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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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Palermo M, Rancourt D. Examining compulsive exercise as a risk factor for eating disorder symptoms in first-year college students using a latent change score modeling approach. Int J Eat Disord 2024. [PMID: 38619370 DOI: 10.1002/eat.24219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 04/02/2024] [Accepted: 04/04/2024] [Indexed: 04/16/2024]
Abstract
OBJECTIVE Research suggests that both compulsive exercise and eating disordered behaviors increase during college. Despite strong cross-sectional associations between compulsive exercise and eating disorders, it is unknown if compulsive exercise is a variable risk factor for eating disorders or simply a correlate. It was hypothesized that increases in compulsive exercise would significantly and prospectively predict increases in overall number of eating disorder symptoms over the study period. METHOD A total of 265 first year college students who did not meet criteria for a full or subthreshold eating disorder diagnosis at Time 1 (age M = 18.15; SD = 0.42; 122 female [46%] at Time 1) completed reports of compulsive exercise and eating disorder symptoms via online questionnaires at four timepoints over the 9-month 2021-2022 academic year (76% retention rate). Hypotheses were tested using a bivariate latent change score model. RESULTS Hypotheses were not supported. Change in compulsive exercise did not predict change in number of eating disorder symptoms. Change in number of eating disorder symptoms also did not predict change in compulsive exercise. CONCLUSIONS Compulsive exercise did not emerge as a variable risk factor for the development of eating disorder symptoms among first year college students. The relationship between these behaviors should be investigated at different developmental timepoints, such as early adolescence, and potential third variables that may explain the observed co-occurrence should be explored. PUBLIC SIGNIFICANCE This study investigated whether increases in compulsive exercise predicted increases in number of eating disorder symptoms among first year college students. Compulsive exercise did not significantly predict number of eating disorder symptoms. Additional research is warranted to clarify the relationship between compulsive exercise and eating disorder symptoms.
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Affiliation(s)
- Madeline Palermo
- Department of Psychology, University of South Florida, Tampa, USA
| | - Diana Rancourt
- Department of Psychology, University of South Florida, Tampa, USA
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Healy DR, Mansson N, Furu M, Bratlandsanda S, Sjögren JM. Maximal Resistance Training in the Treatment of Anorexia Nervosa - A Case Report Series. INTERNATIONAL JOURNAL OF EXERCISE SCIENCE 2024; 17:308-326. [PMID: 38665689 PMCID: PMC11042857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 04/28/2024]
Abstract
Objective Anorexia Nervosa (AN) has one of the highest mortality rates of all mental health disorders, low recovery rate and is associated with widespread endocrine dysfunction. Resistance training (RT) has been consistently shown to provide beneficial effects on health outcomes that are often negatively affected by AN, however participation in exercise is controversial for individuals with AN. The objective of this study was to assess the effects of maximal RT as an add-on to standard of care in patients with AN. Methods Originally, a controlled clinical trial was planned but due to COVID-19 pandemic, the study was prematurely ended and reported as a case series design. Three female inpatients with AN (Age 18-29 years, body mass index (BMI) 14.5-16.3 kg/m2, illness duration 1-7 years) underwent a supervised 6-week RT intervention as an add-on to standard of care. Primary outcome was muscular strength, as measured by a 1-repetition maximum. Secondary outcomes included BMI, eating disorder psychopathology and maladaptive exercise tendencies. Results No adverse events were reported. All three participants improved lower body muscle strength, ranging from 32% to 134% in the leg press. Changes of 4% to 134% in the bench press and -3% to 38% in the pulldown were also observed. Conclusions RT improved muscular strength in the participants. RT as part of standard of care may also provide additional benefits for individuals with AN, although further research is required to determine which subtype of patients would benefit from the addition of RT to their treatment protocol.
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Affiliation(s)
- Darren R Healy
- Department of Nutrition, Exercise, and Sports, University of Copenhagen, Copenhagen, DENMARK
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, FINLAND
| | - Nicole Mansson
- Department of Nutrition, Exercise, and Sports, University of Copenhagen, Copenhagen, DENMARK
| | - Mia Furu
- Department of Nutrition, Exercise, and Sports, University of Copenhagen, Copenhagen, DENMARK
| | - Solfrid Bratlandsanda
- Department of Sport, Physical Education, and Outdoor Sciences, University of South-Eastern Norway, Bø, NORWAY
| | - Jan Magnus Sjögren
- Research Unit of Eating Disorders, Psychiatric Center Ballerup, Ballerup, DENMARK
- Institute for Clinical Science and Psychiatry, Umeå University, Umeå, SWEDEN
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Kauczor-Rieck K, Allroggen M, Gradl-Dietsch G. [Sports and Physical Exercise Therapy in the Treatment of Mental Health Issues in Children and Adolescents]. ZEITSCHRIFT FUR KINDER- UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2024; 52:110-123. [PMID: 38224568 DOI: 10.1024/1422-4917/a000961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2024]
Abstract
Sports and Physical Exercise Therapy in the Treatment of Mental Health Issues in Children and Adolescents Abstract: Mental disorders are among the most common chronic diseases in childhood and adolescence in Germany and worldwide. The health benefits of a physically active lifestyle during adolescence are well documented. Furthermore, a growing body of evidence suggests a positive impact of physical activity on mental health and emotional well-being. Longitudinal studies also show an association between physical activity and reduced risk of developing a mental disorder. Therefore, therapeutic exercise plays an important role in child and adolescent psychiatry. High-quality randomized-controlled trials are needed to substantiate the described effects.
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Affiliation(s)
- Katja Kauczor-Rieck
- Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Klinik für Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie, Homburg, Deutschland
| | - Marc Allroggen
- Universitätsklinik Ulm, Kinder- und Jugendpsychiatrie/Psychotherapie, Ulm, Deutschland
| | - Gertraud Gradl-Dietsch
- LVR-Klinikum Essen, Kliniken und Institut der Universität Duisburg-Essen, Klinik für Psychiatrie, Psychosomatik und Psychotherapie des Kindes- und Jugendalters, Essen, Deutschland
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5
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Conn K, Huang K, Gorrell S, Foldi CJ. A transdiagnostic and translational framework for delineating the neuronal mechanisms of compulsive exercise in anorexia nervosa. Int J Eat Disord 2024:10.1002/eat.24130. [PMID: 38174745 PMCID: PMC11222308 DOI: 10.1002/eat.24130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 12/21/2023] [Accepted: 12/21/2023] [Indexed: 01/05/2024]
Abstract
OBJECTIVE The development of novel treatments for anorexia nervosa (AN) requires a detailed understanding of the biological underpinnings of specific, commonly occurring symptoms, including compulsive exercise. There is considerable bio-behavioral overlap between AN and obsessive-compulsive disorder (OCD), therefore it is plausible that similar mechanisms underlie compulsive behavior in both populations. While the association between these conditions is widely acknowledged, defining the shared mechanisms for compulsive behavior in AN and OCD requires a novel approach. METHODS We present an argument that a better understanding of the neurobiological mechanisms that underpin compulsive exercise in AN can be achieved in two critical ways. First, by applying a framework of the neuronal control of OCD to exercise behavior in AN, and second, by taking better advantage of the activity-based anorexia (ABA) rodent model to directly test this framework in the context of feeding pathology. RESULTS A cross-disciplinary approach that spans preclinical, neuroimaging, and clinical research as well as compulsive neurocircuitry and behavior can advance our understanding of when, why, and how compulsive exercise develops in the context of AN and provide targets for novel treatment strategies. DISCUSSION In this article, we (i) link the expression of compulsive behavior in AN and OCD via a transition between goal-directed and habitual behavior, (ii) present disrupted cortico-striatal circuitry as a key substrate for the development of compulsive behavior in both conditions, and (iii) highlight the utility of the ABA rodent model to better understand the mechanisms of compulsive behavior relevant to AN. PUBLIC SIGNIFICANCE Individuals with AN who exercise compulsively are at risk of worse health outcomes and have poorer responses to standard treatments. However, when, why, and how compulsive exercise develops in AN remains inadequately understood. Identifying whether the neural circuitry underlying compulsive behavior in OCD also controls hyperactivity in the activity-based anorexia model will aid in the development of novel eating disorder treatment strategies for this high-risk population.
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Affiliation(s)
- K Conn
- Monash University, Department of Physiology, 26 Innovation Walk, 3800, Clayton, Australia
- Monash Biomedicine Discovery Institute, 23 Innovation Walk, 3800, Clayton, Australia
| | - K Huang
- Monash University, Department of Physiology, 26 Innovation Walk, 3800, Clayton, Australia
- Monash Biomedicine Discovery Institute, 23 Innovation Walk, 3800, Clayton, Australia
| | - S Gorrell
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, 675 18th street, San Francisco, CA 94143, USA
| | - CJ Foldi
- Monash University, Department of Physiology, 26 Innovation Walk, 3800, Clayton, Australia
- Monash Biomedicine Discovery Institute, 23 Innovation Walk, 3800, Clayton, Australia
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Schaumberg K, Bulik CM, Micali N. Patterns of maladaptive exercise behavior from ages 14-24 in a longitudinal cohort. J Child Psychol Psychiatry 2023; 64:1555-1568. [PMID: 37258173 PMCID: PMC10592554 DOI: 10.1111/jcpp.13844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/25/2023] [Indexed: 06/02/2023]
Abstract
BACKGROUND Exercise for weight loss and maladaptive exercise (exercise that results in negative consequences or interference with daily life) are common behaviors among youth and are associated with increased risk of disordered eating symptoms. The current study clarifies processes that influence exercise-related risk in adolescence and young adulthood, including the frequency with which young people transition between engaging in exercise for weight loss and experiencing negative consequences of this behavior. METHOD Participants from the Avon Longitudinal Study of Parents and Children (ALSPAC) reported on eating disorder cognitions at age 14, and exercise behavior at ages 14, 16, 18, and 24 years old. Analyses examined rates of transition between the categories of 'No Exercise for Weight Loss', 'Exercise for Weight Loss', and 'Maladaptive Exercise' over time, identified overall trends in endorsement of exercise for weight loss and maladaptive exercise, and clarified predictors of these behaviors. RESULTS Endorsement of exercise for weight loss and maladaptive exercise increased over time in both males and females. Those in the 'Exercise for Weight Loss' category were more likely than those in the 'No Exercise for Weight Loss Category' to transition to 'Maladaptive Exercise' over time. Body mass index (Age 13) and fear of weight gain (Age 14) were consistent predictors of maladaptive exercise across sex. CONCLUSIONS Results support re-framing motivations for exercise in youth away from weight loss at a population level and targeting reductions in fear of weight gain for high-risk individuals.
