Related Conditions

Throughout life, we all experience periods of both positive and negative stress. During these times of stress it is quite common for people to experience eating problems and / or sleeping problems. When these problems persist they can cause major distress. They can interfere with daily life and impair an individual's personal, social and professional life. When this is the case, it is important to seek the help and support that you need to try to identify the underlying causes and to develop appropriate coping skills. Seeing a GP to clarify any medical concerns and talking to someone with whom you can address any psychological and emotional issues underlying your difficulty will be of benefit.

Body Dysmorphic Disorder (BDD)

BDD is a preoccupation with an imagined physical defect in appearance or an over-exaggerated concern about a minimal defect. The preoccupation causes severe emotional distress and significant impairment in the individual's life. The obsessive concern can relate to facial features, other parts of the body, hair or even odour.

The person may fear ridicule in social situations and their distress may be so severe that it will lead them to contemplate undergoing procedures to try to change the perceived defect. Procedures rarely bring relief and often lead to a worsening of symptoms.

BDD can lead to social isolation and constant anxiety and obsessing about appearance may make it difficult to concentrate on work / schoolwork. Depression is often present and BDD is also often associated with obsessive compulsive disorder and with delusional disorders.

The distress levels associated with BDD can be so severe that they can lead to suicidal thoughts and to the completion of suicide. It is important not to dismiss the individual's distress. Even if their distress over a perceived defect seems out of perspective to you, it will be extremely real to them.

Treatment usually involves cognitive behavioural psychotherapy. The therapist helps the individual to understand how some of his or her thoughts and perceptions are distorted and helps them replace these perceptions with more realistic ones. The therapist will also help the person to resist any compulsive behaviours associated with the BDD (such as repeatedly looking in mirrors or excessive grooming). If the individual avoids certain situations because of fear of ridicule, the therapist can work with them at finding ways to manage feared situations. In the case of adolescents, some family therapy is seen to be useful. Medication may also be useful in some cases.

Exercise Bulimia

Exercise bulimia is the name given to a form of compulsive or obsessive exercise, where the exercise is used as a means of purging calories to compensate for bingeing (or even just for regular eating). In other words, exercise is being used compulsively to control weight.

It often goes undetected as, to the on-looker, the individuals affected seem to be merely very focused on health and fitness. Weight may not necessarily be very low because when you exercise compulsively your body compensates by slowing down metabolically.

One of the signs that exercise is becoming compulsive is that the person affected will have begun to schedule their lives more and more around exercise, missing social engagements and even missing work and appointments in order to work out.

Other warning signs might include:

  • Working out for hours at a time each day or not taking any rest or recovery days.
  • Working out even if you are injured or feeling unwell or exhausted.
  • Becoming depressed, irritable, behaving irrationally if you can't get a work out in.
  • Experiencing strong feelings of guilt and anxiety when unable to exercise.
  • Never feeling satisfied with your level of fitness or achievement.
  • Valuing yourself in terms of physical fitness and appearance, of achievement and performance rather than in terms of inner qualities.
  • Giving priority to your exercise schedule before attending to relationships.

Some physical consequences of compulsive exercise:

  • Increased risk of injury (such as stress fractures, tendonitis, joint and ligament injuries).
  • Fatigue.
  • Dehydration.
  • Osteoporosis.
  • Arthritis.
  • Heart problems.
  • Hormonal disturbances (loss of libido, irregular or no menstruation) and reproductive problems.
  • Poorer physical and mental performance overall.

Psychological consequences:

  • Low self esteem.
  • Perfectionist, black and white thinking.
  • Depression, anxiety.
  • Irritability.
  • Rigidity.
  • Withdrawal from relationships.
  • Social isolation.
  • Inability to derive joy from eating or from exercise

To overcome exercise bulimia, help can be obtained from a number of sources:

To assess and monitor the physical impact of excessive exercise (and of any other harmful behaviours).

To look at the emotional issues that underlie the compulsion to exercise; to explore the motivation behind your behaviours; to explore attitudes and beliefs around exercise, your body and your health and how these influence your feelings and your behaviour; to help you to reduce your emotional and physiological dependence on exercise.

To advise on how the cycle of eating/ purging through exercise is affecting the metabolism and to advise on how to rehabilitate and rebalance the metabolism; to help you to redress the balance between nutrition and exercise in your life.

The use of a diary to record both food intake and exercising behaviours can be a very helpful recovery tool.

If you are a regular attender at a gym/fitness club, it would be helpful for you to talk to your trainer/ instructor and seek their support in overcoming your problem.

Muscle Dysmorphia / Reverse Anorexia / Bigorexia

Muscle dysmorphia, also known as reverse anorexia or bigorexia is a condition in which a person becomes obsessively focussed on being too small and not muscular enough. People with muscle dysmorphia resort to a variety of measures to try to increase muscle mass. These measures may include excessive exercise including weight lifting and other body building exercises, excessive attention to diet, misuse of high protein diet, misuse of steroids and other muscle-building drugs.

Muscle dysmorphia can affect both men and women although it is more common in men and in most cases the person affected in not in reality small or lacking in musculature. In fact, many body-builders are affected.

The obsession with becoming more muscular takes over the person's life to the extent that it may cause a person to forego or to avoid important social, work related or recreational activities. The preoccupation causes major distress and can have a severe impact on relationships as the person’s life becomes restricted to the pursuit of an unattainable ideal body.

A person with muscle dysmorphia will continue to work out and / or diet despite knowing that it is dangerous to their health and general wellbeing. Because of the distortion in self perception it can be very difficult for the person to recognise that they need help.

Muscle failure, osteoporosis, heart and kidney failure are among some of the risks associated with muscle dysmorphia. Depression is often co-existent with the condition.

Treatment should involve medical evaluation and monitoring as well as psychological therapy. A cognitive behavioural approach is often used.

Muscle Dysmorphia Interview
Audio interview featuring a personal account of the condition know as Muscle Dysmorphia, sometimes refered to as reverse anorexia.

Click here to download the audio interview to your computer for playback. (MP3 file)


Orthorexia or orthorexia nervosa is the name given to a condition which involves a compulsive preoccupation or obsession with dietary purity.

Attention to a "pure" diet becomes problematic when it is an obsession that has a significant negative impact on a person's life. Whereas anorexia nervosa and bulimia nervosa are marked by a chronic concern for the quantity of food being consumed, orthorexia is characterised by an over-concern with the quality of the food consumed.

Thinking about food and about how it is prepared becomes a means of coping with the stresses of life and avoiding the experience of negative emotions.

For the person with orthorexia, wavering from their "perfect" diet can lead to periods of even stricter rules around food and eating or to periods of fasting.

Psychological therapy can help a person to gain an understanding of the thoughts, beliefs and value that underlie the emotions that are driving their obsession with the 'right' diet and help them to restore balance to their relationship with food and to their lives in general.


Pica involves the eating of non-nutritive, non-food substances inappropriate to the developmental level of the individual. Non-food substances may include soil, clay, paper, coal, wood, string, pebbles or hair. Research into Pica is limited and the prevalence may be under-reported due to feelings of embarrassment.

Due to the nature of the disorder, Pica can lead to medical complications such as lead poisoning, intestinal problems and mineral deficiencies. Due to tooth damage, dental problems may also arise.

Iron deficiencies may be an underlying factor in some cases. Some individuals with developmental disabilities may be affected by Pica. This may in part be due to their inability to distinguish between food and non-food items. Small scale studies have pointed to feelings of compulsion and obsession in some individuals affected by Pica, suggesting obsessive compulsive disorder (OCD) may be a factor in some cases.