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Schaumberg K, Bulik CM, Micali N. Patterns of maladaptive exercise behavior from ages 14-24 in a longitudinal cohort. J Child Psychol Psychiatry 2023; 64:1555-1568. [PMID: 37258173 PMCID: PMC10592554 DOI: 10.1111/jcpp.13844] [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] [Accepted: 04/25/2023] [Indexed: 06/02/2023]
Abstract
BACKGROUND Exercise for weight loss and maladaptive exercise (exercise that results in negative consequences or interference with daily life) are common behaviors among youth and are associated with increased risk of disordered eating symptoms. The current study clarifies processes that influence exercise-related risk in adolescence and young adulthood, including the frequency with which young people transition between engaging in exercise for weight loss and experiencing negative consequences of this behavior. METHOD Participants from the Avon Longitudinal Study of Parents and Children (ALSPAC) reported on eating disorder cognitions at age 14, and exercise behavior at ages 14, 16, 18, and 24 years old. Analyses examined rates of transition between the categories of 'No Exercise for Weight Loss', 'Exercise for Weight Loss', and 'Maladaptive Exercise' over time, identified overall trends in endorsement of exercise for weight loss and maladaptive exercise, and clarified predictors of these behaviors. RESULTS Endorsement of exercise for weight loss and maladaptive exercise increased over time in both males and females. Those in the 'Exercise for Weight Loss' category were more likely than those in the 'No Exercise for Weight Loss Category' to transition to 'Maladaptive Exercise' over time. Body mass index (Age 13) and fear of weight gain (Age 14) were consistent predictors of maladaptive exercise across sex. CONCLUSIONS Results support re-framing motivations for exercise in youth away from weight loss at a population level and targeting reductions in fear of weight gain for high-risk individuals.
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Affiliation(s)
| | - Cynthia M. Bulik
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, US
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, USA
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Nadia Micali
- Center for Eating and feeding disorders research, Mental Health Services in the Capital Region of Denmark, Psychiatric Centre Ballerup, Copenhagen, Denmark
- Institut for biologisk psykiatri, Psykiatrisk Center Sct. Hans, Boserupvej 2, 4000 Roskilde, Denmark
- Great Ormond Street Institute of Child Health, University College London, London, UK
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2
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Wons O, Lampe E, Patarinski AG, Schaumberg K, Juarascio A. Change in adaptive and maladaptive exercise and objective physical activity throughout CBT for individuals with eating disorders. Eat Weight Disord 2023; 28:40. [PMID: 37079117 PMCID: PMC10115602 DOI: 10.1007/s40519-023-01566-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 03/23/2023] [Indexed: 04/21/2023] Open
Abstract
Maladaptive exercise (i.e., exercise that compensates for binge eating or is used to avoid negative consequences of not exercising-like weight gain) is a common eating disorder (ED) behavior, yet, some individuals with EDs only engage in adaptive exercise. CBT for EDs targets reducing maladaptive exercise but does not address adaptive exercise. Thus, research is limited on how adaptive and maladaptive exercise are impacted during CBT for EDs. The current study examined how assessor-rated adaptive and maladaptive exercise and objectively measured physical activity changed over a 12-week CBT treatment among adults with transdiagnostic binge eating and restrictive eating that did and did not engage in maladaptive exercise at the start of treatment (n = 13 non-maladaptive exercise group, n = 17 maladaptive exercise group). The overall amount of adaptive and maladaptive exercise was measured via the Eating Disorder Examination Interview and objectively measured physical activity (e.g., step count, minutes of moderate-to-vigorous physical activity [MVPA]) was measured via a wrist-worn fitness tracker. Throughout treatment, the overall amount of adaptive exercise did not significantly change for both groups, but the overall amount of maladaptive exercise significantly decreased in the maladaptive exercise group. Step count did not significantly change for both groups, but minutes of MVPA significantly increased over treatment for the non-maladaptive exercise group. Increases in step count and minutes of MVPA were not associated with ED symptom changes in either group. These results enhance an understanding of exercise changes during transdiagnostic CBT-based ED treatment for individuals with varying baseline exercise profiles.Level of evidence: Level 1, randomized controlled trial.
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Affiliation(s)
- Olivia Wons
- Department of Psychological and Brain Sciences, Drexel University, Stratton Hall, 3141 Chestnut Street, Philadelphia, PA, 19104, USA.
- Center for Weight, Eating, and Lifestyle Science, Drexel University, Stratton Hall, 3141 Chestnut Street, Philadelphia, PA, 19104, USA.
| | - Elizabeth Lampe
- Department of Psychological and Brain Sciences, Drexel University, Stratton Hall, 3141 Chestnut Street, Philadelphia, PA, 19104, USA
- Center for Weight, Eating, and Lifestyle Science, Drexel University, Stratton Hall, 3141 Chestnut Street, Philadelphia, PA, 19104, USA
| | - Anna Gabrielle Patarinski
- Center for Weight, Eating, and Lifestyle Science, Drexel University, Stratton Hall, 3141 Chestnut Street, Philadelphia, PA, 19104, USA
| | - Katherine Schaumberg
- Department of Psychiatry, University of Wisconsin-Madison, 6001 Research Park Blvd, Madison, WI, 53719, USA
| | - Adrienne Juarascio
- Department of Psychological and Brain Sciences, Drexel University, Stratton Hall, 3141 Chestnut Street, Philadelphia, PA, 19104, USA
- Center for Weight, Eating, and Lifestyle Science, Drexel University, Stratton Hall, 3141 Chestnut Street, Philadelphia, PA, 19104, USA
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3
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Schaumberg KE, Robinson L, Hochman A, Micali N. Prospective Associations Between Driven Exercise and Other Eating Disorder Behaviors in Adolescence: A Longitudinal Cohort Study. J Adolesc Health 2022; 70:781-787. [PMID: 35086755 PMCID: PMC9038608 DOI: 10.1016/j.jadohealth.2021.11.022] [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: 07/23/2021] [Revised: 11/11/2021] [Accepted: 11/13/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE Dysfunctional exercise is a common, debilitating symptom across eating disorders (ED). We examined the cross-sectional and longitudinal associations between experiences of exercise and ED behaviors and cognitions in an adolescent, population-based sample. METHODS Adolescents (n = 4,054) self-reported whether they exercised to control shape and weight (exercise for weight loss [EWL]), and, if so, whether they exercised even when injured, and whether exercise interfered with life functioning (driven exercise) at age 14 years, allowing delineation of three exercise-based groups: no-EWL, EWL, and driven exercise. Participants also reported ED cognitions at age 14 years along with other ED behaviors (fasting, purging, binge eating) at ages 14 and 16 years. Sex-stratified regression approaches were employed to examine relationships between these exercise categories at age 14 and ED behaviors and cognitions at ages 14 and 16. RESULTS Cross-sectionally, those in the driven exercise group, compared to the no-EWL group, consistently reported higher levels of ED cognitions and behaviors, with those in the EWL group also reporting higher levels of some ED cognitions and behaviors relative to the no-EWL group. Those in the EWL and driven exercise groups at age 14 also demonstrated a higher prospective likelihood of fasting (boys and girls) and purging (girls only) at age 16, relative to those in the no-EWL group at age 14. DISCUSSION Results inform our understanding of EWL and driven exercise and the developmental timing of ED behaviors in adolescence and point toward the potential utility of targeted prevention for young people who report EWL.
