Exercise bulimia sufferers struggle with guilt when they miss a workout

As a sophomore at Monte Vista High School in Danville, Calif., Brett Zorich was a record-setting track star who left rivals in her dust.

Ultimately, however, her fiercest opponent turned out to be herself.

While experiencing a 5-inch growth spurt at age 15, she fought to maintain the 100 pounds she carried as a 5-foot-2 freshman. And that’s when she says she “got psycho.”

Zorich exercised more than two hours a day and restricted her calories. It was an obsession that turned into what experts call exercise bulimia.

Her symptoms included amenorrhea (loss of the menstrual cycle), fatigue and depression.

“Looking back, I definitely should have been getting help,” says Zorich, now 20.

There is such a thing as too much exercise. Up to 11 million Americans annually suffer from eating disorders, according to the National Eating Disorders Association. Of those diagnosed with bulimia, more than 80 percent use excessive exercise to control their weight, according to a 1999 study.

Exercise bulimia – also known as compulsive exercise or exercise addiction – involves burning off calories through excessive exercise.

The disorder is often difficult to detect, especially in a society that praises fitness. So how do you know if you’re crossing the line from fitness enthusiast to exercise bulimic?

Jackie Holmes, director and founder of Casa Serena Eating Disorders Program in Concord, Calif., has seen a steady increase in patients seeking care for exercise bulimia.

“I think it’s always been there, but it’s so much more pronounced now because of this intense push from the fitness craze that has hit the country,” Holmes says. “There’s been a shift from dieting and everyone’s gotten into being really fit.”

The compulsion to exercise is not the only indicator of the disorder. It can be better understood by gauging the feelings someone relates to exercising, says Holmes.

“Someone who is healthy and just enjoys fitness may have an intense workout they do regularly but wouldn’t mind changing it or skipping a day because of illness, injury, or something that takes priority in their life over exercise,” she says.

“Someone with exercise bulimia would be extremely hesitant to make any changes and would suffer from guilt and anxiety if they were forced to miss the workout.”

Zorich, who holds the girls 800-meter record at Monte Vista, says she continued to run and exercise on a broken ankle and an injured hamstring. Both were caused and worsened by overworking, she says.

Even after her coaches instructed her not to run with her injuries, she would sneak out of her house at night to go running. Track went from being a fun activity to what felt like an obligation or a chore.

“My love for the sport started to dissipate,” she says.

Holmes usually tests patients for bone loss and a drop in protein levels, which often occur because the patient is over-working and under-eating.

“One of my patients recently fell and broke both of her legs because she suffers from severe osteoporosis,” she says.

Additional symptoms include amenorrhea, anxiety, stress and a compulsive nature, she says. Most of the patients Holmes sees are between 15 and 35 years old, the majority of them women.

There is often a codependent disorder such as obsessive compulsive associated with exercise bulimia, she says. It could be something completely separate from an eating disorder, such as anxiety, or could involve symptoms from a related eating disorder (anorexia or classic bulimia).

However, someone suffering from exercise bulimia could use exercise exclusively and fail to show symptoms of other disorders.

For Cassie Birkett, 23, of San Jose, Calif., her codependent disorder was associated with food. She began to restrict her calories if she wasn’t able to exercise them off.

For more than two years, she had amenorrhea and began to lose her hair.

“I know it might sound vain, but losing my hair was so upsetting to me,” she says. “I don’t want to go back to that.”

At her lowest weight, Birkett, weighed just over 100 pounds at 5-foot-3.

“I grew up in a chaotic environment with my family,” she says. “So I feel like I’m always striving to find things that are consistent. Exercise is something I can always count on. When I switch up my routine, I start to feel vulnerable.”

At first, Birkett was hesitant when her half-sister whom she was living with noticed she had a problem, but eventually she recognized that she did need help.

She saw a therapist and nutritionist weekly but has been able to scale back to monthly visits with her therapist. She is still in the process of recovery but has come a long way, she says.

Recovery from exercise bulimia isn’t like some other addictions. Unlike an alcoholic who gives up drinking, it isn’t realistic for an exercise bulimic to give up exercise for life.

When evaluating a person’s recovery, professor James Lock, director of Stanford University’s Eating Disorder Program, looks for normalized thinking as well as normalized behaviors.

He says a normalized relationship with exercise is when exercise is done according to a schedule or desire to be fit, as opposed to being done in excess and in response to what a patient eats during the day.

“In someone who is exercising excessively, they would have to abstain from the behavior for about three months and then reintroduce it safely,” he says.

Cynthia Bates, a San Francisco yoga instructor and nutritionist, has been a recovered exercise bulimic for 15 years. Yet she still has the occasional urge to slip back into unhealthful habits.

“I am tempted mostly when I start feeling out of control in my life, big changes are happening, I’m having difficulty in a relationship, or my job isn’t going as well as I want it to,” Bates says.

For two years, she has been working with a variety of patients, including those recovering from eating disorders. The work helps her to keep on track, she says.

“The first thing I do is get them on a regular schedule of eating healthy food and changing their attitude toward food,” Bates says. “They need to feel like the food is nourishing them, not poisoning them.”

Her own struggle began at age 15 when she was attending high school in Davis, Calif. It worsened when she moved away to college in Los Angeles, and she gained six pounds during her freshman year.

“I freaked out,” says Bates, 40. “I started exercising heavily.

“It was a compulsion for me to exercise every single day. Even when I’d stay up late at night before or I was drinking, I’d get up every morning and run or go to the gym.”

At the peak of her disorder, she was eating around 800 calories a day, with little or no fat in her diet, and exercising for two and a half hours daily.

Finally, around 25, her life began to turn around. Though she didn’t seek traditional therapy, she began to embrace healthy eating, yoga and a balanced lifestyle.

Much of her initial recovery was inspired when she was teaching English in Japan. She found success in eating according to the macrobiotics diet, popular in Japan at the time.

Like Bates, Zorich never sought out professional therapy, but says her coaches played a large part in her recovery. They kept an eye on her during the summer, advising her to mend her injuries and herself.

Zorich now runs for the University of Nevada, Las Vegas track team. Though exercise is still a big part of her life, it comes with limitations.

“I don’t get caught up in it,” she says. “If I don’t win, it doesn’t break me like it used to.”