Exercise Bulimia vs Anorexia Athletica – Differences, Similarities, and Further Reading
We live in a world of intense social and societal pressures. These pressures – to look, act, and perform in specific ways – can dominate our lives. It is because of these pressures that many people struggle with body image and eating disorders, developing a desire to maintain a specific type of body type, even if it means sacrificing their health and wellness.
Two of the most common eating disorders are anorexia nervosa and bulimia nervosa. But these disorders are not the only way that body image issues and behaviors manifest. Sometimes, the issues are more subtle or can be confused with other challenges. This is what happens with anorexia athletica and exercise bulimia – two conditions where the focus of the person’s behavior isn’t in what they eat, but in how they exercise.
About Flourish Psychology
Flourish Psychology is a boutique private practice in NYC that specializes in disordered eating and body image issues. Led by psychologist Dr. Sadi Fox, our therapists use treatments like cognitive behavioral therapy (CBT), dialectical behavior therapy (DBT), art therapy, and many other evidence-based treatments to support adults that are struggling with their body image.
Introduction to Bulimia and Anorexia
Before we can explore anorexia athletica and exercise bulimia, it is important to understand what “anorexia” and “bulimia” are and how their eating disorder symptoms differ.
People with anorexia nervosa see their bodies with a false reality. It is not only that they desire a leaner body. It is that their reality does not make it possible for them to see their bodies objectively. If they look in the mirror, they tend to see their bodies as larger than they are.
Because they feel an intense pressure to lose weight, they essentially stop eating whole meals and instead eat very little food or nothing at all. This results in extreme caloric restriction. Starving their bodies helps them lose weight, which reduces some of the stress they feel to be thin. But it also results in being markedly underweight, and without the nutrition they need for their bodies to function properly.
Those with anorexia are also known for their *excessive* self-control, especially – but not exclusively – about food.
Unlike anorexia, people with bulimia nervosa struggle with a *loss* of self-control around food. They “binge eat,” consuming very large meals and continuing to eat even after their body tells them they’re full. However, because they also feel this pressure to lose weight, people with bulimia follow up their binge eating with “purging.” They may force themselves to regurgitate all of the food they ate, or they may take laxatives or other medications to get rid of the excess calories.
Note: It is possible for someone to eat normal meals but still purge, and it is possible for people to binge eat without purging. These are known as “purging disorder,” and “binge eating disorder,” respectively, and are considered different but related conditions.
Understanding how anorexia nervosa and bulimia nervosa differ can help make it easier to understand the difference between exercise bulimia and anorexia athletica.
What is Exercise Bulimia?
Exercise bulimia is similar to bulimia nervosa. But instead of purging the body of food through vomiting or laxatives, a person with exercise bulimia tries to purge themselves of calories by engaging in excessive exercise. Someone with exercise bulimia will either binge eat or eat a full meal, and then go to the gym and use exercise to try to burn away all the excess calories.
Exercise is healthy. It is also the most effective, doctor-recommended way to lose weight. But everything, including exercise, needs to be completed in moderation. Someone with exercise bulimia tends to go too far with their exercise habits:
They will extensively exercise, usually every day for many hours a day, and continue to go even if they’re feeling sick, hurt, or if they’re busy with other tasks.
This desire to exercise can hurt their quality of life. They may ignore other activities and tasks they need to complete in order to prioritize exercise.
By over-exercising, they become at risk for health related issues, such as myocardial fibrosis, joint pain/injury, and nutritional deficiencies.
They are also at risk for mental health issues that relate to this compulsive desire to lose weight, including low self-esteem, guilt when missing a workout, and shame over this binging/purging behavior.
Exercise bulimia can also be difficult to self-diagnose, especially in those that eat normal sized meals. Since exercise is associated with better health, and because people with exercise bulimia are eating food (although potentially in excess), many people struggle to notice when someone’s exercise habits are a disorder and not just a commitment to better health.
Although there is a risk of caloric restriction, most people with exercise bulimia are able to maintain enough calories to support the core elements of their body. It is the physical risks of overexercising and the obsession with exercise and weight that makes exercise bulimia damaging.
What is Anorexia Athletica and How is it Different From Exercise Bulimia?
Anorexia athletica shares many basic similarities with exercise bulimia. Anorexia athletica – also called hyper-gymnasia and sports anorexia – is another condition where the individual uses exercise as a way to control their body weight, compulsively exercising as a way to burn off calories.
But anorexia athletica is a slightly different condition:
Someone with anorexia nervosa is more likely to reduce their caloric intake, and is using exercise to burn away calories even further. This results in much more extreme caloric restriction than exists with exercise bulimia, though not necessary as much as anorexia nervosa.
Someone with anorexia may see their body image issues as an issue of performance, and their self-esteem may be tied to their ability to perform.
The most important characteristic, however, is the caloric restriction and caloric starvation through exercise. Exercise bulimia may develop into anorexia athletica if the individual starts restricting more and more calories in an effort to reduce their bodyweight.
Anorexia athletica also increases the risks of health complications, as people with this subtype of anorexia do not get adequate nutrition to maintain their body.
When Does Healthy Exercise Commitment Become a Mental Health Issue?
Exercise is healthy. Some people, especially athletes, often find themselves committed to exercise more than the general population, and this is not considered to be an eating disorder or mental health challenge. The difference between a healthy commitment to exercise and an exercise-related eating disorder is typically in the psychological function and behaviors that occur outside of the gym.
People with both anorexia athletica and exercise bulimia usually get no enjoyment out of exercising, and instead see it as more of a compulsion.
People with both anorexia athletica and exercise bulimia show a pre-occupation with calories and body weight.
People with both anorexia athletica and exercise bulimia are making nutritional decisions that hurt their overall health, rather than help them improve performance.
People with both anorexia athletica and exercise bulimia sacrifice their friendships, work, sleep, and happiness in order to exercise – and feel shame if they miss a day even for a good reason.
Because we’re here in Brooklyn in New York City, we see a lot of high profile clients that are often in the public eye, like actors, fashion models, and athletes. Many of these types of clients can develop exercise-associated eating disorders as they’re training for their roles or sports.
It can be difficult for someone with these conditions to seek help, and their community may not notice that they have an eating disorder because of the association between exercise and health. But if someone feels that exercise and weight management are controlling their life, a trained therapist for eating disorders offers the best opportunity to overcome them.
How Does Someone Get Diagnosed?
Most mental health professionals recognize that these behaviors are a manifestation of body image issues similar to other eating disorders. But they are not currently recognized by the Diagnostic and Statistical Manual (the DSM-V) that psychologists and therapists use to diagnose psychological disorders, and so determining when someone has one of these conditions is largely through communication with a therapist that specializes in eating disorders.
We have to look at your overall wellbeing, your behaviors, how you feel that exercise and body image are affecting your life, and more. With the right information, we can determine if you have anorexia athletica, exercise bulimia, or another condition related to psychological health.
But our belief as therapists is also that any issue that is causing you distress or impacting your quality of life is worth addressing, and the presence of a diagnosable disorder is less important than helping you feel like you are on a path toward a better and brighter future.
Looking for More Information?
If you are in Brooklyn or NYC and would like to pursue treatment for yourself or a loved one for any type of eating disorder or body image-related issue, please feel free and contact Flourish Psychology. Our remote services are also licensed to provide therapy throughout the entirety of New York State.
You can also explore our blog, sign up for our newsletter, follow our Facebook page, or bookmark our resources page, as we will be adding more information about eating disorders and mental health in the near future.
– Orthorexia Nervosa