Autism and Anorexia Athletica: Understanding Exercise Addiction

When you hear the terms “eating disorder” and “exercise,” what comes to mind? Most people jump to familiar narratives: wanting to burn calories, punishment for eating, compulsive movement, a form of purging. These stories aren't wrong – they're just incomplete.

For neurodivergent individuals, the relationship between movement and eating disorders tends to follow a different script. In my years of anorexia, I definitely had an unhealthy relationship with exercise, but it was never about burning calories (I never tracked this metric). I also have trouble with the word “compulsive,” as it oversimplifies the complex web of factors that drives neurodivergent individuals to develop rituals and routines around movement. In this two-part series, I'll share my journey to finding joyful movement, offering insights rooted in both science and lived experience.

The Athlete Identity: A Mask for Autism

I have always been a very active person. I grew up playing multiple different sports, and a significant part of my identity was tied to athleticism. From soccer fields to balance beams and cross-country trails, movement was my outlet. But because my athletic abilities became a mask for my undiagnosed autism – a way to compensate for my deep sense of alienation – being an athlete was rooted in equal parts passion and fear.

Just as I pressured myself academically, I approached sports with the same intensity. To me, everything was rooted in competition. I only committed to games if I knew I could win, because otherwise, what was the point? The concept of playing “for fun” felt as foreign as small talk. Without clear metrics for success, the existential void behind “why” I was moving became too vast to bear.

The eating disorder was a way in which I attempted to fill every corner of that existential void. This intersection of anorexia and intense exercise – sometimes dubbed as anorexia athletica – began when I first created my new eating plan while learning about health and nutrition at the age of eleven. I genuinely believed I had found my purpose in life. If I just ate the “good” foods and stuck to the “right” exercise routine, how could anything go wrong? The constraints of anorexia became my safety box, my own little world where everything made sense.

Autistic Exercise Routines

My days were structured around exercise routines. Every morning began with pushups. At track practice, I'd arrive early for extra laps. If I didn’t score a goal during a soccer game, I’d punish myself by running up and down the hills behind the Skyline Park soccer field. Evening runs with my parents around the Muddy River in Brookline became another checkpoint to tick off. Before bed, crunches completed the cycle.

Just like the restriction (which at the time, I viewed as healthy eating) started off as an adventure, so did my carefully constructed exercise plan. But like any obsession, the novelty wore off. After a few months, movement began feeling more like a chore rather than an escape. I went to bed dreading the next days’ exercises, and the combination of caloric restriction and overexertion left me exhausted. But beneath the fatigue ran a current of restless energy. I was literally running on adrenaline, my nervous system locked in fight-or-flight mode. (We’ll unpack the science behind this paradox in Part 2.)

PDA in Eating Disorder Treatment: How Movement Restrictions Backfire

With my nervous system in overdrive and my autistic perseverance in full force, nothing could stop me. So when my treatment team imposed an exercise ban, it only intensified my drive to move. Every chance I got, I would scurry off to the bathroom to do jumping squats, pushups, or planks. I would run up and down the three flights of stairs at my high school between classes. As soon as I got home, I would slam my bedroom door shut, and I couldn’t roll out my exercise mat fast enough.

Even inpatient treatment couldn’t stop me! When I wasn’t gaining weight after months of FBT – due to both secret exercise and hiding food – my parents and I were sat down in the doctor's office to be told that I “needed more support than outpatient treatment could provide.” I was admitted to an inpatient facility that same day. While the staff was designed to track our every move, I found my ways. I did planks under the duvet when it was time for bed, took super long showers to do pushups with my arms and legs straddling the bathtub edges, and even snuck out of the clinic to run in the nearby woods.

Looking back with the neurodivergent lens I have now, I can clearly see how Family-Based Treatment, the exercise ban, and forced treatment all triggered my PDA – a pervasive drive for autonomy that's common in many autistic people with eating disorders. Being told what to eat, when to move, and that I couldn't be trusted to live at home was like waving a red flag in front of a bull. The more they tried to control my behavior, the more determinedly I resisted. Every act of rebellion was a way to assert my autonomy in a situation where I felt powerless.

When Eating Disorder Treatment Causes Trauma for Autistic Folks

It was this behavior that led to a cycle of admissions and dismissals. With each new facility came new labels: “treatment resistant”' “defiant,” “manipulative,” among others. After years of being bounced around like a pinball between treatment centers, I was eventually kicked out of the system entirely and sent home with the message that I was “too complex.”

As to be expected, my abandonment by the treatment system pushed me further into the eating disorder's grip. Deep down, everyone with an eating disorder wants freedom. It's why the codependency with our caregivers arises: we push back against them, testing their limits, almost daring them to give up on us. The defiance comes from a desperate need to know: will they keep believing in me, even when I make it nearly impossible? But the system had confirmed my worst fears by giving up entirely. Just when it seemed my obsession couldn't get worse, my hyperfocus on food and exercise spiraled to new depths – until I reached a point when I decided I didn’t want this life anymore.

And that’s the first step to healing your relationship with movement: wanting it to be different. In Part 2 of this series, I cover three autistic traits that can drive exercise addiction in anorexia, and how these same traits can become our greatest tools in eating disorder recovery.