Exercise and Eating Disorders

Exercise and movement play a complicated role with eating disorders. While exercise certainly has its benefits, when taken to the extreme, it may be a sign of destructive coping. This resource discusses healing one’s relationship to compulsive exercise.

athletes and eating disorders
athletes and eating disorders

Athletes and Eating Disorders

relative energy deficiency in sports
relative energy deficiency in sports

Relative Energy Deficiency in Sport (RED-S)

iMove: Helping Your Clients Heal from Compulsive Exercise By Amy Gardner
iMove: Helping Your Clients Heal from Compulsive Exercise By Amy Gardner

iMove: Helping Your Clients Heal from Compulsive Exercise By Amy Gardner

Pulling from her owen experience with compulsive exercise and from her work with many clients, Amy Gardner shows you how to help your clients move out of a compulsive exercise pattern.

Using Trauma-Informed Yoga To Treat Eating Disorders & Substance Use Disorders

Using Trauma-Informed Yoga To Treat Eating Disorders & Substance Use Disorders by Timberline Knolls

Many people struggle with the effects of trauma during their lives. But this can be especially true for people who are working toward healing from certain behavioral health conditions, including eating disorders and substance use disorders.

For those who are struggling with these concerns, trauma-informed yoga can be a powerful component of the healing process. Trauma-informed yoga is a gentle and person-centered approach to yoga practice that strives to empower participants and help them reconnect with their bodies in a safe and therapeutic way.

Characteristics of Trauma-Informed Yoga

Trauma is a person’s unique response to an overwhelming or distressing situation. According to survey data, about 61% of U.S. adults have endured at least one adverse childhood experience (ACE), and almost 1 in 6 have been through four or more ACEs prior to age 18.

Trauma-informed approaches recognize the need to support people wherever they may be on their personal paths to healing from trauma. Key components of trauma-informed care include:

  • Physical and emotional safety
  • Choice and control for participants
  • Collaboration with providers
  • The presence of trust and respect
  • Opportunities for empowerment and success

Trauma-informed yoga embraces the above principles while also incorporating the potentially healing practices of mindfulness, breathing, and safe movement. Recognizing the way trauma can reside in the body, trauma-informed yoga invites participants to connect with their physical experiences in a safe, supported way. While trauma can disrupt self-regulation, harm self-esteem, and cause a heightened sense of danger, trauma-informed yoga can begin to repair these feelings of disconnection and reestablish safety.

How Trauma-Informed Yoga Can Help

The lingering impacts of trauma can contribute to or worsen the symptoms of an eating disorder or substance use disorder, as well as complicate the recovery process. So it can be crucial for someone who is in recovery and wondering whether yoga can help to find a safe trauma-informed program.

A trauma-informed approach to yoga involves helping participants access healing in an individualized and careful way. Participants should ideally experience the following qualities in a trauma-informed yoga session:

  • The facilitator uses accessible and inclusive language to guide the class and respects each person’s bodily autonomy.
  • Healing and safety are top priorities, and each person moves at their own pace and only engages in practices they feel comfortable with.
  • The experience supports nervous system regulation and helps each participant achieve a calm and present state. This can help someone who is receiving treatment for an eating disorder or addiction establish a sense of safety and stability that can promote recovery.

For those who have eating disorders, trauma-informed yoga can also help with managing some of the unique struggles that may come with these disorders, including feelings of anxiety, shame, and low self-worth. Because trauma-informed yoga uses simple, accessible movements and lets participants determine their own experience, it can offer a safe, nonjudgmental, and healing setting for participants. Additionally, it can help deepen the mind-body connection and promote needed relaxation.

Trauma-informed yoga can also help those who are suffering from substance use disorders navigate recovery and improve their well-being. One study looked at the benefits of trauma-informed yoga for various groups, including people who were receiving treatment for substance use concerns. The study found that:

  • After attending multiple trauma-informed yoga classes, 18%-36% more students stated that they were using self-regulation skills in their daily lives.
  • Among the students who were receiving substance use treatment, a majority said that yoga was a helpful part of treatment and that they learned skills that helped them abstain from substance use.