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Affiliation(s)
| | - Cynthia M. Bulik
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, US
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, USA
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Nadia Micali
- Center for Eating and feeding disorders research, Mental Health Services in the Capital Region of Denmark, Psychiatric Centre Ballerup, Copenhagen, Denmark
- Institut for biologisk psykiatri, Psykiatrisk Center Sct. Hans, Boserupvej 2, 4000 Roskilde, Denmark
- Great Ormond Street Institute of Child Health, University College London, London, UK
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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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Hay P, Mohsin M, Liu L, Touyz S, Meyer C, Arcelus J, Madden S, Attia E, Pike KM, Conti J. Impact of LEAP and CBT-AN Therapy on Improving Outcomes in Women with Anorexia Nervosa. Behav Sci (Basel) 2023; 13:651. [PMID: 37622791 PMCID: PMC10451721 DOI: 10.3390/bs13080651] [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: 05/25/2023] [Revised: 07/28/2023] [Accepted: 08/01/2023] [Indexed: 08/26/2023] Open
Abstract
Anorexia nervosa (AN) is a mental health disorder that has serious physical, emotional and social consequences. Whilst cognitive behavioural therapy for AN (CBT-AN) has demonstrated efficacy, there remains a global need to improve AN treatment. Compulsive exercise activity therapy (LEAP) is an active therapy consisting of the addition to CBT-AN of eight specific sessions that focus on exercise and motivation for behavioural change. This paper presents a secondary analysis of 74 female participants in a randomised control trial of LEAP plus CBT-AN versus CBT-AN alone. The main aim of this study was to explore putative predictors and to estimate the magnitude of changes due to LEAP for specific outcome measures. Participants (LEAP: n = 36; CBT-AN: n = 38) were assessed at three successive surveys: baseline, end of therapy, and 6 months post-therapy. The overall effect sizes for changes between baseline to end of therapy and baseline to 6-month follow-up assessment showed large effect sizes (Cohen's d > = 0.80) for mental-health-related quality of life (MHRQoL), weight concern, dietary restraint, eating concern, AN stage change, and psychological distress (all p < 0.05). The results also indicated that several pre-treatment characteristics, including body mass index (BMI), level of eating disorder (ED) symptoms, and MHRQoL are important for identifying whether a treatment is likely to be effective. Future treatment programs should aim to optimise early improvements in BMI, ED symptoms, and MHRQoL.
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Affiliation(s)
- Phillipa Hay
- Mental Health Research Unit, Liverpool Hospital, South Western Sydney Local Health District, NSW Health, Liverpool, NSW 2170, Australia
- Translational Health Research Institute, School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia
| | - Mohammed Mohsin
- Mental Health Research Unit, Liverpool Hospital, South Western Sydney Local Health District, NSW Health, Liverpool, NSW 2170, Australia
- Faculty of Medicine & Health, School of Clinical Medicine, University of New South Wales, Sydney, NSW 2052, Australia
| | - Liquan Liu
- School of Psychology, Western Sydney University, Sydney, NSW 2560, Australia
- The MARCS Institute for Brain, Behaviour and Development, Western Sydney University, Sydney, NSW 2560, Australia
| | - Stephen Touyz
- Inside Out Institute, University of Sydney, Sydney, NSW 2006, Australia
| | - Caroline Meyer
- International Digital Laboratory, The University of Warwick, Coventry CV4 7AL, UK
| | - Jon Arcelus
- Institute of Mental Health, University of Nottingham, Nottingham NG7 2TU, UK
- Psychoneurobiology of Eating and Addictive Behaviors Group, Bellvitge Biomedical Research Institute (IDIBELL), Bellvitge University Hospital, University of Barcelona, 08908 Barcelona, Spain
| | - Sloane Madden
- The Sydney Children’s Hospitals Network, Westmead, Sydney, NSW 2145, Australia
| | - Evelyn Attia
- The New York State Psychiatric Institute, Columbia University, New York, NY 10032, USA
| | - Kathleen M. Pike
- World Health Organization Collaborating Centre for Capacity Building and Training in Global Mental Health, Columbia University Medical Center, New York, NY 10032, USA
| | - Janet Conti
- Translational Health Research Institute, School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia
- School of Psychology, Western Sydney University, Sydney, NSW 2560, Australia
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Miller ML, Sanzari CM, Timko CA, Hormes JM. Impact of virtual adjunctive cognitive remediation therapy on cognitive flexibility and treatment outcomes in comorbid anorexia nervosa and exercise dependence as quantified using novel biomarkers: A stage 1 registered report. Int J Eat Disord 2023; 56:1449-1460. [PMID: 37464977 DOI: 10.1002/eat.23942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 03/04/2023] [Accepted: 03/15/2023] [Indexed: 07/20/2023]
Abstract
OBJECTIVE Anorexia nervosa (AN) is associated with significant individual mental and physical suffering and public health burden and fewer than half of patients recover fully with current treatments. Comorbid exercise dependence (ExD) is common in AN and associated with significantly worse symptom severity and treatment outcomes. Research points to cognitive inflexibility as a prominent executive function inefficiency and transdiagnostic etiologic and maintaining mechanism linking AN and ExD. This study will evaluate the initial efficacy of adjunctive Cognitive Remediation Therapy (CRT), which has been shown to produce cognitive improvements in adults with AN, in targeting cognitive inflexibility in individuals with comorbid AN and ExD. As an exploratory aim, this study also addresses the current lack of quick and cost-effective assessments of cognitive flexibility by establishing the utility of two proposed biomarkers, heart rate variability and salivary oxytocin. METHOD We will conduct a single-group, within-subjects trial of an established CRT protocol delivered remotely as an adjunct to inpatient or intensive outpatient treatment as usual (TAU) to adult patients (n = 42) with comorbid AN and ExD. Assessments, including self-report, neuropsychological, and biomarker measurements, will occur at three time points. RESULTS We expect CRT to increase cognitive flexibility transdiagnostically and consequently, along with TAU, positively impact AN and ExD compulsivity and symptom severity, including weight gain. DISCUSSION Findings will inform the development of more effective integrative interventions for AN and ExD targeting shared mechanisms and facilitate the routine assessment of cognitive flexibility as a transdiagnostic risk and maintaining factor across psychopathologies in clinical and research settings. PUBLIC SIGNIFICANCE Patients with anorexia nervosa often engage in excessive exercise, leading to harmful outcomes, including increased suicidal behavior. This study examines the preliminary efficacy of an intervention that fosters flexible and holistic thinking in patients with problematic eating and exercise to, along with routine treatment, decrease harmful exercise symptoms. This study also examines new biological markers of the inflexible thinking style thought to be characteristic of anorexia nervosa and exercise dependence.
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Affiliation(s)
- McKenzie L Miller
- Department of Psychology, University at Albany, Albany, New York, USA
| | | | - C Alix Timko
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Philadelphia, USA
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, The Children's Hospital of Philadelphia, Philadelphia, Philadelphia, USA
| | - Julia M Hormes
- Department of Psychology, University at Albany, Albany, New York, USA
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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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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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12
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Griffiths MD, Landolfi E, Szabo A. Does Exercise Addiction Exist Among Individuals Engaged in Team-Based Exercise? A Position Paper. Int J Ment Health Addict 2023. [DOI: 10.1007/s11469-023-01039-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
Abstract
AbstractExercise addiction is a term used to describe dysfunctional exercise behavior characterized by the classic symptoms of addictions, which eventually result in physical, psychological, or social harm to the affected individual. While well over 1000 peer-reviewed papers on problematic exercise have been published, very few studies have explored the conceptual differences between team-based and individual-based exercise, and no previous study has critically addressed this issue. The rationale for this distinction is that team-based exercise is typically organized and scheduled by others with little or no control over its timing by the individual team member. On the contrary, individual-based exercise can be self-scheduled. Consequently, more (total) control over its timing facilitates the satisfaction of craving-induced urges characterized by an addiction. It is posited that exercise addicts, in general, are “lone wolves” in the context of their addiction. Therefore, being addicted to exercise in team sports is only possible if the individual resorts to additional individually-controlled exercise above and beyond team-based training. To support this position, the present paper briefly reviews the few studies conducted in this area and examines how their results match the diagnostic interpretation of “addiction.” The present position paper highlights that “control” over the addictive behavior, in this case, exercise, is an important marker in the potential for the risk of exercise addiction. Therefore, future studies should consider that team-based exercise assigns little control to the individual. However, the extent to which additional individual-based exercise occurs and poses a risk of addiction within team exercises merits further research attention.
