Excessive Exercise & Eating Disorders – Movement of Recovery – Part II

As we both worked on this project, the first thing we made sure of was that we didn’t call it “exercise” recovery, instead, we use the word “movement.”

There are a lot of negative connotations around the word exercise, whereas movement is a more flowy word that gets across what we are calling for in this project.

Movement is a natural state for human beings. It is something that we do in simply breathing every day. Our hope is to encourage that natural engagement rather than forcing the body to do something.

First, let’s introduce ourselves and our specific roles at Timberline Knolls.

I (Maggie) work as the Director of Nutrition Services with Timberline Knolls. In this position, I get to do creative things such as working with peers to come up with what our residents need in the moment.

I (Natalie) am a Dance Movement Therapist (DMT), yoga specialist, and trauma specialist at Timberline Knolls. I lead DMT and yoga groups as well as regular, verbal, counsel and process groups with psychoeducation.

We see a significant overlap between eating disorders and trauma, so, we work to support individuals in working through that. In addition to our jobs, we work with a Dietary Team, a Therapy Team, Physicians, and an Admissions and Discharge Team.

In this article series, we will discuss some practical ways to incorporate movement into treatment.

Function of Eating Disorder Behaviors

Focusing on the functions of eating disorders is essential so that we’re looking at how the disorder formed, and from where the behaviors came. One aspect we see is experiential avoidance, so, maybe an individual is experiencing an external issue, but, the issue becomes internal because it feels like a safer place to put it or cope with it.

As such, disordered behaviors sometimes become the solution to this problem such as restricting, binging, purging, body-checking, obsessive thinking, etc. These behaviors are often compensatory and become compulsive.

We look at these behaviors from the perspective of, the individual thinking it serves a particular function and that gives us a little bit more information and flexibility around what we can do to help them address that need.

Self-awareness can also be an essential function that may play a role in behaviors and be helpful in recovery. We try to support residents in building more self-awareness so that they can start to understand on their own and can have more power over their choices and what they do in treatment.

These are the main functions that we work to learn more about and understand in our work.

Excessive Exercise & Eating Disorders

What is Excessive Exercise?

Defining “excessive” exercise can be difficult because it is viewed as such a “healthy” habit. As a result, there is a lot of misinformation out there. According to the DSM-5, the behavior must be recurring, on average, at least once a week for three months.

That may not seem like a lot, and, many of our Timberline Knolls residents would fit into that description.

With that, it becomes up to use to determine whether it is excessive or problematic, looking at whether it occurs after a binge for example or asking that crucial question above – is it keeping them from engaging in a meaningful life?

I (Maggie) often describe an over-exercise symptom giving the example of a client we worked with that was in high school.

She would carry around 10 to 12 books during the schools days an refuse to go to class, instead just pacing up and down the hallway.

She would share that she wanted to go to school and to class and to do well, but, she had this compulsion, she couldn’t stop moving. Another symptom is not having breaks. We always recommend a minimum of two rest days.

Other symptoms include exercising at inappropriate times, exercise accompanied with intense guilt, rigid scheduling or documentation, exercising solely for weight changes, minimizing their fear of eating, or engaging in exercise without proper nutrition.

The belief that this is sustainable, too, is a symptom because so often it isn’t sustainable for any human being. So, again, creating high expectations that cannot be met.

Exercise and Eating Disorders

The eating disorders that we see commonly paired with over-exercise would be anorexia, bulimia, and body dysmorphia. We often see this associated with the perfectionist attitudes where the function would be being perfect or trying to be “right.”

We find, with this, that there is a cycle of “never enough” and the individual always wanting more. This often leads to individuals exercising excessively despite illness, fatigue, or injury.

Individuals with eating disorders also often try to set and attain unrealistic goals, always reaching for something that is unattainable.

This is true in recovery, as individuals will create goals that may be unattainable not only for a standard human but, particularly, for someone who is trying to recover from an eating disorder.

This mentality of just “pushing through” creates a challenge in recovery because individuals are afraid that, if they let go of that mentality, they just won’t do anything at all.

We try to support them in replacing this all-or-nothing thinking with a more balanced view on what they can achieve.

Complications of Excessive Exercise

Signs that might indicate problematic exercise are exercising despite injury or sickness, avoiding social functions to exercise, or firmly adhering to an obsessive and regimented exercise routine.

An important factor in all of these is that the exercise takes away from the individual’s ability to live a full life.

Continually becoming ill because of overworking the body, missing functions or time with loved ones, or exercising so excessively that time is lost where an individual could be having fun or, even sleeping – all of these take away from an individual living a dynamic and meaningful life.