Finding the Right Trauma-Informed Yoga Programming

Trauma-informed yoga can offer many pathways to better well-being and be an excellent complement to traditional therapies. But it is not a one-size-fits-all approach. If someone is receiving treatment for an eating disorder or substance use disorder, it can be helpful for them to be their own best advocate. Many treatment programs and providers offer yoga that is trauma-informed, but an effective program ideally honors individual needs and promotes emotional and physical safety at each step. Recovery is a process, and yoga can play a healing role when it meets someone where they are on their journey.

Eating Disorders a Danger for Competitive Young Athletes

Eating Disorders a Danger for Competitive Young Athletes

By Timberline Knolls 

For many parents, getting their children involved in athletics is a top priority during their young ones’ school-age years.

Participating in sports helps children get regular exercise, develop lasting friendships, and learn valuable skills like leadership and teamwork that extend outside of the playing field.

But as some kids advance in certain sports and look for any possible competitive edge, there can be obstacles along the way that can have dangerous consequences. One of the most serious hazards for many young people who are striving to be the best athlete they can be is the risk for developing an eating disorder.

The pressure to excel 

Though it’s certainly possible for an athlete in a team sport to develop an eating disorder, these dangerous health conditions are more common among those who play sports that have a strong focus on appearance, diet, and weight requirements. These can include:

  • Track or cross-country
  • Gymnastics
  • Wrestling
  • Figure skating
  • Dancing
  • Swimming or diving
  • Boxing

There’s also the individual aspect of many of these sports. Figure skating and gymnastics, in particular, place an athlete as the center of attention in what is often tightfitting clothing. The spotlight and pressure to strive for perfection, both in sport and in appearance, are immense.

That can lead a young person to consider habits that seem simple enough on the surface but, as you look further, are often the precursors to disordered eating. Calorie counting may turn into dieting, which can lead to excessive exercise. All of a sudden, a young athlete’s quest to be their best may take a sharp turn toward an unhealthy spiral that requires professional help.

The types of eating disorders that affect athletes

 The most common eating disorders in athletes are anorexia nervosa, bulimia nervosa, and binge-eating disorder. It’s important to understand how they differ so that you can look for signs of these disorders if an athlete you know may be struggling.

  • Bulimia nervosa: This is marked by repeated episodes of eating a large amount of food at once, called bingeing, and then doing something to avoid weight gain, such as purging.
  • Anorexia nervosa: Athletes who are living with anorexia tend to eat very little and severely limit the types of food they eat. Severe calorie restriction can lead to extreme thinness, a badly distorted body image, and fear of weight gain.
  • Binge-eating disorder: This is a loss of control over what you’re eating and how much. People who have binge-eating disorder eat a large quantity of food without purging, which often leads to guilt and shame.

These aren’t the only disordered eating habits a young athlete can struggle with. Athletes can also be prone to conditions that are not recognized as clinically diagnosed eating disorders but are still frequent and potentially as dangerous.

These include orthorexia, an unhealthy focus on clean, healthy eating that can lead to malnutrition, and compulsive exercise, which can lead to muscle soreness, osteoporosis, an increased risk for injury, and loss of a menstrual cycle.

Warning signs and how to help

If you notice a young athlete who seems to be increasingly concerned with weight limits or goals, weight check-ins or measurements, or who exercises frequently away from their sport, it may be time to take further action.

If you see things like dehydration or changes in your child’s hair, skin, or nails, it’s likely time to consult a physician or mental health provider. But there are also steps you can take even if you’re not noticing red flags.

  • Try to make sure that your child understands that what they see on social media isn’t always real. Many fad diets and improper weight loss techniques begin here.
  • Talk to your child’s coach to see if they’re a positive influence and not someone who makes negative remarks about weight.
  • Find coaches who stress motivation and enthusiasm rather than body size and shape.