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A qualitative investigation of the phenomenology of muscle dysmorphia: Part 2. Body Image 2023; 44:78-92. [PMID: 36549091 DOI: 10.1016/j.bodyim.2022.12.001] [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: 08/06/2022] [Revised: 11/27/2022] [Accepted: 12/01/2022] [Indexed: 12/24/2022]
Abstract
Muscle dysmorphia (MD) is a mental disorder characterised by preoccupation that one lacks muscularity and/or leanness, leading to substantial functional impairment. This article is the second of a two-part qualitative study examining the phenomenology of MD among 29 adults with diagnosed MD. We used reflexive thematic analysis to generate five themes which capture the role of exercise in the lives of people with MD. In summary, participants were highly motivated by a constant desire to progress their strength and appearance, and bad or missed workouts which threatened to derail their progress were associated with acute mental health impairment. Most participants scheduled rest days and modified workouts, both for muscle building-related goals and to reduce the risk of injuries, but often continued to exercise when sick. Alongside appearance-driven motivations, participants reported exercising for a variety of non-appearance-related reasons, including to structure their daily lives, boost self-esteem, regulate affect, and gain a sense of control from being able to manipulate their body composition. Exercise was often regarded as a core part of one's identity and overwhelmingly perceived as a net positive behaviour. Sample participant resistance training and cardio routines are described in detail within this article.
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14
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Narducci DM. Black box warning: when exercise is not medicine. Br J Sports Med 2023; 57:134-136. [PMID: 36609351 DOI: 10.1136/bjsports-2022-106291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2022] [Indexed: 01/09/2023]
Affiliation(s)
- Dusty Marie Narducci
- Department of Family Medicine and Department of Sports Medicine, University of South Florida, Tampa, Florida, USA
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15
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Quesnel DA, Cooper M, Fernandez-Del-Valle M, Reilly A, Calogero RM. Medical and physiological complications of exercise for individuals with an eating disorder: A narrative review. J Eat Disord 2023; 11:3. [PMID: 36627654 PMCID: PMC9832767 DOI: 10.1186/s40337-022-00685-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 11/01/2022] [Indexed: 01/12/2023] Open
Abstract
Individuals with eating disorders (ED) experience prolonged malnutrition, binge episodes, and compensatory behaviours that affect every organ system. Psychological and physiological symptoms are worsened with comorbid dysfunctional exercise, seen in up to 80% of those with an ED. Although return to exercise is an important component of treatment and recovery, little is known about the contraindications and risks of exercise engagement specific to those with an ED. This paper provides a comprehensive narrative review of the medical and physiological complications of engaging in exercise during ED treatment and outlines when exercise may be contraindicated or used in modified or cautionary ways. We conducted a literature search on MEDLINE, PubMed, and PsychArticles to identify relevant articles, which yielded six categories of medical and physiological complications of ED that may be exacerbated by exercise: energy availability, cardiovascular health, electrolyte abnormalities, biomedical function markers, sex hormones, and body composition. We summarize the evidence for these complications for readers and offer an initial set of recommendations for incorporating exercise during ED treatment based on our findings. This review may serve as a resource for members of ED treatment teams to help evaluate more readily and confidently whether exercise is safe for individual patients and when modifications and caution may be warranted.
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Affiliation(s)
- Danika A Quesnel
- Department of Psychological Clinical Science, University of Toronto, 320 Huron Street, Toronto, ON, M5S 3J7, Canada.
| | - Marita Cooper
- Department of Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Maria Fernandez-Del-Valle
- Department of Functional Biology, University of Oviedo, Oviedo, Spain.,Health Research Institute of the Principality of Asturias (ISPA), Oviedo, Spain
| | - Alanah Reilly
- Alanah Reilly Exercise Physiologist, Brisbane, Australia
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Remilly M, Mauvieux B, Drigny J. Personality Traits Associated with the Risk of Exercise Dependence in Ultraendurance Athletes: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1042. [PMID: 36673797 PMCID: PMC9858902 DOI: 10.3390/ijerph20021042] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 12/30/2022] [Accepted: 12/31/2022] [Indexed: 06/17/2023]
Abstract
Exercise dependence (ED) is common in endurance athletes and can lead to physical and psychological distress with various health effects. We designed a prospective cross-sectional study to investigate the personality traits associated with ED among ultraendurance athletes. A total of 507 participants (41.6 (9.8) years, men: 73.7%) completed (1) a screening questionnaire about sociodemographic data, sporting habits, and healthcare data, (2) the Exercise Dependence Scale-Revised (EDS-R, 21 items scored from 1 (never) to 6 (always), 7 subscales), (3) the Big Five Inventory (BFI), and (4) 2 items of the SCOFF (Sick-Control-One Stone-Fat-Food) questionnaire regarding possible eating disorders. Based on the EDS-R scores, 37 (7.3%) participants were at risk for ED (scores ≥ 5/6 on ≥3 subscales), 366 (72.2%) were nondependent but symptomatic (scores ≥ 3/6 on ≥3 subscales), and 104 (20.5%) were asymptomatic. Participants with ED had a greater training volume and a higher prevalence of possible eating disorders. A higher level of neuroticism was associated with increased EDS-R scores (r = 0.294; p < 0.001), with significantly higher scores in the ED group (F = 14.50, p < 0.001). The association between neuroticism and ED was not moderated by the presence of eating disorders. These findings will help to screen ultraendurance athletes at risk for ED and optimize their care.
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Affiliation(s)
- Marion Remilly
- Normandie Univ, UNICAEN, CHU de Caen Normandie, Service de Médecine du Sport, 14000 Caen, France
| | - Benoit Mauvieux
- Normandie Univ, UNICAEN, INSERM, COMETE, GIP CYCERON, 14000 Caen, France
| | - Joffrey Drigny
- Normandie Univ, UNICAEN, CHU de Caen Normandie, Normandie University, Service de Médecine du Sport, Service de Médecine Physique et de Réadaptation, INSERM, COMETE, GIP CYCERON, 14000 Caen, France
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17
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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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18
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Wons O, Lampe E, Patarinski AG, Schaumberg K, Butryn M, Juarascio A. Perceived influence of wearable fitness trackers on eating disorder symptoms in a clinical transdiagnostic binge eating and restrictive eating sample. Eat Weight Disord 2022; 27:3367-3377. [PMID: 36006603 PMCID: PMC9403232 DOI: 10.1007/s40519-022-01466-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 07/31/2022] [Indexed: 01/06/2023] Open
Abstract
Wearable fitness trackers are an increasingly popular tool for measuring physical activity (PA) due their accuracy and momentary data collection abilities. Despite the benefits of using wearable fitness trackers, there is limited research in the eating disorder (ED) field using wearable fitness trackers to measure PA in the context of EDs. Wearable fitness trackers are often underused in ED research because there is limited knowledge about whether wearable fitness trackers negatively or positively impact PA engagement and ED symptoms in individuals with EDs. The current study aimed to assess the perceived impact wearable fitness trackers have on PA engagement and ED symptoms over a 12-week CBT treatment for 30 individuals with binge eating and restrictive eating that presented to treatment engaging or not engaging in maladaptive exercise. Participants in the maladaptive exercise group (n = 17) and non-maladaptive exercise group (n = 13) wore a fitness tracker for 12 weeks and completed questionnaires assessing participants' perceptions of the fitness trackers' influence on ED symptoms and PA engagement throughout treatment. Results demonstrated a small percentage of individuals perceived the fitness tracker influenced ED behaviors or PA engagement, and there were mixed results on whether participants positively or negatively perceived the fitness tracker influenced them to engage in ED behaviors or PA engagement. Although preliminary, these results demonstrate the need to continue using objective measurements of PA via wearable fitness trackers to further our understanding of the positive and negative effects of fitness trackers on clinical ED samples.Level of Evidence: Level 1, randomized controlled trial.
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Affiliation(s)
- Olivia Wons
- Department of Psychological and Brain Sciences, Drexel University, Stratton Hall, 3141 Chestnut Street, Philadelphia, PA, 19104, USA.