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Affiliation(s)
| | - Lauren Robinson
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; GOSH Institute of Child Health, University College London, London, UK
| | - Ayelet Hochman
- Department of Psychology, St. John's University, Queens, New York
| | - Nadia Micali
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; GOSH Institute of Child Health, University College London, London, UK; Great Ormond Street Institute of Child Health, Child and Adolescent Mental Health Palliative care and Pediatrics Section, UCL, London, UK; Department of Psychiatry, Faculty of Medicine, University of Geneva, Geneva, Switzerland; Department of Pediatrics, gynecology and obstetrics, Faculty of Medicine, University of Geneva, Geneva, Switzerland
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Clinical features of children and adolescents with anorexia nervosa and problematic physical activity. Eat Weight Disord 2022; 27:119-129. [PMID: 33677778 DOI: 10.1007/s40519-021-01159-8] [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: 11/22/2020] [Accepted: 02/22/2021] [Indexed: 10/22/2022] Open
Abstract
PURPOSE Problematic physical activity (PPA) is a symptom commonly present in patients suffering from anorexia nervosa (AN). This study aims to refine the clinical description of children with early-onset AN and adolescents with standard-onset AN and associated PPA, in order to better understand their associated features, and to offer them adapted care and physical activity programs. METHODS 107 participants treated at the Salvator University Hospital Centre of Marseille for AN were retrospectively evaluated by the Exercise Dependence Scale Revised concerning PPA. Other self-report questionnaires were used to evaluate eating disorder, anxiety and depressive symptoms, quality of life, emotions, sleep, and attention deficit disorder with or without hyperactivity. RESULTS In the entire sample, the presence of PPA was associated with significantly higher levels of eating disorder (EDI-2: p = 0.001) and body image concerns (p = 0.002), anxiety (STAI-Y-trait: p = 0.013) and depression (p = 0.006), as well as significantly lower psychological well-being (p < 0.001) and quality of life (p < 0.001) and impaired sleep (PSQI: p = 0.008). The early-onset group showed a lower prevalence of PPA than the standard-onset group (p < 0.05) but their clinical symptomatology, when this symptom was present, was significantly more severe (EDI-2: p < 0.01; BSQ: p < 0.05; CDI: p < 0.05; STAI-Y-trait: p < 0.05). CONCLUSION PPA appears to be associated with more severe features in patients with early-onset AN, which seems to differ from standard-onset. It seems necessary to refine our knowledge on the involvement of PPA in the severity of AN, especially in patients with early-onset AN who remain little studied so far. LEVEL OF EVIDENCE Level V, descriptive study (evaluation data retrospectively studied).
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Koposov RA, Stickley A, Ruchkin V. Bulimia Symptoms in Russian Youth: Prevalence and Association With Internalizing Problems. Front Psychiatry 2022; 12:797388. [PMID: 35126206 PMCID: PMC8811208 DOI: 10.3389/fpsyt.2021.797388] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 12/23/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND There has been limited research on bulimia symptoms in adolescents from the general population outside the United States. This study aimed to evaluate the prevalence of bulimia symptoms in Russian youth and explore the associations between a clinical level of self-reported probable bulimia nervosa (BN) and internalizing problems, binge drinking and functional impairment by gender. METHODS Data were collected from a representative sample of school students (N = 2,515, 59.5% female) from Northern Russia [age M (SD) = 14.89 ± 1.13 years]. Probable BN and internalizing psychopathology were assessed using self-report scales. Chi-square and independent sample t-tests were used to compare respondents' demographic characteristics and disordered eating behaviors. GLM multivariate analysis of covariance was used to assess the associations between probable BN, functional impairment and mental health problems (MHP) by gender. RESULTS Analyses showed that the 3-month prevalence of probable BN was higher in girls (3.9%) than in boys (1.2%). Probable BN was associated with depressive and anxiety symptoms, somatic anxiety, somatic complaints, binge drinking and functional impairment. Boys reported a higher level of problem scores in relation to probable BN. CONCLUSIONS Our findings suggest that bulimia symptoms are prevalent in Russian adolescents and are associated with MHP and functional impairment. Timely recognition of bulimia symptoms and associated MHP is important for early prevention and intervention strategies.
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Affiliation(s)
- Roman A. Koposov
- Regional Centre for Child and Youth Mental Health and Child Welfare, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - Andrew Stickley
- Department of Preventive Intervention for Psychiatric Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Japan
- Stockholm Center for Health and Social Change, Södertörn University, Huddinge, Sweden
| | - Vladislav Ruchkin
- Child and Adolescent Psychiatry Unit, Department of Neuroscience, Uppsala University, Uppsala, Sweden
- Child Study Center, Yale University Medical School, New Haven, CT, United States
- Säter Forensic Psychiatric Clinic, Säter, Sweden
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Di Lodovico L, Hatteea H, Couton C, Duriez P, Treasure J, Gorwood P. Physical exercise-related endophenotypes in anorexia nervosa. Int J Eat Disord 2021; 54:1181-1188. [PMID: 33710637 DOI: 10.1002/eat.23503] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 02/28/2021] [Accepted: 02/28/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND The persistence of physical exercise in anorexia nervosa (AN) despite underweight and its maintaining factors are poorly understood. The aim of this study was to explore the attitudes toward physical exercise and its effects on emotions, cognitive functioning, and body image perception in patients with AN, and to search for exercise-related endophenotypes of the pathology. METHODS Physical exercise dependence, quantity, and dysregulation were assessed by the Exercise Dependence Scale (EDS), the Godin Leisure Time Exercise Questionnaire (GLTEQ) and a standardized effort test in 88 patients with AN, 30 unaffected relatives and 89 healthy controls. Changes in positive and negative affect, cognitive rigidity, and body image distortion were measured before and after the effort test in the three groups. RESULTS Patients with AN had higher scores on the EDS and the GLTEQ and used more effort in the standardized effort test. These three measures of physical exercise correlated with negative emotions at baseline. After the effort test, patients with AN had marked emotional improvement, a moderate increase in body image distortion and a small increase in cognitive rigidity compared to HC. Unaffected relatives also had a significant postexercise increase of positive emotion. DISCUSSION The mood-related drive for physical exercise has the characteristics of an endophenotype of the disorder. Excessive and driven physical exercise may be state-associated features of AN, driven by the positive effect on emotional wellbeing.
