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Schaumberg K, Pictor L, Frank M. Adaptive and Maladaptive Exercise in Eating Disorders. Curr Top Behav Neurosci 2024. [PMID: 39042250 DOI: 10.1007/7854_2024_499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/24/2024]
Abstract
While exercise is generally associated with positive health outcomes, in the context of eating disorders, exercise has high potential to become maladaptive. Maladaptive exercise is compelled or compulsive in nature for the purposes of weight and shape control or to obtain/avoid other eating disorder-relevant consequences. A transdiagnostic eating disorder feature with moderate-to-high prevalence across restrictive- and bulimic-spectrum eating disorders, maladaptive exercise is often associated with negative mental and physical health sequalae. Several proposed threat- and reward-related biobehavioral mechanisms may initiate or perpetuate maladaptive exercise. While exercise is generally contraindicated during periods of acute medical concern, adaptive forms of exercise are also present among those with eating disorders, and facilitation of adaptive exercise has potential to promote physical and mental health benefits during eating disorder recovery. Detailed assessment and targeted interventions are needed to address the clinical conundrum of how and when to integrate exercise into eating disorder treatment.
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Affiliation(s)
| | - Lauren Pictor
- Department of Psychiatry, University of Wisconsin, Madison, WI, USA
| | - Max Frank
- Department of Psychiatry, University of Wisconsin, Madison, WI, USA
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Alghamdi NA, Aldhwayan MM, Albassam RS, Asseri RF, Alyousef AF, Naaman RK, Alzuman MA, Almukhlifi AJ, Alquraishi MI. The Arabic Version of Compulsive Exercise Test among Saudi Population; Translation and Validation. Sports (Basel) 2024; 12:176. [PMID: 39058067 PMCID: PMC11280584 DOI: 10.3390/sports12070176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Revised: 05/27/2024] [Accepted: 05/29/2024] [Indexed: 07/28/2024] Open
Abstract
Compulsive exercise is a condition characterized by uncontrollable exercise behaviour that may lead to severe and harmful physical and psychological consequences. Indeed, compulsive exercise is among the early symptoms of eating disorders that may affect different age groups. Globally and among Arab countries, compulsive exercise is common, while the screening methods used to assess compulsive exercise are limited. Thus, the Compulsive Exercise Test (CET) has emerged as a tool to assess cognitive, behavioural, and emotional factors related to compulsive exercise. The CET is a self-report, Likert-type scale comprising five distinct subscales. The increase in the CET scores is more likely associated with worsened pathology. Since the Arab countries lack such an assessment tool, we aimed to translate the CET into Arabic, validate the translated version, confirm the factor structures, and assess the internal consistency of the different subscales. Herein, we used the forward-backward translation method as recommended by the World Health Organization (WHO). The overall validity index of the translated version showed a score higher than 0.78, while the scale-level content validity index based on the average calculating method (S-CVI/Ave) and the agreement method (S-CVI/UA) were 0.91 and 0.58, respectively. Moreover, we recruited 399 Arabs living in Saudi to measure the internal consistency, and the value of the substantive internal consistency with Cronbach's α was 0.81. Subsequently, four of the Arabic-CET subscales had substantive internal consistency with Cronbach's α values higher than or equal to 0.70. Furthermore, the exploratory factor analysis results supported the substantial use of the five-subscale model. Taken together, our study supports using the Arabic-CET version to measure exercise compulsiveness among Arabs.
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Affiliation(s)
- Nouf A. Alghamdi
- Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11433, Saudi Arabia
| | - Madhawi M. Aldhwayan
- Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11433, Saudi Arabia
| | - Reem S. Albassam
- Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11433, Saudi Arabia
| | - Rana F. Asseri
- Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11433, Saudi Arabia
| | - Aljouhara F. Alyousef
- Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11433, Saudi Arabia
| | - Reem K. Naaman
- Department of Preventive Dental Sciences, College of Dentistry, Taibah University, Madinah 42353, Saudi Arabia
| | - Manar A. Alzuman
- Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11433, Saudi Arabia
| | - Aseel J. Almukhlifi
- Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11433, Saudi Arabia
| | - Mohammed I. Alquraishi
- Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11433, Saudi Arabia
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Liao Z, Birgegård A, Monell E, Borg S, Bulik CM, Mantilla EF. Maladaptive exercise in eating disorders: lifetime and current impact on mental health and treatment seeking. J Eat Disord 2024; 12:86. [PMID: 38915052 PMCID: PMC11194861 DOI: 10.1186/s40337-024-01048-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 06/18/2024] [Indexed: 06/26/2024] Open
Abstract
BACKGROUND Many patients with eating disorders report exercise as a central symptom of their illness-as a way to compensate for food intake, prevent weight-gain, and/or reduce negative affect. Previous findings show associations between maladaptive exercise and more severe eating disorder pathology, higher risk for relapse, other co-morbid symptoms, and worse treatment outcome. METHODS In this study, we included 8252 participants with eating disorders and investigated associations between maladaptive exercise (both lifetime and current) and ED pathology, illness duration, depression, anxiety, self-harm and suicidal ideation, and treatment seeking patterns in individuals with lifetime maladaptive exercise. Participants were included via the Swedish site of the large global study The Eating Disorders Genetics Initiative (EDGI) and completed measures of both lifetime and current symptomatology. RESULTS Results indicate that lifetime maladaptive exercise is associated with higher prevalence of lifetime depression and anxiety and with patients more often receiving treatment, although these results need to be investigated in future studies. Current maladaptive exercise was associated with more severe ED symptoms, and higher levels of depression, anxiety, obsessive-compulsive traits, and suicidal ideation. CONCLUSIONS Our findings point to the complexities of exercise as an eating disorder symptom and the need for clearly assessing and acknowledging this, as well as tailoring interventions to treat this symptom to achieve sustainable recovery.
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Affiliation(s)
- Zhenxin Liao
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Nobels väg 12a, Stockholm, 171 77, Sweden.
| | - Andreas Birgegård
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Nobels väg 12a, Stockholm, 171 77, Sweden
| | - Elin Monell
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Nobels väg 12a, Stockholm, 171 77, Sweden
- Stockholm County Council, Stockholms Centrum för ätstörningar, Wollmar Yxkullsgatan 27, Stockholm, 118 50, Sweden
| | - Stina Borg
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Nobels väg 12a, Stockholm, 171 77, Sweden
| | - Cynthia M Bulik
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Nobels väg 12a, Stockholm, 171 77, Sweden
- Department of Psychiatry, University of North Carolina at Chapel Hill, CB #7160, 101 Manning Drive, Chapel Hill, NC, 27599-716, USA
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599-716, USA
| | - Emma Forsén Mantilla
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Nobels väg 12a, Stockholm, 171 77, Sweden
- The Swedish School of Sport and Health Sciences, GIH, Lidingövägen 1, Box 5626, Stockholm, 114 86, Sweden
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Lock JD, Le Grange D, Bohon C, Matheson B, Jo B. Who Responds to an Adaptive Intervention for Adolescents With Anorexia Nervosa Being Treated With Family-Based Treatment? Outcomes From a Randomized Clinical Trial. J Am Acad Child Adolesc Psychiatry 2024; 63:605-614. [PMID: 38142046 PMCID: PMC11144105 DOI: 10.1016/j.jaac.2023.10.012] [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: 06/27/2023] [Revised: 10/19/2023] [Accepted: 12/14/2023] [Indexed: 12/25/2023]
Abstract
OBJECTIVE Anorexia nervosa (AN) is a serious psychiatric disorder with high morbidity and mortality. The current evidence supports the use of family-based treatment (FBT), but recovery rates are only about 40%. Improving treatment outcomes among adolescents with AN will save lives, improve health, and prevent chronicity. This study examined the relative efficacy of adding intensive parental coaching (IPC) to standard FBT for patients who do not respond by weight gain of 2.4 kg by session 4, a clinical predictor of outcome at the end of treatment, to improve remission rates (>94% of expected mean body mass index). METHOD The study recruited 107 participants and their families from across the United States; 69 participants failed to respond early and were randomly assigned to continue with standard FBT or to receive 3 sessions of IPC. Participants were adolescents (ages 12-18) meeting DSM-5 criteria for AN; 6.5% were male, and 11% were Hispanic. RESULTS Main outcomes were mean body mass index >94% expected for age, height, and sex. Secondary outcomes included change in eating-related cognitions. Adding IPC to early nonresponders did not improve outcomes except for participants whose parents demonstrated low parental self-efficacy at baseline (moderator). Early weight gain of 2.4 kg by session 4 was replicated as a predictor of end of treatment remission. CONCLUSION Parental self-efficacy moderates IPC as an adaptive treatment for adolescents with AN. Baseline parental self-efficacy assessment can be used to identify families most likely to benefit from adding IPC to FBT. Future studies should consider earlier interventions to improve early response rates. PLAIN LANGUAGE SUMMARY Anorexia nervosa is a serious psychiatric disorder. While family-based treatment (FBT) has the largest evidence base for adolescents with anorexia, recovery rates are only about 40%. This study investigated the addition of 3 sessions of intensive parental coaching intervention (IPC) to FBT among youth with anorexia who did not gain adequate weight early in treatment, a predictor of recovery by the end of treatment. Youth with inadequate weight gain were randomized to either receive FBT with IPC or FBT as usual. Overall, adding IPC did not improve outcomes among youth with anorexia. However among those whose parents demonstrated low parental self-efficacy at baseline, youth who received FBT with IPC had higher remission rates than youth who received FBT alone. CLINICAL GUIDANCE Intensive parental coaching shows promise for improving outcomes among youth with anorexia whose parents report low parental self-efficacy. CLINICAL TRIAL REGISTRATION INFORMATION Adaptive Treatment for Adolescent Anorexia Nervosa; https://clinicaltrials.gov/; NCT03097874.