- Center for Weight, Eating, and Lifestyle Science, Drexel University, Stratton Hall, 3141 Chestnut Street, Philadelphia, PA, 19104, USA.
| | - Elizabeth Lampe
- Department of Psychological and Brain Sciences, Drexel University, Stratton Hall, 3141 Chestnut Street, Philadelphia, PA, 19104, USA
- Center for Weight, Eating, and Lifestyle Science, Drexel University, Stratton Hall, 3141 Chestnut Street, Philadelphia, PA, 19104, USA
| | - Anna Gabrielle Patarinski
- Center for Weight, Eating, and Lifestyle Science, Drexel University, Stratton Hall, 3141 Chestnut Street, Philadelphia, PA, 19104, USA
| | - Katherine Schaumberg
- Department of Psychiatry, University of Wisconsin-Madison, 6001 Research Park Blvd, Madison, WI, 53719, USA
| | - Meghan Butryn
- Department of Psychological and Brain Sciences, Drexel University, Stratton Hall, 3141 Chestnut Street, Philadelphia, PA, 19104, USA
- Center for Weight, Eating, and Lifestyle Science, Drexel University, Stratton Hall, 3141 Chestnut Street, Philadelphia, PA, 19104, USA
| | - Adrienne Juarascio
- Department of Psychological and Brain Sciences, Drexel University, Stratton Hall, 3141 Chestnut Street, Philadelphia, PA, 19104, USA
- Center for Weight, Eating, and Lifestyle Science, Drexel University, Stratton Hall, 3141 Chestnut Street, Philadelphia, PA, 19104, USA
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19
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Martenstyn JA, Maguire S, Griffiths S. A qualitative investigation of the phenomenology of muscle dysmorphia: Part 1. Body Image 2022; 43:486-503. [PMID: 36356368 DOI: 10.1016/j.bodyim.2022.10.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 10/18/2022] [Accepted: 10/19/2022] [Indexed: 11/09/2022]
Abstract
Muscle dysmorphia (MD) is a psychological disorder defined by preoccupation with one's perceived lack of muscularity and/or leanness, causing significant functional impairment. Studies of individuals with diagnosed MD are rare and no large-scale qualitative studies of the disorder exist. We conducted a qualitative study exploring the lived experiences of 29 individuals with diagnosed MD. Using reflexive thematic analysis, we generated five themes capturing the core features of MD. We identified two distinct phenotypes of MD: a "muscular/lean phenotype" focused on both gaining muscle and remaining lean, and a "muscular phenotype" with a sole preoccupation of increasing muscle mass. Participants also described their physique goals as never-obtained "moving goalposts", differed in their desire for muscularity versus leanness, and experienced fluctuations in body dissatisfaction during "cutting" versus "bulking" phases, and pre- versus post-workout. Almost all participants reported avoiding public body exposure and compulsively mirror-checking. Most were rigorous dieters who meticulously tracked their caloric and macronutrient intake, and were obsessive about meeting protein targets. Disruptions to dieting and training were often minimised by compromising their social lives. Low self-esteem appeared a predisposing factor for MD, while social comparison, body image distortion, and integration of MD into one's self-identity may represent maintaining factors. Additional clinically valuable insights into MD's phenomenology are discussed in detail.
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Affiliation(s)
- Jordan A Martenstyn
- Clinical Psychology Unit, School of Psychology, The University of Sydney, Camperdown, NSW, Australia; InsideOut Institute for Eating Disorders, Charles Perkins Centre, The University of Sydney, Camperdown, NSW, Australia.
| | - Sarah Maguire
- InsideOut Institute for Eating Disorders, Charles Perkins Centre, The University of Sydney, Camperdown, NSW, Australia; Sydney Local Health District, NSW Health, St Leonards, NSW, Australia
| | - Scott Griffiths
- Melbourne School of Psychological Sciences, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, VIC, Australia
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20
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Galvin J, Evans EH, Talbot CV, Wilson C, Richards G. The associations between autistic traits and disordered eating/drive for muscularity are independent of anxiety and depression in females but not males. PLoS One 2022; 17:e0276249. [PMID: 36251679 PMCID: PMC9576073 DOI: 10.1371/journal.pone.0276249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 10/03/2022] [Indexed: 11/19/2022] Open
Abstract
Previous research has shown a positive correlation between autistic traits and eating disorder symptoms, and this relationship appears to be independent of co-occurring mental health status. The current study followed a pre-registered analysis plan with the aim to investigate a previously unconsidered factor in the relationship between autistic traits and disorders of eating and body image: the drive for muscularity. Participants (N = 1068) completed the Autism Spectrum Quotient (AQ), Hospital Anxiety and Depression Scale (HADS), Eating Attitudes Test-26 (EAT-26) and Drive for Muscularity Scale (DMS). Positive correlations between AQ and EAT-26 and AQ and DMS were observed. In females, AQ remained significantly correlated with EAT-26 and DMS when controlling for co-occurring anxiety and depression symptoms, but this was not the case in males. These findings demonstrate the moderating role of sex, and the need to consider autistic traits in individuals diagnosed with, or at a heightened risk for, disorders of eating and body image.
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Affiliation(s)
- John Galvin
- Department of Psychology, Birmingham City University, Birmingham, United Kingdom
| | | | | | - Claire Wilson
- School of Education, University of Strathclyde, Glasgow, United Kingdom
| | - Gareth Richards
- Faculty of Medical Sciences, School of Psychology, Newcastle University, Newcastle upon Tyne, United Kingdom
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21
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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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22
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Kolar DR, Kaurin A, Meule A, Schlegl S, Dittmer N, Voderholzer U. Interpersonal, affective and compulsive features of driven exercise in anorexia nervosa. J Affect Disord 2022; 307:53-61. [PMID: 35337926 DOI: 10.1016/j.jad.2022.03.044] [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: 11/19/2021] [Revised: 03/15/2022] [Accepted: 03/17/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND This preregistered (https://osf.io/g9ajb) analysis sought to integrate the current literature on trait compulsivity into maintenance models of driven exercise in anorexia nervosa (AN). We tested whether compulsivity increases the likelihood of driven exercise via interpersonal and affect-regulatory pathways. METHODS We used multilevel structural equation modeling to test the hypothesis that trait compulsivity predicts a stronger within-person link between affect-regulatory difficulties or interpersonal sensitivity and driven exercise in female adolescents and adults with AN. We used data from five assessments across inpatient treatment and 6-months follow-up of 207 adult and adolescent patients with AN (1035 datapoints). RESULTS In line with our hypotheses, patients who generally experienced more affect-regulatory difficulties or stronger interpersonal sensitivity tended to engage in driven exercise more strongly. Moreover, high levels of trait compulsivity amplified the effect of interpersonal sensitivity on driven exercise across time. Contrary to our hypotheses, the link between affect regulation and driven exercise was not moderated by compulsivity. Similar effects on general eating disorder psychopathology were found, but no cross-level moderation effect of compulsivity. LIMITATIONS Due to sample size, potential AN subtype-dependent effects were not analyzed. CONCLUSION Our results suggest that driven exercise coincides with self-reported experiences of interpersonal sensitivity and that this link varies as a function of compulsivity such that the within-person coupling is stronger among those scoring high on compulsivity. To derive clinically useful functional models of driven exercise, future studies might use intensive longitudinal data to investigate its momentary associations with affect and interpersonal sensitivity in the context of compulsive traits.
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Affiliation(s)
- D R Kolar
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany.
| | - A Kaurin
- Faculty of Health/School of Psychology and Psychiatry, Witten/Herdecke University, Witten, Germany
| | - A Meule
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany; Schoen Clinic Roseneck, Prien am Chiemsee, Germany
| | - S Schlegl
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany; Schoen Clinic Roseneck, Prien am Chiemsee, Germany
| | - N Dittmer
- Schoen Clinic Roseneck, Prien am Chiemsee, Germany
| | - U Voderholzer
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany; Schoen Clinic Roseneck, Prien am Chiemsee, Germany; Department of Psychiatry and Psychotherapy, University Medical Center Freiburg, Freiburg, Germany
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23
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Martenstyn JA, Jeacocke NA, Pittman J, Touyz S, Maguire S. Treatment Considerations for Compulsive Exercise in High-Performance Athletes with an Eating Disorder. SPORTS MEDICINE - OPEN 2022; 8:30. [PMID: 35239063 PMCID: PMC8894522 DOI: 10.1186/s40798-022-00425-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 02/13/2022] [Indexed: 01/11/2023]
Abstract
Compulsive exercise is linked with poorer treatment outcomes in people with eating disorder (EDs). High-performance athletes represent a growing and complex subcomponent of the broader ED population, and emergent evidence indicates that different conceptualisations of compulsive exercise are needed in this population. Existing randomised controlled trials in ED populations have demonstrated small treatment effects on compulsive exercise compared with control groups; however, athletes were sparsely sampled across these studies. Thus, the extent to which current treatments for compulsive exercise in EDs are also effective in high-performance athletes is unknown. For this opinion paper, we sought representation from high-performance sports leadership, someone with lived experience of both an ED and high-performance athletics, and ED clinical experts. We discuss the utility of recommending exercise abstinence in ED treatment with athletes, as well as a number of other treatment strategies with some evidence in other contexts for further consideration and research in this population. These include using mindfulness-based interventions as an adjunct to cognitive-behavioural therapies, using wearable technologies and self-reported fatigue to inform training decisions, and incorporating greater exercise variation into training programs. We also offer practical considerations for clinicians seeking to apply foundational elements of cognitive-behavioural interventions (e.g., exposure and response prevention, cognitive restructuring, behavioural experiments) into an ED treatment program for a high-performance athlete. Future research is needed to examine characteristics of pathological compulsive exercise in athletes and whether available treatments are both feasible and effective in the treatment of compulsive exercise in athletes with an ED.
