1
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Davis HA, Rush M, Smith GT. Reciprocal relations between body dissatisfaction and excessive exercise in college women. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2024; 72:1473-1479. [PMID: 35728008 DOI: 10.1080/07448481.2022.2080508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 05/10/2022] [Accepted: 05/16/2022] [Indexed: 06/15/2023]
Abstract
Objective: Body dissatisfaction elevates the risk for disordered eating behaviors. Excessive exercise is prevalent among college women and associated with harm. Risk theory posits a bidirectional relationship between risk factors for disordered eating behaviors and the behaviors themselves. This study investigated the longitudinal, reciprocal relationship between body dissatisfaction and excessive exercise. Participants and methods: College women (n = 302) assessed in August (baseline) and November (follow-up). Results: Baseline body dissatisfaction significantly predicted increases in excessive exercise endorsement at follow-up, controlling for baseline excessive exercise endorsement and body mass index (BMI). Baseline excessive exercise endorsement predicted increases in body dissatisfaction at follow-up, controlling for baseline body dissatisfaction and BMI. Conclusions: Findings support the presence of a positive feedback loop between body dissatisfaction and excessive exercise; both predict increases in risk for the other, regardless of weight status. Future research should test whether this process is ongoing and predicts further distress.
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Affiliation(s)
- Heather A Davis
- Department of Psychology, Virginia Polytechnic Institute and State University, Blacksburg, Virginia, USA
| | - Molly Rush
- Barnes-Jewish Hospital System in St. Louis, St. Louis, Missouri, USA
| | - Gregory T Smith
- Department of Psychology, University of Kentucky, Lexington, Kentucky, USA
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2
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Palermo M, Rancourt D. Examining compulsive exercise as a risk factor for eating disorder symptoms in first-year college students using a latent change score modeling approach. Int J Eat Disord 2024. [PMID: 38619370 DOI: 10.1002/eat.24219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 04/02/2024] [Accepted: 04/04/2024] [Indexed: 04/16/2024]
Abstract
OBJECTIVE Research suggests that both compulsive exercise and eating disordered behaviors increase during college. Despite strong cross-sectional associations between compulsive exercise and eating disorders, it is unknown if compulsive exercise is a variable risk factor for eating disorders or simply a correlate. It was hypothesized that increases in compulsive exercise would significantly and prospectively predict increases in overall number of eating disorder symptoms over the study period. METHOD A total of 265 first year college students who did not meet criteria for a full or subthreshold eating disorder diagnosis at Time 1 (age M = 18.15; SD = 0.42; 122 female [46%] at Time 1) completed reports of compulsive exercise and eating disorder symptoms via online questionnaires at four timepoints over the 9-month 2021-2022 academic year (76% retention rate). Hypotheses were tested using a bivariate latent change score model. RESULTS Hypotheses were not supported. Change in compulsive exercise did not predict change in number of eating disorder symptoms. Change in number of eating disorder symptoms also did not predict change in compulsive exercise. CONCLUSIONS Compulsive exercise did not emerge as a variable risk factor for the development of eating disorder symptoms among first year college students. The relationship between these behaviors should be investigated at different developmental timepoints, such as early adolescence, and potential third variables that may explain the observed co-occurrence should be explored. PUBLIC SIGNIFICANCE This study investigated whether increases in compulsive exercise predicted increases in number of eating disorder symptoms among first year college students. Compulsive exercise did not significantly predict number of eating disorder symptoms. Additional research is warranted to clarify the relationship between compulsive exercise and eating disorder symptoms.
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Affiliation(s)
- Madeline Palermo
- Department of Psychology, University of South Florida, Tampa, USA
| | - Diana Rancourt
- Department of Psychology, University of South Florida, Tampa, USA
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3
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Lampe EW, Schaumberg K, Kolar D, Coniglio K, Cooper M, Chapa DAN, Gorrell S. Working out measurement overlap in the assessment of maladaptive exercise. Int J Eat Disord 2024; 57:558-567. [PMID: 38221645 PMCID: PMC10947899 DOI: 10.1002/eat.24127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 12/21/2023] [Accepted: 12/21/2023] [Indexed: 01/16/2024]
Abstract
OBJECTIVE Although exercise is generally considered healthy, many individuals engage in maladaptive exercise (e.g., compulsive in nature). Several definitions of maladaptive exercise exist, leading to multiple, varied assessment tools; assuming homogeneity across these assessments contributes to low consensus in etiological models. METHOD We used a Jaccard Index to quantify content overlap among 15 commonly-used self-report instruments measuring maladaptive exercise, with 31 features identified across 224 items. RESULTS The most common features were exercise to control weight/shape and to avoid negative affect (both included in 9/15 instruments), or compensate for calories consumed (8/15 instruments). Overlap among instruments was low (.206) and no features were common across all instruments. CONCLUSIONS Findings generally support theoretical models of exercise in eating pathology. However, instruments most commonly used to assess maladaptive exercise measure heterogenous content. Careful consideration should be taken when comparing findings derived from differing instruments, when synthesizing literature on maladaptive exercise, and when selecting instruments to measure specific maladaptive exercise features. PUBLIC SIGNIFICANCE Many, varied, tools exist for the assessment of maladaptive exercise (e.g., compulsive or compensatory) in the context of eating disorders. Assuming homogeneity across tools contributes to low consensus in the field. We used a Jaccard Index to quantify content overlap among 15 self-report instruments measuring maladaptive exercise. The most commonly used instruments measure heterogenous content. Careful consideration should be taken when synthesizing literature and selecting instruments to use in research.
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Affiliation(s)
- Elizabeth W. Lampe
- Center for Weight Eating and Lifestyle Science (WELL Center), Drexel University, Philadelphia, PA, United States
| | | | - David Kolar
- Department of Psychology, University of Regensburg, Regensburg, Germany
| | - Kathryn Coniglio
- Department of Psychology, Rutgers University, Rutgers NJ, United States
| | - Marita Cooper
- Children’s Hospital of Philadelphia, University of Pennsylvania, Philadelphia PA, United States
| | - Danielle A. N. Chapa
- Department of Psychiatry, University of Pittsburgh, Pittsburgh PA, United States
| | - Sasha Gorrell
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco CA, United States
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4
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Campos PF, Frazier LD, Almeida M, de Carvalho PHB. Validation and measurement invariance of the Compulsive Exercise Test among Brazilian and American young adults. Eat Weight Disord 2024; 29:2. [PMID: 38170406 PMCID: PMC10764460 DOI: 10.1007/s40519-023-01627-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 11/27/2023] [Indexed: 01/05/2024] Open
Abstract
PURPOSE To evaluate compulsive exercise, researchers often rely on the widely used Compulsive Exercise Test (CET). However, the measure has shown unstable factor structure in several validation studies and is not available in Portuguese for use in Brazil. We aimed to describe the translation and cultural adaptation of the CET to Brazilian Portuguese, to test several factor structures among Brazilian and US samples of men and women, to test measurement invariance across countries, and to evaluate its internal consistency. Furthermore, we sought to evaluate convergent validity, correlating the CET with a measure of eating disorder symptoms, and to compare compulsive exercise symptoms between countries. METHODS Four models of the latent structure of the CET were tested using confirmatory factor analyses (CFAs), three-factor structure with 15 items, three-factor structure with 18 items, four-factor structure with 21 items, and the original five-factor structure with 24 items, in a sample of 1,531 young adults (601 Brazilians and 930 Americans), aged 18-35 years. RESULTS A series of CFAs demonstrated that the three-factor structure with 15 items showed a better fit to the data. This model demonstrated good convergent validity and internal consistency. Results from the CET multigroup CFA showed evidence for the invariance at the configural, metric, and scalar levels across Brazilians and Americans. Furthermore, significant differences were found between Brazilians and Americans, with Brazilians demonstrating higher scores on the Avoidance and rule-driven behavior and Mood improvement subscales, whereas US participants scored higher on the Weight control exercise subscale. CONCLUSIONS Results support the three-factor structure with 15 items to be used as a measure of compulsive exercise among Brazilians and Americans, allowing cross-cultural comparisons between these countries. LEVEL OF EVIDENCE Level V, Cross-sectional, Psychometric study.
