Exercise and eating disorders

Exercise dependence is a common feature of eating disorders, anorexia and bulimia alike. However, the ever-astute Cathy pointed out on yesterday's post on exercise bulimia that the term really isn't that well-defined. Some people use the term to mean anyone who exercises to purge calories has exercise bulimia, whether or not they binge and purge or if their weight is "normal." Of course, I had a massive exercise dependence during both the strict AN phases of my disorder, and also for many of the phases in which I was diagnosed with EDNOS. Exercise was a way to rid myself of unwanted calories, either standard daily intake or if I ate more than I thought I should. Out-of-control binges were a much rarer phenomenon for me, so I never had a disorder that would meet the criteria for bulimia.

As the always-fabulous Cindy Bulik pointed out this afternoon on Twitter, there is a clinical difference in the different phenomena that are described under the umbrella of "exercise bulimia." Binge eating + excessive exercise = non-purging bulimia nervosa. Excessive exercise + low weight = anorexia nervosa.

Although I do understand the need to develop different formal definitions for the different disorders in which abuse of exercise is present, the existence od exercise dependence is common to many EDs. Both someone with BN and AN can have exercise dependence, but exercise bulimia doesn't have a formal definition. It is sadly common and underdiagnosed, but take the use of the term "exercise bulimia" with a grain of salt. I wish they would just address exercise addiction, or exercise dependence, or compulsive exercise* and leave it at that. These terms would also capture the significant number of people with EDNOS.

*For what it's worth, I use these terms somewhat interchangably. I know there are probably minor differences in precisely what they mean, but I think they all describe the same thing. English class dismissed.

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sayhealth said...

I agree with what Cindy Bulik pointed out. However, we must also consider that there are people who fall into low weight + binge eating + restricting + excessive exercise. What does that equal? I mean, obviously part of it would depend on the presence of a period or not (ridiculous, imo), weight, frequency of binges, etc. My guess is that they might be diagnosed ed-nos. Or perhaps non purging BN. Or, depending on if the binges were subjective or objective, how frequent they were, etc., perhaps they could be AN-b/p subtype.

Gah! I think this shows us again how desperately these criteria need to be reworked.

Carrie Arnold said...

If amenorrhea was a part of your equation, then you would have the AN-BP subtype (as the subtype calls for the definition of regular binge eating and/or purging). If the person did still have a period but was underweight, they would have EDNOS. If the person had a period and was normal weight, it would be non-purging BN.

I was using my phone earlier, so I couldn't get the link, but there's a whole (fantastic!) section in the International Journal of Eating Disorders about DSM-V and eating disorders that's freely available by clicking here.

Cammy said...

This is a really interesting issue. I tackled my thoughts/experience on it a while back (http://buildingbeautybeyondbody.blogspot.com/2009/04/anorexia-athletica-vs-exercise-bulimia.html), and that has been one of the most-viewed posts in the history of my blog. Further evidence that EDs are on a continuum, not in categories.

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I'm a science writer, a jewelry design artist, a bookworm, a complete geek, and mom to a wonderful kitty. I am also recovering from a decade-plus battle with anorexia nervosa. I believe that complete recovery is possible, and that the first step along that path is full nutrition.

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