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Affiliation(s)
- Jordan A Martenstyn
- Clinical Psychology Unit, School of Psychology, The University of Sydney, Sydney, NSW, Australia. .,InsideOut Institute for Eating Disorders, Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia.
| | | | - Jana Pittman
- School of Medicine, Blacktown Hospital, Western Sydney University, Sydney, NSW, Australia
| | - Stephen Touyz
- InsideOut Institute for Eating Disorders, Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
| | - Sarah Maguire
- InsideOut Institute for Eating Disorders, Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia.,Sydney Local Health District, NSW Health, St Leonards, Sydney, NSW, Australia
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24
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Ruiz-Turrero J, Massar K, Kwasnicka D, Ten Hoor GA. The Relationship between Compulsive Exercise, Self-Esteem, Body Image and Body Satisfaction in Women: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031857. [PMID: 35162878 PMCID: PMC8835063 DOI: 10.3390/ijerph19031857] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 02/05/2022] [Accepted: 02/05/2022] [Indexed: 02/01/2023]
Abstract
Purpose: In this study, we aimed to test the relationship between compulsive exercise and self-esteem, body image, and body satisfaction as potential predictors of eating disorders. Methods: Self-report measures of compulsive exercise beliefs and behaviors, self-esteem, body image, and body satisfaction, were completed by 120 female participants through an online questionnaire. Factor analyses with varimax rotation were performed to create exercise-frequency groups. ANOVA’s were performed on Body Mass Index (weight adjusted for height squared, BMI), current minus ideal weight, self-esteem, body image, and body satisfaction to determine if there were differences depending on these exercise groups. Results: Factor analysis revealed two factors for compulsive exercise beliefs and behaviors: (1) Exercise Fixation, and (2) Exercise Frequency and Commitment. Based on those factors, participants were subdivided into four clusters: (1) pathological obligatory exercisers, (2) exercise fixators, (3) committed exercisers, and (4) non-exercisers. No differences were found between these groups for BMI or current minus ideal weight. Pathological obligatory exercisers and committed exercisers spend significantly more hours on exercise weekly compared to exercise fixators or non-exercisers. No differences between pathological obligatory exercisers, exercise fixators, and non-exercisers were found on self-esteem or body satisfaction, where the committed exercisers scored significantly better. Both committed exercisers and non-exercisers scored significantly better on body image flexibility compared to pathological obligatory exercisers and exercise fixators. Conclusion: Compulsive exercise has both an exercise volume and an emotional component. The level of compulsive exercise is linked to one’s self-esteem, body image, and body satisfaction and those factors could be a target for future interventions.
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Affiliation(s)
- Juncal Ruiz-Turrero
- Department of Work and Social Psychology, Maastricht University, P.O. Box 616, 6200MD Maastricht, The Netherlands; (J.R.-T.); (K.M.)
| | - Karlijn Massar
- Department of Work and Social Psychology, Maastricht University, P.O. Box 616, 6200MD Maastricht, The Netherlands; (J.R.-T.); (K.M.)
| | - Dominika Kwasnicka
- Faculty of Psychology, SWPS University of Social Sciences and Humanities, Aleksandra Ostrowskiego 30b, 53-238 Wrocław, Poland;
- NHMRC CRE in Digital Technology to Transform Chronic Disease Outcomes, School of Population and Global Health, University of Melbourne, 333 Exhibition Street, Melbourne 3000, Australia
| | - Gill A. Ten Hoor
- Department of Work and Social Psychology, Maastricht University, P.O. Box 616, 6200MD Maastricht, The Netherlands; (J.R.-T.); (K.M.)
- Correspondence:
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25
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Coniglio KA, Cooper M, Selby EA. Behavioral reinforcement of pathological exercise in anorexia nervosa. Int J Eat Disord 2022; 55:184-192. [PMID: 34626127 DOI: 10.1002/eat.23626] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 09/29/2021] [Accepted: 09/29/2021] [Indexed: 12/29/2022]
Abstract
Pathological exercise in anorexia nervosa (AN) is a harmful behavior associated with a chronic course and poor prognosis. To date, no comprehensive theoretical model exists to describe pathological exercise in the context of AN, and as such, few treatments are effective at promoting direct and sustained pathological exercise extinction. Using a framework put forth by Wise & Koob (2014), debating the relative importance of positive and negative reinforcement in substance use, we present three hypotheses of behavioral reinforcement of exercise, encompassing biological, psychological, and environmental influences. Specifically, we argue that exercise is positively reinforced through receipt of biological and behavioral rewards, negatively reinforced through avoidance of aversive emotions, and that these two systems work in tandem over time to engrain pathological exercise as a habit. We then present suggestions for testing each of these hypotheses as future directions for the field.
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Affiliation(s)
- Kathryn A Coniglio
- Department of Psychology, Rutgers, The State University of New Jersey, New Brunswick, New Jersey, USA
| | - Marita Cooper
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Edward A Selby
- Department of Psychology, Rutgers, The State University of New Jersey, New Brunswick, New Jersey, USA
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26
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Beeler JA, Mourra D, Zanca RM, Kalmbach A, Gellman C, Klein BY, Ravenelle R, Serrano P, Moore H, Rayport S, Mingote S, Burghardt NS. Vulnerable and Resilient Phenotypes in a Mouse Model of Anorexia Nervosa. Biol Psychiatry 2021; 90:829-842. [PMID: 32950210 PMCID: PMC7855473 DOI: 10.1016/j.biopsych.2020.06.030] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 06/26/2020] [Accepted: 06/30/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Increased physical activity is a common feature of anorexia nervosa (AN). Although high activity levels are associated with greater risk of developing AN, particularly when combined with dieting, most individuals who diet and exercise maintain a healthy body weight. It is unclear why some individuals develop AN while most do not. A rodent model of resilience and vulnerability to AN would be valuable to research. Dopamine, which is believed to play a crucial role in AN, regulates both reward and activity and may modulate vulnerability. METHODS Adolescent and young adult female C57BL/6N mice were tested in the activity-based anorexia (ABA) model, with an extended period of food restriction in adult mice. ABA was also tested in dopamine transporter knockdown mice and wild-type littermates. Mice that adapted to conditions and maintained a stable body weight were characterized as resilient. RESULTS In adults, vulnerable and resilient phenotypes emerged in both the ABA and food-restricted mice without wheels. Vulnerable mice exhibited a pronounced increase in running throughout the light cycle, which dramatically peaked prior to requiring removal from the experiment. Resilient mice exhibited an adaptive decrease in total running, appropriate food anticipatory activity, and increased consumption, thereby achieving stable body weight. Hyperdopaminergia accelerated progression of the vulnerable phenotype. CONCLUSIONS Our demonstration of distinct resilient and vulnerable phenotypes in mouse ABA significantly advances the utility of the model for identifying genes and neural substrates mediating AN risk and resilience. Modulation of dopamine may play a central role in the underlying circuit.
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Affiliation(s)
- Jeff A. Beeler
- Dept. of Psychology, Queens College and The Graduate Center, CUNY, Flushing, NY, 11367 USA
| | - Devry Mourra
- Dept. of Psychology, Queens College and The Graduate Center, CUNY, Flushing, NY, 11367 USA
| | - Roseanna M. Zanca
- Dept. of Psychology, Hunter College and The Graduate Center, CUNY, New York, NY, 10065 USA
| | - Abigail Kalmbach
- Dept. of Psychiatry, Columbia University, New York, NY, 10032 USA
| | - Celia Gellman
- Dept. of Psychiatry, Columbia University, New York, NY, 10032 USA,Dept. of Molecular Therapeutics, NYS Psychiatric Institute, New York, NY 10032 USA
| | - Benjamin Y. Klein
- Dept. of Psychiatry, Columbia University, New York, NY, 10032 USA,Dept. of Developmental Neuroscience, NYS Psychiatric Institute, New York, NY 10031 USA,Dept. of Microbiology and Molecular Genetics, Hebrew University, Jerusalem, Israel
| | | | - Peter Serrano
- Dept. of Psychology, Hunter College and The Graduate Center, CUNY, New York, NY, 10065 USA
| | - Holly Moore
- Dept. of Psychiatry, Columbia University, New York, NY, 10032 USA,Dept. of Systems Neuroscience, NYS Psychiatric Institute, New York, NY 10032 USA,National Institute on Drug Abuse, Bethesda, MD
| | - Stephen Rayport
- Dept. of Psychiatry, Columbia University, New York, NY, 10032 USA,Dept. of Molecular Therapeutics, NYS Psychiatric Institute, New York, NY 10032 USA
| | - Susana Mingote
- Dept. of Psychiatry, Columbia University, New York, NY, 10032 USA,Dept. of Molecular Therapeutics, NYS Psychiatric Institute, New York, NY 10032 USA,Advanced Science Research Center, The Graduate Center, CUNY, New York, NY 10031 USA
| | - Nesha S. Burghardt
- Dept. of Psychology, Hunter College and The Graduate Center, CUNY, New York, NY, 10065 USA,Dept. of Psychiatry, Columbia University, New York, NY, 10032 USA
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27
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Fan H, Gan Y, Wang R, Chen S, Lipowska M, Li J, Li K, Krokosz D, Yang Y, Lipowski M. The Relationship between Obligatory Exercise and Eating Attitudes, and the Mediating Role of Sociocultural Attitudes towards Appearance during the COVID-19 Pandemic. Nutrients 2021; 13:4286. [PMID: 34959839 PMCID: PMC8709158 DOI: 10.3390/nu13124286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/23/2021] [Accepted: 11/26/2021] [Indexed: 01/07/2023] Open
Abstract
A strong sociocultural context could affect an individual's aesthetic standards. In order to achieve a socially recognized ideal appearance, obligatory exercisers might increase dieting behavior when exercise actions are disturbed, thereby placing the individual at risk of eating disorders. The current study mainly examined the relationship between obligatory exercise and eating attitudes during the COVID-19 pandemic, and considered the mediating role of externalized sociocultural attitudes towards appearance between the two. A total of 342 participants (175 females, 167 males) from various regions of China were invited to fill out the questionnaires including the Obligatory Exercise Questionnaire, the Sociocultural Attitudes Toward Appearance Questionnaire-3, and the Eating Attitudes Test. In total, 51.5% of the participants presented symptoms of an obligatory exercise behavior. Among them, males, young adults, and the participants with lower BMI had higher OEQ scores, whereas females and young adults had higher EAT-26 scores. Meanwhile, 9.4% of the participants might have had an eating disorder. The OEQ score was positively correlated with the EAT-26 total score as well as SATAQ-3 'Pressures' and 'Information' subscales. In addition, the EAT-26 total score was positively correlated with the SATAQ-3 'Pressures' and 'Information' subscales. Externalized sociocultural attitudes towards appearance served as a mediator between obligatory exercise behavior and eating attitudes, and the mediation effect accounted for 56.82% of the total effect. Obligatory exercise behavior may have an indirect effect on eating attitudes through sociocultural attitudes towards appearance. Given the sociocultural information and pressures, in order to maintain or pursue an ideal appearance, many people tend to keep a pathological diet. Thus, forming a positive and healthy social aesthetic orientation is beneficial in helping obligatory exercisers to develop reasonable eating habits.