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Affiliation(s)
- Priscila Figueiredo Campos
- NICTA, Body Image and Eating Disorders Research Group, Federal University of Juiz de Fora, 745 São Paulo Street, City Center, Governador Valadares, Minas Gerais, 35010-150, Brazil
| | - Leslie D Frazier
- Department of Psychology, Florida International University, Miami, FL, USA
| | - Maurício Almeida
- NICTA, Body Image and Eating Disorders Research Group, Federal University of Juiz de Fora, 745 São Paulo Street, City Center, Governador Valadares, Minas Gerais, 35010-150, Brazil
| | - Pedro Henrique Berbert de Carvalho
- NICTA, Body Image and Eating Disorders Research Group, Federal University of Juiz de Fora, 745 São Paulo Street, City Center, Governador Valadares, Minas Gerais, 35010-150, Brazil.
- AMBULIM, Eating Disorders Program, Institute of Psychiatry, University of São Paulo, São Paulo, Brazil.
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5
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Harris A, Mannan H, Hay P, Aouad P, Arcelus J, Attia E, Crosby R, Madden S, Meyer C, Touyz S. Assessment and treatment of compulsive exercise in anorexia nervosa - A combined investigation of Compulsive Exercise Activity Therapy (LEAP) and Compulsive Exercise Test subscales. Eat Behav 2024; 52:101825. [PMID: 38006774 DOI: 10.1016/j.eatbeh.2023.101825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 11/05/2023] [Accepted: 11/10/2023] [Indexed: 11/27/2023]
Abstract
INTRODUCTION Compulsive exercise is a transdiagnostic feature of eating disorders which adversely affects aspects of recovery, such as length of hospitalisation, risk of a chronic outcome, and risk of relapse. CompuLsive Exercise Activity TheraPy (LEAP) aims to reduce compulsive exercise through a cognitive behavioural approach. This study aims to investigate the effect of LEAP on compulsive exercise behaviour using subscales of the Compulsive Exercise Test (CET), a measure of exercise in individuals with eating disorders. Predictive validity of the CET's subscales and its ability to predict eating psychopathology are investigated. METHOD This study used data from a randomized controlled trial of LEAP (1). Linear mixed modelling was used to investigate the effect of LEAP on compulsive exercise behaviour, and the predictive ability of CET subscales on various outcomes. The CET was compared to other exercise measures to assess its superiority in predicting eating psychopathology. RESULTS LEAP was superior in reducing the scores of the CET's Avoidance and Rule Driven Behaviour and Exercise Rigidity subscales. All subscales made a contribution to the respective models. The CET was superior to other measures in predicting eating pathology. CONCLUSION The results lend credibility to LEAP's ability to reduce core parts of compulsive exercise. The CET has been found to target important aspects of compulsive exercise behaviour, and has was superior to other exercise measures in predicting eating psychopathology.
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Affiliation(s)
| | - Haider Mannan
- Translational Health Research Institute, School of Medicine, Western Sydney University.
| | - Phillipa Hay
- Translational Health Research Institute, School of Medicine, Western Sydney University; Mental Health Services, SWSLHD, Campbellown, Australia.
| | - Phillip Aouad
- The University of Sydney, Australia; InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, University of Sydney and Sydney Local Health District.
| | - Jon Arcelus
- Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom.
| | - Evelyn Attia
- New York State Psychiatric Institute, Columbia University Irving Medical Center, New York, USA; Weill Cornell Medical College, New York, USA.
| | - Ross Crosby
- Center for Biobehavioral Research, Sanford Research, Fargo, North Dakota, USA; Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota, USA.
| | - Sloane Madden
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.
| | - Caroline Meyer
- International Digital Laboratory, The University of Warwick, Coventry CV4 7AL, UK.
| | - Stephen Touyz
- The University of Sydney, Australia; InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, University of Sydney and Sydney Local Health District.
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6
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Rankin R, Conti J, Touyz S, Arcelus J, Meyer C, Hay P. Dancing with change: a qualitative exploration of in-session motivation to change in the treatment of anorexia nervosa. AUSTRALIAN PSYCHOLOGIST 2023. [DOI: 10.1080/00050067.2022.2151338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Rebekah Rankin
- School of Social Sciences and Psychology, Western Sydney University, Sydney, Australia
- Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, Australia
| | - Janet Conti
- School of Social Sciences and Psychology, Western Sydney University, Sydney, Australia
| | - Stephen Touyz
- Clinical Psychology Unit, School of Psychology, University of Sydney, Sydney, Australia
- InsideOut Institute, Level 2, Charles Perkins Centre, University of Sydney, Sydney, Australia
| | - Jon Arcelus
- Institute of Mental Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Caroline Meyer
- WMG and Warwick Medical School, University of Warwick, Coventry, UK
| | - Phillipa Hay
- Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, Australia
- Campbelltown Hospital, South West Sydney Local Health District (SWSLHD), Sydney, Australia
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7
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Meneguzzo P, Dal Brun D, Cazzola C, Pillan A, Bonello E, Todisco P. Compulsive exercise in eating disorders: Validation of the Italian scale and evaluation of its relationships with body image concerns and quality of life. Eat Behav 2022; 47:101675. [PMID: 36201976 DOI: 10.1016/j.eatbeh.2022.101675] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 09/26/2022] [Accepted: 09/26/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Compulsive exercise (CE) has been proposed as one of the maladaptive elements that might concur to developing and maintaining an eating disorder (ED), even if no conclusive consensus is yet available. This study evaluates the psychometric properties of the Compulsive Exercise Test (CET), the questionnaire most frequently discussed in the literature. Our second aim is to evaluate the relationships between CE, quality of life, and different body concerns in a group of individuals. METHODS Two different studies are performed. In the first study, we evaluate the psychometric properties of the Italian CET with a sample of 272 individuals (157 with different diagnoses of ED). In the second study, a group of 75 ED patients is compared to 68 of their peers looking for specific differences and relationships between CE, quality of life, and body concerns. RESULTS The CET shows optimal psychometric proprieties, and a five-factors structure. CE is linked to more severe specific psychopathology in ED patients, including increased thoughts of restraint and concerns about weight and shape. Moreover, weight phobia and quality of life are predictors of CE in patients. CONCLUSION The specific role of CE is discussed according to its connections with a core psychopathological element like weight phobia. Specific profiles of CE emerged for each clinical subgroup, and they corroborate the presence of different cognitive/physical approach to exercise. The CE showed to be a dysfunctional element with a disruptive role in patients' quality of life. Future directions and possible applications of the CET are also discussed.
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Affiliation(s)
- Paolo Meneguzzo
- Department of Neuroscience, University of Padova, Padova, Italy; Padova Neuroscience Center, University of Padova, Padova, Italy.
| | - David Dal Brun
- Department of Linguistic and Literary Studies, University of Padova, Padova, Italy
| | - Chiara Cazzola
- Eating Disorders Unit, Casa di Cura "Villa Margherita", Arcugnano - Vicenza, Italy
| | - Anna Pillan
- Eating Disorders Unit, Casa di Cura "Villa Margherita", Arcugnano - Vicenza, Italy
| | - Elisa Bonello
- Eating Disorders Unit, Casa di Cura "Villa Margherita", Arcugnano - Vicenza, Italy
| | - Patrizia Todisco
- Eating Disorders Unit, Casa di Cura "Villa Margherita", Arcugnano - Vicenza, Italy
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8
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Cresswell C, Watson HJ, Jones E, Howell JA, Egan SJ. The role of compulsive exercise in the relationship between perfectionism and eating disorder pathology in underweight adolescents with eating disorders. Eat Behav 2022; 47:101683. [PMID: 36410135 DOI: 10.1016/j.eatbeh.2022.101683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 11/09/2022] [Accepted: 11/10/2022] [Indexed: 11/16/2022]
Abstract
Perfectionism has a strong association with eating disorders. Research in non-clinical adults has suggested that perfectionism has both direct and indirect effects on eating disorder symptoms, and that compulsive exercise is a potential mediator. The aim of this study was to understand whether perfectionism is associated with eating disorder symptoms, both directly and indirectly through compulsive exercise in underweight adolescents with eating disorders. Participants were 149 female adolescents (M = 14.90 years, age range 13-17) with eating disorders from the Helping to Outline Paediatric Eating Disorders (HOPE) Project, an ongoing, registry study of individuals consecutively referred individuals to a statewide eating disorder service. The majority had a diagnosis of anorexia nervosa restricting type (66 %), followed by unspecified feeding or eating disorder (21 %), and anorexia nervosa binge-eating purging type (13 %). To test the model, path analyses with bootstrapping were conducted. All paths were statistically significant, including the indirect effect from perfectionism to eating disorder pathology via the mediator of compulsive exercise, and the direct effect of perfectionism on eating disorder pathology. Overall, this research provides further evidence that compulsive exercise may be one factor that can explain the relationship between perfectionism and eating disorder symptoms. Future research should seek to determine the relative efficacy of approaches for the treatment of eating disorders in adolescents which target perfectionism and compulsive exercise.
