2011 - Huw Goodwin - CompulsiveexerciseTheroleofpersonalitypsychologica[Retrieved-2014!08!30]

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Compulsive Exercise: The Role of Personality,Psychological Morbidity, and Disordered Eating

Huw Goodwin, BSc (Hons), MRes1

Emma Haycraft, PhD 1*Anne-Marie Willis, RMN2

Caroline Meyer, PhD 1

ABSTRACTObjective: Compulsive exercise hasbeen closely linked with eating disorders,and has been widely reported in bothclinical and nonclinical settings. It hasbeen shown to have a negative impacton eating disorder treatment and out-come. However, the risk factors for com-pulsive exercise have not been examined.This study aimed to provide a rst step inidentifying potential cross-sectional pre-dictors of compulsive exercise.

Method: The sample consisted of 1,488male and female adolescents, aged 12 14 years old, recruited from schools inthe United Kingdom. Participants com-pleted measures of compulsive exercise,personality, psychological morbidity, and

disordered eating attitudes during aschool class period.

Results: Multiple stepwise regressionsshowed that the strongest cross-sectionalpredictors of compulsive exercise were adrive for thinness, perfectionism, andobsessive-compulsiveness.

Discussion: These results are discussedin terms of the role that personal factorsmay play in the development of compul-sive exercise. VVC 2011 by Wiley Periodi-cals, Inc.

Keywords: compulsive exercise; adole-

scents; psychological; perfectionism; OCD

(Int J Eat Disord 2011; 44:655660)

Introduction

Eating Disorders (ED) comprise a variety of pro-blematic behaviors, including bingeing, purging,and restricting food consumption. 1 Another suchproblematic behavior that has been widely reported in both clinical and nonclinical settings isthat of compulsive exercise. Compulsive exercisehas been dened as an intense drive to be active,often in a rigid, routine-like fashion that is predo-minantly performed to manage weight and shape,as well as alleviating negative emotions. 2,3 It hasbeen found in as many as 39% of anorexia nervosa (AN) patients and 23% of Bulimia Nervosa (BN)patients at admission to an ED clinic 4 and has beenlinked with greater treatment time, poorer out-come, and increased chance of relapse. 5,6

Additionally, compulsive exercise has been foundin community samples, 3 and has been implicatedin the etiology of ED. 7 The development of EDpredominantly occurs around early adolescence, 8

and yet little to no research on compulsive exercisehas been conducted among adolescent samples.This age-group represents an important populationto study in risk factor research into ED andcompulsive exercise and, as such, investigationsare required to identify whether a compulsive driveto exercise is directly linked to disordered eating attitudes at this early age.

Importantly, not all individuals with ED patho-logy display a compulsive drive to exercise.Therefore, it is likely that there are specicpsychological and personality differences thatrender an individual at risk of specically developing a compulsivity towards exercise. How-ever, the risk factors for compulsive exercise arepoorly understood.

One possible personality trait linked to thedevelopment of compulsive exercise is perfec-tionism, which has been reported as a risk factorfor both AN 9 and BN. 10 Perfectionism has already been found to be an antecedent to obligatory exercise, 11 as well as exercise dependence; 12

terms which encompass similar, if not thesame, constructs as compulsive exercising. Another possible risk factor is obsessive-com-pulsiveness, which has also been strongly linked

Supported by Loughborough University.*Correspondence to: Emma Haycraft, Loughborough University

Centre for Research into Eating Disorders, School of Sport, Exerciseand Health Sciences, Loughborough University, LeicestershireLE11 3TU, United Kingdom. E-mail: [email protected]

Accepted 16 November 2010

1 Loughborough University Centre for Research into EatingDisorders, Loughborough University, Leicestershire,United Kingdom

2 Cotswold Spa, Huntercombe Hospitals, Worcestershire, UnitedKingdom

Published online 14 February 2011 in Wiley Online Library(wileyonlinelibrary.com). DOI: 10.1002/eat.20902

VVC 2011 Wiley Periodicals, Inc.

