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Some people can't stop exercising. They just can't get enough. They are so obsessive about exercise that they have to be treated for a condition called exercise bulimia. Part of their treatment, oddly enough, is more exercise.

Bulimia is a condition that compels people who have it to purge their bodies of what they feel are excess calories. Some methods of purging are, well, icky. There are people who purge by inducing vomiting, taking laxatives, dehydrating themselves with diuretics, or revving up their metabolisms with caffeine.

And there are people who get rid of calories their bodies actually need with exercise. These are people who are living with a condition called exercise bulimia.

When I was doing an internship in Washington, I shared a run-down walk-up flat with another intern who probably would have been diagnosed with exercise bulimia. I'll call him Dave. My roomie and I didn't have lots of money for entertainment. I'd go to the National Zoo, or maybe a free concert on the Capitol steps. But Dave didn't need free entertainment options. Dave took long runs every day. He would leave our building two blocks from the White House and run to the Washington Monument. Then he would circle the Smithsonian and run to Georgetown. Then he would find something new on the way back.

Dave ran 20 miles (32 km) every day. Seven days a week. No matter what the weather. Dave also ate paleo before anybody ever heard of paleo. Dave was determined to maintain a nearly-zero body fat.

Nearly four decades later, Dave is still a runner. He's had a wonderful life and he's been a blessing to many people. But he had to make some adjustments to keep exercise from taking over his existence. Dave had to overcome exercise bulimia.

What's the formal definition of exercise bulimia?

Exercise bulimia is a condition also known as hypergymnasia, compulsive exercise, excessive exercise, or anorexia athletica. It has some of the features of an eating disorder, in that people living with the condition exercise compulsively to make sure they don't get fat, but it also has features of OCD (obsessive-compulsive disorder).

A loose definition of exercise bulimia is feeling compelled to perform a preset pattern of exercise every day, for more than an hour a day, in a way that interferes with life activities. When your exercise interferes with your other goals in life, you have a problem.

So, does exercise bulimia mean you're some kind of exercise nut?

Not at all! A diagnosis of exercise bulimia usually does mean you have some issues with:

  • Perfectionism. People who live with exercise bulimia have a body image they just can't compromise. It may not be an unrealistic body image, as is usually the case in anorexia, but it is a fixed idea of what their shape and weight are supposed to be.
  • Low agreeableness. People who can be diagnosed with exercise bulimia don't see a way to compromise on their exercise routines. They just don't see an alternative.
  • Narcissism. This doesn't mean someone should be compared to the body's lower digestive orifice. This just means that they really, really need their me-time.
  • Neuroticism. People who have exercise bulimia may go off the handle when they don't get their exercise. An example is the long-distance runner who becomes frustrated in the ER after breaking a bone because she hasn't exercised in several hours.
  • Extraversion. In this case, the outward-looking elements of personality look out to exercise, not to people.
There isn't a pill you take to get over exercise bulimia. (Sometimes medications for anxiety are helpful in dealing with the transition to a lifestyle in which you take charge of exercise, exercise doesn't take charge of you.) But there is a role for exercise in your life even while you recover from exercise bulimia.

Exercise for exercise bulimia. Really?

Part of a program for overcoming exercise addiction is taking charge of your life, including exercise. Here are five general ways people who suffer hypergymnasia can achieve eugymnasia, just the right amount of exercise:

  • Self-awareness. People who are addicted to exercise first have to realize how much their lives are taken over by exercise. Fortunately, there's an app for that. Various tracking devices give objective feedback on just how much time and energy their users invest in exercise.
  • Structure. People who live with exercise bulimia need to set limits on exercise and stick to them without second-guessing or negotiation. The magic number for hours of exercise per day is usually one. Exercise bulimics usually have to resolve to exercise an hour a day and only an hour a day, end of discussion.
  • Variety. Exercise for exercise bulimics is usually from the Sturm und Drang ("storm and stress") school of physical fitness. Not many exercise addicts actually listen to Wagner as they work out, but it's almost as if they are waiting for the Valkyries to sweep them off to Valhalla before they quit. It's important to ease off on routine, and to try new things. Or maybe just go about exercise slowly enough to let something new happen.
  • Exercise ed. When you are addicted to exercise, you usually aren't learning new things about exercise. It's possible to become addicted to exercise information, too, but spending some time every week, although not every day, learning more about medicine, physiology, and exercise technology opens you up to new ways of enjoying physical activity.
  • Listening to your body. Learn to say "ouch." Don't suppose there's always pain before gain. Get in the habit of just saying "no" to exercise.

Exercise bulimics can be terrific people. My old buddy Dave has led an exemplary life. But exercise bulimics are happier people when they get their compulsion to exercise under control.

  • Pettersen G, Rosenvinge JH, Bakland M, Wynn R, Mathisen TF, Sundgot-Borgen J. Patients' and therapists' experiences with a new treatment programme for eating disorders that combines physical exercise and dietary therapy: the PED-t trial. A qualitative study protocol. BMJ Open. 2018 Jan 8
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  • Photo courtesy of SteadyHealth

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