More than a symptom: qualitative exploration of embodied control and restlessness in compulsive movement in eating disorders

TL;DR

People with eating disorders often feel compelled to move or exercise, and this behavior serves emotional and symbolic purposes beyond calorie control.

Contribution

The study reveals how compulsive movement is experienced and changes during treatment across different eating disorder diagnoses.

Findings

Participants reported reduced guilt and increased self-awareness by the end of treatment.

Persistent restlessness and subtle compensatory activity were more common in those with longer illness duration.

Diagnostic subgroups differed in how they framed movement, such as moral duty in anorexia or mood regulation in bulimia.

Abstract

Compulsive physical activity is a common but underexplored feature of eating disorders (ED). Beyond calorie expenditure, it often serves complex psychological, symbolic, and embodied functions. Understanding how these behaviors are experienced and change during treatment can guide more effective interventions. This study explored the lived experience of compulsive movement in individuals with anorexia nervosa (AN), bulimia nervosa (BN) and binge eating disorder (BED), and examined whether diagnosis or duration influenced narrative change during inpatient care.

Sixty-five inpatients with EDs (mean age = 22.15 years; range 16–33) completed an open-ended questionnaire within the first week of admission (T0) and during the final week of hospitalization (T1). The Clinical Interview for Compulsive Exercise [10] was adapted to a written format to elicit spontaneous narratives about movement. Reflexive thematic analysis identified shared themes in T0. For the longitudinal analysis, the T0 and T1 narratives were compared between individuals to capture changes in meaning, content, and emotional tone. The original interview domains were merged into five thematic categories to describe improvement, persistence, or worsening, and subgroup comparisons were made by diagnosis and duration (≤ 3 vs. >3 years).

Five overarching themes emerged at T0: control and compensation, emotional regulation, rigidity and rituality, motor restlessness and bodily discomfort, and covert activity/non-exercise movement. By T1, most of the participants described reduced guilt, greater flexibility, and increased self-awareness. However, persistent restlessness and subtle compensatory activity were reported, particularly in the long-duration group (> 3 years). Diagnostic subgroups differed in emphasis: AN participants often framed movement as a moral duty, BN participants as a means of regulating mood, and BED participants in relation to body image concerns or “getting back on track” with healthy routines.

Compulsive movement in EDs is a multifaceted, transdiagnostic phenomenon. Inpatient care can foster meaningful narrative change, although embodied restlessness may require longer-term treatment. Clinicians should address both the behavioral and symbolic dimensions of movement to support long-lasting recovery.

Many people with eating disorders (ED) feel a strong urge to move, exercise or stay active, even when it harms their health. This can include formal exercise, constant fidgeting, standing for long periods, or other invisible activity. These behaviors can be about more than burning calories—they can help manage emotions, give a sense of control, or feel like a moral obligation. In this study, we spoke to 65 people hospitalized for anorexia nervosa, bulimia nervosa, or binge eating disorder. During their first week in the hospital and again before they went home, they answered open questions about their experiences with movement. We looked for common themes in their responses and then compared how their stories changed over time. We also explored whether their experiences differed by diagnosis or by how long they had been unwell. We found that most people reported positive changes at the end of treatment. Many described feeling less guilty if they rested, being more flexible in their routines, and having more insight into their behaviors. However, some still felt restless or found it hard to stop subtle forms of activity. People with shorter illness histories tended to be more open to change, while those with longer illness histories more often saw movement as part of their identity. These results show that inpatient treatment can help people change their relationship with movement, but long-standing habits may need more time and different approaches to change. Treatments should address not only physical behaviors but also the personal meanings and feelings related to movement.