Dimensions of Compulsive Exercise across Eating Disorder Diagnostic Subtypes and the Validation of the Spanish Version of the Compulsive Exercise Test.

Sarah Sauchelli,Amparo Del Pino-Gutiérrez,Roser Granero,Susana Jiménez-Murcia,Zaida Agüera,Fernando Fernández-Aranda,Jon Arcelus

doi:10.3389/fpsyg.2016.01852

Abstract

Objectives: Compulsive exercise in eating disorders has been traditionally considered as a behavior that serves the purpose of weight/shape control. More recently, it has been postulated that there may be other factors that drive the compulsive need to exercise. This has led to the development of the Compulsive Exercise Test (CET); a self-reported questionnaire that aims to explore the cognitive-behavioral underpinnings of compulsive exercise from a multi-faceted perspective. The objectives of this study were threefold: (1) to validate the Spanish version of the CET; (2) to compare eating disorder diagnostic subtypes and a healthy control group in terms of the factors that drive compulsive exercise as defined by the CET; (3) to explore how the dimensions evaluated in the CET are associated with eating disorder symptoms and general psychopathology.Methods: The CET was administered to a total of 157 patients with an eating disorder [40 anorexia nervosa, 56 bulimia nervosa (BN), and 61 eating disorder not-otherwise-specified (EDNOS)] and 128 healthy weight/eating controls. Patients were assessed via a semi-structured interview to reach a DSM-IV-TR diagnosis. Additionally, all participants completed the Symptom Checklist-90-Revised (SCL-90R) and the Eating Disorders Inventory-2 (EDI-2).Results: Confirmatory factor analysis demonstrated adequate goodness-of-fit to the original five-factor model of the CET. BN and EDNOS patients scored higher in the avoidance and rule-driven behavior, weight control, and total CET scales in comparison to the healthy controls, and higher across all scales apart from the exercise rigidity scale compared to the anorexia nervosa patients. Mean scores of the anorexia nervosa patients did not differ to those of the control participants, except for the mood improvement scale where the anorexia nervosa patients obtained a lower mean score. Mean scores between the BN and EDNOS patients were equivalent. The CET scales avoidance and rule-driven behavior, weight of control and total CET scores were positively correlated with the clinical assessment measures of the SCL-90R and EDI-2.Conclusion: Compulsive exercise is a multidimensional construct and the factors driving compulsive exercise differ according to the eating disorder diagnostic subtype. This should be taken into account when addressing compulsive exercise during the treatment of eating disorders.

Highlights

Excessive exercise is a recurrent behavior in eating disorder (ED), believed to be implicated in the etiology, development, and maintenance of these disorders (Davis et al, 1997; Taranis et al, 2011)
The first part of the table presents the descriptive data for each group, followed by the global F-test exploring the presence of overall differences between the groups, and the pairwise comparisons estimating mean differences between the ED diagnostic subtypes
A similar pattern was observed in terms of the SCL90R Global Severity Index (GSI) mean score, in this case there were no differences between the anorexia nervosa (AN) patients and the eating disorders not-otherwise-specified (EDNOS) patients

Summary

Introduction

Excessive exercise is a recurrent behavior in EDs, believed to be implicated in the etiology, development, and maintenance of these disorders (Davis et al, 1997; Taranis et al, 2011). A quantitative approach to excessive exercise has been questioned; it is unclear whether focus should be placed on current or lifetime exercise or the amount/type of exercise required for it to be considered as excessive (Meyer and Taranis, 2011). It has, been argued that it is not the amount/intensity of exercise per se that is problematic in EDs, but the presence of a compulsive drive to engage in exercise (Meyer and Taranis, 2011; Meyer et al, 2011). Compulsive exercise may be a more accurate representation of the pathological exercise profile of these patients given that it emphasizes the cognitions that maintain the behavior

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Conclusion