Eating disorders are extremely dangerous conditions that can derail a young athlete’s career — and their long-term health. By understanding what to watch out for — and the right steps to take if you notice any warning signs — you can ensure that your child is happy and healthy in competition, at school, and at home.

Recognizing Anorexia Athletica in Athletes

Recognizing Anorexia Athletica in Athletes

By Timberline Knolls Staff

Anorexia athletica, also known as exercise bulimia, is a type of eating disorder that involves excessive exercise in athletes. The disorder is similar to anorexia nervosa, a condition that involves restrictive eating. With anorexia athletica, a person may restrict their diet as well as overexercise, resulting in dangerous weight loss and malnutrition. Anorexia athletica can be difficult to detect, but it is important to receive treatment for the disorder  as soon as possible to avoid physical and emotional damage.

Understanding Anorexia Athletica

Anorexia athletica is an eating disorder that affects athletes. Typically, the more physical activity you get, the more calories your body needs. However, those who struggle with anorexia athletica consume limited calories despite their high activity levels.

The restrictive eating of anorexia athletica is similar to that of other eating disorders like anorexia nervosa. Focus on appearance, distorted body image, and fear of weight gain can also be present in those who have anorexia athletica. However, individuals who have anorexia athletica may not meet all the criteria for other eating disorders, making it an eating disorder not otherwise specified (EDNOS).

What Causes Anorexia Athletica

Anorexia athletica can be difficult to detect because exercise can be healthy and an essential part of training for athletes. An athlete’s dedication to their sport may even be mistaken for the symptoms of anorexia athletica. Athletes are typically under immense pressure from coaches, teammates, and peers to be in the best shape they can be. Unfortunately, many sports have an emphasis on losing weight and even require regular weigh-ins, which only exacerbates the problem.

Participation in sports in which athletes feel pressured to lose weight in a short amount of time, like wrestling and boxing, may also increase an athlete’s risk for anorexia athletica behaviors. According to one study, 33% of male athletes in weight class sports showed signs of an eating disorder. For women in weight class sports, nearly 62% of athletes reported disordered eating.

For some, low self-esteem and negative body image may also play a role. Sports like gymnastics, swimming and diving, and dance involve tight-fitting uniforms that may worsen body dysmorphia for athletes.

Eating disorders like anorexia athletica are considered mental health conditions, and other mental health disorders, such as anxiety, depression, and obsessive-compulsive disorder, may increase a person’s risk for developing an eating disorder.

Warning Signs of Anorexia Athletica

While anorexia athletica may go undetected even by the person who is struggling with it, there are some warning signs to watch closely for. One of the main signs of anorexia athletica is restricting calorie intake. Restricting calories can result in some noticeable side effects, such as:

  • Difficulty concentrating
  • Lack of energy
  • Fatigue
  • Irritability
  • Increased recovery time between workouts
  • Frequent injuries

The other major sign of anorexia athletica is excessively working out. This can involve feeling anxious, angry, or guilty when having to miss a workout and becoming defensive when told that they work out too much.

Left untreated, the symptoms of anorexia athletica can lead to damage to the bones and joints, a weakened immune system, arthritis, osteoporosis, and irregular menstruation. It is important to take the signs of anorexia athletica seriously and seek treatment for the disorder right away to prevent future damage.

Treating Anorexia Athletica

Anorexia athletica is treatable and requires the right mental health, nutrition, and fitness care. Therapy from a mental health professional can treat the symptoms of a range of eating disorders, including anorexia athletica. During therapy, an expert will discuss patterns of thinking, coping, and behavior to determine the root cause of anorexia athletica.

An important part of anorexia athletica treatment is discussing nutrition and how to work out in a healthy way. In treatment, those who are struggling with anorexia athletica can learn how to focus on optimizing their nutrition while avoiding dangerous calorie restricting, and finding a more balanced exercise routine.