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Affiliation(s)
- Laura Di Lodovico
- Clinique des Maladies Mentales et de l'Encéphale, Hôpital Sainte-Anne, GHU Paris Psychiatrie et Neurosciences, Paris, France
| | - Hanna Hatteea
- Clinique des Maladies Mentales et de l'Encéphale, Hôpital Sainte-Anne, GHU Paris Psychiatrie et Neurosciences, Paris, France
| | - Céline Couton
- Université Paris-Saclay, Psychiatrie-Comorbidités-Addictions, Villejuif, France.,Psychiatry and Addictology Unit, APHP, Hôpitaux Universitaires Paris-Sud, Villejuif, France
| | - Philibert Duriez
- Clinique des Maladies Mentales et de l'Encéphale, Hôpital Sainte-Anne, GHU Paris Psychiatrie et Neurosciences, Paris, France.,Université de Paris, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, Paris, France
| | - Janet Treasure
- Department of Psychological Medicine, Section of Eating Disorders, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Philip Gorwood
- Clinique des Maladies Mentales et de l'Encéphale, Hôpital Sainte-Anne, GHU Paris Psychiatrie et Neurosciences, Paris, France.,Université de Paris, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, Paris, France
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7
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Chapa DAN, Kite BA, Forbush KT, Tregarthen JP, Argue S. Eating-disorder psychopathology and driven exercise change models: A latent change score analysis. Int J Eat Disord 2020; 53:2013-2025. [PMID: 33141971 DOI: 10.1002/eat.23392] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 09/29/2020] [Accepted: 09/29/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Approximately 50% of people with eating disorders (EDs) engage in driven exercise to influence their weight or shape and/or to compensate for loss-of-control eating. When present, driven exercise is associated with a lower quality-of-life, longer hospital stays, and faster rates-of-relapse. Despite the seriousness of driven exercise, most treatments for EDs do not target maladaptive exercise behaviors directly. Given the large proportion of patients with an ED who engage in driven exercise and its effect on treatment outcomes, it is critical to understand what predicts change in driven exercise. The purpose of this study was to test whether ED symptoms prospectively predicted change in driven exercise and vice versa. METHOD Participants were Recovery Record (RR) users (N = 4,568; 86.8% female) seeking treatment for an ED. Participants completed the Eating Pathology Symptoms Inventory (EPSI) monthly for 3 months. RESULTS In the full sample, dynamic bivariate latent change score analyses indicated that high levels of dietary restraint and restricting prospectively predicted reductions in driven exercise. Among persons with anorexia nervosa (AN), high levels of binge eating predicted increased driven exercise. Among persons with bulimia nervosa (BN), high levels of body dissatisfaction predicted increased driven exercise. Among persons with binge-eating disorder (BED), high levels of binge eating, purging, and restricting predicted reductions in driven exercise. DISCUSSION Results highlight changes that may predict increased or decreased driven exercise relative to other ED symptoms for AN, BN, and BED groups. These preliminary findings could inform future research on ED treatment efforts to manage driven exercise.
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Affiliation(s)
| | - Benjamin A Kite
- Department of Psychology, University of Kansas, Lawrence, Kansas, USA
| | - Kelsie T Forbush
- Department of Psychology, University of Kansas, Lawrence, Kansas, USA
| | | | - Stuart Argue
- Recovery Record, Inc, Palo Alto, California, USA
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8
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Wons OB, Michael ML, Lin M, Juarascio AS. Characterizing rates of physical activity in individuals with binge eating disorder using wearable sensor technologies and clinical interviews. EUROPEAN EATING DISORDERS REVIEW 2020; 29:292-299. [PMID: 33247869 DOI: 10.1002/erv.2811] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 10/19/2020] [Accepted: 11/13/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Research suggests physical activity (PA) improves behavioural, psychological and behavioural symptoms in individuals with binge eating disorder (BED), yet self-reported PA is notably low. Little remains known about objective rates of PA and subclinical levels of maladaptive PA (i.e., compensatory or driven PA), and few studies have attempted to understand the role that dissatisfaction and overvaluation with shape and weight plays in promoting PA in individuals with BED. We sought to characterize PA and investigate whether elevated rates of shape and weight concerns contribute to rates of PA in individuals with BED. METHOD Individuals meeting DSM-5 diagnosis of BED (N = 56) completed the Eating Disorder Examination and wore a Fitbit Flex 2 for 1 week. RESULTS On average, participants recorded 7621.12 (SD = 3034.20) daily steps and 194.30 (SD = 161.45) weekly moderate-to-vigorous PA minutes. About 21% of participants reported subclinical levels of maladaptive PA. Greater shape and weight overvaluation predicted lower duration of compensatory PA. CONCLUSION A small percentage of individuals with BED are engaging in subclinical levels of maladaptive PA, and there is a need to identify factors that influence rates of PA in individuals with BED.
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Affiliation(s)
- Olivia B Wons
- Center for Weight, Eating, and Lifestyle Sciences (WELL Center), Drexel University, Philadelphia, Pennsylvania, USA.,Department of Psychology & WELL Center, Drexel University, Philadelphia, Pennsylvania, USA
| | - Megan L Michael
- Center for Weight, Eating, and Lifestyle Sciences (WELL Center), Drexel University, Philadelphia, Pennsylvania, USA.,Department of Psychology & WELL Center, Drexel University, Philadelphia, Pennsylvania, USA
| | - Mandy Lin
- Center for Weight, Eating, and Lifestyle Sciences (WELL Center), Drexel University, Philadelphia, Pennsylvania, USA
| | - Adrienne S Juarascio
- Center for Weight, Eating, and Lifestyle Sciences (WELL Center), Drexel University, Philadelphia, Pennsylvania, USA.,Department of Psychology & WELL Center, Drexel University, Philadelphia, Pennsylvania, USA
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Melissa R, Lama M, Laurence K, Sylvie B, Jeanne D, Odile V, Nathalie G. Physical Activity in Eating Disorders: A Systematic Review. Nutrients 2020; 12:nu12010183. [PMID: 31936525 PMCID: PMC7019575 DOI: 10.3390/nu12010183] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 12/29/2019] [Accepted: 01/02/2020] [Indexed: 12/12/2022] Open
Abstract
Abnormally high levels of physical activity have been documented throughout the literature in patients with eating disorders (ED), especially those diagnosed with anorexia nervosa (AN). Yet no clear definition, conceptualization, or treatment of the problematic use of physical activity (PPA) in ED patients exists. The aim of this review is to propose a new classification of PPA, report the prevalence, triggers, predictors, maintainers and other related factors of PPA in ED patients, in addition to proposing a comprehensive model of the development of PPA in AN. A total of 47 articles, retrieved from Medline and Web of Science, met the inclusion criteria and were included in the analysis. As a result, the new approach of PPA was divided into two groups (group 1 and group 2) according to the dimension (quantitative vs qualitative approach) of physical activity that was evaluated. The prevalence of PPA in ED was reported in 20 out of 47 studies, the comparison of PPA between ED versus controls in 21 articles, and the links between PPA and psychological factors in ED in 26 articles, including depression (16/26), anxiety (13/26), obsessive–compulsiveness (9/26), self-esteem (4/26), addictiveness (1/26), regulation and verbal expression of emotions (1/26) and anhedonia (1/26). The links between PPA and ED symptomatology, PPA and weight, body mass index (BMI) and body composition in ED, PPA and age, onset, illness duration and lifetime activity status in ED, PPA and ED treatment outcome were reported in 18, 15, 7, 5 articles, respectively. All of the factors have been systematically clustered into group 1 and group 2. Results focused more on AN rather than BN due to the limited studies on the latter. Additionally, a model for the development of PPA in AN patients was proposed, encompassing five periods evolving into three clinical stages. Thus, two very opposite components of PPA in AN were suggested: voluntarily PPA increased in AN was viewed as a conscious strategy to maximize weight loss, while involuntarily PPA increased proportionally with weight-loss, indicating that exercise might be under the control of a subconscious biological drive and involuntary cognition.
