When Does Exercising Become a Form of Self-Harm?

Exercising undoubtedly has significant health benefits and is one of the most important modifiable risk factors in preventing chronic diseases. Experts say sometimes it can also be a form of self-harm.

Regular exercise can lower the risk of major chronic conditions that plague modern societies, such as heart disease, stroke, type 2 diabetes, and cancer. Exercising has also been shown to be effective in treating depression and depressive symptoms, with some research even comparing its effect with that of antidepressants.

However, people experiencing emotional distress may resort to intense exercise to convert their emotional pain to physical or as a form of punishment for their life experiences, according to Nicholas Fabiano, M.D., a resident at the University of Ottawa Department of Psychiatry.

Fabiano wrote in his recent commentary published in Sports Psychiatry that such harmful exercise behaviors may be reinforced by family, friends, and healthcare providers, further perpetuating this cycle.

Self-harm refers to intentionally injuring yourself, often in an attempt to cope with complicated feelings or overwhelming situations.

Fabiano argues that excessive and intense exercise with the intent of self-harm leads to further maladaptive coping behaviors and has the potential to manifest as serious physical injuries or impairment.

“As these behaviors may be perceived as positive, they may mask the underlying distress a person is experiencing, leading to a lack of support or underrecognition of mental disorders such as depression,” the commentary reads.

Exercise as purging

Lacresha Hall, M.D., a quadruple board certified psychiatrist who works with patients suffering from eating disorders, says they may consider excessive exercising a form of purging, which is a compensatory mechanism to make up for calories that have been eaten. It is often seen in individuals with bulimia nervosa and anorexia nervosa.

Hall tells Healthnews, “Some patients report using exercise specifically as a form of punishment or self-harm, while others may not be conscious they are using it in this way.”

For example, a patient of Hall’s reported exercising until they collapsed to justify eating a small fruit bar, while another tried to punish themselves by exercising for 3-4 hours at night.

However, excessive exercising is often only one form of self-harm, as many individuals also engage in other behaviors such as cutting, scratching, and burning.

The signs of using exercise as self-harm

Engaging in exercise that seems overly intense or long in duration compared to the usual routine during a difficult time may be a sign of using it as self-harm, Fabiano says.

According to Hall, some of the warning signs include the following:

• Forgoing activities in lieu of exercise.
• Having to burn off or earn your food.
• Exercising secretly, in the middle of the night, or at times when exercise would be inappropriate or unexpected.
• Exercising in response to anger or frustration for eating.
• Exercising when you have an injury or do not feel well.
• Exercising multiple times a day or/and for several hours a day.
• Associating exercise with words such as “deserve” and “punish.”
• Exercising to the point of negative consequences, such as passing out, becoming lightheaded or dizzy, and experiencing frequent injuries.

Exercising for health benefits

While some people may punish themselves with intense physical activity, research suggests exercising may also work as self-harm prevention.

For example, eight weeks of aerobic exercise reduced the frequency of self-harm in adolescent girls. In adults, exercising was found to significantly decrease suicide attempts.

Adults need at least 150 minutes of moderate-intensity or 75 minutes of vigorous-intensity physical activity a week, according to the Physical Activity Guidelines for Americans.

The dose makes the poison, and the principle also applies to exercise. Physical activity is crucial for maintaining physical and mental health; however, it is important to ensure that exercise is not used as a form of punishment or purging.