Anorexia and hyperactivity explained

Anorexia is characterized by a complex picture of symptoms. And one of the most frequently observed symptoms is hyperactivity in the form of physical activity. In fact, hyperactivity can be seen in about half of all anorexic patients.

This may actually sound familiar to you: In the phase when I severely restricted my food intake, I still seemed energetic from the outside and I was more likely to jump up the mountain while hiking – and that even almost without sweating at all. It seemed pretty effortless even though I was malnourished.

how does hyperactivity look like in anorexia

Hyperactivitycan be oberved as excessive exercise like running, biking, or strength exercises (yes, even that gym addiction that many recovery accounts tout isn’t necessarily that healthy!). It goes so far that the patients have to constantly tap their legs, tap their fingers on the table, or prefer to stand rather than sit, even when they are at rest. But also taking a longer path even though you don´t need to can be a form of it.

So if you can observe one or more symptoms of this in yourself, then you are well on your way to learning more about it and also getting suggestions on how you can calm this compulsive behaviour.

hyperactivity as a result of cognitive control?

Why is it always necessary to move, rock back and forth and ideally never stand still? It is not uncommon for patients to collapse from weakness. They get injured, train despite exhaustion or injury and actually no longer really enjoy the movement.

The most common assumption is to lose weight – that is, that hyperactivity is for compulsive weight loss.

However, recent research shows that physical hyperactivity is not only subject to cognitive control. Hyperactivity also has physiological causes, among other things.

bio-evolutionary explanation

Today food is available to us anytime and anywhere. Most of us can get food fairly easily. But it´s not always been that easy and effortlessly. Our ancestors (hunter-gatherers) had to accumulate body fat reserves during periods of food abundance, which then ensured survival during periods of food shortage. This allowed humans to survive periods of famine. But now: how does hyperactivity play into this?

Well, when there was no food and there was a period of food-deprivation, the hunter-gatherers couldn’t just sit around and conserve their energy reserves because the food didn’t just come to the front door via Uber. Hyperactivity during periods of starvation can be viewed as an evolutionary protective mechanism. This enabled our ancestors to obtain food more efficiently.

observations in rats

There is an interesting animal model for the connection between hyperactivity and anorexia: rats kept in a running wheel cage gradually increase their activity. If you now reduce access to food to one hour a day, they increase their running activity excessively. If the experiment is not aborted, it ends fatally (=deadly!!!). The same effect occurs when food is constantly offered, but the amount of food is reduced to 50% of the food intake under resting conditions.

Paradoxically, then, physical activity and malnutrition seem to potentiate each other.

Even if these observations on animals cannot be transferred 1:1 to humans, they do provide initial information on how malnutrition and hyperactivity are connected.

neuro-biological explanation

– Malnutrition can lead to failure of parts of the brain involved in relaxation/regeneration and activity regulation

– Corticosterone: involved in metabolism and gluconeogenesis (provision of energy through the breakdown of muscle mass) – necessary because the central nervous system is 70% dependent on glucose = ensures survival

– Norepinephrine Turn-Over: Abnormally low from malnutrition, but levels of norepinephrine increase with exercise. (Norepinephrine has an activity-enhancing effect, is involved in the stress response and has a positive impact on motivation) Which in turn stimulates an increase in serotonin turnover. The lack of norepinephrine seems to be compensated by hyperactivity over a shorter period of time, but hyperactivity maintains malnutrition and malnutrition maintains hyperactivity, so that sooner or later the body’s own resources are used up (ending fatally)

>> In anorexia, hyperactivity is not a disorder of the nervous system per se, but an adaptation to malnutrition

simply said...

If you couödn´t quite understand everything I just said: In other words, it simply means that the perceived hyperactivity and perceived excess of energy is a result of malnutrition. It all comes down to chemical reactions in your brain. And even if that sounds well and good at first, the hyperactivity – or rather the pursuit of the urge to move – keeps the eating disorder alive. And there is nothing nice about that: 10-15% of all anorexic patients die from it.

Why exercising is not always the healthier choice

The consequences of anorexia are already serious. But it is particularly dangerous when excess sport and malnutrition come together: initially there is a risk of constant injuries and a drop in performance because the body cannot recover and is becoming weaker and weaker. For example, bone density decreases due to malnutrition and bone fractures are more likely. In the long term, there is a risk of osteoporosis, a disruption in the hormonal balance (sleep, fertility, libido, hunger and satiety, insulin, thyroid hormones,…), irreparable kidney damage and even death.

So even if it is highly praised in social media and in society that it is something good not to miss a workout and to train until you tremble (no pain, no gain and such nonsense) – sport is not always “healthy “. It should not be neglected that social behavior and body perception also suffer, which in turn can promote anxiety disorders and depression. So be aware of the risks if you want to continue exercising and I hope you choose life because the recovery is really worth it!

Tips to calm down your hyperacitivity and get out of that rut

So now on to what you can do to tame your hyperactivity so you don’t put yourself in danger and get out of this vile cycle. You might have guessed it: to get out of the cycle, you have to consciously get out. If you continue to exercise at this rate, it keeps the chemical reactions going on in your brain. So what you’re doing right now doesn’t seem to be helping you quit. Here are a few tips on how to slow down your exercise routine without overwhelming yourself

reduce your sports workload. Instead of 1h training you could train 45min or instead of 7 days a week 5-6 times. Since your urge to move is probably quite high at the moment, it is unlikely that you will be able to do without it completely.
Instead of going for a run or gym and HIIT, try yoga and Pilates. This is not only gentler on your body, but also trains your mind and has a positive effect on body perception
find new hobbies. Now that you may be spending quite a bit of time exercising, you should replace that time with something you enjoy doing. Maybe crocheting, painting, sudokus, learning a new language, playing or learning to play an instrument, calling or meeting friends, etc.
write down your thoughts. Why do you think you need to move NOW immediately. Is the world really going to end then? Would that really be the worst-case scenario?
Learn to not link your eating behaviour with the amount of exercise. Your body needs quite a bit of energy just to keep you alive.
Change your attitude towards a potential weight gain

Take care of yourself ♥

Resources and studies

Behl, C. et al. (2008). Neurobiologie psychischer Störungen. In: Holsboer, F., Gründer, G., Benkert, O. (eds) Handbuch der Psychopharmakotherapie. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-540-68748-1_12

Duclos M, Gatti C, Bessière B, Mormède P. Tonic and phasic effects of corticosterone on food restriction-induced hyperactivity in rats. Psychoneuroendocrinology. 2009 Apr;34(3):436-45. doi: 10.1016/j.psyneuen.2008.10.008

Kohl M, Foulon C, Guelfi JD. Aspects comportementaux et biologiques de l’hyperactivité dans l’anorexie mentale [Hyperactivity and anorexia nervosa: behavioural and biological perspective]. Encephale. 2004 Sep-Oct;30(5):492-9. French. doi: 10.1016/s0013-7006(04)95463-2