vocational accomplishments in such a way that they appear as healthy, high-functioning individuals.

Activity disorders, like eating disorders, are expressions of and defenses against feelings and emotions and are used to soothe, organize, and maintain self-esteem. Individuals with the eating disorders (anorexia nervosa and bulimia nervosa) and those with activity disorders are similar to one another in many respects. Both groups attempt to control the body through exercise and/or diet and are overly conscious of input versus output equations. They are extremely committed individuals and pride themselves on putting mind over matter, valuing self-discipline, self-sacrifice, and the ability to persevere.

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They are generally hard-working, task-oriented, high-achieving individuals who have a tendency to be dissatisfied with themselves as if nothing is ever good enough. The emotional investment these individuals place on exercise and/or diet becomes more intense and significant than work, family, relationships, and, ironically, even health. Those with activity disorders lose control over exercise just as those with an eating disorder lose control over eating and dieting, and both experience withdrawal when prevented from engaging in their behaviors.

Individuals with anorexia nervosa and bulimia nervosa and those with activity disorders usually score high on the EDI subscales of perfectionism and asceticism and have similar distortions in their cognitive (thinking) styles. The following list includes examples of the thinking patterns of people with activity disorders that are similar to the mental distortions in those with eating disorders.

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Medical Reference from "The Eating Disorders Sourcebook"

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