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Affiliation(s)
- Rizk Melissa
- INSERM U1178, Maison de Solenn, 97 Boulevard De Port Royal, 75014 Paris, France;
- Université Paris-Sud and Université Paris Descartes, Ecole Doctorale des 3C (Cerveau, Cognition, Comportement), UMR-S0669, 75006 Paris, France
- Psychiatry Unit, Institut Mutualiste Montsouris 42, Boulevard Jourdan, 75014 Paris, France;
- Correspondence: ; Tel.: +33-787-483626
| | - Mattar Lama
- Nutrition Program, Department of Natural Sciences, Lebanese American University, Beirut 1102, Lebanon;
| | - Kern Laurence
- Laboratoire EA 29 31, LINP2-APSA, et Laboratoire EA 4430 CLIPSYD Université Paris Nanterre UFR-STAPS, 200, Avenue de la République, 92001 Nanterre CEDEX, France
| | - Berthoz Sylvie
- Psychiatry Unit, Institut Mutualiste Montsouris 42, Boulevard Jourdan, 75014 Paris, France;
- INCIA UMR-5287 CNRS, Université de Bordeaux, 33076 Bordeaux, France
| | - Duclos Jeanne
- Sciences Cognitives et Sciences Affectives, Université de Lille, CNRS, UMR 9193—SCALab, 59045 Lille, France;
- Département de Psychiatrie, Hôpital Saint Vincent de Paul, GHICL, F-59000 Lille, France
| | - Viltart Odile
- Institute of Psychiatry and Neurosciences of Paris, Unité Mixte de Recherche en Santé (UMRS) 1266 Institut National de la Santé et de la Recherche Médicale (INSERM), University Paris Descartes, 75014 Paris, France;
- Department of Biology, University of Lille, 59000 Lille, France
| | - Godart Nathalie
- INSERM U1178, Maison de Solenn, 97 Boulevard De Port Royal, 75014 Paris, France;
- Psychiatry Unit, Institut Mutualiste Montsouris 42, Boulevard Jourdan, 75014 Paris, France;
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10
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Davis HA, Ortiz AML, Smith GT. The Occurrence and Covariation of Binge Eating and Compensatory Behaviors Across Early to Mid-Adolescence. J Pediatr Psychol 2019; 43:402-412. [PMID: 29048479 DOI: 10.1093/jpepsy/jsx113] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 08/15/2017] [Indexed: 11/13/2022] Open
Abstract
The purpose of this study was to examine the occurrence and covariation of four eating disorder behaviors across the elementary, middle, and high school years. In a sample of 1,906 youth measured over 5 years at nine time points, from the past year of elementary school through the second year of high school, binge eating, purging (self-induced vomiting), compensatory exercise, and fasting behavior were assessed by self-report. Over the 5-year period, rates of binge eating and purging increased but rates of compensatory exercise and fasting decreased. Girls and boys did not differ in their rates of engagement in any of the behaviors. Within time, the behaviors covaried modestly. Health-care professionals are advised to assess each behavior individually, rather than base interventions on the presence or absence of a diagnosable eating disorder. Gender should not be a basis for assessing for the presence of any of these behaviors.
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11
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Ortiz AML, Davis HA, Smith GT. Transactions among thinness expectancies, depression, and binge eating in the prediction of adolescent weight control behaviors. Int J Eat Disord 2019; 52:142-152. [PMID: 30623973 DOI: 10.1002/eat.23001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 11/26/2018] [Accepted: 11/27/2018] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Binge eating, the transdiagnostic risk associated with depression, and the eating disorder-specific risk associated with expectancies for reinforcement from thinness have been identified as risk factors for the development of weight control behaviors. The purpose of this study was to examine if these risk factors transact to further predict risk in youth. METHOD Binge eating, depressive symptoms, thinness expectancies, and weight control behaviors were assessed in 1,758 adolescents three times during the transitional period between middle school and high school. We tested six different possible transactional processes. RESULTS Mediation tests demonstrated that both 8th grade binge eating and 8th grade depressive symptoms predicted 10th grade weight control behaviors through their predictive influence on thinness expectancies in 9th grade. However, our results were not consistent with a mediational process in which 8th grade thinness expectancies predicted 9th grade depression to further predict 10th grade weight control behaviors. No interactions among binge eating, depressive symptoms, or thinness expectancies predicted weight control. Results did not differ between girls and boys. DISCUSSION Thinness expectancies appear to mediate the predictive influence of binge eating and depressive symptoms on risk for engaging in weight control behaviors. These results add to theoretical understanding of risk and suggests potential intervention pathways for clinicians.
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12
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Swenne I. Changes and predictive value for treatment outcome of the compulsive exercise test (CET) during a family-based intervention for adolescents eating disorders. BMC Psychol 2018; 6:55. [PMID: 30442197 PMCID: PMC6238357 DOI: 10.1186/s40359-018-0265-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 10/25/2018] [Indexed: 11/28/2022] Open
Abstract
Background The aim of this study was to explore changes in the Compulsive Exercise Test (CET) following a family-based intervention in adolescents with restrictive eating disorders (ED). It was hypothesized that compulsive exercise would improve with successful intervention against the ED but also that a high level of compulsive exercise at presentation would be associated with a less favourable outcome. Method The CET, the Eating Disorders Examination-Questionnaire (EDE-Q), and body mass index were available for 170 adolescents at presentation and at a one-year follow-up. Treatment was a family-based intervention and included that all exercise was stopped at start of treatment. Recovery was defined as EDE-Q score < 2.0 or absence of an ED at an interview. Results Exercise for weight control and for avoiding low mood, which are related to ED cognitions, decreased in recovered patients. Exercise for improving mood did not change in either recovered or not recovered patients. The CET subscale scores at presentation did not independently predict recovery. Conclusion Compulsive exercise is one of several ED related behaviours which needs to be targeted at the start of treatment. With successful treatment it decreases in parallel with other ED related cognitions and behaviours but without a loss of the ability to enjoy exercise.
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Affiliation(s)
- Ingemar Swenne
- Department of Women's and Children's Health, Uppsala University, S-75185, Uppsala, Sweden.
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Schlegl S, Dittmer N, Hoffmann S, Voderholzer U. Self-reported quantity, compulsiveness and motives of exercise in patients with eating disorders and healthy controls: differences and similarities. J Eat Disord 2018; 6:17. [PMID: 30002829 PMCID: PMC6038234 DOI: 10.1186/s40337-018-0202-6] [Citation(s) in RCA: 17] [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: 12/30/2017] [Accepted: 06/01/2018] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Compulsive exercise (CE) is a frequent symptom in patients with eating disorders (EDs). It includes, in addition to quantitatively excessive exercise behaviour, a driven aspect and specific motives of exercise. CE is generally associated with worse therapy outcomes. The aims of the study were to compare self-reported quantity of exercise, compulsiveness of exercise as well as motives for exercise between patients with anorexia nervosa (AN), bulimia nervosa (BN) and healthy controls (HC). Additionally, we wanted to explore predictors of compulsive exercise (CE) in each group. METHODS We investigated 335 female participants (n = 226 inpatients, n = 109 HC) and assessed self-reported quantity of exercise, compulsiveness of exercise (Compulsive Exercise Test), motives for exercise (Exercise Motivations Inventory-2), ED symptoms (Eating Disorder Inventory-2), obsessive-compulsiveness (Obsessive-Compulsive Inventory-Revised), general psychopathology (Brief Symptom Inventory-18) and depression (Beck Depression Inventory-2). RESULTS Both patients with AN and BN exercised significantly more hours per week and showed significantly higher CE than HC; no differences were found between patients with AN and BN. Patients with EDs and HC also partly varied in motives for exercise. Specific motives were enjoyment, challenge, recognition and weight management in patients with EDs in contrast to ill-health avoidance and affiliation in HC. Patients with AN and BN only differed in regard to exercise for appearance reasons in which patients with BN scored higher. The most relevant predictor of CE across groups was exercise for weight and shape reasons. CONCLUSIONS Exercise behaviours and motives differ between patients with EDs and HC. CE was pronounced in both patients with AN and BN. Therefore, future research should focus not only on CE in patients with AN, but also on CE in patients with BN. Similarities in CE in patients with AN and BN support a transdiagnostic approach during the development of interventions specifically targeting CE in patients with EDs.
