RadioMD Presents: HER Radio | Original Air Date: February 19, 2015
Hosts: Michelle King Robson and Pamela Peeke, MD
Guest: Victoria Abel, MA

PAM: Okay, Michelle. Check this out. Anorexia athletica. Have you heard of this?

MICHELLE: No, but I suspect I don’t have it.

PAM: That’s right. Because I can’t get you to assume the vertical. We’re not even going to go there, honey. Another day. Another segment. Alright.

So, this is a huge question out there. How many times do you go to a gym and you find someone just whacking away on all of the equipment. They’re always there. It looks like they probably pay rent there and what’s that about? When does exercise become obsession and unhealthy?

We have our “go to” eating disorders expert, Victoria Abel. I’m so happy to have her back again. She is fabulous. She has her Master’s Degree in Counseling Psychology, many years in the field of addiction and recovery, works out of Sundance Addiction Center out in Arizona for the Elements Behavioral Group and this is just such a hot topic, Victoria.

First, Michelle and I welcome you back on HER Radio. If you could, tell us what is anorexia athletica?

DR. ABEL: Well, thanks for having me back on the show.

I’m seeing so much more of this. It’s different than traditional anorexia because it’s not just focused on food, it’s really focused on body size and working out. So, not only is it people who are working out in the gym, but it’s also people who are involved in sports who maybe since they were very little, there was an over focus on their body size and their body’s ability. They’ve taken that to the point of not just being a great athlete and being successful, but really being held hostage by their body--not only their food intake, but also their body mass and their muscle and their ability to function in their sport.

MICHELLE: So, Victoria, who’s most likely to suffer from this and then is it related to any other kind of eating disorder?

DR. ABEL: It is very related to classic anorexia, but there is that added compulsive exercise part in it. We’re seeing mostly young girls, but we’re also seeing a lot of young boys, who are kind of slipping through the cracks because they’re still possibly performing well in sports. So, what we’re looking at is maybe a gymnast, tennis player, wrestler who, since they were little, their coaches have been like, “You’re too fat there. You’re too big there.” Or, “We need to change your body” and so there going to go to any lengths with their food and their exercise to the point of electrolyte imbalance, heart arrhythmia, kidney stones, bone breakage—whatever they can—in order to keep that body type that’s going to fit into their athletic sport of choice.

PAM: So, Victoria, there’s so many women out there saying, “Oh, come on. I don’t have any problem. I just show up and, hey, I do a lot of working out.”

DR. ABEL: Right.

PAM: “And maybe I’m a little obsessive about what I eat, but, you know, surely I don’t have this.” So, why don’t you tell us the signs and symptoms of anorexia athletica?

DR. ABEL: The signs and symptoms are if you’re too tired or if your body is really hurting and feeling damaged or you have a bone break or a sprain and we’re still finding ourselves in the gym. We’re still finding ourselves pounding the pavement running. If your kid, let’s say, is having a birthday party and you’re like, “Oh, wait. I can’t eat that piece of cake,” or, “I can’t do this because that isn’t within the caloric structure that my coach or my personal trainer is telling me to do.” There’s really no freedom in life any more. The body is really hurting and we do it anyway.

The other thing is that if people are having a sport or an activity that they used to really love and now they don’t really love it any more but they’re doing it because they feel like they have to and that there’s a feeling of guilt if you don’t go to the gym or you don’t do your training exercises—a feeling of guilt and failure if your body just isn’t able to take it.

MICHELLE: So, Victoria, are there treatments? Are there options for women who suffer from this and what are they?

DR. ABEL: Yes. It’s women and men. For sure. I have, actually three of my clients in my private practice right now who are former male wrestlers and who really struggle with this. So, we have both genders. The treatments that we’re looking for are a little bit different than classic anorexia because if their worth and value have been wrapped up in not just their body but also their sport of choice or whatever they’re doing and that if their worth and value is only if they get this, reach this goal, win this race or if they win this match, to really begin to look at what is their worth regardless of their sport.

So, it’s almost like they have to grieve the sport. It doesn’t mean they can’t have it any more or they can’t ever go to the gym, because we have to look at it in moderation, but it’s really grieving that self-identity wrapped up in the behavior versus your identity and worth being wrapped up in who you are as a person. So, finding out who you are versus who you are as an athlete alone.

MICHELLE: So, do you have to go to a treatment center for this?

PAM: Now, you keep saying athlete. Yeah. Yeah. I mean, where do you go?

DR. ABEL: It doesn’t just have to be athletes. It could just be people who are just compulsively exercising, for sure. But, there’s always that goal. You’re going to get your personal best with the weightlifting or you’re going to get your personal best. So, it doesn’t have to be a sport always, but we find that most often we can pick people out more easily when they are involved in a group sport.

So, yes, there are treatment centers for sure that are able to do this--that are able to identify it. The work is really specific because we can’t just place “eating disorder” treatment on it because this is very different. In this, you really have to look at the role of, there’s a whole “other person”, let’s say. There’s a whole other aspect of addiction which could be the going to the gym or training or exercising that needs to be addressed and that relationship has to be healed before you can be in recovery.

So, yes, there’s in-patient treatment. There’s also some out-patient, but it’s still really new in the field of recovering from eating disorders.

PAM: Well, it’s not even recognized by the Standard Mental Health Diagnostic Manuals, correct?

MICHELLE: I was going to say.

DR. ABEL: No, not at all. It’s not in the DSM-V nor is it under the diagnoses to be considered because eating disorders, I think, in diagnostic and assessment tools, we’re advancing faster and we’re getting more sophisticated with our eating disorders than we’re able to catch up with in terms of diagnosis at this point. I think that it’s something that we have to look at, but exercise is still seen as this healthy thing to do, but with that compulsive mind, we can take something that’s actually a very healthy thing and really turn it into distortion.

MICHELLE: So, the insurance company doesn’t cover it either, I take it?

DR. ABEL: Not under that diagnostic code, but if they have a code of anorexia nervosa, you can get insurance coverage for it.

MICHELLE: That’s very good to know.

PAM: So, you’re really looking at the whole issue of body image.

DR. ABEL: Yes.

PAM: You’re looking at very vulnerable people who are listening to coaches and maybe even anybody—a dance instructor—anybody, who, even a single word from them, could change everything and, suddenly, it’s not just about athletic performance, it’s about self-worth and self-esteem. Would you agree?

DR. ABEL: Absolutely. Because if the coach makes a comment about, “Oh, did you eat some cake this weekend?” Or, even getting on the scale I think about so much, in terms of wrestling. To be in certain classes you have to actually weigh a certain thing. It becomes extremely obsessive and the restriction of caloric intake in order to look good in that tutu or to be in that wrestling outfit or to be on that horse is pretty

PAM: And, basically be perfect. Just to be perfect.

Victoria, I can’t tell you how grateful we are for you to be able to help us with anorexia athletica and telling us obsessive exercise is unhealthy.

Go to CenterforAddictionNutrition.com to learn more about Victoria’s wonderful work.

I’m Dr. Pam Peeke with Michelle King Robson.

MICHELLE: Ladies, make sure you understand more about anorexia athletica because it affects both men and women.

You’re listening to HER Radio on RadioMD. Like us on Facebook. Follow us on Twitter.

Stay well.