The workout that can kill

A woman with a history of exercise-induced collapses works feverishly on the treadmill at her university health club. Another woman, with no observable health problems besides her particularly slim frame, admits that her own workouts tend to interfere with her academic life. What's going on here? Why are two otherwise accomplished women pushing the envelope of their own health and well-being? Anorexia or bulimia athletica -- two eating disorders that accompany detrimental over-exercise -- are every bit as debilitating and deadly as their more well-known parent disorders. Eating disorders are treatable; they also tend to run in families. Athletes with these disorders report on the whole that their sports-specific dieting began early, and most felt that "puberty had occurred too early for optimal performance" in their sport, according to Anna Carson, a well-known mental health nurse. The onset of eating disorders can coincide with prolonged dieting, frequent weight fluctuations and a sudden increase in athletic training, injury or loss of a coach, according to one Norwegian study. And 50 percent of anorexia sufferers are also afflicted with bulimia, or binging and purging. But not all bulimics have low body weight. Both anorexia and bulimia can induce their sufferers to over-exercise -- hence the term "athletica." Certain studies have found a correlation between eating disorders and sexual abuse. There may also be family problems such as substance abuse, rape, incest, verbal abuse or other forms of familial neglect. Researchers have made great strides in examining the role of naturally-occurring opioids in the body and their role in anorexia or bulimia athletica. The eating disordered person attempts to compensate for mood disturbances by intensive exercise to increase these endorphins. Other studies have compared the relationships between self-starvation and self-mutilation. Self-mutilation produces a metenkephaline rush in the people who cut themselves, producing a sense of release. Issues of control, clinical depression, clinical anxiety, intimate relationship difficulties and the pressures of burgeoning adulthood combine powerfully. Starving or depriving oneself is a quiet expression of anger against these forces. But to the suffering woman, she never has to raise her voice as long as she manipulates her eating. Carson has summed up the soothing mechanism of eating disorders this way: "When you can't accomplish your too-high goals, you don't eat. "When things don't go right, you don't eat. "When people don't do what they should, you don't eat. "When events don't run smoothly, you don't eat. "When people don't like your behavior, you don't eat." After each of these mantra, with anorexia athletica, the sufferer adds, "And I work out to be better." But where is the line drawn? Depression is a common causal agent of most eating disorders, with 71 percent of sufferers also enduring major clinical depression. Obsessive-compulsive disorder co-occurs in 10-15 percent of anorexics. Bulimics show clinical depression in 40 percent of cases, clinical anxiety in 45 percent of cases, substance abuse including alcohol abuse in 49 percent of cases, bipolar disorder in 12 percent of cases and borderline personality disorder in 60 percent of cases. Clearly, an exercise regimen is not going to adequately address these problems. Yet not addressing these issues can be deadly. In a Swedish study that is notable for its long- term view of the problem, death from anorexia nervosa over a 33-year period was 18 percent -- all via outright starvation or suicide. Mortality statistics from anorexia nervosa range from 5 percent to 18 percent, across studies. Intervention at the campus level makes sense when students become sufferers. Unfortunately, exercise bulimia and anorexia athletica are facets of eating disorders that have a higher social tolerance. Yet the risk to the victim is still high. But action to combat the disorder is mobilizing on campus. An in-service information session will be held at Gimbel Gym on April 18. An eating disorder team has formed to provide resources and information. And Career and Psychological Services offers group and individual therapy, referrals to outside resources and assistance to student groups seeking to set up discussions and activities to promote awareness. Guidance for Understanding Image, Dieting and Eating has a variety of programs available to students and student groups. And their Web site -- http://www.dolphin.upenn.edu/~guide/contact.html -- offers a wealth of information for those interested in helping to fight these deadly disorders. Early intervention is key. The bottom line is that life doesn't have to keep hurting. Take the risk.

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