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Affiliation(s)
- Hongying Fan
- School of Psychology, Beijing Sport University, Beijing 100084, China; (Y.G.); (R.W.); (S.C.); (Y.Y.)
| | - Youteng Gan
- School of Psychology, Beijing Sport University, Beijing 100084, China; (Y.G.); (R.W.); (S.C.); (Y.Y.)
| | - Ruohang Wang
- School of Psychology, Beijing Sport University, Beijing 100084, China; (Y.G.); (R.W.); (S.C.); (Y.Y.)
| | - Siming Chen
- School of Psychology, Beijing Sport University, Beijing 100084, China; (Y.G.); (R.W.); (S.C.); (Y.Y.)
| | | | - Jianye Li
- Faculty of Physical Culture, Gdańsk University of Physical Education and Sport, Górskiego 1, 80-336 Gdańsk, Poland; (J.L.); (K.L.); (D.K.)
| | - Keqiang Li
- Faculty of Physical Culture, Gdańsk University of Physical Education and Sport, Górskiego 1, 80-336 Gdańsk, Poland; (J.L.); (K.L.); (D.K.)
| | - Daniel Krokosz
- Faculty of Physical Culture, Gdańsk University of Physical Education and Sport, Górskiego 1, 80-336 Gdańsk, Poland; (J.L.); (K.L.); (D.K.)
| | - Yin Yang
- School of Psychology, Beijing Sport University, Beijing 100084, China; (Y.G.); (R.W.); (S.C.); (Y.Y.)
| | - Mariusz Lipowski
- Faculty of Physical Culture, Gdańsk University of Physical Education and Sport, Górskiego 1, 80-336 Gdańsk, Poland; (J.L.); (K.L.); (D.K.)
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28
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Bergmeier HJ, Morris H, Mundell N, Skouteris H. What role can accredited exercise physiologists play in the treatment of eating disorders? A descriptive study. Eat Disord 2021; 29:561-579. [PMID: 31818224 DOI: 10.1080/10640266.2019.1701351] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Including exercise alongside other therapeutic approaches may help to address dysfunctional exercise use and improve eating disorder treatment outcomes. However, traditional treatment teams often lack the expertise needed to safely prescribe exercise. The aims of this study were to explore the perceptions and experiences of Accredited Exercise Physiologists (AEPs) relating to working with clients diagnosed with eating disorders to identify the role they play in the treatment of eating disorders and identify future training needs. Individual semi-structured telephone interviews were conducted with 12 (n = 9 females) AEPs working in the eating disorders field. Thematic analysis was conducted to extract major themes from the interview transcripts. Five major themes were identified: (1) The role of AEPs in the treatment of individuals with eating disorders is comprehensive; (2) Treatment is more effective when all components are addressed; (3) The absence of therapeutic exercise within standard treatment protocols reflects limitations of traditional scope of practice and knowledge about the role of AEPs; (4) Methods of acquiring further knowledge are insufficient for those in current practice; and (5) Accredited comprehensive training is currently unavailable but needed. This qualitative study showed that AEPs believe they can play a major role in the treatment of eating disorders and that treatment outcomes for individuals are likely to be greatly enhanced when dysfunctional exercise is addressed. Multidisciplinary training is needed.
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Affiliation(s)
- Heidi J Bergmeier
- Monash Centre for Health Research and Implementation, Monash University, Clayton, Australia
| | - Heather Morris
- Monash Centre for Health Research and Implementation, Monash University, Clayton, Australia
| | - Niamh Mundell
- Institute for Physical Activity and Nutrition, Deakin University, Burwood, Australia
| | - Helen Skouteris
- Monash Centre for Health Research and Implementation, Monash University, Clayton, Australia
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29
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Smith LL. The Central Role of Hypothermia and Hyperactivity in Anorexia Nervosa: A Hypothesis. Front Behav Neurosci 2021; 15:700645. [PMID: 34421554 PMCID: PMC8377352 DOI: 10.3389/fnbeh.2021.700645] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 06/24/2021] [Indexed: 12/24/2022] Open
Abstract
Typically, the development of anorexia nervosa (AN) is attributed to psycho-social causes. Several researchers have recently challenged this view and suggested that hypothermia and hyperactivity (HyAc) are central to AN. The following hypothesis will attempt to clarify their role in AN. Anorexia nervosa patients (ANs) have significantly lower core temperatures (Tcore) compared to healthy controls (HCs). This reduced temperature represents a reset Tcore that needs to be maintained. However, ANs cannot maintain this Tcore due primarily to a reduced basal metabolic rate (BMR); BMR usually supplies heat to sustain Tcore. Therefore, to generate the requisite heat, ANs revert to the behavioral-thermoregulatory strategy of HyAc. The majority of ANs (~89%) are reportedly HyAc. Surprisingly, engagement in HyAc is not motivated by a conscious awareness of low Tcore, but rather by the innocuous sensation of "cold- hands" frequently reported by ANs. That is, local hand-thermoreceptors signal the brain to initiate HyAc, which boosts perfusion of the hands and alters the sensation of "cold-discomfort" to one of "comfort." This "rewarding" consequence encourages repetition/habit formation. Simultaneously, hyperactivity increases the availability of heat to assist with the preservation of Tcore. Additionally, HyAc induces the synthesis of specific brain neuromodulators that suppress food intake and further promote HyAc; this outcome helps preserve low weight and perpetuates this vicious cycle. Based on this hypothesis and supported by rodent research, external heat availability should reduce the compulsion to be HyAc to thermoregulate. A reduction in HyAc should decrease the production of brain neuromodulators that suppress appetite. If verified, hopefully, this hypothesis will assist with the development of novel treatments to aid in the resolution of this intractable condition.
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Affiliation(s)
- Lucille Lakier Smith
- Human Performance Laboratory, Department of Kinesiology, School of Health Sciences, East Carolina University, Greenville, NC, United States
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30
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Harrison AN, Rocke KD, James Bateman C, Bateman A, Chang SM. Physical activity and disordered eating behaviours: Are Caribbean adolescents at risk? INTERNATIONAL JOURNAL OF PSYCHOLOGY 2021; 57:218-226. [PMID: 34398467 DOI: 10.1002/ijop.12802] [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: 10/04/2020] [Accepted: 07/24/2021] [Indexed: 11/06/2022]
Abstract
Excessive physical activity (PA) has been linked to increased risk for disordered eating behaviours and eating disorders. This study investigates the relationship between PA and disordered eating behaviours and attitudes (DEBAs) among Jamaican adolescents. This cross-sectional study included 521 adolescents, 12-19 years. Anthropometric measurements were collected, and adolescents completed questionnaires on disordered eating behaviours (EAT-26), physical activity, self-esteem and affect. Associations were assessed using sex-specific mixed-effect linear and logistic regression models. Participants reported exercising an average of 3 days per week. Adolescents who exercised for a longer duration had greater odds of having elevated EAT-26 scores (at least 1 hour-OR = 2.04; 95% CI = 1.03, 4.06; p = .042), while a higher exercise frequency among males (3-5 days per week) was protective against DEBAs (OR 0.38; 95% CI = 0.16, 0.88; p = .025). Female adolescents reported higher prevalence of elevated EAT-26 scores than males (p < .01). Increased negative affect increased odds of an elevated EAT-26 score. Exercise duration and frequency play a role in disordered eating behaviours in Jamaican adolescents and vary by gender. Our findings have implications for weight management interventions and policies, encouraging healthcare providers to monitor PA levels as well as negative affect in adolescents who display disordered eating behaviours.
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Affiliation(s)
- Abigail N Harrison
- Department of Child and Adolescent Health, The University of the West Indies, Mona, Jamaica
| | - Kern D Rocke
- The George Alleyne Chronic Disease Research Centre, The University of the West Indies, Bridgetown, Barbados
| | - Caryl James Bateman
- Department of Sociology, Psychology and Social Work, The University of the West Indies, Mona, Jamaica
| | - Andre Bateman
- Department of Kinesiology, Michigan State University
| | - Susan M Chang
- Caribbean Institute for Health Research, The University of the West Indies, Mona, Jamaica
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31
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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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32
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McDonald JB, Rancourt D. Treating Bulimia Nervosa and Achieving Medically Required Weight Loss: A Case Study. COGNITIVE AND BEHAVIORAL PRACTICE 2021. [DOI: 10.1016/j.cbpra.2021.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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33
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Beeler JA, Burghardt NS. Commentary on Vulnerability and Resilience to Activity-Based Anorexia and the Role of Dopamine. JOURNAL OF EXPERIMENTAL NEUROLOGY 2021; 2:21-28. [PMID: 33768216 PMCID: PMC7990270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Activity-based anorexia (ABA) is a commonly used rodent model of anorexia nervosa that is based on observations made in rats decades ago. In recently published work, we describe using this paradigm to model vulnerability and resilience to anorexia nervosa in mice, where vulnerability is characterized by hyperactivity and life-threatening weight loss and resilience is characterized by adaptation and weight stabilization. Using genetically modified hyperdopaminergic mice, we also demonstrate that increased dopamine augments vulnerability to ABA. Here, we briefly review our findings and discuss how obtaining vulnerable and resilient phenotypes enhances utility of the ABA model for understanding the neurobiological basis of anorexia nervosa. We comment on our dopamine findings and close by discussing implications for clinical treatment.
