Compulsive Exercise And The Eating Disorders

Toward An Integrated Theory Of Activity

Alayne Yates

• Publisher: Routledge
• Year: 2013
• eBook ISBN: 9781134853373
• Edition: 1
• Topic: Psychology
• Subtopic: Clinical Psychology
• Index: Psychology

The author examines the linkages and similarities between compulsive athletics and eating disorders, and proposes that they are different manifestations of a single condition: the activity disorder.

PART I

Clinical Issues

CHAPTER 1

Independent Activity: Exercise and Diet

On the television screen, members of the “Pepsi generation” leap, run, laugh, and gyrate, scarcely pausing long enough to relate to one another. This disconnected but enthusiastic jumble becomes a proclamation of youth, health, and the potential for success. From the chorus of “Up With People” to the welcoming ceremony at Club Med, it is the barrage of motion, of color, of sound that inspires a sense of power and vitality. Toward what goal do these persons strive, or does it really matter?

Activity, or the condition of being active, can serve as an important regulator in the intrapsychic economy, that is, individuals may not feel comfortable or of value if they are not active. Conversely, they may be distinctly uncomfortable when they face the condition of inactivity. A common example is that of the busy professional who slips a disc and is forced to rest. He is restless and irritable, but makes the best of a bad situation by catching up on his journals. When he recovers, he will not rest and, indeed, he will continue to design his life around activity.

In 1988, Lamar Alexander authored a best-selling tale, Six Months Off, which describes a period of time in which he put aside the heavy demands of a political career and took his wife and four children to Australia. He wished to have nothing to do, time to relax and enjoy the family he had neglected during his eight years as governor of Tennessee. Yet, as the reader browses through this pleasant volume, he realizes that the author had already agreed to write the book before the trip began. Not only did the family tour the far reaches of Australia, riding 100 miles on horseback across the legendary Snowy Mountains, but they fished barramundi in Northern Territory crocodile country, raced at 155 miles per hour on the bullet train in Japan, traveled through communist China, visited the Kremlin, and crossed the Berlin Wall. During a relatively quiet moment in Australia, the parents took computer lessons while the children attended the local school.

Lamar Alexander represents the age in which he was born and raised. If he had been more inclined toward rest and relaxation, he would never have been governor of Tennessee, written a book, or perhaps had four children. Lamar Alexander, and people like him, are the mainstay of the nation: independent, productive, active, and achieving individuals. All the more reason why we should begin to examine the internal, as well as external, functions of activity.

This book is about individuals who are consumed by activity: persons who, if they are not engaged in an activity, are thinking about it, reevaluating past performance, and planning for their future endeavors. To a lesser extent, this book is about most of us.

EXTREMES OF DIET AND EXERCISE

From 1983-1989, Drs. Leehey, Shisslak, Crago, Allender, and Yates interviewed more than 150 male and female runners in depth. They found that a few of these runners carried the sport to an unusual extreme; running had become the central focus of their lives and they continued to run even when injured. The investigators called these individuals “obligatory runners” because they seemed to be unable to “not run.” Obligatory runners appeared similar, in a number of respects, to eating disordered women: obligatory runners are extremely committed athletes and eating disordered women are extremely committed dieters. Individuals in both groups attempt to control the body through exercise and diet; they are well aware of the input/output equation—that they can burn up calories through exercise. Are there other similarities between eating disordered women and compulsive athletes?

Although some obligatory runners are female and some eating disordered individuals are male, for convenience we will refer to persons with an exercise compulsion as “he” and persons with an eating disorder as “she.” When we speak of the eating disorders, we are referring to a category which embraces anorexia (anorexia nervosa) and bulimia (bulimia nervosa). Anorexia signifies relentless food restriction while bulimia usually implies a cycle of gorging followed by vomiting or diuretic/laxative abuse, but it also may refer to an alternating pattern of bingeing and starving. These entities are regarded as different expressions of the same underlying process: many eating disordered women are known to move back and forth between the two categories. Anorexia and bulimia have many more likenesses than they have differences (Garner, Garfinkel & O'Shaughnessy, 1985; Mitchell, Pyle et al., 1986) and the validity of separating the two diagnoses is questionable (Beumont, George & Smart, 1976; Casper et al., 1980; Garner et al., 1985).

THE “NEW” EATING DISORDERED WOMAN

There has been a significant shift in the level of pathology that is associated with the eating disorders. Forty years ago the typical eating disordered woman was the “classic” anorexic patient. She was an immature, severely disturbed adolescent who drastically restricted her food intake, remained bound within the family, and was socially isolated and unlikely to marry (Crisp, 1965a; Russell, 1970).

Of particular interest are the “new” eating disordered women of the 70s, 80s and 90s. These women are quite distinct from the “classic” eating disordered women who still present in the clinic. The “new” eating disordered women are far more likely to be bulimic and they are unlikely to be emaciated, immature, and bound within an enmeshed family. They seem relatively well adjusted and they may have been raised in an apparently normal family (Turnbull et al., 1989). They are more apt to have become eating disordered at an older age, to be married (Heavey et al., 1989) and to function very well in educational and vocational spheres. A non-clinic sample of bulimic women seems most like a sample of professional women (Teusch, 1988) and professional women are distinctly independent.

The apparent health of many eating disordered women suggests that there may be a relatively non-pathological route to the eating disorders. Yet our understanding of these women continues to be largely based upon studies of poorly functioning women, often hospitalized patients.

Eating disordered women who are educated, high achieving, and relatively healthy are the ones who seem most like the obligatory runners in our study. The obligatory runners, like the well-functioning eating disordered women, are relative newcomers on the scene.

EXERCISE AND DIET: FACTS AND FIGURES

The number of people involved in exercise activity has increased substantially over the past several decades. Forty-nine percent of the population in the United States exercise daily, according to a 1987 Gallup poll. Twice as many persons exercise regularly now as did 25 years ago. The numbers continue to rise: in 1988, 8.5 million people ran or jogged frequently; this was a half a million more than had engaged in that form of exercise the year before (American Sports Data Survey, 1989).

Individuals are more likely to be involved in a fitness program if they are young, male, better educated, have a higher income, and are involved in a professional or business occupation. In 1987, some 7 million young and middle-aged individuals spent 5 million dollars on health club membership fees (Time, 6/24/88). There are an estimated 17 million sports injuries each year. The increase in athletic activity seems to be a reflection of self dissatisfaction: 61 percent of the population were satisfied with their health in the 1970s but only 55 percent were satisfied with their health in the mid 1980s. (Glassner, 1988).

Dieting is a current cultural phenomenon which, like exercise, focuses on the control of the body. Six-year-old children have already acquired a preference for bodies that are long and lean (Kirkpatrick & Sanders, 1978; Feldman, Feldman & Goodman, 1988) and 37 percent of grade school children have already tried to lose weight (Maloney, McGuire & Daniels, 1988). Fully 78 percent of adolescent girls now wish to weigh less (Eisele, Hertsgaard & Light, 1986) and 70 percent have attempted to lose weight in the past year (Wadden et al., 1989). Three-quarters of the women who attend college are dieting in order to control their weight (Jacobovits et al., 1977). Seventy-six percent of respondents to a survey by a popular women's magazine considered themselves too fat, including the 45 percent of those classified as underweight (Wooley & Wooley, 1985). Dieting has become normative behavior for women in the culture (Polivy & Herman, 1987).

The importance of diet and exercise in contemporary culture can be appreciated by the extent to which these activities are elaborated. Individuals who wish to diet can readily immerse themselves in dietary supplements, calorie counters, magazines, recipes or “fat farms.” In 1988, Americans spent 74 billion dollars on diet foods—a third of the nation's food bill (Time, 7/25/88). Those who wish to exercise may choose among nautilus machines, stop watches, fitness magazines, and health clubs. In 1987, some 7 million Americans bought 738 million dollars worth of exercise machines for the home, when a decade earlier they had spent only 5 million on such equipment. Individuals who are not somewhat interested in dieting and/or exercise may be at odds with cultural or group expectations.

A DEFINITION OF ACTIVITY

Dieting and exercise are activities—but so are a host of other pursuits. The concept of activity may seem to be “as big as all outdoors,” i.e., so broad that it becomes meaningless. To be alive is to be active. However, this book is not concerned with any and all activities; it is concerned with those independent, goal-directed activities that people engage in above and beyond the usual family and work activities—like dieting and running. This definition does not exclude “workaholism,” i.e., cognitive activity that is above and beyond the usual work activity but it is more concerned with nonessential endeavors that are pursued in the name of self development or self satisfaction.

INVOLVEMENT OF THE BODY

When individuals wish to control the body, to make it stronger, prettier, fleeter, or fitter, they may become involved in an exercise or diet program. Because these activities are designed to change and control the body, they will be called “body-based activities.” Aerobic dance, special diets, and working out are examples of socially condoned, body-based activities. The involvement of the body distinguishes these activities from non-body-based self improvement activities such as painting, woodworking, gardening, building a model car, etc. Body-based activities inevitably focus on what the body takes in, such as food, and what the body can produce, such as running a five-minute mile. The translation is apt to be immediate and direct; improvement can be measured in concrete units such as pounds, inches, time, and distance. Diet and exercise are the most common body-based activities.

AN INTENSE COMMITMENT

When individuals pursue an activity such as diet or exercise, they often have a goal in mind: to fit into a size 10 dress or to become physically fit. When they accomplish the goal, they cast about for some other avenue of self development. A few individuals are different: once they commit themselves to a diet or exercise program they stay committed. They simply reset their goals. One can never be too thin or too fit.

Persons who make an unusually intense commitment to diet or exercise are similar to one another in certain respects (Yates, Leehey, & Shisslak, 1983). They are generally intelligent, high-achieving individuals from well-to-do families. They are self-reliant persons who have a tendency to be dissatisfied with themselves; they inhibit their anger and spend a good deal of time thinking about who they are and where they stand in life. They are concerned about self worth and they have explored various avenues of self development in an attempt to see what fits best. They are hardworking, task oriented, and persistent. In brief, these individuals tend to be successful and well adapted to the demands of life in an industrialized culture.

Any activity can become problematic if it assumes too central a position in the life of the individual. Photography and computer “addiction” are examples of the overuse of non-body-based activities. The eating disorders and compulsive athleticism are examples of the overuse of body-based activities. These persons spend most of their free time either engaged in, or thinking about, diet or exercise. Their emotional investment in the activity becomes more intense and significant than the investment in family or in work.

When runners push themselves to the limit, this can precipitate a variety of muscular, joint, and tendon injuries. Some runners become so caught up in the sport that they continue to run after they injure themselves, even when they are in pain or when they have been told that they risk permanent debility (Little, 1969; Morgan & Costill, 1972; Yates et al., 1983). Running in spite of contraindications such as a cardiac arrhythmia can result in sudden death (Thompson et al., 1979). Coronary heart disease is said to be the major killer of conditioned runners aged 40 years and older who die while running (Waller & Roberts, 1980). The demise of Jim Fixx, the marathoner, is a notable example. A less obvious consequence occurs when runners restrict their intake relative to their output; they may be consuming quite a lot of food but not enough to compensate for the massive expenditure of energy. This may cause them to enter a state of physical deprivation.

Like the extremes of running, the extremes of dieting can be harmful to the body. Bulimic women who vomit can erode the enamel on the teeth, suffer from osteoporosis, parotiditis, edema, electrolyte imbalance, cardiac irregularities, and gastric dilatation (Herzog & Copeland, 1985; Garner, Garfinkel & O'Shaughnessy, 1985), but these complications are rarely lethal. Anorexia is the most malignant form of the eating disorders. Schwartz and Thompson (1981) estimate the mortality rate in anorexia at six percent. Anorexic and bulimic women regularly restrict or manipulate their food intake relative to output and they not uncommonly enter a state of physical deprivation.

When obligatory runners continue to run in spite of clear contraindications, they have lost control over the athletic process (Yates et al., 1983) much as eating disordered women have lost control over the process of dieting. When serious athletes are injured so that they can no longer run, they suffer severe tension, depression, anger, and a sense of bodily deterioration (Chan & Grossman, 1988; Smith et al., 1990). These are “withdrawal” symptoms that are similar to the symptoms that eating disordered women experience when they are prevented from dieting or purging (Pillay & Crisp, 1977).

ORGANIZATION AND INTENT

This book presents clinical case studies of obligatory runners and eating disordered women and attempts to integrate this information with data obtained from sociocultural, psychologic, and biologic research to generate a more comprehensive understanding of these conditions. It relies more upon the research on the eating disorders than upon the investigations of compulsive athleticism, simply because there has been a great deal more accomplished in the field of the eating disorders.

In the next several chapters we will draw a number of parallels between the eating disorders and compulsive athleticism. We will suggest that these conditions have enough features in common so that both could be subsumed under a larger category, the activity disorder. This is not meant to imply that an “activity disorder” is or should be a recognized diagnostic category. There is no activity disorder in the Diagnostic and Statistical Manual of psychiatric diagnoses. The activity disorder is simply a concept that will allow us to explore the overlap between compulsive athleticism and the eating disorders.

The book is divided into three sections. Part I presents sociocultural and historical perspectives, case material from our research on obligatory running, and case material from the eating disorder service. We explore the many points of correspondence between these conditions and the relationship to other forms of compulsive activity. Part II examines current perspectives and research on the eating disorders and compulsive athleticism and how current biological and psychological data would or would not support the concept of an activity disorder. Part HI attempts to integrate these and other findings to advance a theory that could explain the etiology, symptomatology, and course of a common entity, the activity disorder. Last, we will suggest a therapeutic approach to these disorders.

CHAPTER 2

Historical and Cultural Perspectives

HISTORICAL

ASCETICISM

The term “asceticism” is derived from a Greek word that means training for the attainment of an ideal or goal (Yates, 1987). The goal may be one of soldiery, athleticism, learning, work, or religion. Asceticism is a denial of the pleasures of the flesh in favor of these laudable activities. As there are only so many pleasures of the flesh (chiefly eating, drinking, sleeping, socializing, resting, making love), asceticism has tended to assume a certain format regardless of the age in which it occurs. Fichter (1987) portrays the association between fasting, ex...

Table of contents

• Front Cover
• Half Title
• Title Page
• Copyright
• Dedication
• Contents
• Acknowledgments
• Part I. Clinical Issues
• Part II. Theoretical Overview
• Part III. A Theory of Activity
• References
• Author Index
• Subject Index