The Role of Exercise in Eating Disorder Recovery

For people with depression, anxiety, or really any form of mental illness, a common refrain from well-meaning friends and acquaintances is often “well just exercise. That will help you feel better”. It’s true that there is good evidence that regular exercise can improve mental health (although there are many problems with simply prescribing exercise). However trying to incorporate exercise into a recovery and treatment regime becomes infinitely more complex in the context of an eating disorder. Over exercise is often a symptom of eating disorders, and for many people trying to recover it’s also a trigger for other self-destructive behaviors.

Because exercise is an important element both in healthy weight maintenance and improving mental health, but is also a triggering and potentially dangerous activity for someone with a history of overexercise, people in treatment for eating disorders must walk a delicate tight rope when it comes to their exercise regimes. This has been a particular struggle for me, and I’ve been looking for ways to bring exercise into my treatment in a positive fashion.

There are a few techniques that I’ve had some success with, but if anyone has more suggestions, please share in the comments. The first way that I’ve found to improve my relationship with exercise is to stop using the word exercise to refer to movement. This opens the way for all kinds of “exercise” that don’t involve going to the gym and using equipment that loudly announces your calories burned to you every time you look down. I swing dance and I rock climb and sometimes I just throw dance parties in my room and sometimes I try to just go for walks or have squirt gun fights with my friends. The more that I can find things that I enjoy which also happen peripherally to involve movement, the better.

The reason I try to use this technique is because the moment my brain is convinced that I am “exercising”, it becomes convinced that I need to hit certain markers of acceptability: burn a certain number of calories, exercise for a certain period of time, stick to a certain regime. If I don’t use the label “exercise” to describe what I’m doing, but rather focus on “fun activity, preferably with friends”, I get a lot more mileage out of the activity and don’t fall into a negative spiral that tells me I am not acceptably fit. Looking for activities that fit this mold also lets me double dip on my activities: not only do I exercise but I also find some depression fighting positive activities, and potentially social time as well.

Something else that has worked well for me is to accept that sometimes a complete break from exercise is necessary. I find exercise extremely helpful with anxiety and don’t like leaving it entirely behind (especially as I’ve been pretty active my whole life). However when I’m compulsively exercising every day, it can be much harder to try to slowly lower the amount of exercise that I’m doing while still doing some. In many ways it’s easier to simply say that I can’t be responsible about my exercising at this moment in time and I need to take some time off. This has the added benefit of giving me LOTS of extra time to do other positive things with my day.

There are a lot of ways that cutting exercise out of  your life for a time can backfire. How do you deal with all the anxiety you worked off before? How do you accept loss of muscle mass or increase in fat? How and when do you begin to add exercise back in without swinging immediately into over exercise mode again? Especially if you’re doing this while you’re trying to increase your caloric intake, it can take a serious toll on your emotions and your motivation to continue treatment. Unfortunately, this is one of those places I don’t have the answers: I’m struggling to find ways to begin incorporating exercise again without it becoming unhealthy.

One helpful way to deal with feeling guilty about not exercising or feeling extremely compelled to started exercising again is to find some friends who aren’t big on exercise. This doesn’t mean you have to dump your friends who are extremely fit, but there are people out there who aren’t particularly interested in physical fitness and are perfectly happy with their lives. I am a big proponent of distract until you’re in a healthier place, and finding people who will encourage you to do other types of fun and interesting things, model other versions of healthiness and happiness, and generally not bring up exercise as something you have to do is a great way to build a life that doesn’t circulate around exercise.

The final, and perhaps most difficult thing to do if you’re working on overexercise is to make sure that you’re not paying any money for exercise. What I mean by that is if you’re paying for a gym membership or classes or a personal trainer: stop. I’ve found that when I’m shelling out money I feel obligated to “get my money’s worth”. You can always go to the local rec center and swim some laps or go for a run or a bike ride. But those ongoing expenses are a constant pressure to get to the gym and make it worth it and I’ve found that pressure nearly unbearable.

Of course all of these are just suggestions that I have found helpful, and won’t work for everyone. I’d love to hear other suggestions in comments, especially from those who have found an exercise regime that works for them.

