When exercise becomes socially accepted self-harm

Posted on December 29, 2020

(Last Updated On: December 29, 2020)

The fitness world has an extreme segment. One we tend to either give intense praise, or be dismissive of.

CrossFit: it tends to either bring about exuberant cheers or cavalier jeers.

This is in large part because the fitness and exercise world tends to draw extreme personalities, I’d argue to a greater extent than most industries.

For a long time this was exemplified by the bodybuilding community. It used to be a joke in the fitness world how narcissistic most bodybuilders were, as well as “what are they trying to make up for? haha.”

However, 1) that’s moved on to other fitness pursuits (bodybuilding isn’t what it was) and 2) there were always people who had some legitimate psychological concerns about those personalities. Like, no, really, what are they trying to make up for?

Many personal trainers can attest to the kind of personalities in the fitness space. They get involved wanting to help people get healthier, physically, but soon realize many of the clients they work with have mental issues leading to their physical issues. If someone is clinically depressed, but that’s not being addressed or has been intractable, you might not get too far on the exercise or diet front until that hurdle has been cleared. (Other times, it can go the other way.)

-> It reminds me of an emergency room doctor I trained. She thought she was getting into a line of work meant to save people from traumatic physical events, only to realize more than 50% of her time was spent dealing with opioid addicts. She was in no way equipped to treat their underlying disease. She could only attempt to treat their symptoms.

This is true even of the trainers. You don’t have to look far into many trainer’s backgrounds to see an extreme past. For instance, a 100lb weight-loss and a contemporary view they can never have a sip of alcohol or a sniff of “processed food” i.e. a very all or nothing view on nutrition and fitness. Where they’re bragging they haven’t missed a workout in ten years.

With everyday people, we’ll often see those who get very into a fitness program, with extreme dieting and exercise.

I wouldn’t say it’s agreed upon -I’m not sure how much this is even truly discussed (one reason for me writing about it)- but talking to many clients of this kind through the years, I’d say there is a nearly silent belief that many of these people are addicts, and that you don’t really beat addiction, but you substitute one for another.

I don’t know enough about addiction to know if that’s true, but there are clearly anecdotes. Most obvious is the person who is, say, a drug addict, gets sober, in part, by running, like crazy. Miles after miles. Or gets intensely dedicated to lifting weights. Many would say they haven’t overcome their addiction, they’ve instead traded it, but hey, at least it’s a healthier addiction.

If it’s not that, the other explanation I’ve seen thrown around is the addict has not actually addressed their addiction, but found another avenue to “run from it.” Instead of substance abuse to get their mind off or dull their pain, they use…and abuse…exercise.

That’s where this post comes in. I never thought about it phrased this way, but this article, detailing an extreme exerciser’s experience with mental illness, describes that aspect as extreme exercise as “a socially accepted form of self-harm.”

“”these more extreme races were my versions of self-harm,” he says. “They were well received by my society. Society and my mom made me feel worthy for completing them, so I continued finding harder and harder events.”

This is a point of view I think the fitness industry should take rather seriously.

Eating disorders have quite a negative perception around them, but extreme exercise does not. In fact, the more intense the exercise? The more we, on average, champion it. People who don’t want to push their limits? We often call them lazy and soft.

This is despite the fact an exercise intensity of jogging, a few times a week, is about as much health benefit, from a life extension standpoint, you’re going to get.

I might write about this more in-depth someday as I don’t think this is completely ironclad, but we have known, to the best of our knowledge, for many years, that more does not mean better. Not even close:

Source: Run for your life…at a comfortable speed and not too far

Look at that chart! Once you run about THREE miles a week, you get as much benefit as TWENTY. And once above 20, you start coming close to being no better than being sedentary.

This finding has been replicated many times. Not exactly the same distances and whatnot, but the general theme of -when it comes to our broadest measure of health: life expectancy- that some exercise is great; more is typically meh. Basically, once you start training for a marathon, we start seeing negative effects.

-> Now, whether that’s all attributable to the physical training, or is in part explained by the personalities who get into marathon like training? Whether you can train for a marathon, take a few months off, then do it again, to help bring down your lifetime average weekly mileage? (Olympic marathoners, people who are largely former marathoners, live longer than the average person.) Whether you can just do one a year? That hasn’t been answered, in my view. But we have to go with the information we have.

