By Mary Anne Cohen, LCSW, BCD
A neighbor of mine challenged her overweight husband to lose weight, and so she bought him an exercise audio CD. He responded cheerfully, "Great! I'll listen to it in the car as I drive to work!" We all had a good laugh at the lengths he went to avoid exercise.
Americans have a complicated relationship with exercise. Mark Twain once declared, "Whenever I feel the urge to exercise come on, I lie down until it passes." This comment is echoed by Lucy, of the comic strip Peanuts, "Exercise is a dirty word
Every time I hear it, I wash my mouth out with chocolate."
We are amused by these remarks because we all recognize that avoiding exercise is not healthy and that daily exercise benefits us greatly. We burn calories, discharge stress, improve our circulation, and lower our blood pressure; we sleep better and feel a sense of wellbeing from challenging our bodies.
So we ask ourselves: If exercise is good, shouldn't more exercise be better?
Not necessarily. Sometimes exercise becomes too much of a good thing. Instead of being a supportive friend, it becomes our worst enemy. Ellen represents the opposite side of the coin from healthy exercise. Ellen sets her alarm for 5:30 AM to go out running before school, she plays tennis five days a week, and works out on her treadmill most nights. Ellen cannot stop exercising even when she is tired or sick.*
Ellen is one of a growing number of women and men who has developed an exercise addiction. Because we hold exercise in such high esteem, we admire and envy those who devote great amounts of time to working out. Keeping fit has become a national pastime, and we often don't realize when we, or someone we care about, is out of control with exercise.
Many terms have been put forth to describe behavior like Ellen's: compulsive exercise, exercise bulimia, exercise abuse, exercise dependence, and obligatory exercise. Exercise is considered excessive:
1. When it significantly interferes with important activities Marie often skipped family parties because she had to go to the gym. Sometimes she also skipped homework or cancelled going out with friends in order to finish her workout routine.
2. When it occurs at inappropriate times In the throes of her addiction, Suzanne exercised late into the night with her bedroom light turned off. While her family slept, she was doing crunches.
3. When it occurs in inappropriate settings Jessica, another exercise addict, ran in Prospect Park before sunrise while it was still dark despite the potential danger.
4. When the person exercises despite injury or other medical complications Jeff had developed a stress fracture from jogging but continued despite increasing pain. Stacey developed a painful "tennis elbow" but felt compelled to keep on going.
5. When guilt, anxiety, or depression occur if a workout is missed Exercise addicts use exercise to cope with depression or anxiety, and they experience guilt and unease if unable to perform their exercise ritual.
6. When the person does not take any days to rest or recover between workouts The driving compulsion to keep exercising prevents the person from moderating their routine to allow the body a chance to recuperate.
The correct name for exercise addiction is "exercise bulimia" and this is actually a form of an eating disorder. Bulimia refers to recurrent episodes of binge eating of large amounts of food. The bulimic feels a loss of control over his/her eating and tries to compensate for the calories ingested.
There are two types of bulimia:
The Purging Type: The person regularly resorts to self-induced vomiting or the misuse of laxatives, diuretics, or enemas.
The Nonpurging Type: The person uses other inappropriate behaviors to compensate for unwanted calories, such as fasting or excessive exercise.
Compulsive exercise has little to do with the pleasure of movement and health. Its roots lie in struggles having to do with fear, self-esteem, perfectionism, and control. Marsha described an inner pressure to continue her strenuous jogging regime despite having injured her knee. She had created a punishing routine for herself that was wearing her out but she couldn't stop. Unlike most exercise bulimics who just want to be left alone to practice their compulsion, Marsha was exhausted and came to therapy to figure out how to help herself.
During the course of her therapy, Marsha expressed a deep anxiety about her aging father's impending death. She felt powerless and out of control to rescue him from his illness but, while jogging, she would have temporary relief from her worry about him. "I feel on top of the world when I'm jogging. It's like a high. But afterwards my body aches and I feel empty inside." As a teenager, Marsha worried about being fat and had gone on fasts and liquid diets with a brief period of anorexia. We discovered that this occurred around the time her grandmother was dying. It was very helpful for Marsha to see her pattern the loss of someone she loved made her reach for something to take away her pain. Focusing on dieting or fat or calories or weight or exercise presents a temporary sense of control over painful feelings.
In the course of her therapy, Marsha began to feel a lot worse. As she moderated her workouts, she lost the escape from her fears that jogging provided. She became more depressed as she no longer could hide from her emotional stress. Often patients will leave therapy at this point in an attempt to avoid facing their pain. But Marsha did not "run away." We helped her through "anticipatory mourning" about her father's looming death and also to resolve some buried guilt about her grandmother's death that she had never confronted. Although Marsha felt worse before she felt better, she concluded, "Having the courage to face my inner demons actually made me feel stronger. My never-ending need to develop strong muscles ebbed when I felt stronger emotionally."
If you are concerned that you may exercise too much, consider the following questions:
1. Do you find that you pressure yourself to exercise more if you overeat?
2. Did your interest in exercise begin with a desire to lose weight?
3. Do you fear if you don't exercise every day you'll gain weight?
4. Are you preoccupied with being thinner and have a lower body mass/lean muscle ratio as athletes do?
5. Do you ever vomit, take laxatives, or diuretics after eating?
6. Do you feel virtuous when dieting, restricting your dietary intake, or exercising?
7. Do others tell you that you exercise too much?
If you answered even half of these questions with a "yes," you may be exercising too much. It is important to see a health professional, such as a doctor, therapist, or nutritionist. Many compulsive exercisers find they need therapy to help them deal with exercise bulimia. Like Marsha, you may feel stronger after tackling your problems directly rather than trying to exercise them away.
*All names changed for confidentiality.
Mary Anne Cohen is Director of The New York Center for Eating Disorders. This is an excerpt from her book, French Toast for Breakfast: Declaring Peace with Emotional Eating which is available for 9 Continuing Ed credits: