Excessive Exercise in Eating Disorders

Excessive exercise (EE) is common among eating disorder patients. Indeed, in the study I’ll write about today, 39% of patients engaged in EE. Previous studies have tried to find psychopathological and personality correlates of EE but the results have been inconsistent. Some studies have suggested that impulsivity and addictiveness are highly correlated with EE whereas others found that anxious and depressive traits were more closely associated.

In a retrospective case series study involving outpatients with AN and BN, Penas-Lledo et al. found higher levels of anxiety and depression… among those who were identified as exercising excessively. The authors claimed that exercise might serve to reduce anxiety and stress in individuals with AN. In a similar study with adolescent inpatients with AN, Holtkamp et al. found that anxiety significantly predicted variance in exercise levels. These investigators proposed that anxiety symptoms in combination with food restriction contributed to increased levels

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Think You Are Not “Sick Enough” Because You Didn’t Lose Your Period? Read This.

Anonymous asked, “I’ve never lost my period. Weight restored I am naturally thin, but even at a BMI of 15 or so I always got my period (although it wasn’t always regularly). This makes me feel like I’m not actually sick because I hear about everyone losing their period.”

eatruncats replied: “To the anon who asked about losing periods: For all the times she worries about not being sick enough because she never lost her period, there are people who lost their periods at BMIs of 18, 19, and 20 who worry about not being sick enough because they never got to a BMI of 15. If you have an eating disorder, you are “sick enough.” Period.

As it stands now, amenorrhea–or the loss of three consecutive menstrual cycles–is a diagnostic criterion for anorexia nervosa. Individuals who have not lost their periods are diagnosed with eating disorder … Continue reading →

Predictors of Diagnostic Crossover and Symptom Fluctuation in Eating Disorders

Symptom fluctuation and diagnostic crossover are common in eating disorder patients. A study by Eddy et al. (2008) – who followed patients over an average of 7 years – showed that crossover between subtypes and full-syndrome diagnoses is very common : of those initially diagnosed with anorexia nervosa, almost 73% crossed over to another diagnosis (between symptoms and to bulimia nervosa). More specifically, roughly 50% experienced fluctuation between subtypes (restricting, AN-R, and binge/purge type, AN-BP) and roughly 35% crossed over to bulimia nervosa (a subset experienced both). Of those initially diagnosed with bulimia, roughly 14% crossed over to AN-BP and of those, 3.91% crossed over to AN-R.

This finding (though, well-known to ED specialists and even more well-known to patients) has important implications for treatment. For example, CBT and anti-depressants seem to have positive results in bulimic patients, but not so much in anorexics. What then, about those that crossover … Continue reading →