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Affiliation(s)
- Camilla Cresswell
- Discipline of Psychology, School of Population Health, Curtin University, Perth, Australia
| | - Hunna J Watson
- Discipline of Psychology, School of Population Health, Curtin University, Perth, Australia; Department of Psychiatry, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, United States; Division of Pediatrics, School of Medicine, The University of Western Australia, Perth, Australia
| | - Emily Jones
- Eating Disorders Program, Child and Adolescent Health Service, Perth, Australia
| | - Joel A Howell
- Discipline of Psychology, School of Population Health, Curtin University, Perth, Australia; Centre for Clinical Interventions, Perth, Australia
| | - Sarah J Egan
- Discipline of Psychology, School of Population Health, Curtin University, Perth, Australia; enAble Institute, Faculty of Health Sciences, Curtin University, Perth, Australia.
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9
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Schlegl S, Vierl L, Kolar DR, Dittmer N, Voderholzer U. Psychometric properties of the Compulsive Exercise Test in a large sample of female adolescent and adult inpatients with anorexia nervosa and bulimia nervosa. Int J Eat Disord 2022; 55:494-504. [PMID: 35199345 DOI: 10.1002/eat.23694] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 02/09/2022] [Accepted: 02/09/2022] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The Compulsive Exercise Test (CET) was developed to assess compulsive exercise in patients with eating disorders (EDs), but originally validated in a nonclinical sample, and psychometric properties were only investigated in small clinical samples. Therefore, the aim of this study was to examine its psychometric properties in a large clinical sample of adolescent and adult inpatients with anorexia nervosa and bulimia nervosa. METHOD A sample of 2,535 German female inpatients with EDs completed the CET and other instruments at admission and discharge. Factor structure (confirmatory [CFA] and exploratory factor analyses [EFA]), internal consistency and construct validity, measurement invariance across age and diagnostic groups, group comparisons of means, as well as sensitivity to change during treatment were assessed. RESULTS The CET showed high internal consistency, very good construct validity, and sensitivity to change. CFA indicated a better fit of four-factor and three-factor solutions compared to the original five-factor model. However, subsequent EFA identified an optimum for a five-factor model. Only three subscales were satisfactorily invariant to measurement, but not the CET total score. Only small differences in scores between patient groups were observed. DISCUSSION Results support internal consistency, construct validity, and sensitivity to change, whereas factor structure remains inconclusive, questioning the theoretical basis of the CET. There is limited support for using the lack of enjoyment subscale, and only moderate support for using the rigidity subscale in patients with EDs. It is recommended to further explore and/or revise the original CET, including investigation in other samples, for example, male samples.
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Affiliation(s)
- Sandra Schlegl
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilians-University (LMU), Munich, Germany.,Schoen Clinic Roseneck, Prien am Chiemsee, Germany
| | - Larissa Vierl
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilians-University (LMU), Munich, Germany
| | - David R Kolar
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Nina Dittmer
- Schoen Clinic Roseneck, Prien am Chiemsee, Germany
| | - Ulrich Voderholzer
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilians-University (LMU), Munich, Germany.,Schoen Clinic Roseneck, Prien am Chiemsee, Germany.,Department of Psychiatry and Psychotherapy, University Hospital, Freiburg, Germany
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10
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Ganson KT, Lavender JM, Rodgers RF, Cunningham M, Nagata JM. Compulsive exercise and vaping among a sample of U.S. College students aged 18-26 years. Eat Weight Disord 2022; 27:1153-1161. [PMID: 34181209 DOI: 10.1007/s40519-021-01251-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 06/17/2021] [Indexed: 02/07/2023] Open
Abstract
PURPOSE To determine the association between compulsive exercise and vaping among college students aged 18-26 years, and to characterize the type of vaping used among participants who report compulsive exercise. METHODS Cross-sectional, pooled data from two survey years (2018-2020; N = 2125) of the national (U.S.) Healthy Minds Study were analyzed. Compulsive exercise was measured based on number of occurrences in the past 28 days (analyzed continuously and among those who reported ≥ 1 and ≥ 20 occurrences). Vaping was measured based on reported use in the past 30 days. Most recent type of vaping was assessed only among participants who reported vaping. Logistic regression analyses were conducted to estimate the associations between compulsive exercise and vaping, while adjusting for covariates. RESULTS For every additional occurrence of compulsive exercise reported by participants, their odds of also reporting vaping increased by 5% (95% CI 1.01-1.09). Participants who reported 20 or more occurrences of compulsive exercise in the past 28 days, a clinical threshold, had 3.71 (95% CI 1.28-10.76) higher odds of vaping in the past 30 days. Among participants who endorsed vaping, nicotine vaping was the most common recent type for those who reported any (76.2%) or 20 or more (50.2%) occurrences of compulsive exercise. CONCLUSION Compulsive exercise is associated with vaping in a national, U.S. sample of college students, with nicotine vaping being the most common type used. Screening for both compulsive exercise and vaping, particularly if either is reported, among college-age young adults is necessary to implement prevention and intervention strategies. LEVEL OF EVIDENCE V, cross-sectional descriptive study.
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Affiliation(s)
- Kyle T Ganson
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street W, Toronto, ON, M5S 1V4, Canada.
| | - Jason M Lavender
- Department of Medicine, Uniformed Services University, Bethesda, MD, USA.,Military Cardiovascular Outcomes Research (MiCOR) Program, Bethesda, MD, USA.,Metis Foundation, San Antonio, TX, USA
| | - Rachel F Rodgers
- Department of Applied Psychology, Northeastern University, Boston, MA, USA.,Department of Psychiatric Emergency and Acute Care, Lapeyronie Hospital, CHRU Montpellier, France
| | - Mitchell Cunningham
- School of Psychology, The University of Sydney, Sydney, North South Wales, Australia
| | - Jason M Nagata
- Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA
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11
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Ganson KT, Mitchison D, Rodgers RF, Cunningham ML, Murray SB, Nagata JM. Compulsive exercise among college students: 5-year time trends in prevalence and demographic, substance use, and mental health correlates. Eat Weight Disord 2022; 27:717-728. [PMID: 34024038 DOI: 10.1007/s40519-021-01210-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 05/08/2021] [Indexed: 12/19/2022] Open
Abstract
PURPOSE To provide 5-year time trends in prevalence and demographic, substance use, and mental health correlates of compulsive exercise among a national sample of college men and women. METHODS We analyzed 4 academic survey years (2016-2020; N = 8251) of the national (USA) Healthy Minds Study. Compulsive exercise was measured by self-report of any occurrence of "compulsive" exercise in the past 4 weeks. Unadjusted prevalence of compulsive exercise in the past 4 weeks was estimated across the 4 survey years by sex. Multiple logistic regression analyses were conducted among the pooled sample and stratified by sex to estimate the associations between compulsive exercise in the past 4 weeks and demographic, substance use, and mental health correlates. RESULTS Among the pooled sample, 11% (95% confidence interval [CI] 9.60-12.42%) of men and 17% (95% CI 15.86-18.24%) of women reported compulsive exercise in the past 4 weeks. Prevalence across the 4 survey years remained stable among men and women. Higher body mass index was associated with greater odds of any compulsive exercise in the past 4 weeks among men, while any sports participation was associated with greater odds of any compulsive exercise in the past 4 weeks among women. Compulsive exercise in the past 4 weeks was associated with greater odds of all mental health symptoms and illicit drug use among men and women, and higher odds of alcohol use among women. CONCLUSION Compulsive exercise is relatively common among college men and women and is associated with substance use behaviors and poor mental health symptoms. LEVEL OF EVIDENCE V, cross-sectional descriptive study.
