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

Abstract

Background: 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.

Methods: 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).

Results: 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.

Conclusions: 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.