In eating disorder treatment, exercise is a compensatory behaviour to lose weight and alleviate anxiety about weight. In traditional treatments and inpatient settings, we encourage and sometimes enforce no exercise at all. And sometimes there is certainly a role for reducing or having a break from exercise, particularly when it is driven, compulsive and impacting on health.
But when I put my trauma hat on (it never comes off really!), I wonder about the value of rethinking our approach to exercise.
I will use an example to hopefully illustrate my thinking:
Let’s consider the example of Chloe. After eating, Chloe feels like the food is “stuck” in her stomach and not moving. This is followed by anxiety and thoughts about weight gain, leading her to move, walk, pace, run, etc. We would traditionally call this ED compensatory behaviours to try to move on the stuck food and reduce anxiety about weight gain.
Now typically, we might teach Chloe skills to distract from that feeling, to reframe the interpretation of the bloating, to wear more comfortable clothes after eating, etc. All these strategies are helpful to reduce the symptoms in the here and now.
But what if we got closer to the stuck and heavy sensation? What if we became curious about what Chloe’s body was trying to tell her and achieve rather than guiding her away from the feeling? Most importantly, what if we become curious about her body’s urge to move rather than seeing it as just an ED behaviour.
When this happened, Chloe recalled, through the help of an affective bridge or float back, that she had felt stuck and trapped for a lot of her adolescence. She could not control her parent’s divorce; was stuck going to a school she did not like and trapped in a house she hated. To cope with this stuck feeling, she paced in her room.
In the trauma field Chloe’s stuck feeling would be viewed as a freeze response, and the need to move, as Chloe’s efforts to complete the stress cycle by mobilizing her body into fight/flight. Polyvagal theory would say that Chloe is moving out of dorsal vagal and into sympathetic action. In the ED field we might say this is compulsive exercise and try to stop the behaviour.
When Chloe understood that the stuck feeling in her body was connected to her past experiences of being stuck and trapped and not actually food being stuck in her body, she could appropriately use movement to complete the stress cycle without her ED part compulsively using it to manage weight. She was also able to use yoga poses and gentle stretches to remind her body that it was not stuck, without compulsive exercise.
This example highlights the importance of understanding the survival and adaptive role of exercise rather than always viewing it is an ED behaviour. Of course, sometimes an ED part might use this behaviour for other reasons but if we can get compromise between parts to use exercise to complete the stress cycle in more adaptive ways perhaps we could reduce the distress clients experience when exercise is taken away from them. Because this coping strategy being taken away might leave them feeling stuck again and the cycle continues!