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Affiliation(s)
- Kyle T Ganson
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street W, Toronto, ON, M5S 1V4, Canada.
| | - Deborah Mitchison
- School of Medicine, Translational Health Research Institute, Western Sydney University, Sydney, Australia
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia
| | - Rachel F Rodgers
- APPEAR, Department of Applied Psychology, Northeastern University, Boston, MA, USA
- Department of Psychiatric Emergency & Acute Care, Lapeyronie Hospital, CHRU, Montpellier, France
| | | | - Stuart B Murray
- Department of Psychiatry and the Behavioral Sciences, University of Southern California, Los Angeles, CA, USA
| | - Jason M Nagata
- Department of Pediatrics, University of California, San Francisco, San Francisco, CA, USA
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12
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Martin SJ, Luzier J, Saulnier KG. Changes in unhealthy exercise in outpatient eating disorder treatment: examining emotion avoidance mechanisms. Eat Weight Disord 2022; 27:675-682. [PMID: 33978952 DOI: 10.1007/s40519-021-01205-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 04/27/2021] [Indexed: 11/25/2022] Open
Abstract
Unhealthy exercise (UE) is a common symptom of eating disorders (EDs) associated with elevated chronicity and relapse. Previous research suggests that UE serves an emotion regulation function, especially to reduce negative affect. UE may be especially prevalent among individuals with anorexia nervosa (AN), as UE and restrictive eating may be used to avoid unpleasant emotions. It is unclear whether changes in emotion avoidance (EA) can lead to changes in UE over time. The current study examined whether month 1 EA mediated the relation between baseline UE and month 2 UE in a clinical sample of 127 patients (Mage = 22.52 [SD = 11.75], 92.9% female) recruited from an ED outpatient treatment program. The current study also explored whether this mediation was stronger for individuals with AN than other ED diagnoses. Findings revealed that changes in EA significantly mediated the relation between changes in UE from baseline to month 2 of treatment. ED diagnosis did not moderate this relation. Findings suggest that improvements in EA may reduce UE over time. Treatment should target UE through cultivation of increased emotion acceptance.Level of evidence Level III: evidence obtained from well-designed cohort study.
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Affiliation(s)
- Shelby J Martin
- West Virginia University School of Medicine-Charleston Division, Charleston, USA. .,Charleston Area Medical Center Institute for Academic Medicine, Charleston, USA.
| | - Jessica Luzier
- West Virginia University School of Medicine-Charleston Division, Charleston, USA.,Charleston Area Medical Center Institute for Academic Medicine, Charleston, USA
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13
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Nagata JM, Peebles R, Hill KB, Gorrell S, Carlson JL. Associations between ergogenic supplement use and eating behaviors among university students. Eat Disord 2021; 29:599-615. [PMID: 32129729 PMCID: PMC7483647 DOI: 10.1080/10640266.2020.1712637] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Ergogenic supplements to improve athletic performance are commonly used among college athletes, but little is known about their association with eating disorder symptoms. The objective of this study was to examine associations between ergogenic supplement use and disordered eating attitudes and behaviors among university students, and to compare differences by sex. Undergraduate students from 10 top-ranked National College Athletics Association (NCAA) Division I colleges completed an online survey on supplement use, athletic activities, and eating attitudes and behaviors. Among 1633 university students, males (38.9%) reported higher rates of current supplement use than females (15.2%) (p < .001). In linear regression models adjusting for athletic status and body mass index, current supplement use was associated with higher Eating Disorders Examination-Questionnaire (EDE-Q) Global, Shape Concern, and Restraint scores in both males and females. Supplement use was associated with driven/compelled exercise (OR 2.00, 95% CI 1.33-2.99) in males and diuretic (OR 6.39, 95% CI 2.02-20.22) and diet pill use (OR 3.07, 95% CI 1.79-5.27) in females. Results suggest ergogenic supplement use is common in undergraduates and associated with disordered eating attitudes and behaviors. Clinicians should screen for disordered eating behaviors particularly in young adults who use ergogenic supplements.
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Affiliation(s)
- Jason M Nagata
- Department of Pediatrics, University of California, San Francisco, California, USA
| | - Rebecka Peebles
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Katherine B Hill
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, USA
| | - Sasha Gorrell
- Department of Psychiatry, University of California, San Francisco, California, USA
| | - Jennifer L Carlson
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, USA
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14
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'Feeling fat' is associated with specific eating disorder symptom dimensions in young men and women. Eat Weight Disord 2021; 26:2345-2351. [PMID: 33389705 DOI: 10.1007/s40519-020-01074-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 11/13/2020] [Indexed: 10/22/2022] Open
Abstract
PURPOSE 'Feeling fat,' the somatic experience of having excess body weight that is not fully explained by true adiposity, correlates with eating pathology in clinical and non-clinical samples. It is unknown whether 'feeling fat' more strongly relates to specific eating disorder symptom dimensions that typically characterize anorexia nervosa, bulimia nervosa, and/or binge eating disorder. Understanding the significance of 'feeling fat's relationship with specific eating disorder symptom dimensions-cognitive restraint, dietary restriction, binge eating, and purging-may suggest its relevance to particular forms of eating pathology and elucidate treatment directions for addressing 'feeling fat'. METHODS Questionnaires were completed by 989 undergraduates (54.3% female). RESULTS Path analyses indicated significant associations between feeling fat and all symptom dimensions; these paths were not moderated by gender. The best fitting model was the model including paths from 'feeling fat' to all symptom dimensions; no other model had equivalent fit. CONCLUSION 'Feeling fat' relates to all examined symptoms of eating disorders in a mixed-gender non-clinical population. These results indicate that 'feeling fat' is associated with multiple core symptoms of eating pathology, pointing to 'feeling fat's significance to eating pathology maintenance across the spectrum of eating pathology. Future research should compare the influence of 'feeling fat' on these symptoms in mixed-gender clinical samples. LEVEL OF EVIDENCE Level V, cross-sectional descriptive study.
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15
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Mehak A, Racine SE. 'Feeling fat,' eating pathology, and eating pathology-related impairment in young men and women. Eat Disord 2021; 29:523-538. [PMID: 31762406 DOI: 10.1080/10640266.2019.1695451] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
'Feeling fat' has received little empirical attention despite clinical recognition as an eating disorder maintenance factor. This experience also occurs in non-clinical populations and may relate to elements of subclinical eating pathology. The present study examined whether 'feeling fat' independently contributes to eating pathology and eating pathology-related impairment, over and above over-evaluation of weight and shape and dysphoria. University students (N = 990; 54.3% female) completed questionnaires measuring these constructs. Moderated multiple hierarchical regression analyses evaluated 'feeling fat''s unique contribution to eating pathology and impairment, and the moderating effects of gender and eating disorder symptom severity. 'Feeling fat' accounted for significant unique variance in eating pathology, but not eating pathology-related impairment, over and above over-evaluation of weight and shape and dysphoria. The relationship between 'feeling fat' and eating pathology-related impairment was stronger in women than in men. Symptom severity did not moderate the relationship between 'feeling fat' and either dependent variable. 'Feeling fat' distinctly relates to eating pathology in a sample of young adults, suggesting that 'feeling fat' deserves attention in individuals without eating disorders. Future research should longitudinally investigate the direction of the relationship between 'feeling fat' and eating pathology and examine mechanisms of gender differences in 'feeling fat.'
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Affiliation(s)
- Adrienne Mehak
- Department of Psychology, McGill University, Montréal, Canada
| | - Sarah E Racine
- Department of Psychology, McGill University, Montréal, Canada
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16
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Martin SJ, Schell SE, Srivastav A, Racine SE. Dimensions of unhealthy exercise and their associations with restrictive eating and binge eating. Eat Behav 2020; 39:101436. [PMID: 33069001 DOI: 10.1016/j.eatbeh.2020.101436] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 08/07/2020] [Accepted: 09/28/2020] [Indexed: 12/22/2022]
Abstract
Unhealthy exercise is a core symptom of eating disorders that predicts greater chronicity and risk of relapse. A detailed conceptualization of unhealthy exercise in the context of eating disorders is only beginning to emerge, and associations between specific dimensions of unhealthy exercise and eating disorder symptoms have received little attention. The aim of the current study was to examine associations between three key dimensions of unhealthy exercise - compulsive exercise (i.e., rule-driven exercise to avoid negative affect), exercise to control weight/shape, and exercise to compensate for recent food intake - with restrictive eating and binge eating. Participants were 239 women drawn from two separate studies of emotions and eating behavior; 126 (52.7%) endorsed restrictive eating and/or objective binge eating episodes in the past three months. Unhealthy exercise dimensions were measured using the Compulsive Exercise Test and investigator-designed items, and eating disorder symptoms were assessed using the Eating Pathology Symptoms Inventory. Restrictive eating was only associated with avoidance and rule-driven exercise, whereas binge eating was significantly correlated with all unhealthy exercise variables. Multiple regression results revealed that only compensatory exercise was uniquely associated with binge eating. Unhealthy exercise consists of partially distinct dimensions with differential relations to core eating disorder symptoms. Future research should examine unhealthy exercise dimensions in patients with eating disorder diagnoses and consider whether treatments for specific unhealthy exercise forms might be beneficial.
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Affiliation(s)
| | - Sarah E Schell
- Department of Psychology, McGill University, Montreal, Canada
| | | | - Sarah E Racine
- Department of Psychology, McGill University, Montreal, Canada.
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17
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Predicting the restrictive eating, exercise, and weight monitoring compulsions of anorexia nervosa. Eat Weight Disord 2020; 25:701-707. [PMID: 30900140 PMCID: PMC7256099 DOI: 10.1007/s40519-019-00674-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Accepted: 03/13/2019] [Indexed: 01/13/2023] Open
Abstract
PURPOSE Compulsions surrounding restrictive eating, exercise, and weight monitoring are thought to maintain abnormal eating behaviour in individuals with anorexia nervosa (AN). This study aimed to determine if AN psychopathology and trait anxiety explain the presence of restrictive eating, exercise, and weight monitoring compulsions in a mixed sample. METHODS Participants were 31 females with AN and 31 age and gender-matched healthy individuals (HC). Restrictive eating, exercise and weight monitoring compulsion presence was compared between AN and HC groups. Multivariable poisson regression analyses, adjusted for diagnostic status, were conducted to assess the association of both AN psychopathology and trait anxiety with compulsions across the mixed group. RESULTS Individuals with AN endorsed a greater number of restrictive eating, exercise and weight monitoring compulsions compared to HC. In adjusted poisson regression analyses neither AN psychopathology nor trait anxiety predicted compulsion presence: incidence rate ratio (IRR) for AN psychopathology = 1.15 [95% CI 0.84, 1.57], p = 0.39; IRR for trait anxiety = 1.01 [95% CI 0.97, 1.06], p = 0.50. CONCLUSIONS Greater presence of restrictive eating, exercise and weight monitoring compulsions was reported by individuals with AN, supporting the conceptualisation of disorder behaviours as compulsive. The study was underpowered to robustly evaluate the association between predictors of interest and the compulsions outcome, largely owing to the small sample size. Further investigation is required, ideally using methods able to identify causal and mediation effects. LEVEL OF EVIDENCE Level V, cross-sectional study.
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18
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Alcaraz-Ibáñez M, Paterna A, Sicilia Á, Griffiths MD. Morbid exercise behaviour and eating disorders: A meta-analysis. J Behav Addict 2020; 9:206-224. [PMID: 32644935 PMCID: PMC8939419 DOI: 10.1556/2006.2020.00027] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 03/17/2020] [Accepted: 04/04/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND AND AIMS This study examined the relationship between self-reported symptoms of morbid exercise behaviour (MEB) and eating disorders (ED) using meta-analytic techniques. METHODS We systematically searched MEDLINE, PsycINFO, Web of Science, SciELO and Scopus. Random effects models were used to compute pooled effect sizes estimates (r). The robustness of the summarized estimates was examined through sensitivity analyses by removing studies one at a time. RESULTS Sixty-six studies comprising 135 effect-sizes (N = 21,816) were included. The results revealed: (a) small-sized relationship in the case of bulimic symptoms (r = 0.19), (b) small- (r = 0.28) to medium-sized relationships (r = 0.41) in the case of body/eating concerns, and (c) medium-sized relationships in the case of overall ED symptoms (r = 0.35) and dietary restraint (r = 0.42). Larger effect sizes were observed in the case of overall ED symptoms in clinical, younger, and thinner populations, as well as when employing a continuously-scored instrument for assessing ED or the Compulsive Exercise Test for assessing MEB. Larger effect sizes were also found in female samples when the ED outcome was dietary restraint. CONCLUSIONS The identified gaps in the literature suggest that future research on the topic may benefit from: (a) considering a range of clinical (in terms of diagnosed ED) and non-clinical populations from diverse exercise modalities, (b) addressing a wide range of ED symptomatology, and (c) employing longitudinal designs that clarify the temporal direction of the relationship under consideration.
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Affiliation(s)
- Manuel Alcaraz-Ibáñez
- Department of Education, University of Almería, Almería, Spain
- Health Research Centre, University of Almería, Almería, Spain
| | - Adrian Paterna
- Department of Education, University of Almería, Almería, Spain
- Health Research Centre, University of Almería, Almería, Spain
| | - Álvaro Sicilia
- Department of Education, University of Almería, Almería, Spain
- Health Research Centre, University of Almería, Almería, Spain
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19
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Harris A, Hay P, Touyz S. Psychometric properties of instruments assessing exercise in patients with eating disorders: a systematic review. J Eat Disord 2020; 8:45. [PMID: 32884810 PMCID: PMC7465430 DOI: 10.1186/s40337-020-00315-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 07/19/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Research has identified factors specific to exercise in eating disorder patients such as affect regulation and compulsivity. Existing measures of exercise behaviour which were not originally designed for eating disorder patients may not adequately assess these factors. The aim of this systematic review is to identify and assess the psychometric properties of all self-report measures of exercise designed to be used with eating disorder patients. METHOD A systematic review was conducted following the PRISMA guidelines. MedLine, Scopus and PsycINFO were systematically searched. A total of 12 studies examining two measures, the Exercise and Eating Disorders and the Compulsive Exercise Test, met inclusion criteria. RESULTS Validation studies showed promising results for both tests and established internal consistency, concurrent and convergent validity, and construct validity. The factor structure of the Compulsive Exercise Test was not confirmed in the majority of the studies included in this review, while there are only two studies conducting factor analysis on the Exercise and Eating Disorders. CONCLUSION The two measures identified by this systematic review represent the current research on measures of compulsive exercise for eating disorder patients. Further research is needed to confirm a factor structure and validate both the Compulsive Exercise Test and the Exercise and Eating Disorders in more diverse clinical samples.
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Affiliation(s)
- Astrid Harris
- School of Psychology, University of Sydney, Sydney, Australia
| | - Phillipa Hay
- Translational Health Research Institute, School of Medicine, Western Sydney University, Penrith, Australia
| | - Stephen Touyz
- InsideOut Institute and School of Psychology, University of Sydney, Sydney, Australia
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20
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Vrabel K, Bratland-Sanda S. Exercise Obsession and Compulsion in Adults With Longstanding Eating Disorders: Validation of the Norwegian Version of the Compulsive Exercise Test. Front Psychol 2019; 10:2370. [PMID: 31695652 PMCID: PMC6817603 DOI: 10.3389/fpsyg.2019.02370] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 10/04/2019] [Indexed: 11/23/2022] Open
Abstract
Objectives The objectives of this study were to (1) validate the Norwegian version of the Compulsive Exercise Test (CET) in adults with longstanding eating disorders, and (2) explore predictors of high CET-score. Methods: Adult inpatients (n = 166) with longstanding DSM-IV Anorexia Nervosa, Bulimia Nervosa (BN) or Eating Disorder not Otherwise Specified (EDNOS) completed the CET instrument, Eating Disorder examination questionnaire (EDE-Q), Beck Depression Inventory-II (BDI-II) and Symptom checklist-90 (SCL-90). A total CET score of 15 or above was defined as high CET-score. ANOVA, Confirmatory factor analysis, Pearson’s correlation, and logistic regression were used to analyze the data. Results Cronbach’s alpha varied from 0.68 to 0.96 for the CET and its subscales. The confirmatory factor analysis showed adequate fit. Convergent validity of the CET demonstrated correlation between EDE-Q global and subscale scores and CET total score. The same pattern was found for correlation between CET subscales and EDE-Q subscales. EDE-Q global score and frequency of exercise episodes predicted high CET-score, yet 21% of the patients with high CET score had less than one episode of exercise per week. Conclusion The Norwegian version of CET is valid and useful for assessing compulsive exercise in a sample with longstanding ED. The understanding of compulsive exercise must to a greater extent differ between obsessions and compulsions, as a significant number of patients with high CET score showed no or little exercise behavior.
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Affiliation(s)
- Karianne Vrabel
- Research Institute, Modum Bad Psychiatric Center, Vikersund, Norway
| | - Solfrid Bratland-Sanda
- Department of Sports, Physical Education and Outdoor Life, University of South-Eastern Norway, Kongsberg, Norway
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21
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Accuracy of self-reported physical activity in patients with anorexia nervosa: links with clinical features. J Eat Disord 2019; 7:28. [PMID: 31463050 PMCID: PMC6706937 DOI: 10.1186/s40337-019-0258-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 08/01/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND High levels of physical activity (PA) have long been described in patients with Anorexia Nervosa (AN). Despite the importance of measuring PA in this population, there are two important factors that remain unknown. First, it is not clear how accurate self-report measures of PA are among patients. Second, little is known about how clinical characteristics are associated with the accuracy of self-reported PA. Therefore, this study aimed to examine the accuracy of self-reported PA compared to an objective measure of PA in patients with AN. It also investigated whether levels of accuracy/inaccuracy were associated with compulsive exercise, motivation to change, and psychological distress. METHOD Data were analysed from 34 adult outpatients with AN. Patients wore an accelerometer device (ActiGraph) for 4 days and completed a retrospective self-report measure of exercise (Exercise Participation Screening Questionnaire). They also completed measures of compulsive exercise (Compulsive Exercise Test), motivation to change (The Anorexia Nervosa Stages of Change Questionnaire), and psychological distress (Kessler-10). RESULTS On the self-report measure, patients accurately reported their time spent in moderate and vigorous intensity PA, however, they significantly under-reported their light physical activity (compared to the accelerometer data). Accurate reporting of total PA was positively associated with higher levels of compulsive exercise. There was evidence to suggest that clinical features, such as motivation to change and psychological distress, may be associated with inaccurate reporting at some levels of PA intensity and not others. CONCLUSIONS Results indicate that patients with AN are likely to under-report their light intensity PA. We also found preliminary evidence for how compulsive exercise, motivation to change, and distress are associated with self-reported PA accuracy. Clinical implications and directions for future research are considered. TRIAL REGISTRATION ACTRN12610000585022. Taking a LEAP forward in the treatment of anorexia nervosa: a randomized controlled trial. NHMRC grant: 634922.
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22
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Wade T. Celebrating research contributions from Australia: Marking the XXIVth annual meeting of the Eating Disorder Research Society. Int J Eat Disord 2018; 51:1117-1118. [PMID: 30270452 DOI: 10.1002/eat.22944] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 07/28/2018] [Indexed: 11/11/2022]
Abstract
This Virtual Issue of the International Journal of Eating Disorders (IJED) is released to mark the XXIVth Eating Disorder Research Society (EDRS) meeting in Sydney, Australia. This is the second EDRS meeting in Australia, reflecting the strong contribution of Australian researchers to eating disorder research internationally. Attendees at the Sydney EDRS meeting will be able to access the top 10 cited papers from IJED by Australian authors in 2016-2017, cited an average of 10.2 times each. It is pleasing to note the strong representation of early career researchers and the range of topics addressed.
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Affiliation(s)
- Tracey Wade
- School of Psychology, Flinders University, Adelaide, Australia
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23
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Hay P, Touyz S, Arcelus J, Pike K, Attia E, Crosby RD, Madden S, Wales J, La Puma M, Heriseanu AI, Young S, Meyer C. A randomized controlled trial of the compuLsive Exercise Activity TheraPy (LEAP): A new approach to compulsive exercise in anorexia nervosa. Int J Eat Disord 2018; 51:999-1004. [PMID: 30051623 DOI: 10.1002/eat.22920] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 06/11/2018] [Accepted: 06/11/2018] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To compare the efficacy of the compuLsive Exercise Activity theraPy (LEAP) programme integrated with manualized cognitive behavioral therapy for anorexia nervosa (CBT-AN) compared to CBT-AN alone. METHOD Seventy-eight adults were randomized to CBT-AN, delivered with or without eight embedded sessions of LEAP, for a total of 34 individual outpatient sessions. Participants were assessed at baseline, the end of the first phase of CBT-AN (which included LEAP), mid-therapy, end of therapy, and at 3 and 6 months follow-up. Linear mixed effects modelling was used for comparing trajectories over time by group in primary outcomes of pathological exercise cognitions and secondary outcomes of exercise frequency, BMI, eating disorder (ED) symptoms, AN stage of change, anxiety/depression, and health related quality of life. RESULTS There were significant improvements over time in all outcomes. There were no significant differences between treatment groups in primary outcome measures. Fidelity and end-of-treatment participant satisfaction were satisfactory across both conditions. DISCUSSION CBT-AN and LEAP added to CBT-AN resulted in improved attitudes and beliefs toward exercise and general improvements in BMI and ED psychopathology in people with AN.
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Affiliation(s)
- Phillipa Hay
- Discipline of Mental Health, Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, Campbelltown, Australia
| | - Stephen Touyz
- Department of Clinical Psychology, School of Psychology, University of Sydney, Sydney, Australia
| | - Jon Arcelus
- Faculty of Medicine & Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom.,Department of Psychiatry, Leicestershire Adult Eating Disorders Service, Leicestershire Partnership NHS Trust, Bennion Centre, Glenfield Hospital, Leicester, United Kingdom
| | - Kathleen Pike
- Division of Behavioral Health Services and Policy Research, Columbia University, New York, New York
| | - Evelyn Attia
- Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, New York
| | - Ross D Crosby
- Neuropsychiatric Research Institute, Fargo, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota
| | - Sloane Madden
- Department of Psychiatry, Eating Disorders Service at the Sydney Children's Hospitals Network, Sydney, Australia
| | - Jackie Wales
- Department of Psychiatry, Leicestershire Adult Eating Disorders Service, Leicestershire Partnership NHS Trust, Bennion Centre, Glenfield Hospital, Leicester, United Kingdom
| | | | - Andreea I Heriseanu
- Department of Clinical Psychology, School of Psychology, University of Sydney, Sydney, Australia
| | - Sarah Young
- Department of Psychiatry, Eating Disorders Service at the Sydney Children's Hospitals Network, Sydney, Australia
| | - Caroline Meyer
- Discipline of Behavioural Psychology, WMG and Warwick Medical School, University of Warwick, Coventry, United Kingdom.,Discipline of Psychology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
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24
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Danielsen M, Bjørnelv S, Bratberg GH, Rø Ø. Validation of the exercise and eating disorder questionnaire in males with and without eating disorders. Int J Eat Disord 2018. [PMID: 29537659 PMCID: PMC6001437 DOI: 10.1002/eat.22855] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE The need to consider gender when studying exercise in eating disorder (ED) has been underscored. The study aimed to test the psychometric properties and factor structure of the exercise and eating disorder (EED) questionnaire for males with and without ED, to highlight gender differences, and to explore issues relevant for a male version of the EED questionnaire. METHOD This cross sectional study included 258 male participants: 55 ED patients (inpatients and outpatients) and 203 student controls. The patient group consisted of 54.5% (n = 30) with AN, 18.2% (n = 10) with BN, 27.2% (n = 15) with unspecified ED. The ED sample was treated as transdiagnostic in all analyses. t Tests, chi-square test, correlations analyses, and a principal component analysis were conducted. RESULTS The analyses confirmed that the EED questionnaire had adequate psychometric properties, and a four-factor solution: (a) compulsive exercise, (b) positive and healthy exercise, (c) awareness of bodily signals, and (d) weight and shape exercise. The questionnaire discriminated significantly (p < .01- < .001) between patients and controls on the global score, subscales, and 16 out of 18 individual items. Convergent validity was demonstrated by high correlations between the EED questionnaire and the eating disorder examination questionnaire (r = .65). DISCUSSION The results indicated that the EED questionnaire is a valid and reliable tool for males. It is a clinically derived, self-report questionnaire to assess compulsive exercise among ED patients, regarding attitudes and thoughts toward compulsive exercise and identification of treatment targets and priorities.
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Affiliation(s)
- Marit Danielsen
- Eating Disorder Unit, Department of PsychiatryLevanger Hospital, Hospital Trust Nord‐TrøndelagLevanger7600Norway
| | - Sigrid Bjørnelv
- Eating Disorder Unit, Department of PsychiatryLevanger Hospital, Hospital Trust Nord‐TrøndelagLevanger7600Norway,Department of Mental Health, Faculty of Medicine and Health SciencesNorwegian University of Science and TechnologyTrondheimNorway
| | - Grete Helen Bratberg
- Department of ResearchNord‐Trøndelag Hospital TrustLevangerNorway,Faculty of Nursing and Health SciencesNord UniversityNorway
| | - Øyvind Rø
- Regional Eating Disorder Service, Division of Mental Health and AddictionOslo University HospitalOsloNorway,Division of Mental Health and Addiction, Institute of Clinical MedicineUniversity of OsloOsloNorway
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25
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Exercise Caution: Questions to Ask Adolescents Who May Exercise Too Hard. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15040797. [PMID: 29671779 PMCID: PMC5923839 DOI: 10.3390/ijerph15040797] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 04/05/2018] [Accepted: 04/17/2018] [Indexed: 11/18/2022]
Abstract
When the primary goal of exercise is to compensate for food intake and to alter body shape and weight, it is considered compulsive and may be harmful. Compulsive exercise (CE) is important in the pathogenesis of eating disorders (EDs). Many healthy adolescents engage in CE too, and this may indicate a risk for EDs. Our aim was to learn more about ED risk factors tied to CE and to try to isolate questions to ask in order to probe for high ED risk in adolescents engaging in CE. Using two well-established instruments (the Structural Analysis of Social Behavior and the Eating Disorders Examination Questionnaire), we studied associations between ED variables and CE in healthy adolescent boys and girls. We examined gender-specific items to generate the best possible fit for each gender. Individuals with CE displayed significantly greater ED pathology and more self-criticism, and this pattern was stronger in girls than in boys. Risk factors for ED among individuals with CE differed slightly for boys and girls. We put forward a set of gender-specific questions that may be helpful when probing for ED risk among adolescents engaging in CE.
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26
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Young S, Touyz S, Meyer C, Arcelus J, Rhodes P, Madden S, Pike K, Attia E, Crosby RD, Hay P. Relationships between compulsive exercise, quality of life, psychological distress and motivation to change in adults with anorexia nervosa. J Eat Disord 2018; 6:2. [PMID: 29441204 PMCID: PMC5799909 DOI: 10.1186/s40337-018-0188-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Accepted: 01/25/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND For people with anorexia nervosa (AN), compulsive exercise is characterized by extreme concerns about the perceived negative consequences of stopping/reducing exercise, dysregulation of affect, and inflexible exercise routines. It is associated with increased eating disorder psychopathology and poor clinical outcome. However, its relationships with two important clinical issues, quality of life (QoL) and motivation to change, are currently unknown. This study aimed to assess the cross-sectional relationships between compulsive exercise, QoL, psychological distress (anxiety and depressive symptoms, and obsessive-compulsive traits) and motivation to change in patients with AN. METHOD A total of 78 adults with AN participated in this study, which was nested within a randomized controlled trial of psychological treatments for AN. At baseline (pre-treatment), participants completed questionnaires assessing compulsive exercise, eating disorder (ED) psychopathology, QoL, psychological distress and motivation to change. RESULTS Baseline correlational analyses demonstrated a moderate positive relationship between compulsive exercise and ED psychopathology, and a weak positive relationship between compulsive exercise and psychological distress. There was a moderate negative relationship between compulsive exercise and eating disorder QoL. CONCLUSIONS These results indicate compulsive exercise is moderately associated with poorer QoL and weakly associated with higher distress. Targeting compulsive exercise in the treatment of anorexia nervosa may help reduce the burden of illness and improve patients' engagement in treatment. TRIAL REGISTRATION ACTRN12610000585022. Taking a LEAP forward in the treatment of anorexia nervosa: a randomized controlled trial. NHMRC grant: 634922.
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Affiliation(s)
- Sarah Young
- Griffith Taylor Building, School of Psychology, University of Sydney, Sydney, Australia
| | - Stephen Touyz
- School of Psychology, University of Sydney, Sydney, Australia
| | - Caroline Meyer
- WMG, University of Warwick, United Kingdom & University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Jon Arcelus
- Institute of Mental Health, Faculty of Medicine & Health Sciences, University of Nottingham, Nottingham, UK
- Leicestershire Adult Eating Disorders Service, Leicestershire Partnership NHS Trust, Bennion Centre, Glenfield Hospital, Leicester, UK
| | - Paul Rhodes
- School of Psychology, University of Sydney, Sydney, Australia
| | - Sloane Madden
- School of Medicine, University of Sydney, Sydney, Australia
- Eating Disorders Service at the Sydney Children’s Hospitals Network, Westmead, Australia
| | - Kathleen Pike
- Division of Behavioral Health Services and Policy Research, Columbia University, New York, USA
| | - Evelyn Attia
- Department of Psychiatry, College of Physicians and Surgeons of Columbia University, Weill Cornell Medical College, New York, USA
| | - Ross D. Crosby
- Neuropsychiatric Research Institute, Fargo, North Dakota USA
- University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota USA
| | - Phillipa Hay
- Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, Campbelltown, Australia
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Dittmer N, Jacobi C, Voderholzer U. Compulsive exercise in eating disorders: proposal for a definition and a clinical assessment. J Eat Disord 2018; 6:42. [PMID: 30505444 PMCID: PMC6260729 DOI: 10.1186/s40337-018-0219-x] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Accepted: 09/11/2018] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Compulsive exercise has been recognized as a highly prevalent symptom in eating disorders (ED) for over 100 years and is associated with poor short-term and long-term treatment outcome. Progress in understanding and treatment of compulsive exercise will remain limited as long as no consensus framework for definition and assessment of compulsive exercise exists, as results cannot be compared across clinical studies.Based on existing literature, it was our aim to propose a transdiagnostic definition and a clinical assessment for compulsive exercise, that can be applied to adolescent and adult patients with ED. METHOD During a series of meetings of experienced clinicians at a highly specialized hospital for eating disorders, we elaborated a transdiagnostic definition of compulsive exercise in ED. Additionally, we derived a clinical interview for the assessment of compulsive exercise and its different subtypes. RESULTS The core criterion when defining and assessing compulsive exercise is a pathologically increased exercise pattern characterized by 1) excessive exercise that a patient feels driven to perform in response to an obsession or according to rules that must be applied rigidly, and 2) exercise that is aimed at preventing or reducing distress or at preventing some dreaded consequence. A second necessary criterion is the physical or psychological burden caused by compulsive exercise, i.e., that it is time-consuming, significantly interferes with the patient's daily routine, occupational functioning or social relationships or is continued despite medical injury, illness, or lack of enjoyment. Insight that compulsive exercise is excessive or unreasonable was added as an optional criterion.Compulsive exercise manifests itself in three different subtypes: 1) vigorous exercise, 2) marked increase in daily movement, or 3) motor restlessness.The above criteria must be met during the past 6 months, together with one of the three subtypes of compulsive exercise. CONCLUSIONS The proposed criteria aim to foster the discussion around definition and assessment of compulsive exercise with the goal of reaching an international consensus in the near future.Providing a consistent framework for researchers and clinicians would considerably advance understanding and treatment of compulsive exercise in ED patients.