If you or someone you know is struggling with anorexia athletica, help is available.


Study Links Eating Disorders, Exercise Addiction

Study Links Eating Disorders, Exercise Addiction by Timberline Knolls Staff

A person runs on a treadmill.

A recently published study from the United Kingdom suggests that individuals who develop eating disorders may also have a significantly elevated risk of becoming addicted to exercise.

According to this study, which originally appeared in the January 2020 edition of the journal Eating and Weight Disorders – Studies on Anorexia, Bulimia and Obesity, the prevalence of exercise addiction among individuals who have an eating disorder is 3.7 times greater than it is among those who have not been diagnosed with an eating disorder.

This conclusion was based on a meta-analysis of nine separate research projects. The nine projects included data on 2,140 subjects from multiple nations, including the U.K. and the United States. This pool of subjects included 408 people who had been diagnosed with an eating disorder and 1,732 who had not.

“Our study shows that displaying signs of an eating disorder significantly increases the chance of an unhealthy relationship with exercise, and this can have negative consequences, including mental health issues and injury,” the study’s lead author, Mike Trott, said in a Jan. 28 news release that announced his team’s findings. Trott is a Ph.D. researcher at Anglia Ruskin University in Cambridge.

What Is Exercise Addiction?

Exercise addiction is not included in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). This means that this condition is not recognized by the American Psychiatric Association (APA) as an official diagnosis with an established set of diagnostic criteria.

However, exercise addiction’s absence from the DSM-5 does not mean that the condition is ignored by professionals. Multiple studies, such as the one conducted by Mike Trott’s team at Anglia Ruskin University, have attempted to document the symptoms, causes, and effects of exercise addiction. Many clinicians and programs have developed treatment protocols to assist individuals whose lives have been impacted by exercise addiction.

As is the case with other forms of addiction or behavioral compulsions, exercise addiction is characterized by overpowering urges and an inability to moderate or control one’s actions, even after experiencing negative outcomes. People who develop exercise addiction may work out excessively, overexert themselves, fail to allow for proper rest periods, and otherwise act in a manner that puts their physical health and mental well-being at risk.

When people who struggle with exercise addiction are not able to work out, they may experience anxiety, depression, and other forms of emotional distress.

The National Eating Disorders Association (NEDA) has identified the following as among the many potential health consequences of compulsive exercise:

  • Altered resting heart rate
  • Diminished energy levels
  • Loss of bone density
  • Disrupted menstrual cycle
  • Pain in muscles, bones, and joints
  • Increased prevalence of stress fractures and other injuries
  • Increased frequency of upper respiratory infections and other illnesses

Excessive Exercise and Eating Disorders

Although exercise addiction is not included as an official diagnosis in the DSM-5, this reference manual does contain multiple references to unhealthy exercise-related behaviors in relation to eating disorders.

For example, the DSM-5 identifies excessive exercise as a compensatory behavior among individuals who have developed bulimia nervosa. In the aftermath of binge-eating episodes, people who have bulimia may exercise excessively in an attempt to prevent weight gain.

The DSM-5 also notes that some people who develop anorexia nervosa demonstrate excessive levels of physical activity prior to the onset of the restrictive eating behaviors that are symptomatic of anorexia.

Excessive exercising is also associated with body dysmorphic disorder, a mental health disorder that is characterized by a preoccupation with perceived flaws in one’s physical appearance. As the DSM-5 notes, body dysmorphic disorder can co-occur with eating disorders.

As is the case with exercise addiction, the excessive exercise-related behaviors that are associated with anorexia, bulimia, and body dysmorphic disorder are self-defeating actions that can harm a person’s physical health and contribute to the onset or exacerbation of mental health concerns.

Comprehensive Solutions

Anyone who struggles with an eating disorder needs effective care from a qualified provider. When an eating disorder is accompanied by a compulsion to exercise excessively, it is vital that the individual receives comprehensive treatment from a provider who can identify and address all the concerns that have been preventing them from living a healthier life.