International Journal of Eating Disorders 44:7 655660 2011 655

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with compulsive exercise in both clinical andnonclinical ED samples. For example, compulsiveexercise has been related to obsessive-compul-siveness in a sample of health club exercisers(Wyatt, Unpublished Doctoral Dissertation), andto excessive exercise in clinical ED groups. 13,14

A key feature of compulsive exercise is a negativemood, such as, experiencing feelings of anxiety,depression, and guilt, when deprived of exer-cising. 15 However, other studies have found nega-tive affect, in its various forms (i.e., anxiety anddepression), to be related to continued exerciseand not simply a resultant state of exercise depriva-tion. For example, Coen and Ogles 11 found thatcompulsive exercisers reported higher levels of anxiety than non-compulsive exercisers. Similarly,greater levels of depression have been relatedto compulsive exercise in both clinical and non-clinical ED samples. 16,17

In addition to general anxiety, social anxiety hasbeen associated with ED, with women with eating disordered behavioral tendencies being more likely to be fearful of negative evaluation and have a greater sensitivity to the impressions of others. 18

Specic to exercise, a tendency towards socialcomparisons has been shown to have a strongerimpact on adolescent boys exercising than on theireating. 19 Previous research has also found thatsocial physique anxiety, a body specic form of social anxiety, is positively related to greaterexercise frequency. 20 However, no study hasfocused on the role of social physique anxiety inthe development of compulsive exercise.

In summary, compulsive exercise is a proble-matic behavior that affects many individuals withED. A thorough review of previous research hasidentied several personality traits and psychologi-cal states as potential correlates of compulsiveexercise, 21 but relationships with compulsive exer-cise have yet to be tested in adolescents. It is alsonot clear which of these potential predictors of compulsive exercise are the most potent risk factors for its development.

Using a nonclinical adolescent sample, thisstudy aims to identify which personality, psycho-logical, and disordered eating factors are the bestcross-sectional predictors of compulsive exercise.It is hypothesized that all signicant predictors will be positively associated with compulsiveexercise. Given the paucity of previous research,no predictions were made regarding whichvariable would be the best predictor of compul-sive exercise.

Method

Participants

This research was conducted in nine schools acrossthe United Kingdom as part of an ongoing larger scaleresearch project. This study reports on a sample of 1,488participants, aged 1214 years old (mean age of 12.98 years; SD 5 0.73), with gender being equally distributed(girls 5 54.1%; boys 5 45.9%). The sample predominantly (95.3%) classied their ethnicity as White British, andall the schools were from areas of average to low levels of economic deprivation. 22 Self-reported height and weightinformation was converted into body mass index (BMI)for each participant, which was then converted into a z score, so that they were standardized for both age andgender. 23 The mean values for BMI z scores were 0.32(SD 5 1.39) for boys and 0.08 (SD 5 1.34) for girls.

Measures and Procedure

Institutional Review Board ethical approval wasgranted before questionnaire packs were sent to theparticipating schools. Questionnaire packs were com-pleted in a school class period by pupils aged between 12and 14 years old. Following informed consent, the parti-cipants provided background information on nationality,ethnicity, age, gender, height and weight, and thencompleted the following validated measures:Compulsive Exercise Test. 3 The compulsive exercisetest (CET) is a 24-item measure that assesses the level of compulsive exercise. It has ve subscales that representthe ve core features of the behavior, namely: Avoidance

and Rule-Driven Behavior; Weight Control Exercise;Mood Improvement; Lack of Exercise Enjoyment; andExercise Rigidity. Responses are scored on a six-pointLikert scale, anchored with 0never true and 5always true. The level of compulsive exercise is thenidentied by creating a total CET score, which iscalculated by summing the mean item score for each of the ve subscales. Higher scores represent greater levelsof compulsive exercise. A psychometric evaluation of the CET in these adolescents has already supported itsuse. 2 In the current sample, the total CET had a Cronbachs alpha of 0.88.Eating Disorder Inventory-2. 24 The drive for thinness,bulimia, and body dissatisfaction subscales of the eating disorder inventory-2 (EDI-2) were administered to assessdisordered eating attitudes. The EDI-2 measures theattitudes underpinning AN and BN and has been usedreliably among adolescents. 25 The Cronbachs alpha values found in this study were 0.84 (drive for thinness),0.72 (bulimia), and 0.90 (body dissatisfaction).Child and Adolescent Perfectionism Scale. 26 The childand adolescent perfectionism scale (CAPS) is a 22-item,two-scaled measure of perfectionism specically worded