I’ve written about this myself, numerous times, years ago:

Athletes are not the epitome of health

We shouldn’t view strength training as cardio

Yet we continue to push, brag about, endorse, extreme exercise. (Or we ignore the potential negatives of it.) How many of the most popular trainers are known primarily because they either engage or endorse extreme exercise? Think about Jillian Michaels and the hey-day of The Biggest Loser. Think about the trainers you follow. Think about their Instagram. I’d bet odds are you found them because they have a really impressive deadlift, or stay at 4% body fat year round, or routinely profile themselves and or their clients doing some crazy ass exercise.

Not only is this extreme level not helping people physically over the longterm, we have to seriously question if we are feeding a mental health problem. Are we helping people run from their true issue(s)? Are we helping them substitute their addiction?

Being on the lookout

Plenty of people are into intense exercise because they view it, I like to think of it, as an adventure. That’s great!

Nobody is saying the point of fitness is merely to get people to live as long as possible. If athletes want to push the limits of what humans can do physically, if you want to push your own limits, that can be great and just a cool thing to do. There’s more to life than living longer than others.

But these personalities are the exception. After all, more people take a bus around the Grand Canyon than walk it. And there’s a point where a person is pushing their limits because they’ve merely found another way to hurt themselves, one which has less stigma. Rather than destroy their liver with alcohol, they’ve decided to destroy their heart and knees with never ending miles, in part because we endorse that behavior as worthwhile.

A lot of trainers are meandering through the dark on this front. Below are some traits I’ve found to be on the lookout for. Of course this is personal experience, a little research and talking with psychiatrists I’ve had as clients, but I’ve found this lines up rather well with a simple Google search of “risk factors for exercise addiction”. Where I’m simply adding more context and examples.

-> Note I do not do in-depth research on this because, well, I’m not a psychiatrist. I’m not diagnosing or treating anybody. I’m only looking for alarm bells to help know what I’m dealing with, and if applicable, help initiate the process for someone else to make that call.