Thoughtfulness, Tragedy, and Autonomy

A few weeks ago I wrote about some of the rhetoric that we use around women’s rights and their autonomy in terms of their own bodies. In particular, I focused on women’s health, and how the dialogue around women’s health tended to have two modes: “this is serious, debilitating, and tragic” or “A WOMAN DID SOMETHING WITH HER OWN BODY WOOHOO!” I believe that this type of dichotomy exists in all sorts of places in women’s lives, and that it doesn’t do women any good. When we are talking about women’s lives, almost nothing exists in the black and white places of life. More often than not, there is a dialectic. Something can be empowering and good while also being thoughtful or difficult. To look at a particular example from my own life: my attempts at recovering from an eating disorder are clearly a form of taking my own empowerment in hand and standing up to many of the expectations of women in my life. However at the same time it is something that comes with a great deal of pain, a great deal of stress and anguish and difficulty, and a great deal of thought and reflection. Most of the empowering things in our lives come only after deliberation and reflection.

 

Because of the role of oppression in women’s lives, we need to be extremely careful about understanding how the personal and the communal interplay in any individual decision that a woman makes. For example, I am all for applauding when a woman exercises her rights over her body, but having some empathy for the fact that it might have been a hard or confusing or thought-filled decision is probably a good idea. Societally, when a woman takes control of her own body and does something like have an abortion or have a mastectomy, she is helping to break down patriarchal values and oppression for everyone around her, including herself. However personally, these may be decisions that required some thought, that were painful or uncomfortable, or that just were not fun. We are allowed to both praise something and show sympathy for whatever toll it might have taken on the individual who enacted it.

 

Having empathy about the experiences that women go through while they are exercising their rights allows us to hear the individual experiences, something that has always been hugely important to the women’s movement. We cannot try to improve women’s experiences unless we actually take the time to hear what those experiences are.

 

Particularly in the realm of women’s health, we can both applaud someone for the fact that they have done something bold in their personal choices, while also recognizing that most health decisions and procedures come with some price and that we should be aware of that. We should recognize and celebrate that women go through complex thought processes surrounding their mental health. We should make it HARD for conservatives to view us as stupid little womens who don’t know anything about their own health and who just frivolously run around cutting pieces of ourselves off. We should respect each other enough to make thoughtfulness (without tragedy) part of the dialogue about women’s health. It’s something that is often missing. More often we hear about morality, or about rights, or about access, or about money. Rarely do we stop and listen to deliberations that women have to go through in order to make their healthcare decisions, particularly when they are in oppressive situations that limit their access. When thoughtfulness does come into the dialogue, it’s often as a way of casting women’s healthcare and health choices as something tragic, difficult, or heartbreaking in a way that men’s health is not (few people talk about how thought-filled the decision to get a vasectomy is, despite the fact that people probably put a great deal of thought into it).

 

Indeed the idea that “thoughtful” necessarily means difficult is simply wrong and unhelpful. We are thoughtful about many things. Sometimes they’re difficult and also positive (deciding where to go to college), sometimes they’re difficult and heartbreaking (whether to pull the plug on a dying relative) sometimes they’re not difficult at all and they’re just great (like trying to decide which flavor of cupcake to buy…that takes a lot of thought let me tell you) and sometimes they’re not difficult but they kind of suck anyway (like choosing to get a pap smear, which I always think about and always know what I’m going to answer and always hate the answer to anyway). We think about all kinds of things and we make decisions based on thought processes all the time. Saying that something requires thought or reflection doesn’t necessarily mean that we don’t know what we’re going to answer or that it will hurt us or that it will have a negative consequence. It just means we wanted to make sure it was the right decision.

 

We need to create space for the ways that women actively navigate their lives, and the balance that they must constantly keep between their personal needs, their personal decision making, and the societal pressures around them. We need to keep in mind that while a woman might have really loved getting that abortion because it was exactly the right thing in her life, there are social repercussions and we should be empathetic to that. We need to keep in mind all the sacrifices that women make nearly every time they make a choice about how to exercise their autonomy. And the more we do this, the less we will have black and white thinking and dichotomies, and the more we will have a conscientious dialogue with other women about how frustrating it is to navigate the world we live in, in which there are almost no “right” choices, only better choices. I think that definitionally, as women, nearly every decision we make has to be thoughtful (obviously there are some exceptions, but when you’re part of an oppressed group you’re forced to be more conscious of your decisions). And because of this, we are always aware of the costs and the benefits of our decisions. Now we need to start recognizing that process in others.