Karen came to my office due to feelings of depression and helplessness. She revealed that she spent countless hours at the gym exercising and pushing her body to its limits and still felt fat and unattractive. Though Karen would appear slim, physically fit and attractive in anyone’s eyes, she felt trapped in a cycle of binging on food followed by excessive exercising, leading to exhaustion and injury. She stated that her exercise routine had began to take precedence over coming into work or meeting friends socially and that missing her 3-4 hour workout could lead to feelings of depression or irritation. Karen is suffering from what mental health professionals would call exercise bulimia. Exercise bulimia is an eating disorder that is now considered to be almost as dangerous as anorexia yet much more difficult to detect as the individuals affected seem to be merely health fanatics. Exercise bulimia is characterized by binging on food, followed by an impulse to “purge” the excess calories consumed, by exercising it off. It is estimate that nearly 5 million people in the United States suffer from eating disorders and that close to 12% of gym goers are exercise bulimics. What distinguishes an exercise bulimic from a health fanatic is the intention or motivation behind the exercising. Exercise bulimia is not as much about physical health and fitness as it is about self-esteem, perfectionism, and control. To an exercise bulimic missing exercising throws them into a state of panic or depression as thoughts of getting fat preoccupy every moment of their life. It is believed that bulimics have an underlying depression, which they try to assuage with food as if trying to fill a bottomless void. This is then countered by severe feelings of guilt and shame that are experienced as a result of overeating. Exercise is then no longer viewed as a desired healthy activity but as a punitive and necessary measure to stave off the possibility of weight gain and the intolerable feelings of self-loathing. Exercise bulimia is quite difficult to detect as exercise is considered to be a healthy and desirable activity in our society. A physician may first suspect there might be a problem when a woman gets amenorrhea or stops menstruating due to a drop in estrogen levels associated with over exercising. Exercise bulimia can also lead to physical harm when a woman’s body fat drops below normal levels and she begins to injure easily.
Exercise bulimia is a disorder and may be a symptom of deeply rooted emotional issues originating from specific family dynamics or past traumatic experiences such as sexual or physical abuse or loss of a loved one. It was found that bulimics often come from families where food was used as a way of controlling behavior and conflicts about eating ensued around the dinner table. Some bulimics report having critical and perfectionist standards imposed on them, which set them up for chasing an elusive self-image and never being good enough. Some other possible causes for developing bulimia may have to do with an individual’s inability to express or experience negative feelings. Perhaps negative emotions were not tolerated in their family and eating became a way of coping with unexpressed feelings of anger, frustration or sadness. How many of us clearly remember the childhood message: “Eat this, it will make you feel better”, a clear message that our feelings could be “treated” with food. Food then becomes the drug of choice for bulimics who thus learn to self medicate their depression or anxiety.
Some traditional treatments for exercise bulimia are support groups, cognitive behavioral therapy, psychotherapy or psychotropic medication. Recently it has been documented that bulimics are highly suggestible and respond well to treatment with hypnosis and guided visual imagery. Guided imagery allows for the individual to create a new body image that is self-accepting and self valuing. According to research, hypnotherapy was found to be an effective treatment intervention with bulimics as it focuses on providing suggestion to eliminate the symptoms of the destructive behavior as well as creating an opportunity to gain insight into the underlying issues that created the symptoms in the first place. The goal of treatment for exercise bulimia whether it is group therapy, psychotherapy, or hypnotherapy is to allow the individual suffering from exercise bulimia to gain awareness regarding the underlying triggers for bingeing and explore feelings of panic, or being out of control. It is also important to get in touch with the restricting or purging behavior and cultivate a healthy body image, by releasing perfectionism and achieving self-acceptance. The first step for an exercise bulimic to take is to acknowledge that they have a problem, which transcends staying slim, and being attractive and understand that they may need professional help. Ultimately this will lead them on a path to healing and self-discovery as well as achieving a greater physical and emotional health.