In the press release that announced his team’s findings about eating disorders and exercise addiction, Mike Trott emphasized the importance of including an exercise component in eating disorder treatment.

“Health professionals working with people with eating disorders should consider monitoring exercise levels as a priority, as this group have been shown to suffer from serious medical conditions as a result of excessive exercise, such as fractures, increased rates of cardiovascular disease in younger patients, and increased overall mortality,” he said.

Creative Arts Therapies Help Patients Struggling with Eating Disorders Communicate Through Nonverbal Language

Creative Arts Therapies Help Patients Struggling with Eating Disorders Communicate Through Nonverbal Language

Written by: Timberline Knolls Staff

Sometimes when an individual is struggling with an eating disorder, they also struggle to find the words to express the depths of how they are feeling. But just because an individual is having difficulty communicating doesn’t mean that there is no hope for recovery from the compulsion to engage in disordered eating.

When combined with other evidence-based therapies, creative arts therapies such as art therapy or dance/movement therapy (DMT) can allow individuals to use nonverbal forms of communication to rediscover their voice. By participating in creative arts therapies under the guidance of licensed therapists, individuals who are suffering from an eating disorder can start to express the feelings that they were unable to verbalize through traditional talk therapy.

The Benefits of Art Therapy

Oftentimes, there just don’t seem to be any words available to truly describe what a person is thinking and feeling about the many ways an eating disorder has disrupted their life. Those feelings are there, affecting their ability to function every single day, but identifying what those feelings are and connecting with them in a tangible way can be challenging.

An art therapist can help an individual to identify those emotions through creative techniques such as drawing, sculpting, painting, or collage. An individual does not need any artistic experience or talent to participate in art therapy because, often, their body and their mind will start to communicate specific messages through these creative activities without even having to think about it.

After an individual creates a piece of art in an art therapy session, their art therapist will work with them to decode the nonverbal messages, metaphors, or symbols in their creation. By engaging the patient in verbal communication through questions about the creative process and their art, an art therapist can help an individual start to express themselves in a safe, nonjudgmental environment.

The Benefits of Dance/Movement Therapy

Our first language is movement, so it comes as no surprise that the mind and body are interconnected. As the name suggests, dance/movement therapy (DMT) uses both dance and movement to help patients achieve specific therapeutic goals, such as improving their self-esteem and body image, understanding how to regulate their emotions, and building better communication skills.

Like with art therapy, patients don’t need any dance experience or talent to engage in DMT. In fact, DMT doesn’t even always involve dancing. Although some DMT programs do consist of various forms of dance, such as ballroom dancing, they also might involve movement such as yoga and stretching.

In a therapeutic setting, dancing or movement activities can help people who are struggling with eating disorders to use nonverbal language to communicate their conscious and unconscious feelings. A therapist who is trained in DMT can assess a patient’s nonverbal language and respond to their movements with the appropriate therapeutic interventions, helping to translate their nonverbal communication into information that can promote the patient’s recovery.

Creative arts therapies are proven, effective methods of helping individuals start to heal from the damage they have experienced from living with an eating disorder. There are so many different ways to communicate, and art therapy and DMT allow patients to open up in ways that they may not have realized were possible.

Combining the Parasympathetic Nervous System and the Outdoors: A Match Made for Maximum Relaxation

Combining the Parasympathetic Nervous System and the Outdoors: A Match Made for Maximum Relaxation

written by MEDA undergraduate intern, Kellie Marie Martin 

Most people can imagine a time when they felt stressed or overwhelmed. Everyday people are exposed to numerous forms of intense stimuli: careers, social media, family matters, and more. When these stressors build up, it isn’t uncommon for individuals to look for a release from their negative emotions. Knowing ways to effectively cope with stress is important for maintaining a healthy well-being. The brain also has methods to induce relaxation that we often aren’t aware of. Understanding how the brain combats stress can very effectively help (or be used as an addition to) other methods used to relieve tension fast.