Engaging in these behaviors is very harmful to the mind and body, resulting in symptoms such as insomnia, depression, fatigue, anxiety, muscular atrophy, bone fractures, or amenorrhea.

It is important to understand that these complications don’t exist in isolation, they often combine to create a really vicious cycle.

For example, an individual may engage in excessive exercise all night, at the expense of their sleep, only to find that they can’t function as they would like the next day and, with perfectionist tendencies, this creates anxiety and depression that worsens throughout the day and as the behaviors continue.

A pattern began to emerge of individuals having both disordered eating behaviors and some pathology or pathologized behaviors or attitudes around physical activity.

Studies indicate that between 50 to 80% of individuals with eating disorders have a skewed attitude toward physical activity as a part of the symptomatology of their eating disorder.

For these behaviors to go unaddressed, it just doesn’t make sense. This is true both during treatment and after.

When individuals are discharged from a facility, they are moving from an environment with boundaries and safety constraints back into the life they were living before. They might feel a compulsion to engage in these behaviors again.

Or, they may simply want to break up the rigidity so that they don’t feel like there are not any options for them as far as exercise and movement is concerned.

These previously maintained behaviors have to be addressed so that they do not go right back into engaging in these compulsive behaviors once they return to that environment.

We want to be able to give them options so that exercise does not feel off limits, but they know how to move their body healthily. It was our belief that a group focusing on this movement would be helpful for individuals working toward recovery.

The group grew pretty organically to become a joint movement and nutrition group, as we would have a client and one of us knew the movement piece, the other had the nutrition piece down, so, it became an immersion of the two.

Benefits of Addressing Physical Activity

When clients engage in this compulsive need to excessively exercise before taking care of even their most basic needs such as sleeping or eating, where we start in addressing these behaviors is to get information on “why.”

We ask these individuals, “what does this physical activity do for you? How does it make you feel?”

A lot of individuals report that it makes them feel some kind of control, makes them feel a strong sense of power, and it made her feel strong.

One person that would do upwards of 3,000 crunches every night reported they liked the sagittal movement of it, that it felt almost like rocking, and it was self-soothing.

By looking at this during a dance movement therapy group one day, we were able to bring some flexibility into what movement might look like. With that same individual, we taught her a yoga sequence and worked with her on not needing this compensatory movement in order to meet her needs.

When she finished her stay here, the number of crunches she did each night had gone from about 3,000 to the low hundreds. She started incorporating yoga movement into her daily routine as well.

So, not only did we work to decrease the number of crunch reps she felt she needed to do, we built in some flexibility of what movement might look like, and she started to find some joy in the yoga movement. She said that it felt good, and she could express herself through it.

She also shared that it helped to reduce her feelings of anxiety, and she was able to limit some of the tremors that happened in her body from the anxiety, as well.

We also address the self-worth aspect, looking into how to uncouple that perfectionism that is tied into the exercise. We also want to decrease the need for external validation through exercise.

We want to work on individuals learning about their own movement, what is enough to them what is over and under, what do these things mean to them.

We also look at reducing shame and guilt around exercise behaviors. The more we create flexibility around what physical activity can look like, the more we can break up and change those thought patterns of, “if I don’t engage in this particular kind of exercise, then I’m not good” or “If I don’t engage in a particular kind of exercise, I have something to feel guilty about.”

There is also the benefit of exercise helping a client to restore weight. Bone density can be improved in the practice of physical activity as well as it promoting muscle-building.

All of this can help the individual to feel physically stronger as well as, potentially, mentally stronger.

Risks in Addressing Physical Activity in Treatment

Also to be considered is that we may be moving in ways that could be triggering to individuals.

There is an adult individual we worked with who had a really rigid set of exercises. She had rigid thoughts such as “50 to 60 lunges is what is best” or “50 to 60 push-ups it what has to be done, it is the only way I can stay strong.”

This individual had a trauma history, and it made sense that she was trying to build up physical strength in order to feel protected and feel like she could be a protector for her family.

We talked about other ways she could build that strength but knew, when working with her, we wouldn’t start with lunges or push-ups. This is because those are her exercises of choice that trigger the need to get through it or feel “that is not enough.”

We also want to talk about what exercise looks like post-discharge. We want to address the risk factors that come in right away such as external triggers in social media or pop culture, even family culture around exercise.

We want to encourage the use of language that is not rigid around physical activity so that individuals have that flexibility in the environment to which they are returning.

Finally, we want to look at what is coming up for individuals as they are re-incorporating movement.

I currently have an outpatient individual that had been in inpatient before and described that a couple of years ago in another facility, she did yoga maybe once a week and nothing else.