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Affiliation(s)
- Jeff A. Beeler
- Department of Psychology, Queens College, CUNY, Flushing, NY, 11367 USA,Department of Psychology, The Graduate Center, CUNY, New York, NY, 10016 USA,Department of Biology, The Graduate Center, CUNY, New York, NY, 10016 USA,CUNY Neuroscience Collaborative, The Graduate Center, CUNY, New York, NY, 10016 USA,Correspondence should be addressed to Jeff A Beeler; , Nesha Burghardt;
| | - Nesha S. Burghardt
- Department of Psychology, Hunter College, CUNY, New York, NY, 10065 USA,Department of Psychology, The Graduate Center, CUNY, New York, NY, 10016 USA,CUNY Neuroscience Collaborative, The Graduate Center, CUNY, New York, NY, 10016 USA,Correspondence should be addressed to Jeff A Beeler; , Nesha Burghardt;
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34
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Mang L, Garghan A, Grant J, Lacey H, Matthews R. An evaluation of efficacy and acceptability of a novel manualised JuniorLEAP group programme for compulsive exercise, for children and adolescents with anorexia nervosa, within an inpatient setting. Eat Weight Disord 2021; 26:591-597. [PMID: 32232776 DOI: 10.1007/s40519-020-00884-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 02/26/2020] [Indexed: 01/15/2023] Open
Abstract
PURPOSE Compulsive exercise is a symptom and a maintenance factor of eating disorders, which increases the risk of relapse. It has been considered a target for treatment, particularly for anorexia nervosa (AN). This audit aims to review the efficacy and acceptability of a new seven-week JuniorLEAP group therapy programme, for children and adolescents with anorexia nervosa. JuniorLEAP was adapted by the authors and based on the Loughborough Eating Disorder Activity Programme (LEAP) for adults. METHODS 32 children and adolescents with anorexia nervosa were allocated to the group in an in-patient setting using entry criteria. All children and adolescents completed seven weekly sessions of the JuniorLEAP programme, as well as pre- and post-treatment questionnaires, including the Eating Disorder Examination Questionnaire (EDE-Q) and the Compulsive Exercise Test (CET). The children and adolescents were also asked to provide qualitative responses about the acceptability of the group. A paired t test was conducted to review the efficacy of the JuniorLEAP programme. RESULTS Significant changes in eating disorder psychopathology was observed, as measured by the EDE-Q, with total mean scores reducing from 3.53 to 2.77 (p = 0.001). Compulsive exercise attitudes were also observed to reduce, as measured by the CET, with total mean scores reducing from 15.39 to 10.90 (p ≤ 0.001). Furthermore, there was a significant reduction in all five subscales of the CET following completion of the group. Qualitative results also demonstrate the group to be acceptable to the patients. CONCLUSION This study finds that a new manualised JuniorLEAP group therapy, specifically adapted for adolescents and children with AN, when used as an adjuvant with other therapies in a residential setting, significantly reduces their compulsive exercise, as measured by CET. The patients reported that the treatment was acceptable. Further research testing the new treatment in a randomised controlled trial is now needed, particularly to disentangle the impact of other aspects of standard treatment in reducing compulsive exercise. LEVEL OF EVIDENCE II.
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Affiliation(s)
| | | | | | - Hubert Lacey
- Newbridge House, Birmingham, UK. .,St. George's, University of London, London, UK.
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35
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Martenstyn JA, Touyz S, Maguire S. Treatment of compulsive exercise in eating disorders and muscle dysmorphia: protocol for a systematic review. J Eat Disord 2021; 9:19. [PMID: 33568203 PMCID: PMC7877054 DOI: 10.1186/s40337-021-00375-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 01/29/2021] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Compulsive exercise is a core feature of both eating disorders and muscle dysmorphia. Earlier models of treatment recommended complete abstinence from exercise in eating disorder populations, but recent guidelines advocate for the gradual inclusion of healthier forms of exercise into an overall treatment plan where appropriate. Given the association between problematic exercise behaviour and poorer prognosis, there has been a recent upsurge in the number of treatment interventions for compulsive exercise in eating disorders. However, no systematic review has been published summarising this existing treatment literature. The aim of this review is to determine the efficacy of existing treatments for compulsive exercise in eating disorders and muscle dysmorphia. METHODS A systematic review will be conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Five electronic databases (PsycInfo, MEDLINE, Embase, Web of Science, and Scopus) will be searched from database inception until November 2020. We will include studies that: (a) sampled adolescents and/or adults with either an eating disorder or muscle dysmorphia; (b) assessed changes in compulsive exercise from pre- to post-intervention; and (c) used a standardised instrument to measure compulsive exercise or related constructs. We will include studies with a comparison group (e.g., randomised controlled trials) and without a comparison group (e.g., pilot studies and case studies) to provide a comprehensive overview of the literature. One reviewer will screen all titles and abstracts against eligibility criteria, with 20% of excluded articles cross-referenced by another reviewer. Full texts will be obtained for articles deemed relevant or where inclusion was uncertain, and will be screened by both reviewers. We will also evaluate the quality of the included studies using a modified Downs and Black (J Epidemiol Community Health 52:377-384, 1998) assessment checklist. DISCUSSION Results from this review will help to determine the most efficacious treatment components for compulsive exercise in eating disorders and muscle dysmorphia. We hope that our results will help inform clinical practice guidelines in recommending targeted interventions for the treatment of compulsive exercise.
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Affiliation(s)
- Jordan Andre Martenstyn
- Clinical Psychology Unit, School of Psychology, The University of Sydney, Sydney, Australia.
- InsideOut Institute for Eating Disorders, The Boden Collaboration for Obesity, Nutrition, Exercise and Eating Disorders, The University of Sydney, Sydney, Australia.
| | - Stephen Touyz
- InsideOut Institute for Eating Disorders, The Boden Collaboration for Obesity, Nutrition, Exercise and Eating Disorders, The University of Sydney, Sydney, Australia
| | - Sarah Maguire
- InsideOut Institute for Eating Disorders, The Boden Collaboration for Obesity, Nutrition, Exercise and Eating Disorders, The University of Sydney, Sydney, Australia
- Sydney Local Health District, NSW Health, St Leonards, Australia
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36
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Chapa DAN, Kite BA, Forbush KT, Tregarthen JP, Argue S. Eating-disorder psychopathology and driven exercise change models: A latent change score analysis. Int J Eat Disord 2020; 53:2013-2025. [PMID: 33141971 DOI: 10.1002/eat.23392] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 09/29/2020] [Accepted: 09/29/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Approximately 50% of people with eating disorders (EDs) engage in driven exercise to influence their weight or shape and/or to compensate for loss-of-control eating. When present, driven exercise is associated with a lower quality-of-life, longer hospital stays, and faster rates-of-relapse. Despite the seriousness of driven exercise, most treatments for EDs do not target maladaptive exercise behaviors directly. Given the large proportion of patients with an ED who engage in driven exercise and its effect on treatment outcomes, it is critical to understand what predicts change in driven exercise. The purpose of this study was to test whether ED symptoms prospectively predicted change in driven exercise and vice versa. METHOD Participants were Recovery Record (RR) users (N = 4,568; 86.8% female) seeking treatment for an ED. Participants completed the Eating Pathology Symptoms Inventory (EPSI) monthly for 3 months. RESULTS In the full sample, dynamic bivariate latent change score analyses indicated that high levels of dietary restraint and restricting prospectively predicted reductions in driven exercise. Among persons with anorexia nervosa (AN), high levels of binge eating predicted increased driven exercise. Among persons with bulimia nervosa (BN), high levels of body dissatisfaction predicted increased driven exercise. Among persons with binge-eating disorder (BED), high levels of binge eating, purging, and restricting predicted reductions in driven exercise. DISCUSSION Results highlight changes that may predict increased or decreased driven exercise relative to other ED symptoms for AN, BN, and BED groups. These preliminary findings could inform future research on ED treatment efforts to manage driven exercise.
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Affiliation(s)
| | - Benjamin A Kite
- Department of Psychology, University of Kansas, Lawrence, Kansas, USA
| | - Kelsie T Forbush
- Department of Psychology, University of Kansas, Lawrence, Kansas, USA
| | | | - Stuart Argue
- Recovery Record, Inc, Palo Alto, California, USA
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37
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Brevers D, King DL, Billieux J. Delineating adaptive esports involvement from maladaptive gaming: a self-regulation perspective. Curr Opin Psychol 2020; 36:141-146. [PMID: 32795945 DOI: 10.1016/j.copsyc.2020.07.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 07/23/2020] [Accepted: 07/23/2020] [Indexed: 12/26/2022]
Abstract
The last decade has witnessed the rise of electronic sports (esports), yet little is known about how involvement in intensive esports relates to self-regulatory processes, such as executive functioning (EF). In this paper, we review the evidence on EF in problematic and non-problematic video-game use. We also consider research on EF in traditional sports athletes, as well as in 'exercise addiction'. The focus of the review is on two core components of EF, namely response inhibition and cognitive flexibility. The available evidence suggests that EF is a reliable marker for indexing specific types of sport and video-gaming expertise, but does not appear to consistently delineate maladaptive from adaptive video-game involvement. Future research avenues on EF that characterize esport players are suggested to advance this area.
