Exercise bulimia: When working out can be an 'addiction'

MANILA, Philippines - Bulimia, a psychological eating disorder characterized by waves of binge-eating followed by inappropriate (and often disturbing) methods of weight control, shot to international notoriety in the 1980's via no less than the late Princess Diana.

Beneath her graceful exterior, Diana, shortly after her marriage to Prince Charles, had admitted to finding comfort in gorging on food 4 to 5 times a day, with bulimia serving as an "escape mechanism."

Years later, the eating disorder became associated with a compulsion for working out. Called "exercise bulimia," it is characterized by excessive exercise and no rest periods.

"Exercise bulimia is a newly recognized eating disorder. It is characterized by a compulsion to purge calories through excessive exercise. It is also known as 'compulsive exercise' or 'exercise addiction,'" Dr. Bonifacio Rafanan Jr., a psysiatrist (a rehabilitation physician) at The Medical City, said in an interview at Mornings@ANC.

He continued, "It is exercise addiction. People need to exercise to a point that it becomes excessive. There are no rest periods. People work out the entire day, and usually spend 2 to 3 hours in a gym. They are at risk of having more injuries, and despite that, they still workout."

Common warning signs of exercise bulimia, according to Rafanan, include:

- inflexibility as to time of day and mode of exercise

- exercising even when sick or injured

- prioritizing exercise over social dates, family functions, work and/or school

- intense fear at states of rest

- intense anxiety at situations where preferred method of exercise is unavailable

- intense guilt when forced to stray from exercise routine

- refusal to eat if unable to exercise.

Rafanan observed that people who are more driven -- particularly women -- are susceptible to developing the condition.

"Women tend to have more risk of having it than men, usually in the middle age group between 20 and 40 years of age. Those who tend to be very perfectionists (and) are quite rigid," he said.

Rafanan added, "People with exercise bulimia tend to count their calories (and) how much they have taken. (And) They have to make sure they do the exercises to compensate for the calories they have taken."

Treatment

According to Rafanan, people with exercise bulimia usually put a high premium on their physique, shy away from people and have guilt-trips if they don't exercise.

They are also prone to exhaustion, fainting, dehydration, tendonitis, muscle tears and other exercise-related injuries since they tend to go over the top with their workout routines.

Given this, Rafanan said exercise bulimia must be immediately -- and properly -- dealt with. Patients, for one, can seek professional help from psychiatrists, therapists, dieticians, and fitness experts.

These people, he said, can help patients identify stressors and conduct behavior modification to prevent the condition from progressing.

The Medical City, among other hospitals, offers wholistic weight management exercise programs which also deal with diet, nutrition and the endocrine system.

Rafanan stressed, however, that treating exercise bulimia, however, should be done gradually. He noted that it is ideal for patients to do exercise from once a day to 3 to 4 times a week.

"Treatment for exercise bulimia is similar to treatment for other eating disorders," he said.