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Affiliation(s)
- James D Lock
- Stanford University School of Medicine, Stanford, California.
| | - Daniel Le Grange
- University of California San Francisco, San Francisco, California; University of Chicago (Emeritus), Chicago, Illinois
| | - Cara Bohon
- Stanford University School of Medicine, Stanford, California
| | | | - Booil Jo
- Stanford University School of Medicine, Stanford, California
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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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Vrabel KR, Bratland-Sanda S. Effects of inpatient treatment on compulsive exercise in adults with longstanding eating disorders: Secondary analysis from a randomized controlled trial with 12-month follow-up. Int J Eat Disord 2024; 57:437-449. [PMID: 38158782 DOI: 10.1002/eat.24108] [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: 06/27/2023] [Revised: 11/17/2023] [Accepted: 11/17/2023] [Indexed: 01/03/2024]
Abstract
PURPOSE This study aimed to examine changes in compulsive exercise among adults with eating disorders (ED) admitted for inpatient treatment in a randomized controlled trial comparing cognitive behavioral therapy (CBT) and compassion-focused therapy (CFT) and whether such changes were influenced by treatment condition, childhood trauma, or level of compulsive exercise. METHOD A total of 130 adults admitted to inpatient treatment for EDs mean (SD) age 30.9 (9.7) years, mean illness duration 14.2 (8.9) years, were randomized to receive CBT or CFT and analyzed using multilevel modeling. Assessments included Eating Disorders Examination - Interview, Compulsive Exercise Test and Childhood Trauma Questionnaire. RESULTS Mean total CET score at baseline was 14.7 (4.0) with no difference between the treatment groups. A total of 63 (48.5%) had CET score ≥ 15, indicating clinical levels. There was an overall time effect on reduction in CET total and all CET subscale scores except Lack of enjoyment, and CFT provided greater reduction compared to CBT on the CET subscale Mood improvements. Patients with clinical CET score levels showed greater reduction on CET total and the subscales Avoidance, Weight, and Rigidity across time compared to persons with non-clinical CET score. Childhood trauma did not predict changes in CET total or subscale scores. DISCUSSION Both CBT and CFT improve overall compulsive exercise. The greater effect of CFT than CBT on exercise as a maladaptive mood regulator calls for further research on how affective oriented psychotherapies can not only reduce compulsive exercise but also promote functional exercise among persons with EDs. PUBLIC SIGNIFICANCE STATEMENT Understanding and addressing compulsive exercise in adults with eating disorders is crucial. This study comparing cognitive-behavioral therapy and compassion-focused therapy shows both improve compulsive exercise. Importantly, compassion-focused therapy has a greater impact as an emotion-focused regulator. This emphasizes the need for further exploration into how emotion-focused therapies can reduce compulsive exercise and promote healthier, functional physical activity for individuals with eating disorders.
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Affiliation(s)
- KariAnne R Vrabel
- Research Institute of Modum Bad, Vikersund, Norway
- Institute of Psychology, University of Oslo, Norway
| | - Solfrid Bratland-Sanda
- Department of Sport, Physical Education and Outdoor Sciences, University of South-Eastern Norway, Bø in Telemark, Norway
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Kern L, Mattar L, Kotbagi G, Romo L, Morvan Y. Is Problematic Physical Activity (PPA) a Uni- or Multi-Dimensional Concept? A Bifactor Analysis of the Exercise Dependence Scale-Revised (EDS-R). Percept Mot Skills 2024; 131:106-134. [PMID: 38061396 DOI: 10.1177/00315125231218745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
The study of exercise dependence, or as we prefer, problematic physical activity (PPA), faces both theoretical and methodological challenges. Different factorial solutions were obtained for the widely used Exercise Dependence Scale-Revised (EDS-R), leading us to question both its latent underlying construct and the interpretation of its factor solutions. Through confirmatory factor analysis (CFA) and the use of a bifactor model (BCFA), we assessed the dimensionality of a French version of the EDS-R. We recruited 745 students from Paris Nanterre University, but we removed 88 responses (16.8%) to retain only those who (a) engaged in a moderate to high levels of physical activity, according to the Global Physical Activity Questionnaire (GPAQ; N = 494; 9.5%), and (b) completed the EDS-R. We used a final sample of 435 students (58.4% of the total population) for a factorial analysis of the EDS-R. We conducted a three-step CFA in Mplus, producing three models: (a) unidimensional, (b) second-order, and (c) bi-factor (BCFA). The results of the BCFA indicated that most EDS-R items were better indicators of a general factor than their respective group factors, except for the second factor measuring a withdrawal construct. These results add to an ongoing debate in the field of behavioral addiction as to how to better conceptualize and measure exercise dependence or PPA. Withdrawal appears to have a special position in this debate, since our BCFA suggested that it is the only specific sub-dimension of the EDS-R scale.
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Affiliation(s)
- Laurence Kern
- Laboratoire Interdisciplinaire en Neurosciences, Physiologie et Psychologie: Apprentissages, Activité Physique et Santé, Université Paris Nanterre, Nanterre, France
- Psychologie Clinique, Psychanalyse et Psychologie du Développement, Université Paris Nanterre, Nanterre, France
| | - Lama Mattar
- Nutrition Program, Department of Natural Sciences, School of Arts and Sciences, Lebanese American University, Beirut, Lebanon
| | | | - Lucia Romo
- Psychologie Clinique, Psychanalyse et Psychologie du Développement, Université Paris Nanterre, Nanterre, France
- Service de pathologie professionnelles et de l'environnement, Assistance Publiques des Hôpitaux de Paris, Hôpital Universitaire Raymond Poincaré, Garches, France
| | - Yannick Morvan
- Psychologie Clinique, Psychanalyse et Psychologie du Développement, Université Paris Nanterre, Nanterre, France
- CESP, Equipe Psychiatrie du développement et des trajectoires, INSERM, Paris, France
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Foyster M, Sultan N, Tonkovic M, Govus A, Burton-Murray H, Tuck CJ, Biesiekierski JR. Assessing the presence and motivations of orthorexia nervosa among athletes and adults with eating disorders: a cross-sectional study. Eat Weight Disord 2023; 28:101. [PMID: 38070009 PMCID: PMC10710386 DOI: 10.1007/s40519-023-01631-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 11/29/2023] [Indexed: 12/18/2023] Open
Abstract
PURPOSE Orthorexia nervosa involves restricting diet based on quality rather than quantity. Although orthorexia is well reported in many at-risk populations, limited data addresses its presence in individuals with eating disorder history (EDs) or athletes. We aimed to identify the presence and potential drivers of orthorexia in adults with EDs and endurance athletes, compared to control subjects. METHODS Participants ≥ 18y included: people with a diagnosed eating disorder (ED as per DSM-5); endurance athletes (training/competing ≥ 5 h/week); or control subjects. Participants (n = 197) completed an online survey assessing orthorexia (eating habits questionnaire, EHQ), eating motivations (TEMS-B) and compulsive exercise (CET). RESULTS ED had the highest orthorexia symptom severity (92.0 ± 3.02, n = 32), followed by athletes (76.2 ± 2.74, n = 54) and controls (71.0 ± 1.80, n = 111) (F (2) = 18.2, p < 0.001). A strong positive correlation existed between weight control motives and higher orthorexia symptom severity (r = 0.54, 95% CI [1.35, 2.36], p < 0.001), while a weak negative association existed between Hunger and Pleasure motives and higher orthorexia symptom severity (r = 0.23, 95% CI [- 2.24, - 0.34], p = 0.008; r = 0.26, 95% CI [- 2.11, - 0.47], p = 0.002, respectively). A moderate positive relationship was found between CET and orthorexia symptom severity (95% CI [1.52, 3.12], p < 0.001). CONCLUSION Adults with ED history and endurance athletes have greater orthorexia symptom severity compared to control. Clinicians working with at-risk populations should screen patients and be aware of red-flags of orthorexic traits, desire to control weight, and compulsive exercise behavior. LEVEL OF EVIDENCE III: Evidence obtained from cohort studies.
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Affiliation(s)
- Mandy Foyster
- Department of Dietetics, Nutrition and Sport, La Trobe University, Bundoora, VIC, Australia
| | - Nessmah Sultan
- Department of Dietetics, Nutrition and Sport, La Trobe University, Bundoora, VIC, Australia
- Department of Nutrition, Dietetics and Food, Monash University, Notting Hill, VIC, Australia
| | - Matilda Tonkovic
- Department of Dietetics, Nutrition and Sport, La Trobe University, Bundoora, VIC, Australia
| | - Andrew Govus
- Department of Dietetics, Nutrition and Sport, La Trobe University, Bundoora, VIC, Australia
| | - Helen Burton-Murray
- Division of Gastroenterology, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Caroline J Tuck
- Department of Dietetics, Nutrition and Sport, La Trobe University, Bundoora, VIC, Australia
- Department of Nursing and Allied Health, Swinburne University, Hawthorn, VIC, Australia
| | - Jessica R Biesiekierski
- Department of Dietetics, Nutrition and Sport, La Trobe University, Bundoora, VIC, Australia.
- Department of Nutrition, Dietetics and Food, Monash University, Notting Hill, VIC, Australia.