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for use within child and adolescent samples. The twoscales are self-orientated perfectionism (CAPS-self) andsocially prescribed perfectionism (CAPS-social). Theformer subscale assesses the degree to which an indivi-dual imposes self-directed levels of perfectionistic stand-ards and behaviors on to his or her self (e.g., I try to beperfect in everything I do). The latter subscale assessesthe degree to which an individual feels that their perfec-tionism is imposed on them by others (e.g., There arepeople in my life who expect me to be perfect). TheCAPS has been previously used with adolescentsand demonstrated good reliability. 27 Cronbachs alpha values for this sample were 0.81 for CAPS-Self and 0.87for CAPS-Social.Spence Child Anxiety Scale. 28,29 The Spence Child Anxiety Scale (SCAS) is a measure of anxiety symptomsamong children. Only the obsessive-compulsive subscale was used in this study (SCAS-OC). It comprises six itemsassessing levels of obsessive-compulsiveness, which

includes items such as I cant seem to get bad or silly thoughts out of my head and I have to do some things in just the right way to stop bad things happening.The SCAS has previously been reliably used withadolescents. 29 The internal reliability gure for the obses-sive-compulsiveness subscale for the current sample was 0.79.Hospital Anxiety and Depression Scale. 30 The Hospital Anxiety and Depression Scale (HADS) is a 14-itemmeasure of anxiety and depression that is widely used inclinical and nonclinical research and practice. The HADShas been validated for use with adolescents, 31 andprovided Cronbachs alpha values of 0.73 for anxiety and

0.56 for depression for the current sample.Social Physique Anxiety Scale. 32 The Social Physique Anxiety Scale (SPAS) is a 9-item scale measuring a respondents level of social physique anxiety, using suchquestions as: In the presence of others, I feel appre-hensive about my physique/gure. The SPAS hasdisplayed good psychometrics among adolescents, 33 andobtained a Cronbachs alpha level of 0.87 for the samplein this current investigation.

Data Analysis

Data were initially screened for normality. As expected,a series of Kolmogorov-Smirnov tests showed that allvariables were non-normally distributed, with the excep-tion of the dependent variable, the CET Total score.Importantly, the residuals were normally distributed and,therefore, no transformations were made for the follow-ing regression analyses. Non-parametric tests were used, where appropriate. Preliminary analysis also demon-strated that age appropriate body mass index (BMI z -scores) was not signicantly correlated with CET Totalscore for either boys ( r 5 .02, p [ .05) or girls ( r 5 .06,

p [ .05). Therefore, BMI z scores were not included in any subsequent analysis as a control variable.

Analyses were conducted separately for boys and girlsdue to signicant differences on many study variables(Table 1). For each gender, a multiple stepwise regression was conducted to examine relationships betweencompulsive exercise and the predictor variables (self-orientated perfectionism, socially prescribed perfec-tionism, obsessive-compulsiveness, anxiety, depression,social physique anxiety, drive for thinness, bulimic atti-tudes, and body dissatisfaction). Signicance was set atp \ .001 due to the large sample size.