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Affiliation(s)
- Sandra Schlegl
- Department of Psychiatry and Psychotherapy, University Hospital of Munich (LMU), Nußbaumstraße 7, 80336 Munich, Germany
| | - Nina Dittmer
- Schoen Clinic Roseneck, Prien am Chiemsee, Germany
- Department of Clinical Psychology and Psychotherapy, Technical University of Dresden, Dresden, Germany
| | - Svenja Hoffmann
- Department of Counseling Psychology, University of Potsdam, Potsdam, Germany
| | - Ulrich Voderholzer
- Schoen Clinic Roseneck, Prien am Chiemsee, Germany
- Department of Psychiatry and Psychotherapy, University Hospital of Freiburg, Freiburg im Breisgau, Germany
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14
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Quesnel DA, Libben M, D Oelke N, I Clark M, Willis-Stewart S, Caperchione CM. Is abstinence really the best option? Exploring the role of exercise in the treatment and management of eating disorders. Eat Disord 2018; 26:290-310. [PMID: 29131718 DOI: 10.1080/10640266.2017.1397421] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Exercise prescription is suggested to help manage exercise abuse and improve overall eating disorder (ED) prognosis. This study explored emerging perceptions of ED health professionals concerning the role of exercise as a supportive treatment for EDs. Semi-structured interviews were conducted with international health professionals (n=13) with expertise in ED treatment. Verbatim transcripts were analyzed through thematic analysis. Four themes were revealed and titled 1) understanding the current state; 2) gaining perspectives; 3) barriers and benefits; 4) one size does not fit all. Within these themes, participants described the current state of exercise in ED treatment and suggested there exists a gap in research knowledge and practice. Participants also identified the implications of incorporating exercise into treatment and how an exercise protocol may be designed. Results enhance the understanding of the role of exercise in ED treatment and how it may further benefit individuals with EDs.
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Affiliation(s)
- Danika A Quesnel
- a School of Health and Exercise Sciences, Faculty of Health and Social Development , University of British Columbia Okanagan , Kelowna , BC , Canada
| | - Maya Libben
- b Department of Psychology, Faculty of Arts and Sciences , University of British Columbia Okanagan , Kelowna , BC , Canada
| | - Nelly D Oelke
- c School of Nursing, Faculty of Health and Social Development , University of British Columbia Okanagan , Kelowna , BC , Canada
| | - Marianne I Clark
- d Te Huataki Waiora, Faculty of Health, Sport and Human Performance , University of Waikato , New Zealand
| | - Sally Willis-Stewart
- a School of Health and Exercise Sciences, Faculty of Health and Social Development , University of British Columbia Okanagan , Kelowna , BC , Canada
| | - Cristina M Caperchione
- a School of Health and Exercise Sciences, Faculty of Health and Social Development , University of British Columbia Okanagan , Kelowna , BC , Canada
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15
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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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16
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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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17
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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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18
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Renz JA, Fisher M, Vidair HB, Hirsch D, Malizio J, Barger H, Fornari V. Excessive exercise among adolescents with eating disorders: examination of psychological and demographic variables. Int J Adolesc Med Health 2017; 31:ijamh-2017-0032. [PMID: 28850546 DOI: 10.1515/ijamh-2017-0032] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 07/14/2017] [Indexed: 11/15/2022]
Abstract
Background While a large number of patients with eating disorders (EDs) engage in excessive exercise (EE), both for weight control and mood regulation, there has been minimal research evaluating the relationship between EE and demographic and psychological factors, especially in adolescent patients. Purpose The goals of this study were to identify the occurrence of EE compared to other ED behaviors and to develop a regression model examining psychological, behavioral and demographic predictors of EE among adolescents with EDs. Methods Demographic and clinical information was determined for 217 adolescent patients in several levels of care (126 outpatient, 61 day program, 28 inpatient) with diagnoses of anorexia nervosa (AN) (24.9%), bulimia nervosa (BN) (25.8%), and eating disorder not otherwise specified (EDNOS) (49.3%). These patients presented to a large ED program and completed a series of questionnaires on admission to the program. Descriptive statistics, t-tests, chi-square analyses and multiple logistic regression were utilized to describe the population of adolescent patients and develop the model for predicting EE. Results Forty-seven percent of patients indicated they participated in EE in the past 4 weeks, compared to 32% for binge eating, 35% for vomiting and 15% for laxative use; 42% of patients with anorexia nervosa participated in EE, compared to 54% with bulimia nervosa and 49% with EDNOS. The regression model that was developed to predict EE, which included factors of depression, anxiety, dietary restraint, age, body mass index (BMI), diagnosis and level of care, correctly classified EE in 71.5% of cases. Dietary restraint and BMI were the two factors found to be significantly associated with EE. Conclusions Forty-seven percent of adolescent patients presenting for treatment of an ED reported participating in EE. This was larger than the numbers of patients reporting other ED behaviors that are commonly assessed, indicating the need for psychoeducation for multidisciplinary treatment teams, assessment, prevention, and clinical treatment services for this problematic behavior. It is important that those who treat patients with ED assess for and monitor EE behaviors that can complicate the treatment.
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Affiliation(s)
- Jessica A Renz
- Division of Child and Adolescent Psychiatryt, Zucker Hillside Hospital, Northwell Health New Hyde Park, USA
| | - Martin Fisher
- Division of Adolescent Medicine, Cohen Children's Medical Center, Northwell Health, Professor of Pediatrics, New Hyde Park, NY 11042, USA, Phone: 516-465-5459, Fax: 516-465-5299.,Hofstra - Northwell School of Medicine, Hempstead, NY, USA
| | - Hilary B Vidair
- Division of Child and Adolescent Psychiatryt, Zucker Hillside Hospital, Northwell Health New Hyde Park, USA
| | - Dina Hirsch
- Division of Child and Adolescent Psychiatry, Zucker Hillside Hospital, Northwell Health, New Hyde Park, NY, USA
| | - Joan Malizio
- Division of Adolescent Medicine, Cohen Children's Medical Center, Northwell Health, New Hyde Park, NY, USA
| | - Hamutal Barger
- Division of Adolescent Medicine, Cohen Children's Medical Center, Northwell Health, New Hyde Park, NY, USA
| | - Victor Fornari
- Division of Child and Adolescent Psychiatryt, Zucker Hillside Hospital, Northwell Health New Hyde Park, USA.,Hofstra - Northwell School of Medicine, Hempstead, NY, USA
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19
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Noetel M, Dawson L, Hay P, Touyz S. The assessment and treatment of unhealthy exercise in adolescents with anorexia nervosa: A Delphi study to synthesize clinical knowledge. Int J Eat Disord 2017; 50:378-388. [PMID: 28093835 DOI: 10.1002/eat.22657] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 11/14/2016] [Accepted: 11/21/2016] [Indexed: 12/30/2022]
Abstract
This study aimed to explore and synthesize expert clinical knowledge on defining and managing unhealthy exercise in adolescents with AN. The Delphi methodology was used. Clinicians (n = 25) considered experts in the treatment of AN in adolescents were recruited internationally to form the panel. The first round of the questionnaires was comprised of five open-ended questions regarding defining, assessing, and treating unhealthy exercise in adolescents with AN. Statements were derived from this data using content analysis, and included as Likert-based items in two subsequent rounds, in which panellists were required to rate their level of agreement for each item. All 25 respondents completed the three rounds of questionnaires. Consensus was achieved for 59.0% of the items included in the second and third round of questionnaires. Although consensus was not achieved, compulsive exercise was the preferred term for the panel when referring to unhealthy exercise in adolescents with AN. The panel clearly delineated features of unhealthy and healthy exercise, and endorsed a number of items considered important to assess for when evaluating exercise in this clinical population. A variety of treatment approaches and strategies reached consensus. Notably, for those who are medically stable and progressing toward recovery, the panel recommended initial exercise restriction practices and reintroducing healthy exercise behaviors, rather than exercise cessation practices. The current findings can serve as preliminary treatment guidelines. A unified approach to labeling and defining unhealthy exercise in the eating disorder literature and clinical settings is required to achieve further progress.