  • They’re taking mental health medication(s)
    • Antidepressants obviously throw up red flags
      • It’s not like I won’t train these people or judge them. I just might be more cautious with certain things. For instance, if early in our relationship they’re asking for more intensity, I might be less agreeable to that than a client without that medication profile.
    • I ask every new client what medications they’re taking. I’ve been blown away how many are on antidepressants. This depends on the population you deal with, but for the general population, various sources say it’s like 10% of adults (roughly double that for women). If you then filter the general population more i.e. people who have weight / body image issues, you can see how you can easily get up past 20% in a gym setting. Something like a quarter of all clients can be quite plausible for some trainers. (Never mind how many people you’re working with who haven’t been diagnosed but would qualify.)
      • This really has to be hammered home because trainers, and frankly, most healthcare workers, are not prepared to deal with the possibility a third(!) of every woman they work with having clinical depression.
  • Mentions of past addictions, most commonly alcohol, drugs, food
  • Routinely doing a version of exercise where most people consider it something impressive, but basically insane
    • Extreme running
      • Consistent marathoning
      • Ultramarathons
      • Those wild obstacle course runs
    • CrossFit
    • Intense recreation sports
      • Especially for an older person due to how hard it can be on the body e.g. the person is constantly injured, yet keeps doing it
    • In the gym 5, 6, 7 days a week
      • Sometimes twice a day
    • Note “routinely” is key here. Someone who wants to do a marathon once, or someone who does something a bit wild once or twice a year, is not the same as someone who does crazy stuff every week.
  • Interested in ever more restrictive diets
    • Liquid dieting
    • Paleo
  • Person with extreme weight swings in their history
    • Often attained in very short time periods with “oh my god” type dieting
    • Women who mention gaining e.g. 100 lbs during pregnancy is a common red flag I’ve seen.
  • Person will trade career advancement, personal relationships, etc. to not miss a workout
    • Most will not even ask their trainer about, say, whether the gym is open on Thanksgiving. These kinds of clients may not only ask, but see if you’ll come in to train them that day too!
  • Person reads about fitness as if they work in the industry. They’re always looking for new techniques, buying new supplements, downloading new apps. They bore easily.
  • Neuroticism
    • A lot of times people default to thinking a clinically depressed or mentally ill person is perpetually down and sullen. That’s not always true. You’ll often see them amped and raring to go at a training session. They’ll be asking for more weight, more reps, more intensity. They often can’t stand still, and talk a mile a minute. They can be exhausting to be around.
  • Negative self-talk; judge themselves too harshly
    • There is a line between self-deprecating and self-loathing. For example, the trainer has to remind the client a couple times about the same technique change, a common thing most clients think nothing of, but this kind of client may go “Argh, I can’t believe how stupid I am that I can’t remember that.” Stuff like that pops up left and right.
  • Doesn’t sleep well
  • Ever seeking more intense exercise
  • Yet doesn’t really have any specific goals or reasons why they want to do intense exercise
  • If they do have goals, never seems to actually enjoy hitting any of the goals. Never really seems to enjoy the exercise period. Just wants more painful exercise to keep coming.
    • This person will often have already had a time (or multiples times) they’ve hit their target weight, only to be unfulfilled by it. (It may have been believed hitting a certain weight would mean happiness, only to realize it didn’t change anything internally.)
  • They’re more prone to injury, likely in part from being constantly stressed
    • You can feel the stress when these people walk through the door. Hell, you can feel it in their text messages and emails too.
  • Often pushes themselves through injury
    • They’re the rare kind of client you have to pull back to do less, rather than push to do more
    • With most clients, it can help if the trainer has some bounce in their step, some energy, a little ra-ra, to help get the client going. With these clients, you may want to be a subdued trainer, to help bring them down.
  • Unnecessarily harsh judgment of non-fitness buffs
    • It’s important to remember humans, and most animals, default is to minimize calorie expenditure. Most of us don’t want to move much, because it’s how we’re wired for survival. Not wanting to exercise is normal.
  • Has trouble taking time off
    • Sometimes you’ll see a person accomplish a really intense goal, then, rather than take time off, barely a day or two later they’re already back to intense activity
    • Often afraid if they take a few days off, they’ll lose their gains
    • There is a tough dynamic here. Asking this kind of person to take a break approaches asking a drug addict to take a day off from drugs. It’s not that basic.
      • I’ve seen exercise addiction compared to gambling, as they’re both not dependent on substance abuse. I kind of view the exercise addict getting injured and having to take time off as the gambling addict who goes bust- that’s when shit can really hit the fan. For lack of a better phrase, it can be rock bottom.

To reiterate, I do not try to treat or diagnose these people. I try to understand where they’re coming from. Once thinking I might be working with this kind of person, I try to be extra cautious about feeding into their addiction / habit / belief of more is better / cool / admirable.

This line is most often clearly crossed once a person is trying to train through injury. I won’t partake in that, and I tell them so. Unless you’re, like dealing with a professional athlete who has a career defining moment on the line, or gets paid to push themselves in that way, I have a hard time seeing situations where that’s justified for everyday people.

That’s really the big issue. If you’re not aware this kind of personality is out there, you might think “Hell yeah! Let’s crank up the intensity! This person wants to get after it! It’s so nice to not have to always motivate people.” Not realizing you’re helping a person hurt themselves. Which is something else to mention- sometimes these people will not be forthright about musculoskeletal pain from the training, so the trainer doesn’t pull back. The trainer can clearly see “Uh, does that hurt?” but the person will go [face grimacing] “Nope! Let’s do it again!”

I also try, if the opportunity presents itself, to refer them to a therapist. I won’t say this out of the blue, but if the conversation presents the opportunity -you tend to hear people’s demons come out when you interact with them 2-3 times a week (a divorce is bothering them, they hate their job, etc.)- then I try to mention it in a way where it’s not a sign of weakness, but something that’s just as admirable as trying to get in better shape. Super simple. “Hey, have you tried talking to a therapist about that? Sometimes a professional can really help. I have some other clients who’ve spoke highly of their experience. I can get a name and number if you’re interested.” Where it’s no different than hiring a trainer, or an accountant for that matter. You’re seeking expertise you don’t have. That’s all.

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