This individual struggled with compulsive exercise and had a goal to do 100 classes in 100 days, so, one every single day.

Then, she went to treatment and did yoga once a week. Since then, she has not moved and described to me a fear of movement, asking, “how will I move appropriately,” “will I go back to that?”

With this group, our hope is to bridge that gap a little bit more and decrease that scary transition.

Binge Eating & Bulimia & Excessive Exercise

Much of the above information considered anorexia, but Binge Eating and Bulimia should still be considered, as they often have misconceptions regarding exercise as well.

There are some misconceptions of people in larger bodies that their exercise has to be at high intensity and frequency. They have shame about their body image and weight.

This can be true, and it is essential to ask them how they feel about their body, as it can be a barrier to movement. We try to make all bodies feel comfortable in group and dispel any of these myths.

One individual had a trauma history of a physically and verbally abusive mom, and grandma would come and save the person from the abuse and take her out to eat.

As a result, eating became the way that she self-soothed. She developed a binge eating disorder and was in a larger body that with which she was uncomfortable.

We worked on a movement plan where, the first week, she didn’t move outside of her regular daily movement. The second week, we went for a walk once for 10 minutes.

She shared that she had shame in walking because she felt winded in walking. She felt she couldn’t do what her peers could do, so we started with very short walks.

She, eventually, built up her ability to comfortably walk around campus, and it didn’t feel like an obligation. It didn’t feel like what she thought exercise would be.

Instead, it felt comforting to her.

That is what we mean by incorporating movement in a slow and great way.

Please See

Excessive Exercise & Eating Disorders – Movement of Recovery – Part I

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Source:

Virtual Presentation by Maggie Garrity, RD, LDN, Director of Nutrition Services Timberline Knolls and Natalie Breitmeyer, DMT/Yoga Therapist in the December 8, 2018, Eating Disorder Hope Virtual Conference III: Blasting Through Bias: A Deep Dive into Underserved Populations and Global Issues 2018

Please visit the Virtual Conference page for other presentations.

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Author:

Margaret Garrity, RD, LDN is the Director of Nutrition Services and her job entails many duties. She oversees the dietitians and diet technicians, carries a caseload of adolescents, supervises the menu and meal planning stages and develops nutrition-related protocols. She also implements current nutrition recommendations, participates in community outreach and trains dietitians. Prior to joining Timberline Knolls, Maggie was the Nutrition Manager at Revolution in Chicago. She started with Timberline Knolls as a diet technician and progressed to a Registered Dietitian. Maggie attended Eastern Illinois University for her undergraduate degree in Dietetics and Nutrition and then completed her dietetic internship at Ingalls Memorial Hospital. She is a member of the Academy of Nutrition and Dietetics, Behavioral Health DPG and South Suburban Academy of Nutrition and Dietetics. Learn More About Margaret Garrity, RD, LDN 

Natalie Breitmeyer, MA, LPC, R-DMT, RYT is currently working as a licensed professional counselor, dance/movement therapist, and yoga specialist for Timberline Knolls in Lemont, Illinois. She received her MA in Counseling and Dance/Movement Therapy from Columbia College Chicago and trained as a yoga teacher with Yogaview Chicago. Natalie is a faculty member at Hubbard Street Dance Chicago’s Lou Conte Dance Studio where she teaches yoga and modern dance. Natalie engages with clients from a humanistic, culturally and trauma-informed lens, and incorporates somatic psychology, yoga philosophy, play therapy, and creative arts therapies into her clinical counseling work. Prior to becoming a counselor, Natalie worked as a freelance dance and theater artist in Chicago and Seattle. She received her BFA in Theater with an emphasis in playwriting and directing from Cornish College of the Arts in Seattle. Learn More About Natalie Breitmeyer, MA, LPC, R-DMT, RYT

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About the Transcript Editor: Margot Rittenhouse, MS, NCC, PLPC is a therapist who is passionate about providing mental health support to all in need and has worked with clients with substance abuse issues, eating disorders, domestic violence victims, and offenders, and severely mentally ill youth.

As a freelance writer for Eating Disorder and Addiction Hope and a mentor with MentorConnect, Margot is a passionate eating disorder advocate, committed to de-stigmatizing these illnesses while showing support for those struggling through mentoring, writing, and volunteering. Margot has a Master’s of Science in Clinical Mental Health Counseling from Johns Hopkins University.

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The opinions and views of our guest contributors are shared to provide a broad perspective of eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer a discussion of various issues by different concerned individuals.

We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.

Published on February 6, 2019.
Reviewed & Approved on February 6, 2019, by Jacquelyn Ekern MS, LPC

Published on EatingDisorderHope.com