1. Exercising excessively "just because" as opposed to intentional exercise in preparation for a competition.
2. Refusing to miss a workout, regardless of weather or injury.
3. Exercising takes precedence over all other activities, including work, school and spending time with friends and family.
4. Experiencing a heightened level of anxiety if unable to engage in exercise.
5. Displaying an elevated rigidity and perfectionism with regard to exercise behaviors.
However, it is important to note that popular cultural narratives around exercise in the United States can pose significant challenges to identifying compulsive exercise -- alone or occurring alongside an eating disorder.
•Exercise is healthy. There has been a major cultural shift around the notion that exercise helps us, not only in supporting general health and maintenance of a healthy weight during an obesity "epidemic," but also as a tool to manage anxiety and stave off depression. This idea, and myriad variations of encouraged and acceptable frequencies of exercise (30 minutes each day; five days a week; etc.) can challenge the identification of dangerous patterns and/or normalize compulsivity, even during assessment by medical professionals.
•I am a competitive athlete. Overreaching is a common method of competitive athletes, and it is based on a principle of training that encourages the athlete to push beyond the body's current ability to improve stamina and performance. Overreaching should not be confused with overtraining, which involves excessive intensity and duration, inadequate recovery time, unhealthy psychological state and malnutrition. Athletes that are overreaching are usually taking in sufficient nutrients and "fuel" to support their purposeful training activities, whereas athletes that are overtraining are nutritionally depleted and are exercising at extreme levels "just because."
•I feel most confident when I am exercising and/or competing in my sport. Endorphins released during exercise make us "feel good." Interestingly, compulsive exercisers often present with higher self-esteem despite having lower body-esteem. This paradox makes complete sense considering the temperament of those suffering from an eating disorder. These individuals are high achievers, see the world in a rigid, "black and white" way and tend to have low reward dependence. Due to the cultural reinforcement around exercise, patients feel good about themselves because they are excelling at something considered to be a "healthy" behavior. Additionally, exercise is concrete, measurable and accepted, and individuals with low reward dependence can do it well and push themselves privately.
•There is no official diagnosis; exercise compulsion must not be a real disorder. The treatment community and the American Psychological Association agree that more research is necessary to validate a formal diagnostic category for exercise compulsion in the Diagnostic and Statistical Manual. However, exercise compulsion is a very real compensatory behavior for many individuals struggling with disordered eating.
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