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Martenstyn JA, Maguire S, Griffiths S. A descriptive analysis of scoring patterns on clinically relevant questionnaires in 26 adults with diagnosed muscle dysmorphia. EUROPEAN EATING DISORDERS REVIEW 2023; 31:737-751. [PMID: 37337333 PMCID: PMC10947593 DOI: 10.1002/erv.3001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 05/17/2023] [Accepted: 06/04/2023] [Indexed: 06/21/2023]
Abstract
OBJECTIVE Few studies have recruited adults with a formal diagnosis of muscle dysmorphia (MD), a psychological illness defined by preoccupation that one lacks muscularity and/or leanness, combined with significant functional impairment. This study presented descriptive statistics for a range of clinically relevant questionnaires in one of the largest samples of adults with confirmed diagnoses of MD. METHOD We recruited 29 adults who met diagnostic criteria for MD as determined by semi-structured diagnostic interviews and administered a battery of questionnaires assessing MD symptomology, compulsive exercise, and disordered eating. Descriptive statistics were calculated for both total and subscale scores for each questionnaire. Raincloud plots are included to show the distribution of total scores. RESULTS Of the 29 participants, 26 completed all questionnaires. Mean scores were high across all questionnaires and broadly consistent with results in past studies that also recruited a clinical MD sample. Most participants scored above proposed clinical cut-off scores for questionnaires assessing compulsive exercise and disordered eating. CONCLUSIONS This study adds to the small body of published questionnaire data in clinical MD samples. We stress that questionnaire scores should not be used alone to infer the presence of MD, but could be considered as a useful adjunct to a comprehensive clinical interview.
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Affiliation(s)
- Jordan A. Martenstyn
- Clinical Psychology UnitSchool of PsychologyThe University of SydneyCamperdownNSWAustralia
- InsideOut Institute for Eating DisordersCharles Perkins CentreThe University of SydneyCamperdownNSWAustralia
| | - Sarah Maguire
- InsideOut Institute for Eating DisordersCharles Perkins CentreThe University of SydneyCamperdownNSWAustralia
- Sydney Local Health DistrictNSW HealthSydneyNSWAustralia
| | - Scott Griffiths
- Melbourne School of Psychological SciencesFaculty of MedicineDentistry and Health SciencesThe University of MelbourneParkvilleAustralia
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Cosh SM, Eshkevari E, McNeil DG, Tully PJ. Classifying excessive exercise: Examining the relationship between compulsive exercise with obsessive-compulsive disorder symptoms and disordered eating symptoms. EUROPEAN EATING DISORDERS REVIEW 2023; 31:769-780. [PMID: 37353901 DOI: 10.1002/erv.3002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 05/11/2023] [Accepted: 06/10/2023] [Indexed: 06/25/2023]
Abstract
OBJECTIVE There remains a lack of consensus around nosology for compulsive exercise (CE). Although widely observed in eating disorders (ED), CE shares theoretical overlap with obsessive-compulsive disorder (OCD), where exercise compulsions occur in response to obsessions. Yet, there is limited and mixed evidence of a relationship between CE with OCD. This study aims to explore the appropriate diagnostic classification of CE through examination of CE in relation to OCD, obsessional thinking, and ED symptoms. METHOD Two hundred and eighty one adults with mental health symptoms, dieting, and exercise behaviour completed measures of OCD, CE, and disordered eating symptoms. Regression and Receiver Operating Characteristic analyses examined relationships between dimensions of CE with OCD and ED symptoms, and the predictive ability of CE assessment for detecting threshold OCD and ED symptoms. RESULTS CE assessment was poor at predicting threshold OCD symptoms, probable Anorexia Nervosa, and Binge Eating Disorder and moderate at detecting probable disordered eating and Bulimia Nervosa. Associations between CE and OCD symptoms were not significant after adjustment for ED symptoms. Obsessional thinking was associated only with lack of exercise enjoyment. CONCLUSIONS Results indicate that excessive exercise might represent a distinct disorder, with some shared traits across CE, OCD and ED symptoms. Findings question the utility of adaptation of OCD diagnostic criteria for CE. Assessment and treatment implications are considered.
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Affiliation(s)
- Suzanne M Cosh
- School of Psychology, University of New England, Armidale, New South Wales, Australia
| | - Ertimiss Eshkevari
- Statewide Eating Disorder Service, South Australian Department of Health and Wellbeing, Government of South Australia, Adelaide, South Australia, Australia
| | - Dominic G McNeil
- Institute for Health and Wellbeing, Federation University, Ballarat, Victoria, Australia
| | - Phillip J Tully
- School of Psychology, University of New England, Armidale, New South Wales, Australia
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Cosh SM, McNeil DG, Tully PJ. Compulsive exercise and its relationship with mental health and psychosocial wellbeing in recreational exercisers and athletes. J Sci Med Sport 2023:S1440-2440(23)00086-5. [PMID: 37296060 DOI: 10.1016/j.jsams.2023.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 04/25/2023] [Accepted: 05/16/2023] [Indexed: 06/12/2023]
Abstract
OBJECTIVES Better understanding of compulsive exercise is needed in sports medicine. Whilst compulsive exercise may impact mental health, the limited research exploring the relationship between compulsive exercise and psychosocial outcomes is equivocal. The majority of studies have examined eating disorder populations where the eating disorder pathology might account for distress. This study explores relationships between compulsive exercise and mental health. DESIGN Cross-sectional observational study. METHODS Australian recreational exercisers and athletes (N = 1157; Mage 36.4, standard deviation = 12.9, 77 % female) recruited through sporting organisations, clubs, and gyms, completed measures of compulsive exercise, depression, anxiety, stress, life satisfaction, social physique anxiety, and self-esteem. Regression analyses examined relationships between dimensions of compulsive exercise and wellbeing. RESULTS After adjustment for eating disorder symptoms and sporting level, compulsive exercise was associated with increased risk of clinically-significant anxiety, depression, and stress symptoms. Compulsive exercise was also associated with lower life satisfaction and self-esteem, and higher social physique anxiety. Notably, different dimensions of compulsive exercise had varying relationships with outcomes, and avoidance and rule-driven behaviour and lack of exercise enjoyment were associated with poorer mental health and wellbeing. CONCLUSIONS Results suggest that compulsive exercise is uniquely associated with a range of psychosocial and mental health outcomes. Results support the need to improve identification and treatment of compulsive exercise in sport and exercise settings. Results highlight that mental health intervention is an important component of treatment, and treatments targeting symptoms related to avoidance and rule-driven behaviour, and anhedonia may be valuable treatment components for those with compulsive exercise.
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Affiliation(s)
- S M Cosh
- School of Psychology, University of New England, Australia.
| | - D G McNeil
- Institute of Health and Wellbeing, Federation University, Australia
| | - P J Tully
- School of Psychology, University of New England, Australia
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12
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White C, Bicaker E, Racine SE. Gender differences in compulsive exercise facets and their associations with eating disorder symptoms. Eat Behav 2023; 49:101737. [PMID: 37150095 DOI: 10.1016/j.eatbeh.2023.101737] [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: 02/23/2023] [Revised: 04/25/2023] [Accepted: 04/28/2023] [Indexed: 05/09/2023]
Abstract
Compulsive exercise (CE) is a core symptom of eating disorders (EDs) that is common in undergraduate men and women. Importantly, CE is a multidimensional construct, and certain facets of CE (i.e., exercise to control weight or to avoid negative affect associated with missed exercise) are more strongly associated with ED symptoms in undergraduate women than others. However, less is known about how CE facets relate to ED symptoms in men. This study examined: 1) gender differences in levels of CE facets, assessed using the Compulsive Exercise Test (CET); 2) whether specific CE facets independently relate to ED symptoms; and 3) whether gender moderates these relationships. Five hundred and ninety-one university students (58.5 % men) completed the CET and Eating Pathology Symptoms Inventory. Women reported significantly greater weight control exercise, exercise for mood improvement, lack of exercise enjoyment, body dissatisfaction, and purging than men, while men reported more muscle building than women. CE motivated by avoidance of negative emotions and performed in a rule-driven manner and weight control CE were associated with the greatest number of ED symptoms. Further, rigid exercise routines were associated with greater muscle building. Women with greater weight control CE experienced more body dissatisfaction, and women with more CE motivated by avoidance of negative emotions experienced more restriction, compared to men. Overall, specific CE facets relate to ED symptoms in men and women. Findings highlight the importance of interventions designed to target unhealthy exercise motivations and of cultivating healthy attitudes towards exercise across genders.
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Affiliation(s)
- Chloe White
- Department of Psychology, Simon Fraser University, Canada
| | - Ege Bicaker
- Department of Psychology, McGill University, Canada
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13
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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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14
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Wang Y, Shi H, Liu S, Wang K, Griffiths MD, Szabo A. Psychometric Evaluation of the Revised Exercise Addiction Inventory (EAI-R) Among Chinese College Students. Int J Ment Health Addict 2022. [DOI: 10.1007/s11469-022-00955-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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15
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Bratland-Sanda S, Schmidt SK, Reinboth MS, Vrabel KA. Under pressure to exercise: a cross-sectional study of characteristics and predictors of compulsive exercise in early adolescents. J Eat Disord 2022; 10:156. [PMID: 36335366 PMCID: PMC9637290 DOI: 10.1186/s40337-022-00686-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 11/01/2022] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND To investigate the frequency of compulsive exercise among early adolescents, and determine the associated impact of sex, physical activity level, exercise habits, motivational regulation, dieting behaviour and health-related quality of life (HRQoL) on compulsive exercise. METHODS Cross-sectional design with 8th grade adolescents (n = 572, mean ± SD age 13.9 ± 0.3 yrs). Outcome assessment was compulsive exercise (Compulsive Exercise Test, CET). Total CET score ≥ 15 was defined as clinical CET score. Further assessment included exercise motivation (Behavioural Regulation of Exercise Questionnaire-2), HRQoL (KIDSCREEN 27), accelerometer-assessed physical activity and Andersen test for cardiorespiratory fitness. Exercise obsession was defined as clinical CET score and < 60 min/day with moderate-to-vigorous objectively assessed physical activity. RESULTS Small sex differences were found for CET total score. Seven percent of the adolescents were classified with clinical CET score, and four percent with exercise obsession. Adolescents with clinical CET score had higher body mass index, more weight loss attempts, and lower physical fitness compared to adolescents with non-clinical CET score. Being a boy, higher scores on introjected motivational regulation and HRQOL subscale parent relation and autonomy, use of exercise monitoring tool, and number of weight loss attempt the past 12 months explained 39% of the total CET score variance. Physical activity level did not predict compulsive exercise. CONCLUSIONS Compulsive exercise in early adolescents was predicted by exercise motivation, exercise habit, and dieting, but not physical activity level. This implicates a distinction of obsessive cognitions about physical activity from performed physical activity in adolescents, and that such cognitions must be addressed in future initiatives that aim to improve adolescents' general physical activity level, health, and wellbeing. Trial registration ClinicalTrials.gov: NCT03906851. Although there is a huge concern about adolescents being insufficiently physically active, there are also adolescents who struggle with issues of compulsive exercise. The issues of compulsive exercise have been rarely studied in adolescents. We therefore aimed to describe compulsive exercise and factors that were associated with and could explain presence of compulsive exercise. A total of 572 8th graders (age 13.9 ± 0.3 yrs) responded to this study. We found that the score on compulsive exercise was higher in boys than in girls, and that adolescents with high score on compulsive exercise had higher body mass index, more weight loss attempts, and lower physical fitness compared to adolescents with low score on compulsive exercise. Also, we found that exercise obsessions, i.e., thinking of exercise without actually exercising, was present in four percent of the respondents. Being a boy, attempting weight loss, exercising to avoid shame/guilt, and exercising for the perceived value of exercise predicted compulsive exercise. Awareness of the compulsive exercise and exercise obsessions is important in public health initiatives that aim to increase adolescents' physical activity level.
