Compulsive Exercising During Eating Disorder Treatment

Parents struggle with their child's wanting vs needing to exercise during eating disorder treatment. We wonder if exercise is healthy or not, and how much exercise is okay (Eating Disorders: Compulsive Exercise In Teens). Here's what I've learned to listen for: "want" vs. "need."

Putting Compulsive Exercise in Perspective

100 years ago, I doubt many people formed the thought or words to say "I need to go burn off this dessert" and, in most of the world today, it would still be an absurd thought. Feeling guilty for eating, or the idea of having to compensate for consumption, is a luxury of abundant calories and earning one's living without physical labor.

But even in modern society, this thought of "getting rid of," "making up for," "burning off" and "earning" through deliberate exertion has to be divided into two ideas: "I want to run" and "I have to run."

When Moving the Body Feels Right It's Not Compulsive Exercise

Exertion can feel good. The endorphins of a satisfying tennis game, run in the park, dance class, bike to work - these are ideally a "want to." These are the signs of a person who is enjoying their body and living fully. These are natural responses to a physical need to be active and stay active. This is not about manipulating one's appearance (though we often phrase it that way), but about maintaining balance in life. It is natural and healthy to be active and to listen to that impulse; just as we do hunger and sleepiness.

Feeling the Burn of Compulsive Exercise

But there is another impulse, and it is a darker one: "I HAVE to." This one is based in obsessive thoughts and compulsive behaviors. It is based in distress about not performing these tasks, and negative thoughts. It is a punishing and unsatisfying impulse for which there is rarely any satisfaction. Words like have to, must, can't miss, should are used more often and with more emotion. This is the kind of impulse that, if thwarted by unexpected schedule changes or injury, leads to emotional crisis and physical distress. This is the kind of compulsion that takes on a life of its own as the routine is continually expanded to "make up for" possible changes in routine or other obligations. This second kind of impulse can be a sign of mental illness.

I recently watched a video at an eating disorders conference shown by Dr. Cynthia Bulik, a F.E.A.S.T. Advisor and prominent scientist in the eating disorder field. The video showed a white rat on a wheel compulsively exercising. It had been deprived of food and was being observed as it continued to run and if allowed to would have continued until it died. This is what happens in anorexia patients as well. Despite exhaustion and energy depletion, muscle wasting and heart damage, they cannot stop without outside intervention. It is not that they want to move, it is that they "have" to keep moving. Somehow seeing it in a rodent on a fruitless circular quest offers perspective on the lady on the Stairmaster at your gym. It isn't a "want," it is a symptom. It isn't something to scorn or pity: it is a symptom requiring intervention.

We need to intervene with compassion and optimism when eating disorder patients are compelled to remain active despite energy depletion. Compulsive exercise, an eating disorder symptom, is not a choice, and can't be treated as willful or tolerable. Loving, firm, and temporary boundaries around exercise are something we can do to help restore the brain and body of our loved ones. Anger, arguing, and despair on our part only feed the guilt and widen the isolation. We can act to interrupt this symptom and help our loved ones recover fully.

Exercise is not "good" or "bad." Understanding the difference between "want" and "need" that helps us respond best.