Results

Characteristics of the Sample

Descriptive statistics can be seen in Table 1 . Themean CET total score represents a mid-point scor-ing average for boys and girls, and is noticeably lessthan has been reported in clinical samples. TheEDI subscale scores also represent average to low levels of disordered eating attitudes. The HADSsubscale scores demonstrate normal levels of depression (i.e., none), while the anxiety subscalemean indicates mild levels of anxiety, according tosuggested norms. 34 The SPAS scores, CAPS-self andCAPS-social, and SCAS-OC scores all representnormal levels for this age group. 27,29,33

Regression Analysis

The nal model of the multiple stepwise regre-ssion for boys and girls can be seen in Table 2 . Forboys, the nal multiple stepwise regression model was signicant, accounting for 39% of the variance

TABLE 1. Means and standard deviations for studyvariables by gender

Variables

Mean (SD) Test ofDifference

z Boys Girls

CET total 10.01 (4.08) 9.94 (3.66) 0.32EDI-drive for thinness 2.82 (3.98) 6.13 (5.90) 10.40*EDI-bulimia 1.99 (3.18) 2.41 (3.49) 3.06*EDI-body dissatisfaction 4.97 (5.67) 10.56 (8.13) 13.02*CAPS-self 34.05 (7.66) 32.91 (8.35) 2.81*CAPS-social 25.15 (8.17) 23.70 (8.33) 3.51*SCAS-OC 0.91 (0.63) 1.00 (0.67) 2.21HADS-anxiety 7.48 (3.65) 8.67 (3.65) 6.23*HADS-depression 4.24 (2.91) 3.92 (2.74) 3.64*SPAS 21.61 (6.98) 28.01 (7.98) 15.11*

Note: Samples sizes differed between tests due to missing data;*p \ .001 (two-tailed); CET, compulsive exercise test; EDI, eatingdisorder inventory; CAPS, child and adolescent perfectionism scale;SCAS-OC, spence child anxiety scale obsessive-compulsiveness sub-scale; HADS, hospital anxiety and depression scale; SPAS, socialphysique anxiety scale.

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of CET total score. In the nal model, EDI-drive forthinness, CAPS-self, SCAS-OC, and CAPS-social were the signicant predictors. The CET total score was not statistically predicted by HADS-anxiety,HADS-depression, SPAS, EDI-bulimia, or EDI-body dissatisfaction.

The nal model of the multiple stepwise regre-ssion for the girls was signicant, and it accountedfor 34% of the variance of CET total score. The nalmodel produced three unique signicant predic-tors. These were EDI-drive for thinness, CAPS-self,and SCAS-OC. For girls, CET total was not statis-tically predicted by CAPS-social, HADS-anxiety,HADS-Depression, SPAS, EDI-bulimia, or EDI-body

dissatisfaction.

Discussion

This study aimed to examine the best cross-sectional predictors of compulsive exerciseamong a sample of adolescents. The results indi-cate that for both boys and girls a drive forthinness was the best predictor, along with self-perfectionism, and then obsessive-compulsive-ness. For boys only, social perfectionism was alsoan additional predictor, although it did notexplain as much variance as the other signicantvariables. The hypothesis that all signicantpredictors would be positively associated withcompulsive exercise was supported.

The signicant drive for thinness nding supports the existing literature linking compulsiveexercise closely with ED. 4 A key nding in thissample, though, was that only a drive for thinness,rather than bulimic attitudes and body dissatis-

faction, signicantly predicted compulsive exercise,for both boys and girls. This drive for thinness isanalogous to symptoms of AN, and so this nding concurs with previous literature identifying compulsive exercise as more prevalent among ANpatients than other ED diagnoses. 4,7 This compul-sivity towards exercise could be a key marker in thedevelopment of AN, particularly as this association with a drive for thinness has been found in a gene-rally healthy, nonclinical group of young adoles-cents. Further research is needed to identify how compulsive exercise interacts with a drive forthinness over time, and whether the exercisecompulsivity puts individuals at increased risk of subsequently developing AN.