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Affiliation(s)
- Damien Brevers
- Institute for Health and Behaviour, Department of Behavioural and Cognitive Sciences, University of Luxembourg, Esch-sur-Alzette, Luxembourg.
| | - Daniel L King
- College of Education, Psychology, & Social Work, Flinders University, Australia
| | - Joël Billieux
- Institute of Psychology, University of Lausanne, Lausanne, Switzerland; Centre for Excessive Gambling, Lausanne University Hospitals (CHUV), Lausanne, Switzerland
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Casper RC, Voderholzer U, Naab S, Schlegl S. Increased urge for movement, physical and mental restlessness, fundamental symptoms of restricting anorexia nervosa? Brain Behav 2020; 10:e01556. [PMID: 32017454 PMCID: PMC7066368 DOI: 10.1002/brb3.1556] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Revised: 12/05/2019] [Accepted: 01/04/2020] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE Continued mobility in the presence of severe weight loss is a well known, yet insufficiently researched characteristic of anorexia nervosa (AN). This study was designed to assess the prevalence of the drive for activity, here operationalized as an increased urge for movement, physical restlessness, and mental restlessness. METHOD Participants were 83 female consecutively admitted adolescent patients qualifying for a diagnosis of AN (ICD-10), restricting subtype. Information collected included responses to a questionnaire inquiring retrospectively about physical and psychological reactions after significant weight loss (on average 12.5 kg) and to measures of psychiatric and eating disorder pathology and exercise behaviors at hospital admission. RESULTS Over 80% of AN patients reported experiencing, at least partly, either, an increased urge for movement, physical or mental restlessness after significant weight loss. Altogether 95.1% reported, at least partly, one or a combination of two or all three symptoms. The sensations coexisted with equally high levels of fatigue and loss of energy, typically observed in starvation. The increased urge for movement and physical restlessness were foremost associated with reported actual physical activity and with weight loss. By contrast, mental restlessness was strongly linked to the degree of eating disorder pathology and to the severity of psychiatric symptoms. DISCUSSION This is the first investigation of the presence of an increased urge for movement, physical restlessness, and mental restlessness after significant weight loss in patients with acute AN. The symptoms, given their high frequency and specificity, are likely pathogenic for AN and, if replicated, deserve to be considered for inclusion as diagnostic criteria for AN.
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Affiliation(s)
- Regina C Casper
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | | | - Silke Naab
- Schön Klinik Roseneck, Prien am Chiemsee, Germany
| | - Sandra Schlegl
- Department of Psychiatry and Psychotherapy, University Hospital of Munich (LMU), Munich, Germany
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Zeeck A, Schlegel S, Jagau F, Lahmann C, Hartmann A. The Freiburg sport therapy program for eating disorders: a randomized controlled trial. J Eat Disord 2020; 8:31. [PMID: 32647573 PMCID: PMC7339379 DOI: 10.1186/s40337-020-00309-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 06/09/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Unhealthy attitudes towards sport and problematic exercise behavior in eating disorders (ED) are common and associated with poorer treatment outcome and higher relapse rates. There is a need to develop and empirically test interventions that could complement standard treatment. The study aimed to assess the efficacy of the Freiburg sport therapy program for eating disorders (FSTP). METHODS Outpatients with ED were randomized either to a 3 month sport therapy program (sport therapy group: STG) or a waiting list control group (CG). Patients were assessed when starting the program and at the end of the intervention. The intervention group (STG) was followed up after 6 month. Main outcome criterion was a reduction in unhealthy exercise (Commitment to Exercise Scale, CES). Secondary outcomes encompassed eating pathology (Eating Disorder Examination, EDE), different dimensions of unhealthy exercise (Compulsive Exercise Test, CET subscales) and exercise quantity (accelerometer). RESULTS Recruitment was challenging. Fifteen patients were randomized to the STG and 11 were randomized to the CG condition. There was no statistically significant difference between groups according to the main outcome criterion. However, the STG showed a significantly stronger reduction in avoidance and rule driven behavior (CET subscale) when compared to the CG. Improvements (STG) were maintained at follow up. CONCLUSIONS There was no statistically significant difference in the reduction of unhealthy attitudes towards sport and problematic exercise behavior between the intervention and the group, as measured with the Commitment to Exercise Scale. Further findings may point to the effectiveness of the program, but have to be interpreted with caution and verified in further studies. A major limitation is the small sample size. TRIAL REGISTRATION Study register: ISRCTN 14776348 (registered 26 January, 2015.
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Affiliation(s)
- Almut Zeeck
- Department of Psychosomatic Medicine und Psychotherapy, Center for Mental Health, Faculty of Medicine, University of Freiburg, Hauptstraße 8, D-79104 Freiburg, Germany
| | - Sabine Schlegel
- Department of Psychosomatic Medicine und Psychotherapy, Center for Mental Health, Faculty of Medicine, University of Freiburg, Hauptstraße 8, D-79104 Freiburg, Germany
| | - Friederike Jagau
- Department of Psychosomatic Medicine und Psychotherapy, Center for Mental Health, Faculty of Medicine, University of Freiburg, Hauptstraße 8, D-79104 Freiburg, Germany
| | - Claas Lahmann
- Department of Psychosomatic Medicine und Psychotherapy, Center for Mental Health, Faculty of Medicine, University of Freiburg, Hauptstraße 8, D-79104 Freiburg, Germany
| | - Armin Hartmann
- Department of Psychosomatic Medicine und Psychotherapy, Center for Mental Health, Faculty of Medicine, University of Freiburg, Hauptstraße 8, D-79104 Freiburg, Germany
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Scharmer C, Gorrell S, Schaumberg K, Anderson D. Compulsive exercise or exercise dependence? Clarifying conceptualizations of exercise in the context of eating disorder pathology. JOURNAL OF CLINICAL SPORT PSYCHOLOGY 2020; 46:101586. [PMID: 34093941 PMCID: PMC8174529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Maladaptive exercise relates to eating disorder (ED) pathology and impairment in clinical and non-clinical populations. At present, two different conceptualizations of maladaptive exercise are often studied in relation to ED pathology: compulsive exercise and exercise dependence. Compulsive exercise functions to avoid negative affect (e.g., guilt and anxiety) associated with not exercising, whereas exercise dependence is associated with tolerance to exercise benefits and avoidance of exercise withdrawal. At present, clinicians and researchers struggle to determine the most appropriate term for describing problematic exercise in individuals with ED pathology. This study aimed to directly compare these conceptualizations of maladaptive exercise in relation to severity of ED pathology. DESIGN This study examined cross-sectional data. METHOD Undergraduate participants (N =235, 78% female) with elevated ED pathology completed the Eating Disorder Examination Questionnaire (EDE-Q), Compulsive Exercise Test (CET), and Exercise Dependence Scale (EDS). Multiple linear regression analyses evaluated associations between EDE-Q and CET and EDS scores and dominance analysis determined which qualities of exercise were uniquely associated with EDE-Q scores. RESULTS Results suggest that compulsive qualities of exercise, including exercise to control shape and weight and to avoid negative affect are more strongly associated with severity of ED pathology than qualities of exercise dependence. CONCLUSIONS Clinicians and researchers working with ED populations can benefit from prioritizing assessments that capture compulsive qualities of exercise. Additionally, these results suggest that interventions that effectively target other compulsive behaviors (e.g., exposure and response prevention) may be promising treatment options for problematic exercise in the context of EDs.
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Affiliation(s)
- Christina Scharmer
- University at Albany, State University of New York, 1400 Washington Avenue, Albany, NY, 12222, USA
| | - Sasha Gorrell
- University of California, 401 Parnassus Avenue, San Francisco, CA, 94143, USA
| | | | - Drew Anderson
- University at Albany, State University of New York, 1400 Washington Avenue, Albany, NY, 12222, USA
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Bratland-Sanda S, Mathisen TF, Sundgot-Borgen J, Rosenvinge JH. Defining compulsive exercise in eating disorders: acknowledging the exercise paradox and exercise obsessions. J Eat Disord 2019; 7:8. [PMID: 30988952 PMCID: PMC6448210 DOI: 10.1186/s40337-019-0238-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 03/18/2019] [Indexed: 01/20/2023] Open
Abstract
Recently Dittmer et al. (JED 6:1-9, 2018). suggested a transdiagnostic definition and a clinical assessment for compulsive exercise in adolescents and adults with eating disorders. In this letter to the editor, we extend the transdiagnostic bridge to the DSM-5-criteria for obsessive-compulsive disorders and hence raise the issue of exercise obsession without compulsive exercise actions. We argue that, at least among persons with bulimia nervosa or binge eating disorders, a belief in the need to exercise to control food, weight and shape, does not necessarily imply that the actual exercise behaviour is excessive in nature. In our opinion, the high scores displayed on compulsive exercise screening instruments is therefore an exercise paradox. This paradox may call attention to the fact that because such obsessions can impair quality of life, they need to be addressed in the clinical evaluation and treatment. Therefore, we suggest adding "exercise obsession" as a fourth subtype of compulsive exercise.
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Affiliation(s)
- Solfrid Bratland-Sanda
- Department of sports, physical education and outdoor sciences, University of South-Eastern Norway, Campus Bø, Gullbringvegen 36, 3800 Bø in Telemark, Norway
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