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Affiliation(s)
- Melissa Noetel
- School of Psychology, The University of Sydney, Australia
| | - Lisa Dawson
- Eating Disorder Service at The Sydney Children's Hospitals Network, Westmead, Australia.,Westmead Clinical School, The University of Sydney, Australia
| | - Phillipa Hay
- Centre for Health Research, School of Medicine, Western Sydney University, Australia
| | - Stephen Touyz
- School of Psychology, The University of Sydney, Australia
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Developmental Trajectories of Boys' Driven Exercise and Fasting During the Middle School Years. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2017; 44:1309-19. [PMID: 26707543 DOI: 10.1007/s10802-015-0119-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Boys appear to engage in eating disorder behavior, particularly nonpurging compensatory behaviors such as driven exercise and fasting, at higher rates than previously thought. Little is known about the development of these behaviors in adolescent boys. In a sample of 631 non-binge eating and non-purging boys studied once in 5th grade and 6 times over the 3 years of middle school (grades 6 through 8), we found that (a) for some youth, driven exercise and fasting were present from grade 6; (b) different boys progressed along different trajectories of engagement in driven exercise and fasting, with some boys engaging in no driven exercise or fasting (65.8 % and 83.5 %, respectively), some boys engaging in driven exercise and fasting throughout middle school (25.2 % and 16.5 %, respectively), and other boys discontinuing engagement in driven exercise (9 %); (c) 5th grade depression, eating expectancies, and thinness expectancies predicted subsequent trajectory group membership; and (d) boys engaging in driven exercise and fasting in 8th grade remained distressed. Boys' engagement in driven exercise and fasting behavior merits the attention of researchers and clinicians.
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21
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Davis HA, Guller L, Smith GT. Developmental trajectories of compensatory exercise and fasting behavior across the middle school years. Appetite 2016; 107:330-338. [PMID: 27544806 DOI: 10.1016/j.appet.2016.08.098] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 08/07/2016] [Accepted: 08/15/2016] [Indexed: 02/06/2023]
Abstract
Compensatory exercise and fasting behavior, in the absence of binge eating and purging, appear to be important eating disorder behaviors that are associated with dysfunction, but little is known about these behaviors in youth. We studied the trajectories of their development in non-binge eating and non-purging girls during early adolescence. Using a longitudinal design, we assessed 564 girls six times over the three years of middle school (grades 6 through 8) and developed trajectories specifying different developmental patterns in relation to the behaviors. Prior to this period, when the girls were in 5th grade (elementary school), we assessed risk factors to predict girls' subsequent trajectory group membership. Compensatory exercise trajectory groups included a non-engagement group, a group that increased in the behavior, and a group that decreased in the behavior. There were two fasting trajectory groups, one consistently engaging in the behavior and the other consistently not. Elementary school levels of depression, eating expectancies, and thinness expectancies predicted subsequent trajectory group membership. Risk for compensatory exercise and fasting should be evaluated as early as in 5th grade. Targeted interventions should focus on girls in late elementary school or middle school, as this appears to be a critical developmental and maintenance period for compensatory exercise and fasting behavior.
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22
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Swenne I. Evaluation of the Compulsive Exercise Test (CET) in Adolescents with Eating Disorders: Factor Structure and Relation to Eating Disordered Psychopathology. EUROPEAN EATING DISORDERS REVIEW 2016; 24:334-40. [PMID: 26892035 DOI: 10.1002/erv.2439] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 01/08/2016] [Accepted: 01/14/2016] [Indexed: 01/23/2023]
Abstract
OBJECTIVE The aims of this study were to explore the factor structure of the Compulsive Exercise Test (CET) in a clinical sample of Swedish adolescents with eating disorders (ED) and to study the relationship of CET with ED cognitions, body weight and exercise frequency. METHODS The compulsive Exercise Test, the Eating Disorders Examination-Questionnaire, body mass index (BMI) and exercise frequency were available at assessment of 210 adolescents (age 14.4 ± 1.6 years) with ED. RESULTS Factor analysis generated four factors with close similarity to factors previously obtained in a community sample of adolescents samples and supported the use of the original version of CET. Exercise for weight control was strongly related to ED cognitions but less to exercise frequency and BMI. Exercise for regulation of mood was related to ED cognitions and exercise frequency but not to BMI. DISCUSSION In adolescents with ED, different aspects of exercise are related to ED cognitions. This needs addressing in the treatment of adolescents with ED. Copyright © 2016 John Wiley & Sons, Ltd and Eating Disorders Association.
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Affiliation(s)
- Ingemar Swenne
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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23
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Noetel M, Miskovic-Wheatley J, Crosby RD, Hay P, Madden S, Touyz S. A clinical profile of compulsive exercise in adolescent inpatients with anorexia nervosa. J Eat Disord 2016; 4:1. [PMID: 26855778 PMCID: PMC4744387 DOI: 10.1186/s40337-016-0090-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 01/14/2016] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND The aim of the current study was to contribute to the development of a clinical profile of compulsive exercise in adolescents with Anorexia Nervosa (AN), by examining associations between compulsive exercise and eating and general psychopathology. METHOD A sample of 60 female adolescent inpatients with AN completed a self-report measure of compulsive exercise and a series of standardized self-report questionnaires assessing eating and general psychopathology. RESULTS Higher levels of compulsive exercise were associated with increased levels of eating disorder psychopathology and anxiety. Specifically, the avoidance aspect (negatively reinforced) of compulsive exercise was associated with elevated scores on measures of eating disorder, anxiety, depression, and obsessive compulsiveness psychopathology, as well as lower self-esteem scores. The mood improvement value (positively reinforced) of compulsive exercise, however, did not reflect such trends. CONCLUSIONS Compulsive exercise driven by avoidance of negative affect is associated with more severe psychological features in adolescent inpatients with AN. The current findings emphasize the need for research and clinical efforts in the development of treatments addressing avoidance of negative affect and compulsive exercise in adolescents with AN.
