Sydney Hoyt enjoyed being a three-sport athlete in high school – volleyball in the fall, swimming through the winter and soccer in the spring. During her senior year, however, something else took over.
An athletic introvert, Hoyt found sanctuary and challenge in the solitary rhythms of running. The newfound compulsion only intensified during her freshman year of college.
That’s when loneliness gripped her, even while sitting in a room filled with friends. Hoyt came to dread meals in the cafeteria, evenings out with classmates, weekend group hikes – anything of a social nature.
She found refuge out on the running paths, pushing her body to the limits. Logging 50 miles a week turned into 60, then 70.
Escaping through exercise
“Exercise was truly my escape from any and all unwanted emotions,” Hoyt said. “It was the only time I felt peace, and my self-worth was completely tied to who I was as an athlete. My entire life was revolving around exercise.”
This article is part of a CU Anschutz Newsroom series exploring addiction, a serious public health issue our doctors and researchers are working hard to address.
See other articles in the series.
Therapists who treat obsessive compulsive disorder (OCD) and exercise addictions, which are often concurrent conditions, say a rigid fixation on a workout routine can be a tip-off to trouble.
“It’s that rigidity and adherence to rules that are mostly in their head, and that lack of flexibility around maybe stopping a little early or listening to their body or exercising while they’re injured, or while they’re sick” that indicate a possible exercise addiction, said Emily Hemendinger, MPH, LCSW, an assistant professor of psychiatry at the CU Anschutz School of Medicine.
It’s estimated that about 10 million Americans may suffer from some form of exercise addiction. The prevalence in Colorado is likely higher due to residents’ enthusiasm for fitness and outdoor activities.
“I think one of the biggest issues is that motivation and willingness (to exercise here) because people are like, ‘Why would I stop? This is good for me,’” Hemendinger said. “So, it can be hard to get that buy-in for treatment. While I see people at varying stages of exercise addiction coming to therapy, more often than not they are far into it because it’s not as noticeable or recognizable to them. But I can say, living in Colorado, it is something I see all the time.”
Hemendinger, also clinical director of the OCD and Anxiety Program at CU Anschutz, battled her own eating disorder and exercise addiction as a young athlete.
She said the neuro-chemical reward system at play in substance-use disorders is likewise activated in an exercise addiction. “We get so many of those good-feeling brain chemicals from exercising,” Hemendinger said. “And just like any other coping skill, it can be taken too far when we’re relying on that one activity, especially if it does make us feel good.”
Sitting with ‘bad’ emotions
The urge to ratchet up that elated feeling – often called a “runner’s high” – can quickly become an all-consuming path away from unpleasant sensations.
In Hoyt’s case, any withdrawal from running meant having to sit with “bad” emotions she’d been avoiding – sadness, loneliness, anxiety and grief.
Through her years of escape, Hoyt struggled to comprehend what was happening. Even while pounding out untold miles on a stress-fractured shin, she didn’t realize that her running had morphed into an addiction.
During her sophomore year of college, Hoyt’s friends pulled her into a room for a quasi-intervention.
“They just said, ‘Hey, we’re really worried about you. You’re not sleeping. It’s affecting your life,’” Hoyt recalled. “I was irritable – not a fun person to be around. I think that’s when it started to hit that, OK, this might be a problem.”
‘Out of control’
At Hoyt’s worst point, she was pallid and thin.
On a run near her parents’ house one day, the world started spinning and Hoyt nearly passed out. “It really scared me, and that was the wake-up call: This isn’t OK. When I got home, I told my mom, ‘This has gotten out of control, and I do need help.’”
Attending Regis University at the time, Hoyt enrolled in an eating disorder therapy program for students. She still thought her exercise fixation stemmed from dysregulated eating, body image issues and introversion. “I didn’t realize how deep-rooted it was with self-esteem issues and control. Those were underlying factors. With exercise addiction and eating disorders, it has so much more to it than just your weight or body image. There are so many other contributing factors.”
