She refers to my compulsive exercise as "purging." This never fails to irritate the hell out of me.
My rationalization that my exercise is not purging:
A) I do not binge. I can literally count on one hand the amount of times I have had out-of-control eating experiences in my nine year journey through anorexia.
B)Exercise doesn't increase if I eat more, because I never eat more than my meal plan, I have a hard enough time just accomplishing my baseline every day.
C) I still exercise even when I've eaten significantly less than I should have, or nothing at all, and thus can't be purging what is not in my system.
D) The exercise increases when I'm stressed, showing that if it is purging anything it is anxiety, not food.
E) The main thing, which I hope makes sense: I don't work out because I ate X, I eat X so that I can make it through my workout.
H's counter evidence:
1) If I can't exercise, I dramatically cut my calories, way beyond what is necessary to compensate for inactivity. Therefore the purpose of the exercise must be to get rid of calories.
2)Getting rid of calories = purging.
I can see her point, but I still don't agree with her. She says it is because I am an intensely controlled person, and I have an aversion to the term "purging" because I associate it with making up for a lapse in control. On this, she is probably right. OK, definitely right. I do have an aversion to the term, but I also feel like it's an inaccurate term in my case.
I could bicker about this all day, and expect/hope that at some point in my future I will look back and realize how stubborn I am being. But the main point of this post is that I wanted to move beyond my own case and discuss the broader issue of labels, which I find to be interesting. I have seen both "exercise bulimia" and "anorexia athletica" referred to in both the popular and medical literature. To me, it seems like EB is over-exercising following a binge, whereas AA is just compulsive exercise as part of a more rigid, obsessional routine. It is more about the ritual and less about the penance. But I am honestly not that familiar with the role that exercise tends to play in "regular" BN (I cringe at using that term, but you know what I mean...), so maybe I am mischaracterizing it? Thoughts?
Honestly I think this whole issue just highlights the fact that there are no cookie-cutter ED cases, and that in reality distorted behaviors (and thoughts) exist along a spectrum, as opposed to discrete categories. Some AN sufferers restrict severely and never work out, others let the exercise increase to the degree that they stay emaciated even while eating roughly as much as an "average" person (cringe again). Most are somewhere in the middle, and many people move up and down the spectrum during the course of their disorder. For me personally, since I've been in college the restriction-exercise balance has shifted significantly from what it was in middle/high school, not quite 180-degrees, maybe around 120.
So, those are my thoughts, what are yours? Discussion?
8 comments:
I relate more to the "more about ritual, less about penance" statement. I see what your therapist is saying about the "purging," and I understand your hesitancy to use the term. You're not really getting rid of something through exercise. You're exercising so that you don't feel as much of a need to get rid of something (aka restrict). That's my interpretation anyway. The reason I go for walks and yoga (well, about 70% of the reason) is so that I feel justified in eating what I do. I feel like, "Ok, at least I moved today." Like I wrote to your last post, I think there's something sad about being held hostage by this magical formula. It would probably be liberating to realize we don't need the ritual like we think we do. I've been on vacations, sans exercise, and nothing happens to my body, for example. Then again, maybe realizing it was all a house of cards would cause a lot of grief..
The problem is that neither EB or AA are formally defined. I do agree with your reasoning, as people with AN can purge and still be objectively AN.
If you binge and purge through exercise or fasting, that's called non-purging bulimia in the DSM-IV. This is what I personally think of as exercise bulimia.
To be honest, I've never really thought about defining AA.
However, BOTH definitions have the exercise addiction component, and that's what needs to be addressed regardless. The name is sort of irrelevant.
How about when you move you ditch the bike and some of the DVDs? Start fresh? Just a thought.
This is tough as there are overlapping criteria in both, though neither are formerly recognized. I normally think of AA as more a subtype of AN and EB a subtype of BN. But both do have an element of "addiction," like Carrie mentioned.