When people get stressed, sometimes the brain reacts by activating its fight-or-flight response. This is controlled by the part of the brain called the sympathetic nervous system (SNS), which is one of two parts of the autonomic nervous system.1 The fight-or-flight response essentially prepares the body to handle the stressful situation by either bracing for a fight or getting ready to flee. Unfortunately, often this response is triggered by non-life-threatening situations, so it is helpful to know how to combat it. This is where the second part of the autonomic nervous system comes in, otherwise known as the parasympathetic nervous system (PSNS).2 The job of the PSNS is to regulate the body’s heart rate and stress levels so that normal bodily functions can resume, rather than be controlled by, the fight-or-flight response.3

The easiest and fastest way to activate the PSNS can be done by putting your face in cool water for approximately 30 seconds.4 This triggers the mammalian diving reflex, which changes the body’s chemistry in order to stimulate the PSNS to initiate a relaxation response.5 The brain essentially thinks it’s in a dangerous underwater situation where remaining calm is vital for survival, so it responds in a way to do just that.6 Although not required, dunking your head in water outdoors (such as in a lake or pool) can provide additional support in making you feel relaxed.

After the PSNS kicks in from the mammalian diving reflex, staying in the water provides an opportunity for gentle movement. Some options for gentle movement include swimming, kayaking, or stretching. Moving the body releases endorphins, which are hormones that help combat anger, anxiety, and sadness. Staying in the water, however, is not always an option.

Another way to activate the PSNS is by practicing yoga. When practicing yoga, the body connects to the mind through breathing techniques, holding postures, and consciously trying to relax.7 Additionally, yoga provides the opportunity for body-awareness and self-awareness. Having the time to look inward is important for maintaining a healthy well-being.

Another possibility to try is activating the PSNS while indoors, and then going outside to maintain maximum relaxation. There are numerous benefits to spending time outdoors, such as increasing vitamin D levels and improving concentration and focus.8 Healthy levels of vitamin D help combat depression, fatigue, and muscle pain as well as promoting strong bone growth.9 The easiest way to increase vitamin D levels is to be outside in the sun. So, while outside, do something enjoyable. Some options are to go on a walk or a hike, plant some flowers, or sit on a park bench. Doing something that requires attention provides the opportunity to only focus on that one thing and push out any stressors from the mind.

Practicing deep breathing outdoors is an effective option that allows you to reap the benefits of being outside as well as cueing the PSNS to kick in. Deep breathing essentially means inhaling and exhaling slowly. This can be done by counting to five as you inhale, and then again counting to five while exhaling.

The next time that you are feeling overwhelmed, consider trying these methods. Dunk your head in cool water, practice some gentle movement (preferably outdoors, but indoors works well too), try practicing yoga, and breathe slowly and deeply. Reducing stress and tension in the body does not have to be a difficult task, but one that is enjoyable instead.



[1] Parasympathetic Nervous System. Biology Dictionary. (2017). https://biologydictionary.net/parasympathetic-nervous-system/

2 Ibid.

3 Ibid.

4 Sevlever, Melina. Dialectical Behavior Therapy (DBT) Distress Tolerance Skills: TIPP Skills. Manhattan     Psychology Group, PC (2018). https://manhattanpsychologygroup.com/dialectical-behavior-therapy-      dbt-distress-tolerance-skills-tipp-skills/

5 Ibid.

6 Ibid.

7 Oijala, Leena. This is How (and Why) a Yoga Practice Strengthens Your Nervous System and Brings  Balance Back to Your Body. Organic Authority (2016). http://www.organicauthority.com/this-is-how-       and-why-a-yoga-practice-strengthens-your-nervous-system-and-brings-balance-back-to-your-body/

8 A prescription for better health: go alfresco. Harvard Health Publishing: Harvard Medical School (2010). https://www.health.harvard.edu/newsletter_article/a-prescription-for-better-health-go-alfresco

9 Ibid.