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Affiliation(s)
- Melissa Noetel
- />School of Psychology, The University of Sydney, Sydney, Australia
| | - Jane Miskovic-Wheatley
- />Eating Disorder Service at The Sydney Children’s Hospitals Network, Westmead, Australia
- />Westmead Clinical School, The University of Sydney, Sydney, Australia
| | - Ross D. Crosby
- />Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, USA
- />Neuropsychiatric Research Institute, Fargo, USA
| | - Phillipa Hay
- />Centre for Health Research, School of Medicine, Western Sydney University, Penrith, Australia
| | - Sloane Madden
- />Eating Disorder Service at The Sydney Children’s Hospitals Network, Westmead, Australia
- />Discipline of Pediatrics, Faculty of Medicine, The University of Sydney, Sydney, Australia
| | - Stephen Touyz
- />School of Psychology, The University of Sydney, Sydney, Australia
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Problematic Exercise in Anorexia Nervosa: Testing Potential Risk Factors against Different Definitions. PLoS One 2015; 10:e0143352. [PMID: 26618359 PMCID: PMC4664470 DOI: 10.1371/journal.pone.0143352] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 11/03/2015] [Indexed: 01/15/2023] Open
Abstract
“Hyperactivity” has a wide prevalence range of 31% to 80% in the anorexia nervosa literature that could be partly due to the plethora of definitions provided by researchers in this field. The purpose of this study was two-fold: 1) To assess the variance across prevalence rates of problematic exercise encountered in patients with anorexia nervosa, in relation to seven different definitions found in the literature. 2) To examine how core eating disorder symptoms and the dimensions of emotional profile are associated with these different definitions and the impact of these definitions on the assessment of patients’ quality of life. Exercise was evaluated in terms of duration, intensity, type and compulsion using a semi-structured questionnaire administered to 180 women suffering from severe anorexia nervosa. Seven different definitions of problematic exercise were identified in the literature: three entailing a single dimension of problematic exercise (duration, compulsion or intensity) and four combining these different dimensions. Emotional profile scores, obsessive-compulsive symptoms, eating disorder symptomatology, worries and concerns about body shape, self-esteem and quality of life were assessed using several established questionnaires. The prevalence of problematic exercise varied considerably from, 5% to 54%, depending on the number of criteria used for its definition. The type and level of eating disorder symptomatology was found to be associated with several definitions of problematic exercise. Surprisingly, a better self-reported quality of life was found among problematic exercisers compared to non-problematic exercisers in three of the definitions. The different definitions of problematic exercise explain the broad prevalence ranges and the conflicting associations generally reported in the literature between problematic exercise and eating disorder-related psychological parameters. There is an urgent need for a valid consensus on the definition of problematic exercise in anorexia nervosa. This will support the development of further research on the etiology and treatment of problematic exercise.
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Wade TD, O'Shea A. DSM-5 unspecified feeding and eating disorders in adolescents: what do they look like and are they clinically significant? Int J Eat Disord 2015; 48:367-74. [PMID: 24854848 DOI: 10.1002/eat.22303] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Revised: 05/04/2014] [Accepted: 05/11/2014] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The recent DSM-5 categorization of eating disorders introduces a new category of eating disorders, Unspecified Feeding and Eating Disorders (UFED), where symptoms do not meet criteria for any other diagnostic category, but cause clinically significant distress or impairment. The aim of the current study was to explore what disorders in UFED might look like in an adolescent population. METHOD We examined a large cohort of adolescent female twins (N = 699) who were assessed on three occasions and who did not meet a DSM-5 eating disorder diagnosis but who reported threshold levels of either fasting and/or driven exercise (N = 33; 4.7%). This group of girls was compared to girls who reported no eating disorder over the three waves, and girls who met a diagnosis of either anorexia nervosa (AN) or atypical AN. RESULTS The UFED group was characterized as being in the overweight range while striving to lose weight, and placing a high degree of importance on weight and shape in their self-evaluation. This group was indistinguishable from the two eating disorder groups on measures of global eating disorder severity, and demonstrated significantly elevated impairment and distress compared to the no eating disorder group commensurate with the eating disorder groups. DISCUSSION Further research of this group is necessary to ensure that these individuals are not overlooked, and that treatment options are appropriate and available.
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Affiliation(s)
- Tracey D Wade
- School of Psychology, Flinders University, Adelaide, South Australia, Australia
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Stiles-Shields C, DclinPsy BB, Lock J, Le Grange D. The effect of driven exercise on treatment outcomes for adolescents with anorexia and bulimia nervosa. Int J Eat Disord 2015; 48:392-6. [PMID: 24729068 DOI: 10.1002/eat.22281] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Revised: 02/27/2014] [Accepted: 03/24/2014] [Indexed: 12/31/2022]
Abstract
OBJECTIVE This study investigated the prevalence of driven exercise (DE) and its role in treatment outcome for adolescents with bulimia nervosa (BN) and anorexia nervosa (AN). METHOD Participants were 201 adolescents with an eating disorder (ED) (80 with BN and 121 with AN) presenting for outpatient treatment at two specialist clinics. All adolescents participated in one of two randomized controlled trials. Descriptive statistics were conducted to evaluate the presence and frequency of baseline DE. Exploratory hierarchical regressions were used to evaluate the effect of baseline DE on treatment outcomes. RESULTS About 66.3% of adolescents with BN and 23.1% of adolescents with AN presented with baseline DE. The presence of baseline DE predicted significantly worse outcomes for adolescents with AN in terms of ED symptom severity (ps < .004); however, baseline DE did not significantly predict any of the evaluated outcomes for adolescents with BN (ps < .05). DISCUSSION The results of this secondary exploratory data suggest that DE is prevalent for adolescents with BN and AN. However, DE may be related to different constructs for adolescents with AN than those with BN, suggesting differences in treatment needs.
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Affiliation(s)
- Colleen Stiles-Shields
- Center for Behavioral Intervention Technologies and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, Illinois
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Cook B, Engel S, Crosby R, Hausenblas H, Wonderlich S, Mitchell J. Pathological motivations for exercise and eating disorder specific health-related quality of life. Int J Eat Disord 2014; 47:268-72. [PMID: 24136170 PMCID: PMC4844088 DOI: 10.1002/eat.22198] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/06/2013] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To examine associations among pathological motivations for exercise with eating disorder (ED) specific health-related quality of life (HRQOL). METHOD Survey data assessing ED severity (i.e., Eating Disorder Diagnostic Survey), ED specific HRQOL (i.e., Eating Disorders Quality of Life Instrument), and pathological motivations for exercise (i.e., Exercise Dependence Scale) were collected from female students (N = 387) at seven universities throughout the United States. Regression analyses were conducted to examine the associations among exercise dependence, ED-specific HRQOL and ED severity, and the interaction of exercise dependence and ED severity on HRQOL scores. RESULTS The overall model examining the impact of ED severity and exercise dependence (independent variables) on HRQOL (dependent variable) was significant and explained 16.1% of the variance in HRQOL scores. Additionally, the main effects for ED severity and exercise dependence and the interaction among ED severity and exercise dependence were significant, suggesting that the combined effects of ED severity and exercise dependence significantly impacts HRQOL. DISCUSSION Our results suggest that pathological motivations for exercise may exacerbate ED's detrimental impact on HRQOL. Our results offer one possible insight into why exercise may be associated with deleterious effects on ED HRQOL. Future research is needed to elucidate the relationship among psychological aspects of exercise, ED, and HRQOL.
