Compulsive jogging: exercise dependence and associated disorder of eating.

A number of patients have been reported who have developed features of an eating disorder following a desire to increase their level of fitness. CASE HISTORY A 42-year-old male school teacher was referred to the psychiatric outpatient clinic by his general practitioner at the request of his brother who had become concerned by the patient's obsession with fitness and also his marked loss of weight. His weight had dropped from 218 lb to 112 lb in the space of two years. He had always been keen on sport, having played a number of games at a national level. He had also been an enthusiastic golfer from the age of six, at one stage reducing his handicap to two. In 1985 he decided suddenly to improve his physical health, having become markedly overweight at 218 lb and also because of a strong family history of ischaemic heart disease. The patient put himself on a strict diet and although he continued to eat mixed foodstuffs he limited his energy intake to 800-1,000 calories per day. He also took up regular running and ran at least five miles a day followed by one hour in a sauna. Running became his priority in life and as soon as his teaching duties finished he set out jogging, followed by a sauna, and later in the evening he would referee basketball. His weight fell to 112 lb which is considerably below the minimum desirable weight for his height of 5 ft 10 ins (1441b), or the average UK weight for height and age (176 lb).1 He was pleased with this loss of weight and did not consider himself to be abnormally thin. As a result, his work as a teacher and, in particular, his marriage suffered. During the weekends he would referee hockey matches, but he would also indulge in binges of eating and taking excess alcohol. At these times he would put on up to 7 lb in weight, which led to marked feelings of guilt. The increase in weight would be quickly controlled by renewed strenuous dieting, exercise and spending time in the sauna. He complained of feeling depressed at times and became bored with his work and dissatisfied with his home life. He had loss of libido. When running he felt elated. His sleep pattern was disturbed, with both initial insomnia and also some early morning wakening. He became obsessed with his performance …