Hoyt was diagnosed with an eating disorder – anorexia nervosa – and, later, OCD.
Treatment options offer new path
“Rarely do I see someone with just OCD,” Hemendinger said. “There’s often depression, substance abuse and substance misuse. And then eating disorders, which may have an addictive or even compulsive exercise piece, are there. In Sydney’s case, she was getting eating disorder treatment and then realized that she had OCD and came over to us for treatment.”
“Even today, exercise still helps me cope with my OCD, but now I work out in a way that’s healthier. It’s not taking over my life.”
– Sydney Hoyt
Hemendinger said she uses a variety of therapies – both cognitive and behavioral – tailored to each person’s case. She helps patients, many of whom are former athletes whose identities revolve around physical activity, rework their relationship with exercise and their bodies. They look at “what’s the function?” of the exercise – identity? coping skill? avoidant strategy? She emphasizes “a lot of acceptance, too, accepting their emotions and thoughts.”
Also, Hemendinger challenges patients to be more flexible. For example, can they handle working out for just 45 minutes instead of 90? “Or maybe having them take days off from exercising or doing something like yoga instead of always running.”
During the COVID pandemic, Hoyt sought therapy at the OCD and Anxiety Program when her OCD flared while working as a registered nurse. She’s noticed that occasionally “exercise or food will start to take over again,” and she’s successfully worked on those issues with Hemendinger.
‘Never really shuts off’
“Even today, exercise still helps me cope with my OCD, but now I work out in a way that’s healthier. It’s not taking over my life,” Hoyt said. “I’m able to enjoy time with my family and friends. But with my OCD, my mind never really shuts off. I’m always hyper-focused on something, worried about something, and exercise is still a way to almost numb the thoughts.”
Digging into the reinforcing feelings behind Hoyt’s exercise addiction – the need for control, a deep-rooted desire to be “perfect” – was an important part of her therapy. Reinforcing factors can be environmental, too – including social media’s “look-at-me” culture and Colorado’s love of fitness.
“There’s a lot of disordered eating going on here,” Hemendinger said. “If you’re in that environment or in a sport that’s very focused on performance and appearance, that’s going to reinforce this addiction.”
Still running
Hoyt is training for a 100-mile race in the mountains. Thanks to tools she’s learned in therapy, the nurse knows how to listen to her body. It’s good to give it rest. She sensibly fuels herself with calories.
The chore is gone. “I think the difference between then and now is back then I felt like I had to do it, and now I do it because I want to.”
Asked if she has advice for anyone struggling with exercise compulsions, Hoyt said it’s essential to reach out for help. Friends, family, therapists – and ask sooner rather than later.
“Recovery is so worth it. I missed out on so many experiences and memories where if I had just gotten help sooner, I could’ve combated this,” she said. “Recovery is never easy, but it’s going to be easier than waiting until you’re in the thick of it, trying to get help when you’re at rock bottom.”
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‘Really sick:’ Social media’s influence on body image During her college years, Sydney Hoyt recalls her social media feeds being filled with “You need to do this workout,” “You should be on this diet” and similar call-to-action messages. She saw posts that glamorized anorexia nervosa. At the time, she was in the throes of an eating disorder, body image issues and a growing exercise addiction. “It’s really sick,” said Hoyt, who recently deleted all of her social media accounts. “It’s definitely harmful for someone going through those things. I also think about just how many kids are out there on social media that are going to be seeing these things, are being fed these things.” Adding to her stress several years ago, Hoyt was battling anxiety and depression. Her social feeds were flooded with images of friends having the times of their lives. “So when I am not – and I’m going through all these things – I started to feel like, ‘What’s wrong with me? Why can’t I fit in, and why can’t I go have this fun in college?’ That type of thing. I just think the constant comparisons and people only posting the good parts of their lives” can harm the mental health of their peers. Hoyt also wants to shed light on another aspect of exercise addictions and body image issues that tend to fly under the radar: They happen to men, too. She has seen two good friends suffer though similar disorders. |