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Affiliation(s)
- Brian Cook
- Neuropsychiatric Research Institute, Fargo, ND,University of North Dakota School of Medicine and Health Sciences, Fargo, ND,Correspondence to: Dr. Brian Cook, Neuropsychiatric Research Institute, Clinical Research, 120 8th St South, Fargo, North Dakota, United States, 58103.
| | - Scott Engel
- Neuropsychiatric Research Institute, Fargo, ND,University of North Dakota School of Medicine and Health Sciences, Fargo, ND
| | - Ross Crosby
- Neuropsychiatric Research Institute, Fargo, ND,University of North Dakota School of Medicine and Health Sciences, Fargo, ND
| | | | - Stephen Wonderlich
- Neuropsychiatric Research Institute, Fargo, ND,University of North Dakota School of Medicine and Health Sciences, Fargo, ND
| | - James Mitchell
- Neuropsychiatric Research Institute, Fargo, ND,University of North Dakota School of Medicine and Health Sciences, Fargo, ND
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Edman JL, Lynch WC, Yates A. The impact of exercise performance dissatisfaction and physical exercise on symptoms of depression among college students: a gender comparison. THE JOURNAL OF PSYCHOLOGY 2014; 148:23-35. [PMID: 24617269 DOI: 10.1080/00223980.2012.737871] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Depression is a common psychological problem and females have been found to be at greater risk for this disorder than males. Although numerous studies have found that physical exercise is negatively associated with risk of depression, some studies suggest that negative exercise attitudes may increase the risk of depression. The present study used the survey method to examine the relationship between depressive symptoms, exercise performance dissatisfaction, body dissatisfaction, and physical exercise among a sample of 895 undergraduate university students. Females reported higher depression and exercise performance dissatisfaction scores than males; however, there were no gender differences in body dissatisfaction. Exercise performance dissatisfaction was positively associated with depression among both males and females. Physical exercise was negatively associated with depression among males, but not among females. The possibility of screening participants enrolled in exercise programs for performance dissatisfaction is discussed as negative exercise attitudes may diminish the positive impact of exercise on depressed mood.
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Fietz M, Touyz S, Hay P. A risk profile of compulsive exercise in adolescents with an eating disorder: a systematic review. ACTA ACUST UNITED AC 2014. [DOI: 10.1080/21662630.2014.894470] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Mangerud WL, Bjerkeset O, Lydersen S, Indredavik MS. Physical activity in adolescents with psychiatric disorders and in the general population. Child Adolesc Psychiatry Ment Health 2014; 8:2. [PMID: 24450542 PMCID: PMC3914726 DOI: 10.1186/1753-2000-8-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Accepted: 01/21/2014] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Adults who suffer from psychiatric disorders report low levels of physical activity and the activity levels differ between disorders. Less is known regarding physical activity across psychiatric disorders in adolescence. We investigate the frequency and type of physical activity in adolescent psychiatric patients, compared with adolescents in the general population. METHODS A total of 566 adolescent psychiatric patients aged 13-18 years who participated in the CAP survey, Norway, were compared to 8173 adolescents aged 13-19 years who participated in the Nord-Trøndelag Health Study, Young-HUNT 3, Norway. All adolescents completed a questionnaire, including questions about physical activity and participation in team and individual sports. RESULTS Approximately 50% of adolescents with psychiatric disorders and 25% of the population sample reported low levels of physical activity. Within the clinical sample, those with mood disorders (62%) and autism spectrum disorders (56%) were the most inactive and those with eating disorders (36%) the most active. This pattern was the same in individual and team sports. After multivariable adjustment, adolescents with a psychiatric disorder had a three-fold increased risk of lower levels of physical activity, and a corresponding risk of not participating in team and individual sports compared with adolescents in the general population. CONCLUSIONS Levels of physical activity were low in adolescent psychiatric patients compared with the general population, yet activity levels differed considerably between various disorders. The findings underscore the importance of assessing physical activity in adolescents with psychiatric disorders and providing early intervention to promote mental as well as physical health in this early stage of life.
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Affiliation(s)
- Wenche Langfjord Mangerud
- Regional Centre for Child and Youth Mental Health and Child Welfare, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
| | - Ottar Bjerkeset
- Faculty of Health Sciences, Nord-Trøndelag University College (HiNT), Levanger, Norway,Department of Neuroscience, Faculty of Medicine, NTNU, Trondheim, Norway
| | - Stian Lydersen
- Regional Centre for Child and Youth Mental Health and Child Welfare, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Marit Sæbø Indredavik
- Regional Centre for Child and Youth Mental Health and Child Welfare, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway,Department of Child and Adolescent Psychiatry, St. Olav’s University Hospital, Trondheim, Norway
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Mood disorders in youth: exercise, light therapy, and pharmacologic complementary and integrative approaches. Child Adolesc Psychiatr Clin N Am 2013; 22:403-41, v. [PMID: 23806312 DOI: 10.1016/j.chc.2013.05.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The therapeutic value of physical exercise, bright light therapy and dawn simulation, and several pharmacologic treatments, including hypericum (St. John's wort), S-adenosylmethionine, and 5-hydroxytryptophan, are reviewed, with a focus on their use for treating major depressive disorder in children and adolescents and also for alleviating depressed mood in the general (nonclinical) population of youth. For each treatment discussed, all published randomized, double-blind, placebo-controlled trials are summarized, along with some additional selected studies. Nutritional psychopharmacology and several other approaches to treating depression will be presented in an upcoming volume in the Child and Adolescent Psychiatric Clinics of North America.
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Hughes EK, Goldschmidt AB, Labuschagne Z, Loeb KL, Sawyer SM, Grange DL. Eating Disorders with and without Comorbid Depression and Anxiety: Similarities and Differences in a Clinical Sample of Children and Adolescents. EUROPEAN EATING DISORDERS REVIEW 2013; 21:386-94. [DOI: 10.1002/erv.2234] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Revised: 04/10/2013] [Accepted: 04/12/2013] [Indexed: 01/13/2023]
Affiliation(s)
| | - Andrea B. Goldschmidt
- Department of Psychiatry and Behavioral Neuroscience; The University of Chicago; IL; USA
| | | | | | | | - Daniel Le Grange
- Department of Psychiatry and Behavioral Neuroscience; The University of Chicago; IL; USA
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Stiles-Shields EC, Labuschagne Z, Goldschmidt AB, Doyle AC, Le Grange D. The use of multiple methods of compensatory behaviors as an indicator of eating disorder severity in treatment-seeking youth. Int J Eat Disord 2012; 45:704-10. [PMID: 22331840 PMCID: PMC3355214 DOI: 10.1002/eat.22004] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/30/2011] [Indexed: 12/18/2022]
Abstract
OBJECTIVE This study investigated the use and frequency of multiple methods of compensatory behaviors and how they relate to eating-related and general psychopathology for youth with eating disorders (ED). METHOD Participants were 398 referrals to a pediatric ED treatment program (91.2% female; M age = 14.9 ± 2.2). ANOVA and chi-square tests compared participants reporting multiple methods of compensatory behaviors, single method of compensatory behaviors, and no compensatory behaviors on measures of ED and general psychopathology. Partial correlations examined associations between compensatory behavior, frequency and severity of ED and general psychopathology. RESULTS Participants reporting multiple methods of compensatory behaviors had significantly greater ED and general psychopathology than the other groups (ps < .001). Frequency of compensatory behaviors was associated with ED psychopathology (partial r = .14; p = .007) but not with general psychopathology. DISCUSSION Engaging in multiple methods of compensatory behaviors is related to greater ED and general psychopathology, whereas frequency is only related to greater ED symptom severity.
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Affiliation(s)
| | - Zandrè Labuschagne
- The University of Chicago, Department of Psychiatry and Behavioral Neuroscience, Chicago, IL, 60637
| | - Andrea B. Goldschmidt
- The University of Chicago, Department of Psychiatry and Behavioral Neuroscience, Chicago, IL, 60637
| | | | - Daniel Le Grange
- The University of Chicago, Department of Psychiatry and Behavioral Neuroscience, Chicago, IL, 60637
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