Concerned about food, exercise compulsion, and bladder control — Help!

Dear Alice,

Last year I was Teetering on the Brink and this year I've fallen off of it. The teetering individual who was worried about how much she thought about food and her weight has turned into a very scared person who has fallen off the brink, with little on her mind but what she eats, when she eats it, and how she looks. I haven't had my period for almost a year and exercise compulsively until I can't anymore, when my legs simply hurt so bad and my knees won't hold me up. Worse, I seem to be losing bladder control — several times when I've been very tired, I've wet the bed at night or been unable to wait until I got to a bathroom. I can't live like this anymore and every morning I promise myself I'm going to change but then night rolls around and I've not changed a thing. Please tell me something that will help — I never knew desperation's face was this thin.

— Needing Help

Dear Needing Help,

Seeking out support after a challenging year is no small feat. Change isn't linear nor immediate and there may be some comfort to be found in knowing that you're still committed to taking care of yourself. What you describe may be related to a number of conditions, but the good news is that a health care provider can provide recommendations options for each mentioned.

To begin, one place to start may be your eating habits. If you’re intensely afraid of gaining weight and you severely restrict your energy intake, you may recognize some or many parts of your experience in those of anorexia. For additional consideration, there is often overlap between anorexia and another eating disorder known as orthorexia. This is characterized by an obsession with "proper" or “healthy” eating. Some signs may be:

  • Compulsive checking of ingredient lists and nutritional labels
  • Cutting out an increasing number of food groups (all sugar, all carbs, all dairy, all meat, all animal products)
  • Spending hours per day thinking about what food might be served at upcoming events
  • Showing high levels of distress when “safe” or “healthy” foods aren’t available

At the moment, this condition doesn’t have a recognized clinical diagnosis or treatment in the current Diagnostic and Statistical Manual of Mental Disorders (DSM-5), but it has been studied since 1998. It’s often treated as a variant of anorexia or obsessive-compulsive disorder. For both anorexia and orthorexia, treatment often includes psychotherapy. As for your frequent physical activity habits, you may recognize parts of your experience in that of a condition called compulsive exercise. Like orthorexia, it isn’t officially recognized in the DSM-5, but is characterized by:

  • Physical activity that significantly interferes with activities, occurs at inappropriate times or in inappropriate settings, or when the individual continues to be active despite injury or other medical complications
  • Intense anxiety, depression, irritability, feelings of guilt, or distress if unable to be physically active
  • Maintenance of an excessive, rigid exercise regimen — despite weather, fatigue, illness, or injury
  • Physical activity used to manage emotions, as a means of purging (needing to “get rid of” or “burn off” calories), as permission to eat, or that is secretive or hidden

In addition to a physical activity routine that takes a toll on the mind and body, you also describe difficulties with some bodily functions. In female athletes, there is a condition known as the female athlete triad caused by an energy imbalance. A health care provider can diagnose this by determining if any of the following are present: low energy availability, menstrual dysfunction, and low bone density. Also, studies have found female athletes are at risk of urinating when you don't want to, also called urinary incontinence. It’s still unclear what links strenuous exercise to urinary incontinence, but the most agreed upon prevention method is a type of physical therapy that supports the pelvic floor muscles. One limitation of this research is that it focused on people assigned female at birth, limiting the ability to generalize this to broader populations.

Some of these conditions may or may not apply to you, but maybe you've recognized a few terms or experiences that may help narrow your search for help. Do any of the symptoms mentioned apply to your experience? What do you find yourself worrying about the most when eating or being physically active? Which of your habits do you perform even if it causes you stress? Thinking over the answers to these questions may help you decide which actions you’d like to take next. You may consider reaching out to a mental health professional to discuss the distress you've been feeling around these areas. Additionally, a health care provider can provide more information and recommendations as to which, if any, treatments may be helpful to you.  

Sending you support,

Last updated Feb 05, 2021
Originally published Oct 01, 1994

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