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Affiliation(s)
- S Bratland-Sanda
- Department of Sport, Physical Education and Outdoor Studies, University of South-Eastern Norway, Gullbringvegen 36, 3800, Bø, Telemark, Norway.
| | - S K Schmidt
- Department of Sport, Physical Education and Outdoor Studies, University of South-Eastern Norway, Gullbringvegen 36, 3800, Bø, Telemark, Norway
| | - M S Reinboth
- Department of Sport, Physical Education and Outdoor Studies, University of South-Eastern Norway, Gullbringvegen 36, 3800, Bø, Telemark, Norway
| | - K A Vrabel
- Research Institute, Modum Bad Psychiatric Centre, Vikersund, Norway.,Institute of Psychology, University of Oslo, Oslo, Norway
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16
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Selenius S, Birgegård A, Forsén Mantilla E. Preliminary evaluation of the online course "I Care" targeting eating disorder knowledge and attitudes among sports coaches and fitness instructors. J Eat Disord 2022; 10:142. [PMID: 36175946 PMCID: PMC9520860 DOI: 10.1186/s40337-022-00663-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 09/11/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Fitness instructors, coaches and trainers are often looked up to and seen as role-models within their sporting community. Since problematic exercise is a common symptom of eating disorders, they are also highly likely to meet individuals at risk for developing eating disorders within their profession. Thus, educating coaches about how to promote healthy ideals within their sports/training context and equipping them with knowledge to be able to detect and approach individuals at risk, is of great importance. METHOD We studied the pre-to-post effects of the I Care online psychoeducational intervention in 150 coaches, trainers, and fitness instructors. Variables included the Compulsive Exercise Test, as well as knowledge of eating disorders, and confidence and awareness regarding approaching, talking to, and referring individuals whose observed behavior raised concerns. RESULTS Results showed significant and large improvements in coaches' confidence and knowledge regarding warning signs and how to approach an at-risk person, and a decrease in their perceived ability to recognize eating disorders by sight, e.g., insight about EDs not being recognizable just by looking at a person. Also, significant positive change in attitudes about their own rule-driven exercise behavior and lack of enjoyment of exercise was observed. CONCLUSIONS Although the lack of a control group compels caution, the study suggests that I Care may have positive effects in terms of a "declaration of intent" toward more positive role-modeling and interactions with clients.
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Affiliation(s)
- Sofia Selenius
- Frisk & Fri-Riksföreningen mot ätstörningar, The National Eating Disorders Patient and Advocacy Organization, Inedalsgatan 5, 11233, Stockholm, Sweden
| | - Andreas Birgegård
- Department of Medical Epidemiology and Biostatistics (MEB), Karolinska Institutet, Nobels väg 12A, 171 77, Stockholm, Sweden
| | - Emma Forsén Mantilla
- Frisk & Fri-Riksföreningen mot ätstörningar, The National Eating Disorders Patient and Advocacy Organization, Inedalsgatan 5, 11233, Stockholm, Sweden. .,Department of Medical Epidemiology and Biostatistics (MEB), Karolinska Institutet, Nobels väg 12A, 171 77, Stockholm, Sweden.
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17
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Datta N, Van Wye E, Citron K, Matheson B, Lock JD. The COVID-19 pandemic and youth with anorexia nervosa: A retrospective comparative cohort design. Int J Eat Disord 2022; 56:263-268. [PMID: 36125016 PMCID: PMC9538435 DOI: 10.1002/eat.23817] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 09/08/2022] [Accepted: 09/09/2022] [Indexed: 01/21/2023]
Abstract
OBJECTIVE There is a growing body of literature suggesting the novel coronavirus pandemic (COVID-19) negatively impacts mental health in individuals self-reporting an eating disorder (ED); however, limited pediatric data is available about the impact COVID-19 has had on youth with EDs, specifically Anorexia Nervosa (AN). Our study uses a cross-sectional design to explore differences in ED symptoms between adolescents diagnosed with AN during the COVID-19 pandemic compared to a retrospective cohort of adolescents for whom these measures were previously collected, prior to the pandemic. METHOD We report cross-sectional data assessing differences between AN behaviors and cognitions during the COVID-19 pandemic compared to a retrospective cohort (n = 25 per cohort) assessed before the pandemic. RESULTS Results suggest that individuals with a first-time diagnosis of AN during the pandemic had lower percent expected body weight, and more compulsive exercise behaviors. CONCLUSIONS These data support existing pediatric findings in exercise and body weight differences in adolescents with AN before and during the pandemic. Findings may be helpful in informing considerations for providers treating ED patients amidst and after the pandemic. PUBLIC SIGNIFICANCE This manuscript compares a retrospective cohort of adolescents diagnosed with AN prior to the pandemic to a cohort of adolescents diagnosed with AN during the pandemic. Results report that adolescents diagnosed with AN during the pandemic have lower weights and increased compensatory exercise behavior compared to adolescents diagnosed with AN before the pandemic despite no difference in length of illness. Findings may be helpful in informing considerations for providers treating ED patients amidst and after the pandemic.
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Affiliation(s)
- Nandini Datta
- Department of Psychiatry and Behavioral SciencesStanford University School of MedicineStanfordCaliforniaUSA
| | - Eliza Van Wye
- Department of Psychiatry and Behavioral SciencesStanford University School of MedicineStanfordCaliforniaUSA
| | - Kyra Citron
- Department of Psychiatry and Behavioral SciencesStanford University School of MedicineStanfordCaliforniaUSA
| | - Brittany Matheson
- Department of Psychiatry and Behavioral SciencesStanford University School of MedicineStanfordCaliforniaUSA
| | - James D. Lock
- Department of Psychiatry and Behavioral SciencesStanford University School of MedicineStanfordCaliforniaUSA
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18
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Harris A, Aouad P, Noetel M, Hay P, Touyz S. Measuring exercise in eating disorder patients: a Delphi study to aggregate clinical and research knowledge. J Eat Disord 2022; 10:139. [PMID: 36096843 PMCID: PMC9469531 DOI: 10.1186/s40337-022-00641-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 07/24/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Exercise is a prominent feature of most eating disorders, and has been shown to have a number of detrimental effects on treatment outcome. There is some disagreement in the literature regarding the construct of compulsive exercise, and assessment and treatment varies significantly. This study therefore aimed to aggregate expert clinicians' and researchers' views on how to define and measure compulsive exercise in eating disorder patients. The expert panel was also asked about questionnaire design, and possible problems when measuring compulsive exercise. METHOD This study used the Delphi method to establish consensus amongst an expert panel. Three successive rounds of questionnaires were distributed to the panel over a period of six months. The first round consisted of four open-ended questions regarding the definition and measurement of compulsive exercise in eating disorder patients. For Round 2, 70 statements were derived from the answers, and panelists were asked to rate each item on a Likert-based scale. An 85% consensus level was chosen. In Round 3, 44 statements were re-rated by the panel. RESULTS Seventeen of 24 participants completed all three rounds of the study. Consensus was achieved for 63% of the items, while 18.5% reached near consensus, and 18.5% did not reach consensus after Round 3. The panel agreed on a number of important aspects of compulsive exercise. Several suggestions regarding the format of a questionnaire assessing this behavior were also endorsed. The panel further identified common difficulties when assessing compulsive exercise in eating disorder patients, notably a lack of consensus still apparent in the literature. CONCLUSION The current findings constitute a further step towards a unified definition of compulsive exercise, and contribute important suggestions to the measurement of this behavior.