I can understand H.'s reasoning, and in a sense your exercise is "purging." However, I think it goes beyond that. To me, there are more neurobiological and anxiety components involved than just compensating your food intake.
In any case, whatever the semantics, it is a problem for a whole lot of people and one that I hope you can overcome one day.
A few interesting links that describes a little more what I am talking about (you may have already read these): http://www.camh.net/Publications/Cross_Currents/Spring_2004/workingoutthepain_crcuspring04.html
http://ondix.com/pdf/docs/test_quiz_essays_studies_1071119272.pdf
Both still use the terms interchangeably but give other perspectives for AA.
I think in AA the main source of anxiety is connected with exercises and achievment in sport. I was dianosed with AA at 14 and if someone asked me if I would rather eat x (which was quite high number) kcal and train 12 hours daily and not lose any weight or eat the same x, lay in my bed and lose weight, I know I would pick the first alternative. Months later my AA switched to AN, but I think exercising continues to be one of the most problematic areas of recovery.
When I imagine someone suffering EB(I don´t know anyone with this "diagnose", so it´s just my speculation)I see someone whose primary problem was rather connected with food intake and I think he/she would choose the latter alternative.
So approximately I think AA sufferer kind of "misuses" the food as a fuel for his obsessive exercising and EB sufferer "misused" exercising for his obsessive eating.
However to return to your spectrum, the relationship to food and exercise is probably much more complicated in both diagnoses.
And to your past post: the moving is great opportunity for changing routines! I am quite anxious about moving, but I hope I will start less obsessive life (LIFE:) as well!
As you pointed out, there are no cookie-cutter cases. I was/am/have been (let's use ALL the verb tenses possible) primarily bulimic, but exercise was NEVER a way to "purge". Yes, it was problematic in its own way, but I never binged and then exercised to purge. For me, I enjoyed exercising, the rush, the high, which was quite a contrast from bingeing and purging, so I didn't want to mix the two.
I did occasionally use exercise, like you, to justify what I WAS eating and keeping down, but in a way, it was actually a way that I felt good about my body and about myself because I felt strong and alive.
Hmm. When I was at my sickest I thought of exercising and restricting in much the same way - I HAD HAD HAD to do it; the fewer calories I took in and the more I burned, the better. It wasn't a rational thought, it was this crazy, almost animal fear of what might happen if I didn't - gain weight, "balloon" as you say, become Jabba the Hutt.
I cut out the exercising for about a year. When I started struggling and restricting again, Jim, against all medical advice, suggested I start moving. But he encouraged fun exercise, like badminton and racquetball. I'm terrible at both, but at least it made me willing to eat a bit more. Somewhere along the line my thinking changed.
Now I'm in limbo a little. Jim's not around all the time, and now I notice I'm being somewhat compulsive with my exercise - it's just what I do, and if I don't it throws me off.
I don't think this helped and holy moly it's long. I'll get back to my more coherent commenting later.
i think labels can be a very dangerous thing ... it is important that we do not let labels define us. i think they are just there to try and categorize things to make it easier for us as humans to try and understand.
end all be all - in my opinion - is that it does not matter what you call it ... what matters is that you do something about it ... you take the steps that are necessary to make a change towards a more full life separate from the ED.
call it whatever you like - just keep taking the next right actions.
i know i can get caught up in the language of things and create loop-holes and think that maybe this doesn't apply to me because _____________ )fill in the blank with whatever it may be at the time). and this thinking and these behaviors only help to keep me stuck.
i then have to look at why i am wanting to stay stuck ... because really that is what i am wanting whenever i get caught up in the logistics of it all.
ugh.
i hope that makes some sense.
i am the queen of finding loopholes - i needed to hear this today. i will take some of my own advice :)
I know how you feel about labeling the exercise as purging, I hate that label myself. I don't see it as necessarily purging because I do it no matter what. I suppose I exercise in order to be able to eat, not exercise because I have eaten or will eat.
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