High levels of perfectionism and obsessive-compulsiveness were also linked to compulsiveexercise. The nding that perfectionism wasamong the best predictors of compulsive

exercise is consistent with previous investiga-tions. 12,14 Although both subscales of perfectio-nism were signicant for the boys, there was a greater association with the self-orientated formof perfectionism. Likewise, for the girls, it wasself-perfectionism and not social perfectionismthat was found to be a signicant predictor of compulsive exercise. Castro and her colleagues 27

found that self-orientated perfectionism wasmore strongly associated with ED than socially prescribed perfectionism. This is also in accor-dance with a previous study that had shown ANpatients to experience their perfectionism as

self-imposed.35

Therefore, this would suggestthat self-perfectionism could be inuential inthe development of ED, and specically AN, andthat it could be operating through compulsiveexercise. The results from the current study demonstrate that this association between self-perfectionism and compulsive exercise occurseven in an adolescent school-based population, where levels of disordered eating symptoms were relatively low. Therefore, if replicated longi-tudinally, this nding could represent a key area for early intervention and/or prevention work of compulsive exercise attitudes, whereby the indi-viduals self-imposed high standards could betargeted with the aim of reducing the compul-sivity towards exercise.

The close link between compulsive exercise andobsessive-compulsiveness has been widely estab-lished in previous research ( Wyatt, UnpublishedDoctoral Dissertation). 13 The ndings from thisinvestigation demonstrate that a compulsivity towards exercise is associated with obsessive-compulsive symptoms even in a community

TABLE 2. Final model for multiple stepwise regressionof personality, psychological, and disordered eatingvariables (predictor variables) on to CET total score(outcome) for boys and for girls

Predictors F (d f ) Adj r 2 Beta T

BoysModel 80.99 (4, 508)* .39EDI-drive for thinness 0.29 7.48*CAPS-self 0.27 6.64*SCAS-OC 0.17 4.29*CAPS-social 0.14 3.45*

GirlsModel 108.47 (3, 621)* .34EDI-drive for thinness 0.34 9.69*CAPS-Self 0.31 8.77*SCAS-OC 0.15 3.97*

Note: *p \ .001; CET, compulsive exercise test; Adj, adjusted; EDI,eating disorder inventory; CAPS, child and adolescent perfectionism scale;SCAS-OC, spence child anxiety scale obsessive-compulsiveness subscale.

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sample of adolescent boys and girls. This close anddirect association could indicate another possiblearea for prevention work of compulsive exercise; work that could target certain individuals withgreater levels of obsessive-compulsiveness.However, it is uncertain whether the compulsivity towards exercise actually develops into a widerobsessive-compulsiveness, or whether the causaldirection is in fact the reverse, with individuals with obsessive-compulsive symptoms being atgreater risk for developing compulsive exercise.

An interesting result from the present study wasthe lack of association between compulsive exer-cise and the psychological factors of anxiety anddepression, as well as social physique anxiety. Thisis contrary to previous literature, 16 although it ispossible that in a nonclinical adolescent sample,the level of psychological morbidity may not yet beclosely linked with exercising. Further research would be needed to identify whether the associa-tion between compulsive exercise and thesepsychological factors only occurs in specic sam-ples, such as in a clinical ED or adult population.

This study has certain limitations that need to behighlighted. First, the cross-sectional nature of thedesign prevents causal attributions. Future researchneeds to replicate these ndings using a longitudinaland/or experimental design to further establishcausality. Second, the self-report nature of the meas-ures could have been susceptible to reporter bias, as well as response error, particularly given the relatively

young age of the sample. This is particularly true of the self-report nature of height and weight infor-mation. The use of self-report BMI data has beenpreviously used in this age group, 36 although it isaccepted that self-report BMI in adolescents must beviewed with caution and objective BMI measure-ment would be preferable in future research.

Overall, the current study ndings support a model where drive for thinness, perfectionism, andobsessive-compulsiveness all predict compulsiveexercise in adolescents. The amount of varianceaccounted for by these personality predictors was

large, with almost 40% of compulsive exercise inboys being explained by these variables. Thissuggests that compulsive exercise is largely a self-driven behavior that is affected by personal attri-butes and, as such, any potential prevention work needs to target the individuals existing personality motivations and general beliefs. Future researchis also required to test the longitudinal associationsbetween these personality traits and compulsiveexercise.

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