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Affiliation(s)
| | | | - Melissa Noetel
- The University of Sydney, Sydney, Australia.,Western Sydney University, Sydney, Australia
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19
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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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20
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Riva A, Falbo M, Passoni P, Polizzi S, Cattoni A, Nacinovich R. High levels of physical activity in female adolescents with anorexia nervosa: medical and psychopathological correlates. Eat Weight Disord 2022; 27:151-162. [PMID: 33704692 DOI: 10.1007/s40519-021-01126-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 01/20/2021] [Indexed: 11/25/2022] Open
Abstract
PURPOSE While overexercise is commonly described in patients who experience anorexia nervosa (AN), it represents a condition still underestimated, especially in the paediatric population. METHOD The present study aims at assessing the possible associations between levels of physical activity (PA) and clinical features, endocrinological data and psychopathological traits in a sample of 244 female adolescents hospitalised for AN subdivided into two groups according to PA levels (high PA vs. no/low PA). The two groups were compared through multivariate analyses, while multiple regression analysis was conducted to determine whether physical activity predict specific outcomes. RESULTS No significant differences were found between the two groups in terms of last Body Mass Index (BMI) before illness, BMI at admission and disease duration, while a difference emerged in delta BMI(rapidity of weight loss), significantly higher in high-PA group (p = 0.021). Significant differences were observed in Free triiodothyronine- (p < 0.001), Free thyroxine (p = 0.046), Follicle-stimulating hormone (p = 0.019), Luteinising hormone (p = 0.002) levels, with values remarkably lower in high-PA group. Concerning psychopathological scales, the high-PA group showed worst Children's Global Assessment Scale (CGAS) scores (p = 0.035). Regression analyses revealed that higher PA predicts higher delta BMI (p = 0.021), presence of amenorrhea (p = 0.003), lower heart rate (p = 0.012), lower thyroid (Free triiodothyronine p < 0.001, Free thyroxine p = 0.029) and gynaecological hormones' levels (Follicle-stimulating hormone p = 0.023, Luteinising hormone p = 0.003, 17-Beta estradiol p = 0.041). Concerning psychiatric measures, HPA predicts worst scores at CGAS (p = 0.019), and at scales for evaluation of alexithymia (p = 0.028) and depression (p = 0.004). CONCLUSIONS Results suggest that high levels of physical activity in acute AN associate with worst clinical conditions at admission, especially in terms of endocrinological and medical features. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Anna Riva
- Child and Adolescent Mental Health Department, Clinica di Neuropsichiatria dell'Infanzia e dell'Adolescenza, University of Milan Bicocca, S. Gerardo Hospital, ASST of Monza, Via Pergolesi, 33, 20900, Monza, Italy.
| | - Mariella Falbo
- Child and Adolescent Mental Health Department, Clinica di Neuropsichiatria dell'Infanzia e dell'Adolescenza, University of Milan Bicocca, S. Gerardo Hospital, ASST of Monza, Via Pergolesi, 33, 20900, Monza, Italy
| | - Paolo Passoni
- Department of Obstetrics and Gynecology, San Gerardo Hospital, ASST Monza, via Pergolesi 33, 20900, Monza, Italy
| | - Serena Polizzi
- Department of Obstetrics and Gynecology, San Gerardo Hospital, ASST Monza, via Pergolesi 33, 20900, Monza, Italy
| | - Alessandro Cattoni
- Department of Pediatrics, University of Milan Bicocca, Fondazione Monza e Brianza per il Bambino e la sua Mamma, S. Gerardo Hospital, via Pergolesi 33, 20900, Monza, Italy
| | - Renata Nacinovich
- Child and Adolescent Mental Health Department, Clinica di Neuropsichiatria dell'Infanzia e dell'Adolescenza, University of Milan Bicocca, S. Gerardo Hospital, ASST of Monza, Via Pergolesi, 33, 20900, Monza, Italy
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21
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Gjestvang C, Bratland-Sanda S, Mathisen TF. Compulsive exercise and mental health challenges in fitness instructors; presence and interactions. J Eat Disord 2021; 9:107. [PMID: 34493315 PMCID: PMC8422740 DOI: 10.1186/s40337-021-00446-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 07/13/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Some physically active people exercise compulsively, which can be associated with several mental health challenges. Fitness instructors are considered important role models for an active, healthy lifestyle; yet little is known about their exercise motives and mental health. The aim of this study was to examine the presence of compulsive exercise and mental health challenges, and their interaction, in fitness instructors. METHODS A total of 270 fitness instructors from Norwegian fitness clubs were recruited for this cross-sectional study. Inclusion criteria were operating as instructors within the current year and understanding Norwegian language. Data were collected by an electronic questionnaire and included demographic information, hours of classes instructed and of personal physical activity, Compulsive Exercise Test (CET), Symptom Check List - 10 (SCL-10), Beck Depression Inventory (BDI), and Eating Disorder Examination Questionnaire (EDE-Q)). RESULTS Females had higher CET scores than males, and 9% of all respondents had CET score above clinical cutoff. Respondents with clinical CET score had higher SCL-10, BDI and EDE-Q global- and subscale scores compared with their counterparts. Although CET was positively and significantly associated with BDI, SCL-10, and EDE-Q, only the latter explained the CET score (ß = 1.23, 99% CI = 0.87, 1.59). CONCLUSION About one out of eleven instructors were above clinical CET cut-off, revealing symptoms of compulsive exercise. EDE-Q significantly contributed in a model explaining 43% of the variation of compulsive exercise.
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Affiliation(s)
- Christina Gjestvang
- Department of Sports Medicine, Norwegian School of Sports Sciences, Oslo, Norway
| | - Solfrid Bratland-Sanda
- Department of Sports, Physical Education and Outdoor Studies, University of Southeast Norway, Kongsberg, Norway
| | - Therese Fostervold Mathisen
- Faculty of Health, Welfare and Organisation, Østfold University College, P.O. Box 700, 1757 Halden, Fredrikstad, Norway.
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22
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Limburg K, Bodill K, Watson HJ, Kane RT, Hagger MS, Egan SJ. Validity of the compulsive exercise test in regular exercisers. Eat Disord 2021; 29:447-462. [PMID: 31634058 DOI: 10.1080/10640266.2019.1677130] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Measurement of compulsive exercise is important for the study of eating pathology in individuals who regularly participate in sport and exercise. The current study examined the factor structure, internal consistency and validity of the compulsive exercise test (CET) in regular exercisers. Participants were recruited via the internet and from sport clubs (n = 313 adults; M = 32 years; 57% female). A three-factor model for the CET was supported which included the weight control exercise, avoidance and rule-driven behaviour, and mood improvement subscales (fit statistics for the three-factor model: χ2SB = 4.39; CFI = .95; NNFI = .94, RMSEA = .100, 95% CI: .093-.110, AIC = 656.92). The subscales lack of exercise enjoyment and exercise rigidity were not retained. All factors demonstrated acceptable internal consistency with Cronbach's α = .77 to .91. The weight control exercise and avoidance and rule-driven behaviour subscales were significantly related to eating disorder symptoms. Given the association between CET subscales and eating disorder symptoms, the CET three-factor model may be informative when assessing eating pathology in individuals who regularly exercise.
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Affiliation(s)
| | - Kate Bodill
- School of Psychology, Curtin University, Perth, Australia
| | - Hunna J Watson
- School of Psychology, Curtin University, Perth, Australia.,Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,School of Paediatrics and Child Health, The University of Western Australia, Perth, Australia
| | - Robert T Kane
- School of Psychology, Curtin University, Perth, Australia
| | - Martin S Hagger
- Psychological Sciences, University of California, Curtin University, Merced, USA.,Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Sarah J Egan
- School of Psychology, Curtin University, Perth, Australia
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23
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Gorrell S, Flatt RE, Bulik CM, Le Grange D. Psychosocial etiology of maladaptive exercise and its role in eating disorders: A systematic review. Int J Eat Disord 2021; 54:1358-1376. [PMID: 33942917 PMCID: PMC8811798 DOI: 10.1002/eat.23524] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 04/13/2021] [Accepted: 04/13/2021] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Although maladaptive exercise (ME) is widely recognized as a clinical feature in transdiagnostic eating disorders, less is known about psychosocial factors that give rise to and perpetuate this behavior. This systematic review aimed to examine the empirical status of this association. METHOD We reviewed 46 full text articles examining longitudinal associations between psychosocial variables and ME. RESULTS Eighteen studies met full inclusion criteria. Based on our qualitative synthesis, evidence suggests reasonably consistent associations between early concern with weight and shape, and negative affect on later development of ME. DISCUSSION Inconsistent and insufficient assessment of ME across a majority of studies underscores caution in interpretation of results, but guides important discussion for future clinical and research efforts.
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Affiliation(s)
- Sasha Gorrell
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, California
| | - Rachael E. Flatt
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Cynthia M. Bulik
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina,Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina,Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Daniel Le Grange
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, California,Department of Psychiatry & Behavioral Neuroscience, The University of Chicago, Chicago, Illinois
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Monell E, Meyer C, Szwajda A, Forsén Mantilla E. Taking the LEAP: study protocol for a randomized, multicentre, naturalistic, efficacy trial of the compuLsive Exercise Activity theraPy (LEAP) - a cognitive behavioral program specifically targeting compulsive exercise in patients with eating disorders. BMC Psychiatry 2021; 21:369. [PMID: 34301226 PMCID: PMC8299452 DOI: 10.1186/s12888-021-03356-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 06/30/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND About half of Swedish eating disorder patients report exercising compulsively and compulsive exercise (CE) is prevalent in all diagnoses and both genders. Yet there are no systematic treatments targeting CE in specialist care. This study aims to evaluate the effects of The CompuLsive Exercise Activity TheraPy (LEAP) - a promising group treatment targeting compulsive exercise, in Swedish eating disorder patients. METHOD One hundred twenty-eight adult females and males suffering from anorexia nervosa, bulimia nervosa or other specified feeding and eating disorders (type 1, 2, or 4) with CE will be recruited via four specialist eating disorder treatment units. Participants will be randomized to receive treatment as usual (control group) or treatment as usual plus LEAP (intervention group). The groups will be assessed on key variables (e.g., BMI, eating disorder symptoms, exercise cognitions and behaviors) at three occasions: initially, after 3 months and after 6 months. DISCUSSION The project takes place in a clinical setting, including both male and female patients with different eating disorder diagnoses with CE, enabling a good indication of the efficacy of LEAP. If our results are positive, LEAP has the potential of benefiting about half of the eating disorder population, with remission and recovery hopefully improving as a result. TRIAL REGISTRATION The trial is registered with the ISRCTN registry (registration date 2020-03-25), trial ID: ISRCTN80711391 .