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Affiliation(s)
- Nina Dittmer
- Schoen Clinic Roseneck, Am Roseneck 6, Prien am Chiemsee, Germany.,2Department of Clinical Psychology and E-Mental-Health, Technische Universität Dresden, Dresden, Germany
| | - Corinna Jacobi
- 2Department of Clinical Psychology and E-Mental-Health, Technische Universität Dresden, Dresden, Germany
| | - Ulrich Voderholzer
- Schoen Clinic Roseneck, Am Roseneck 6, Prien am Chiemsee, Germany.,3Department of Psychiatry and Psychotherapy, University of Freiburg, Freiburg, Germany.,4Department of Psychiatry and Psychotherapy, University of Munich (LMU), Munich, Germany
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Bratland-Sanda S, Vrabel KA. An investigation of the process of change in psychopathology and exercise during inpatient treatment for adults with longstanding eating disorders. J Eat Disord 2018; 6:15. [PMID: 29988511 PMCID: PMC6026520 DOI: 10.1186/s40337-018-0201-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Accepted: 06/01/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Excessive exercise is recognized as a predictor of poor outcome in eating disorders. However, little is known about how excessive exercise might affect the treatment process. The aim of this study was to describe process of weekly changes in eating disorder psychopathology, general psychopathology and exercise, and the possible interactive effects of excessive exercise on these changes during inpatient treatment of longstanding eating disorders. METHODS Eighty-four patients meeting the DSM-IV criteria for Anorexia Nervosa, Bulimia Nervosa, or Eating Disorders Not Otherwise Specified received inpatient cognitive-behavioural therapy including, physical activity and nutritional counselling treatment over 12 weeks. Excessive exercise was defined as having ≥6 episodes of driven exercise during week 1 of treatment. Excessive exercisers received one additional session of individual counseling with the clinical exercise physiologist. The study used repeated measurements during treatment and collected measures of eating disorders: psychopathology (EDE-Q), general psychopathology (SCL-5), and frequencies of exercise and body mass index (BMI). Statistical analysis was performed using repeated measures ANOVA. RESULTS Both eating disorders and general psychopathology were reduced from admission to discharge in excessive exercisers and non-exercisers. There was an overall interaction effect between time (week) and excessive exercise for the process of exercise and eating disorders psychopathology reduction. This interaction effect was also found in week 10 vs 11 regarding general psychopathology. The excessive exercisers showed steep reduction at first, followed by a smaller increase towards the end of treatment in both eating disorder and general psychopathology; this pattern was not found among the non-exercisers. CONCLUSION The process of change in exercise and psychopathology during inpatient treatment of longstanding eating disorders differs across excessive and non-excessive exercisers. Although excessive exercisers were given special attention for their exercise cognition and behavior during treatment, it is apparent that this part of treatment must be further developed.
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Affiliation(s)
- S Bratland-Sanda
- Department of Sports, Physical Education and Outdoor Studies, University of Southeast Norway, Bø in Telemark, Norway
| | - K A Vrabel
- Research Institute and Department of Eating Disorders, Modum Bad Psychiatric Center, Vikersund, Norway
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29
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Monell E, Levallius J, Forsén Mantilla E, Birgegård A. Running on empty - a nationwide large-scale examination of compulsive exercise in eating disorders. J Eat Disord 2018; 6:11. [PMID: 29942510 PMCID: PMC5996558 DOI: 10.1186/s40337-018-0197-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Accepted: 05/15/2018] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Compulsive exercise (CE) has been the neglected "Cinderella" among eating disorder (ED) symptoms, even though it seems to impact severity, treatment and outcome. This prompted a large-scale and systematic examination of the impact of CE in a representative ED sample. METHODS CE was examined in over 9000 female and male patients from a clinical ED database (covering out-patient, day and/or residential treatment) with respect to prevalence, ED diagnosis, ED symptoms, clinical features, patient characteristics, and outcome at 1-year follow-up. Relationships between changes in CE behavior and remission were also examined. RESULTS CE was a transdiagnostic symptom, present in nearly half of all patients (48%). It was associated with greater overall ED pathology, particularly dietary restraint, and negative perfectionism. Initial CE did not impact remission rate, but patients continuing or starting CE during treatment had considerably lower remission rates compared to patients who never engaged in, or ceased with, CE. Results were comparable for females and males. CONCLUSIONS At baseline, there were few differences between patients with and without CE, except a somewhat higher symptom load for patients with CE, and CE did not predict ED outcome. However, how CE developed during treatment to 1-year follow-up considerably impacted remission rates. We strongly recommend CE to be systematically assessed, addressed, and continuously evaluated in all ED patients seeking treatment.
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Affiliation(s)
- Elin Monell
- 1Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.,2Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Johanna Levallius
- 1Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.,2Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Emma Forsén Mantilla
- 1Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.,2Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Andreas Birgegård
- 1Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.,2Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
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Weissman RS, Frank GKW, Klump KL, Thomas JJ, Wade T, Waller G. Ross D. Crosby: Scholar, teacher, mentor, and friend. Introducing a virtual issue honoring the contributions of Ross D. Crosby to the field of eating disorders. Int J Eat Disord 2017; 50:1121-1123. [PMID: 28902416 DOI: 10.1002/eat.22769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 08/04/2017] [Indexed: 11/07/2022]
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Levallius J, Collin C, Birgegård A. Now you see it, Now you don't: compulsive exercise in adolescents with an eating disorder. J Eat Disord 2017; 5:9. [PMID: 28392917 PMCID: PMC5376699 DOI: 10.1186/s40337-016-0129-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 12/01/2016] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Compulsive exercise (CE) has been proposed as significant in the etiology, development and maintenance of eating disorders (EDs), resulting in more severe and enduring pathology. However, few studies have investigated CE longitudinally in adolescents with EDs. We aimed to test if adolescents show the same associations between CE and other clinical variables as previous research has found in adults. METHODS Three thousand one hundred sixteen girls and 139 boys from a clinical ED database were investigated regarding prevalence and frequency of CE and its relation to psychiatric symptoms, associated features and outcome. Denial of illness is common among adolescents and was therefore adjusted for. RESULTS Adjusted CE prevalence in girls was 44%, and CE was most prevalent in bulimia nervosa. As previously found in adults, those with CE scored significantly higher than non-CE on total ED severity, level of restriction and negative perfectionism. However, there were only minor differences between CE and non-CE patients on emotional distress, hyperactivity, suicidality and self-esteem. Among boys, adjusted CE prevalence was 38%, and CE boys scored significantly higher than non-CE on total ED severity. Initial CE did not influence 1-year outcome, although cessation of CE was associated with remission. CONCLUSIONS CE is a common clinical feature in adolescents with EDs and cessation is associated with remission. When controlling for denial of illness, CE had less detrimental impact than predicted. We recommend controlling for denial in studies on ED adolescents and further exploration of classification and treatment implications of CE.
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Affiliation(s)
- Johanna Levallius
- Department of Clinical Neuroscience, Resource Center for Eating Disorders, Center for Psychiatry Research, Karolinska Institutet, SE-113 64 Stockholm, Sweden.,Resource Center for Eating Disorders, Stockholm Health Care Services, Stockholm County Council, SE-113 64 Stockholm, Sweden
| | - Christina Collin
- Department of Clinical Neuroscience, Resource Center for Eating Disorders, Center for Psychiatry Research, Karolinska Institutet, SE-113 64 Stockholm, Sweden.,Resource Center for Eating Disorders, Stockholm Health Care Services, Stockholm County Council, SE-113 64 Stockholm, Sweden
| | - Andreas Birgegård
- Department of Clinical Neuroscience, Resource Center for Eating Disorders, Center for Psychiatry Research, Karolinska Institutet, SE-113 64 Stockholm, Sweden.,Resource Center for Eating Disorders, Stockholm Health Care Services, Stockholm County Council, SE-113 64 Stockholm, Sweden
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