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Affiliation(s)
- Elin Monell
- Department of Medical Biostatistics and Epidemiology, Karolinska Institutet, Stockholm, Sweden.
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Stockholm, Sweden.
| | - Caroline Meyer
- WMG and Warwick Medical School, University of Warwick, Coventry, UK
- Warwickshire NHS Partnership Trust, Coventry, UK
| | - Agnieszka Szwajda
- Department of Medical Biostatistics and Epidemiology, Karolinska Institutet, Stockholm, Sweden
| | - Emma Forsén Mantilla
- Department of Medical Biostatistics and Epidemiology, Karolinska Institutet, Stockholm, Sweden
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Stockholm, Sweden
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Abstract
Pathological exercise behavior is pervasive in eating disorder psychopathology, yet minimal treatment guidance exists for extinguishing it as little is known about how to differentiate pathological from healthy exercise. The purpose of this study was to characterize pathological exercise in terms of motivation to increase the specificity with which both pathological and healthy exercise is described and to inform treatment interventions. Latent profile analysis characterized homogenous groups based on exercise motivation in two samples: college women (n = 200) and women with eating psychopathology (n = 211). These profiles were compared on levels of eating and general psychopathology and emotion dysregulation. Three profiles emerged describing sedentary, pathological exercise, and athlete groups in the first sample, and five profiles describing neutral, sedentary, weight loss, athlete, and pathological exercise groups emerged in the second sample. Findings indicate that motivation style is salient in defining pathological exercise and may, therefore, be a clinically useful treatment target.
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Sicilia Á, Paterna A, Alcaraz-Ibáñez M, Griffiths MD. Theoretical conceptualisations of problematic exercise in psychometric assessment instruments: A systematic review. J Behav Addict 2021; 10:4-20. [PMID: 33822749 PMCID: PMC8969858 DOI: 10.1556/2006.2021.00019] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 01/27/2021] [Accepted: 02/22/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND AIMS The aim of the present systematic review was to identify psychometric tools developed to assess problematic exercise in order to identify and compare their theoretical conceptualisations on which they are based. METHODS A systematic literature search was conducted in the electronic databases Web of Science, Scielo, PsychINFO, PsycTEST and SCOPUS from their inception to January 2020. RESULTS Seventeen assessment instruments met the eligibility criteria to be included in the present review. The instruments were classified according to their conceptualisation into five groups: (i) problematic exercise as an end of an exercise continuum, (ii) problematic exercise as a means of regulating body size and weight, (iii) problematic exercise as dependence, (iv) problematic exercise as a behavioural addiction and (v) no clear conceptualisation. DISCUSSION The results suggest that the conceptualisations of the assessment instruments have resulted in a strong dichotomy in relation to the primary or secondary character of the problematic exercise that might be limiting the capacity of the instruments to adequately capture the multidimensionality of this construct. CONCLUSIONS Given the interest in understanding the complexity surrounding the problematic exercise, future research should develop more comprehensive definitions of this construct. This would allow a greater conceptual consensus to be reached that would allow progress to be made in the study of the problematic exercise.
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Affiliation(s)
- Álvaro Sicilia
- Health Research Centre and Department of Education, University of Almería, Spain
| | - Adrian Paterna
- Health Research Centre and Department of Education, University of Almería, Spain,Corresponding author. E-mail:
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Review: questionnaires as measures for low energy availability (LEA) and relative energy deficiency in sport (RED-S) in athletes. J Eat Disord 2021; 9:41. [PMID: 33789771 PMCID: PMC8011161 DOI: 10.1186/s40337-021-00396-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 03/17/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A sustained mismatch between energy intake and exercise energy expenditure (EEE) can lead to Low Energy Availability (LEA), health and performance impairments characteristic of Relative Energy Deficiency in Sport (RED-S). Questionnaires can conveniently identify symptoms and/or LEA/ RED-S risk factors. This study aimed to systematically identify, and critique questionnaires used or developed to measure LEA/ RED-S risk in athletic populations. METHODS A systematic search was conducted using PubMed database. Full text articles were included if: (i) the questionnaire(s) in the study identified LEA and/or RED-S risk; (ii) studies developed questionnaires to identify LEA and/or RED-S risk; (iii) participants belonged to athletic population(s); and (iv) in English. RESULTS Thirty-three articles met the inclusion criteria and were reviewed, 13 questionnaires were identified. Eight questionnaires had undergone validation procedures, and three questionnaires included questions related to EEE. The most widely used validated questionnaires were Low Energy Availability in Females Questionnaire (LEAF-Q) (48% articles) and Eating Disorder Examination Questionnaire (EDE-Q) (12% articles). The LEAF-Q determines LEA risk from symptoms but cannot be used in males as nearly half of the items (n = 12) relate to menstrual function. The EDE-Q serves as a surrogate marker of LEA risk in both sexes, as it measures a major risk factor of LEA, disordered eating. Better validation is needed for many questionnaires and more are needed to address LEA/RED-S risk in male athletes. CONCLUSION These questionnaires may be effective in identifying intentional energy restriction but less valuable in identifying inadvertently failure to increase energy intake with increased EEE.
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Dreier MJ, Coniglio K, Selby EA. Mapping features of pathological exercise using hierarchical-dimensional modeling. Int J Eat Disord 2021; 54:422-432. [PMID: 33185893 DOI: 10.1002/eat.23406] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 10/23/2020] [Accepted: 10/24/2020] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Pathological exercise is common among those with eating disorders and has typically been characterized as excessive, compulsive, or compensatory in nature. Little is known about how pathological exercise is associated with other eating disorder behaviors or personality traits, or whether these associations differ between men and women. METHOD We used hierarchical dimensional modeling in three samples, including college women (N = 205), women with eating psychopathology (N = 268), and college men (N = 235), to examine latent associations between pathological exercise and eating disorder psychopathology, namely compulsivity, emotion regulation, and body dissatisfaction. RESULTS Using Goldberg's (2006) "bass-ackwards" method, we identified separate 10-factor solutions (women) or an 11-factor solution (men). A distinct muscle building factor arose in the three-factor solution for men, and it also notably arose in the six- and eight-factor solutions for community and college women, respectively, highlighting an important understudied motivation factor in both healthy and pathological exercise. Each solution accounted for 64.8% (college women), 51.9% (women with eating psychopathology), and 43.9% (college men) of the variance in excessive exercise, respectively. DISCUSSION Findings indicate that pathological exercise is associated with different psychological traits (e.g., poor emotion regulation, compulsivity) across populations, and such differences may necessitate unique treatment approaches tailored accordingly.
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Affiliation(s)
- Melissa J Dreier
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kathryn Coniglio
- Department of Psychology, Rutgers University, Piscataway, New Jersey, USA
| | - Edward A Selby
- Department of Psychology, Rutgers University, Piscataway, New Jersey, USA
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Validation of the Intuitive Exercise Scale in Patients With Eating Disorders. JOURNAL OF CLINICAL SPORT PSYCHOLOGY 2021. [DOI: 10.1123/jcsp.2021-0033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Unhealthy cognitive–emotional relationships with exercise can hinder positive treatment outcomes when left unaddressed. However, clinicians lack validated tools to monitor this aspect of treatment. This study examined the 14-item Intuitive Exercise Scale with 165 patients in the United States (Mage = 26.48 years) who were receiving treatment for an eating disorder. The original factor structure was inadequate for the current sample, and exploratory factor analysis generated three factors—emotional exercise, body intuition, and exercise variety. The three-factor solution yielded strong internal consistency and partial support for the scale’s validity. Furthermore, patients scored lowest in body intuition, confirming low awareness of bodily cues common in patients with eating disorders. This study informs how clinicians may integrate and monitor patients’ cognitive–emotional relationship with exercise as part of holistic and intuitive eating disorder treatment approaches.
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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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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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Grosser J, Hofmann T, Stengel A, Zeeck A, Winter S, Correll CU, Haas V. Psychological and nutritional correlates of objectively assessed physical activity in patients with anorexia nervosa. EUROPEAN EATING DISORDERS REVIEW 2020; 28:559-570. [PMID: 32613696 DOI: 10.1002/erv.2756] [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: 02/04/2020] [Revised: 06/05/2020] [Accepted: 06/06/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Physical activity (PA) plays a role in the course of anorexia nervosa (AN). OBJECTIVE To assess the association between PA, nutritional status and psychological parameters in patients with AN. METHOD Using a wearable activity monitor, PA was assessed in 60 female AN inpatients, by step count and time spent in 4 metabolic equivalent (MET)-intensity levels: sedentary behaviour, light, moderate and vigorous PA. In addition, BMI, psychological (patient-reported outcome questionnaires) and nutritional parameters (body fat, energy and macronutrient intake) were assessed. RESULTS The study population spent little time in vigorous PA. BMI on admission and discharge was higher when more time was spent in sedentary behaviour, and lower with more time spent in light PA. Relationships between PA and patient-reported outcomes were weak and limited to an association between vigorous PA and compulsiveness. Low fat mass was associated with more time spent in light PA, while subjects with higher step counts showed less intake of energy, carbohydrates and fat. CONCLUSION The relationship between inadequate food intake and increased PA in patients with AN requires further investigation.
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Affiliation(s)
- Julia Grosser
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Tobias Hofmann
- Center for Internal Medicine and Dermatology, Department of Psychosomatic Medicine; Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Andreas Stengel
- Center for Internal Medicine and Dermatology, Department of Psychosomatic Medicine; Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tübingen, Tübingen, Germany
| | - Almut Zeeck
- Department of Psychiatry and Psychotherapy, Medical Center University of Freiburg, Freiburg, Germany
| | - Sibylle Winter
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Christoph U Correll
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin Berlin, Berlin, Germany.,Department of Psychiatry and Molecular Medicine, Hofstra Northwell School of Medicine, Hempstead, New York, USA.,Department of Psychiatry, The Zucker Hillside Hospital, Queens, New York, USA
| | - Verena Haas
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin Berlin, Berlin, Germany
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L'Insalata A, Trainor C, Bohon C, Mondal S, Le Grange D, Lock J. Confirming the Efficacy of an Adaptive Component to Family-Based Treatment for Adolescent Anorexia Nervosa: Study Protocol for a Randomized Controlled Trial. Front Psychiatry 2020; 11:41. [PMID: 32116856 PMCID: PMC7028765 DOI: 10.3389/fpsyt.2020.00041] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 01/14/2020] [Indexed: 11/13/2022] Open
Abstract
UNLABELLED Family-based treatment (FBT) has the largest evidence base for treating adolescents with anorexia nervosa (AN); 35-50% of cases remit at the end-of-treatment and remain remitted 3-4 years after treatment. Studies of FBT demonstrate that weight restoration by session 4 (of 2.4 kgs) predicts remission at end of treatment in 85-90% of cases. One way to improve outcomes is to tailor treatments to patients depending on successful weight restoration at session 4. Pilot data found that by adding three sessions of Intensive Parental Coaching (IPC) after session 4 improved outcomes in early non-responders. Further, data suggest that the mechanism underlying FBT is early improvements in parental self-efficacy related to re-feeding their child. This manuscript describes a study protocol to examine whether adding IPC to FBT improves outcomes in early non-responders and confirm whether change in parental self-efficacy is the mechanism by which FBT works. This two-site randomized controlled trial (RCT) will randomize 60 adolescents with a DSM-5 diagnosis of AN (30 per site) who are between the ages of 12-18 years old and do not gain 2.4 kgs by session 4 of FBT. Randomized participants will either continue standard FBT or receive the three sessions of IPC and then continue FBT as usual. Both arms include up to 18 sessions over the course of 9 months. Blinded assessments will be conducted at baseline, 3-month within-treatment, end of treatment, and at 6 and 12-month follow-up. Parental-self efficacy will be assessed using the Parent versus Anorexia Scale at all major assessment time points and at each of the first eight sessions of treatment. The primary outcome is achievement of weight remission (> 94% expected mean percent body mass index (BMI) adjusted for age, height, and gender). CLINICAL TRIAL REGISTRATION http://www.ClinicalTrials.gov, identifier NCT03097874.
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Affiliation(s)
- Alexa L'Insalata
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
| | - Claire Trainor
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, United States
| | - Cara Bohon
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
| | - Sangeeta Mondal
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
| | - Daniel Le Grange
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, United States.,Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, IL, United States
| | - James Lock
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
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Gorrell S, Scharmer C, Kinasz K, Anderson D. Compulsive exercise and weight suppression: Associations with eating pathology in distance runners. Eat Behav 2020; 36:101358. [PMID: 31887559 PMCID: PMC7927975 DOI: 10.1016/j.eatbeh.2019.101358] [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: 07/20/2019] [Revised: 11/19/2019] [Accepted: 12/18/2019] [Indexed: 01/18/2023]
Abstract
Some athletes, particularly those who participate in activities that emphasize leanness such as competitive running, are at greater risk for eating disorder (ED) pathology. Compulsive exercise (CE) is linked with ED pathology among female athletes, with evidence that CE for weight control is most strongly correlated with ED thoughts and behaviors. Weight suppression (WS), the discrepancy between highest adult weight and current weight, is also linked with ED symptoms. Taken together, runners with greater WS may be more likely to engage in CE to influence their weight or shape and may subsequently report other associated ED symptoms. As such, the current study investigated associations between CE and ED pathology in a mixed-gender sample of adult distance runners (N = 277, 51% female), and tested the impact of WS on this association. Results indicated that females reported greater CE and ED pathology, whereas males reported greater WS. A significant interaction effect for CE x WS, (p < .05) indicated that the relation between CE and ED scores was stronger among male runners who reported higher WS. In contrast, WS did not impact the association between CE and ED pathology for female runners. Results from the current study have important implications for the assessment and treatment of ED in athletes, specifically runners, and suggest that WS is an important factor to consider when working with male athletes.
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Affiliation(s)
- Sasha Gorrell
- University of California, San Francisco, 401 Parnassus Avenue, San Francisco, CA 94143, USA; University at Albany, State University of New York, 1400 Washington Avenue, Albany, NY 12222, USA.
| | - Christina Scharmer
- University at Albany, State University of New York, Albany, New York, 1400 Washington Avenue, Albany, NY, 12222 USA
| | - Kate Kinasz
- University of California, San Francisco, San Francisco, California 401 Parnassus Avenue, San Francisco, CA, 94143 USA
| | - Drew Anderson
- University at Albany, State University of New York, Albany, New York, 1400 Washington Avenue, Albany, NY, 12222 USA
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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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Badau D, Badau A. Identifying the Incidence of Exercise Dependence Attitudes, Levels of Body Perception, and Preferences for Use of Fitness Technology Monitoring. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15122614. [PMID: 30469525 PMCID: PMC6313704 DOI: 10.3390/ijerph15122614] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Revised: 11/15/2018] [Accepted: 11/18/2018] [Indexed: 12/19/2022]
Abstract
Background: The study was focused on identifying the relationship between the incidence of exercise dependence attitudes, the level of body perception, and preferences for use of fitness technology monitoring. Methods: We investigated 241 students from physical education and sports specializations. We used a questionnaire structured in 5 parts: personal information (age, gender, weight, height, and institutional membership), Exercise Dependence Scale-R (EDS-21), the Compulsive Exercise Test (CET), Body perception questionnaire, and Fitness Monitoring Technology. Results: Application of EDS-21 revealed 8.3% with dependence and CET with 13.4%. Body mass index (BMI) in combination with self-image body: 18 (7.4%) of subjects over-estimated themselves, 18 (7.4%) of subjects underestimated themselves, 38.6% of the subjects were satisfied with their appearance, 17% were very satisfied and none were dissatisfied. A total of 36.1% thought they had the correct weight and 8.7% thought of losing weight. The most preferred monitoring technologies were the treadmill and the smartphone's fitness applications. A total of 11.6% of the subjects always used technologies, and 17% of subjects never did so. Conclusions: In order to identify the level of incidence of exercise dependence, body perception, and preference and frequency of use of monitoring technology, it is necessary to expand the level of knowledge about health and physical activities. The approach would diminish medical incidences of addiction, improve proactive behaviors, and correct prohealth.
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Affiliation(s)
- Dana Badau
- Department of Human Movement Sciences, University of Medicine, Pharmacy, Sciences and Technology of Targu Mures, 540139 Targu Mures, Romania.
| | - Adela Badau
- Department of Physical Education, University of Medicine, Pharmacy, Sciences and Technology of Targu Mures, 540139 Targu Mures, Romania.
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Plateau CR, Bone S, Lanning E, Meyer C. Monitoring eating and activity: Links with disordered eating, compulsive exercise, and general wellbeing among young adults. Int J Eat Disord 2018; 51:1270-1276. [PMID: 30508261 DOI: 10.1002/eat.22966] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 08/29/2018] [Accepted: 09/19/2018] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To explore the relationships between the use of food intake and activity monitoring tools with compulsive exercise, eating psychopathology, and psychological wellbeing. METHOD Participants (N = 352; mean age 21.90 years) indicated their use of activity and food intake monitoring tools, and completed the Compulsive Exercise Test (CET), Eating Disorders Examination Questionnaire (EDE-Q), and the Warwick Edinburgh Mental Wellbeing Scale (WEMWBS). RESULTS Users of monitoring tools reported significantly higher CET and EDE-Q scores than nonusers. Positive associations were detected between the frequency of activity monitoring tool use with CET and EDE-Q scores. Participants who reported using monitoring tools primarily to manage weight and shape reported higher levels of eating and compulsive exercise psychopathology than those who reported using tools to improve health and fitness. DISCUSSION Features of compulsive exercise and eating psychopathology are elevated among users of food intake and activity monitoring tools; and particularly among those who report using the tools for weight and shape purposes. Longitudinal and experimental research is needed to further our understanding of these observed associations, and specifically to explore the prospective relationships between monitoring tool use, eating psychopathology, and compulsive exercise.
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Affiliation(s)
- Carolyn R Plateau
- National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom
| | - Sarah Bone
- National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom
| | - Emily Lanning
- National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom
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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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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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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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41
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Bratland-Sanda S, Øverby NC, Bottegaard A, Heia M, Støren Ø, Sundgot-Borgen J, Torstveit MK. Maximal Strength Training as a Therapeutic Approach in Long-Standing Anorexia Nervosa: A Case Study of a Woman With Osteopenia, Menstrual Dysfunction, and Compulsive Exercise. Clin Case Stud 2018. [DOI: 10.1177/1534650118755949] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In persons with anorexia nervosa (AN), compulsive exercise and osteopenia are common symptoms. Although treatment of osteopenia besides weight regain is lacking, maximal strength training (MST) has been found to be effective in other populations. Such training has not been prescribed to those with AN due to uncertainty of tolerance. We therefore examined use of MST in a woman with long-standing AN, osteopenia, menstrual dysfunction, and compulsive exercise. The MST intervention consisted of four exercises: three sets of five repetitions maximum (RM), 3 times per week for 16 weeks. We examined muscle strength, bone mineral density (BMD), AN psychopathology, and compulsive exercise at baseline, posttest, and 6-month follow-up. Attendance rate was 100%. The subject improved muscle strength by 20% to 40%. BMD in lumbar spine improved by 4% to posttest, and by 8% from baseline to 6-month follow-up. The BMD T-scores shifted from values classified as osteopenic to normal values throughout the course of the intervention, despite continuance of menstrual dysfunction and lack of weight gain. No changes in AN psychopathology or levels of compulsive exercise were detected. Perceived psychological benefits including new bodily experiences were self-reported by the subject, emphasizing the importance of close follow-up by competent instructors.
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Affiliation(s)
| | | | | | - Morten Heia
- University College of Southeast Norway, Bø, Norway
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42
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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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Plateau CR, Arcelus J, Meyer C. Detecting Eating Psychopathology in Female Athletes by Asking About Exercise: Use of the Compulsive Exercise Test. EUROPEAN EATING DISORDERS REVIEW 2018; 25:618-624. [PMID: 29057602 DOI: 10.1002/erv.2561] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 08/18/2017] [Accepted: 09/13/2017] [Indexed: 12/19/2022]
Abstract
The present study assessed the suitability of the Compulsive Exercise Test (athlete version; CET-A) for identifying female athletes with clinically significant features related to or comparable with eating psychopathology. Three hundred and sixty-one female athletes (including 12 with a clinically diagnosed eating disorder) completed the Eating Disorders Examination Questionnaire and the CET-A. Receiver operating curve analysis was employed to identify a cut-off value on the CET-A, which could indicate clinically significant features related to or comparable with eating psychopathology among female athletes. The analysis demonstrated that a CET-A score of 10 successfully discriminated female athletes with a current eating disorder. The results suggest that the CET-A may be a suitable tool for detecting eating psychopathology in female athletes. Additional longitudinal research is needed to evaluate the predictive value of the CET-A. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.
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Affiliation(s)
- Carolyn R Plateau
- National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Jon Arcelus
- Leicestershire Adult Eating Disorders Service, Leicestershire Partnership NHS Trust, Bennion Centre, Leicester, UK.,Institute of Mental Health, Jubilee Campus, University of Nottingham, Nottingham, UK.,Nottingham Centre for Transgender Health, 3 Oxford Street, Nottingham, UK
| | - Caroline Meyer
- WMG, University of Warwick, Coventry, UK.,Warwick Medical School, University of Warwick, Coventry, UK.,University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
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44
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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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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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Mathisen TF, Bratland-Sanda S, Rosenvinge JH, Friborg O, Pettersen G, Vrabel KA, Sundgot-Borgen J. Treatment effects on compulsive exercise and physical activity in eating disorders. J Eat Disord 2018; 6:43. [PMID: 30559966 PMCID: PMC6293524 DOI: 10.1186/s40337-018-0215-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Accepted: 08/29/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Dysfunctional thoughts- and use of physical activity (PA) are core symptoms of the eating disorders (ED) bulimia nervosa (BN) and binge eating disorder (BED). The compulsive desire for PA complicates a favourable treatment outcome; hence, regular, adapted PA led by personnel with competence in exercise science is rarely part of treatment of BN and BED. The present study compared cognitive behaviour therapy (CBT) with a new treatment combining physical exercise and dietary therapy (PED-t) with respect to the short- and long-term changes in the level of compulsive exercise and actual level of PA in women with BN or BED. METHODS We enrolled 187 women with BN or BED, aged 18-40 years, with BMI 17.5-35, in an outpatient randomised controlled therapy trial. Participants were randomised to PED-t or CBT, while waitlist participants served as a control group during the treatment period. The treatment covered 16 weeks, with 6- and 12 months follow-up, and outcomes included self-reported compulsive exercise (CE) and objectively measured PA, analysed by linear mixed regression models. RESULTS Both CBT and PED-t reduced CE from baseline (P < 0.01, Hedges g ~ 0.4), but with no difference to control group. Compared to baseline, only PED-t significantly reduced the number of patients who scored above cut-off rating for CE, but with no between-group differences. The proportion of participants complying with the official recommendation for PA neither changed following treatment, nor emerged different between the treatment arms. CONCLUSION Both therapies resulted in significant improvements in compulsive exercise, a change not found in the control group, however there were no between-group differences. The findings are tempered by the low statistical power due to a small control group size. The number of participants complying with the recommendation for PA were stable throughout the study, and no change in total PA was found. Presence and intensity of CE decline with treatment, but a need to increase PA towards healthy levels remains unsolved. TRIAL REGISTRATION Approved by the Norwegian Regional Committee for Medical and Health Research Ethics (ID: 2013/1871, 16th of December 2013); registered in Clinical Trials (ID: NCT02079935, 17th of February 2014).
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Affiliation(s)
| | - Solfrid Bratland-Sanda
- Department of Sports and Physical Education and Outdoor Sciences, University of South-Eastern Norway, Bø in Telemark, Norway
| | - Jan H Rosenvinge
- 3Department of Psychology, Faculty of Health Sciences, UiT -The Arctic University of Norway, Tromsø, Norway
| | - Oddgeir Friborg
- 3Department of Psychology, Faculty of Health Sciences, UiT -The Arctic University of Norway, Tromsø, Norway
| | - Gunn Pettersen
- 5Department of Health and Care Sciences, Faculty of Health Sciences, The Arctic University of Norway, Tromsø, Norway
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Sauchelli S, Arcelus J, Granero R, Jiménez-Murcia S, Agüera Z, Del Pino-Gutiérrez A, Fernández-Aranda F. Dimensions of Compulsive Exercise across Eating Disorder Diagnostic Subtypes and the Validation of the Spanish Version of the Compulsive Exercise Test. Front Psychol 2016; 7:1852. [PMID: 27933021 PMCID: PMC5121244 DOI: 10.3389/fpsyg.2016.01852] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 11/09/2016] [Indexed: 01/06/2023] Open
Abstract
Objectives: Compulsive exercise in eating disorders has been traditionally considered as a behavior that serves the purpose of weight/shape control. More recently, it has been postulated that there may be other factors that drive the compulsive need to exercise. This has led to the development of the Compulsive Exercise Test (CET); a self-reported questionnaire that aims to explore the cognitive-behavioral underpinnings of compulsive exercise from a multi-faceted perspective. The objectives of this study were threefold: (1) to validate the Spanish version of the CET; (2) to compare eating disorder diagnostic subtypes and a healthy control group in terms of the factors that drive compulsive exercise as defined by the CET; (3) to explore how the dimensions evaluated in the CET are associated with eating disorder symptoms and general psychopathology. Methods: The CET was administered to a total of 157 patients with an eating disorder [40 anorexia nervosa, 56 bulimia nervosa (BN), and 61 eating disorder not-otherwise-specified (EDNOS)] and 128 healthy weight/eating controls. Patients were assessed via a semi-structured interview to reach a DSM-IV-TR diagnosis. Additionally, all participants completed the Symptom Checklist-90-Revised (SCL-90R) and the Eating Disorders Inventory-2 (EDI-2). Results: Confirmatory factor analysis demonstrated adequate goodness-of-fit to the original five-factor model of the CET. BN and EDNOS patients scored higher in the avoidance and rule-driven behavior, weight control, and total CET scales in comparison to the healthy controls, and higher across all scales apart from the exercise rigidity scale compared to the anorexia nervosa patients. Mean scores of the anorexia nervosa patients did not differ to those of the control participants, except for the mood improvement scale where the anorexia nervosa patients obtained a lower mean score. Mean scores between the BN and EDNOS patients were equivalent. The CET scales avoidance and rule-driven behavior, weight of control and total CET scores were positively correlated with the clinical assessment measures of the SCL-90R and EDI-2. Conclusion: Compulsive exercise is a multidimensional construct and the factors driving compulsive exercise differ according to the eating disorder diagnostic subtype. This should be taken into account when addressing compulsive exercise during the treatment of eating disorders.
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Affiliation(s)
- Sarah Sauchelli
- Department of Psychiatry, University Hospital of Bellvitge - Bellvitge Biomedical Research InstituteBarcelona, Spain; Centro de Investigación Biomédica en Red de la Fisiopatología Obesidad y Nutrición, Instituto de Salud Carlos IIIMadrid, Spain
| | - Jon Arcelus
- Institute of Mental Health, Faculty of Medicine & Health Sciences, University of NottinghamNottingham, UK; Leicester Eating Disorder Service, Leicester Glenfield HospitalLeicester, UK
| | - Roser Granero
- Centro de Investigación Biomédica en Red de la Fisiopatología Obesidad y Nutrición, Instituto de Salud Carlos IIIMadrid, Spain; Department of Psychobiology and Methodology, Autonomous University of BarcelonaBarcelona, Spain
| | - Susana Jiménez-Murcia
- Department of Psychiatry, University Hospital of Bellvitge - Bellvitge Biomedical Research InstituteBarcelona, Spain; Centro de Investigación Biomédica en Red de la Fisiopatología Obesidad y Nutrición, Instituto de Salud Carlos IIIMadrid, Spain; Department of Clinical Sciences, School of Medicine, University of BarcelonaBarcelona, Spain
| | - Zaida Agüera
- Department of Psychiatry, University Hospital of Bellvitge - Bellvitge Biomedical Research InstituteBarcelona, Spain; Centro de Investigación Biomédica en Red de la Fisiopatología Obesidad y Nutrición, Instituto de Salud Carlos IIIMadrid, Spain
| | - Amparo Del Pino-Gutiérrez
- Department of Psychiatry, University Hospital of Bellvitge - Bellvitge Biomedical Research InstituteBarcelona, Spain; Nursing Department of Mental Health, Public Health, Maternal and Child Health, The Nursing School of the University of BarcelonaBarcelona, Spain
| | - Fernando Fernández-Aranda
- Department of Psychiatry, University Hospital of Bellvitge - Bellvitge Biomedical Research InstituteBarcelona, Spain; Centro de Investigación Biomédica en Red de la Fisiopatología Obesidad y Nutrición, Instituto de Salud Carlos IIIMadrid, Spain; Department of Clinical Sciences, School of Medicine, University of BarcelonaBarcelona, Spain
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