secondary exercise addiction Flashcards
what is secondary exercise addiction
also termed compulsive exercise!
- Exercise is used as a tool to control weight, body image, or cope with psychological distress.
- Often seen in individuals with eating disorders such as anorexia or bulimia (Trott et al., 2021).
- Rooted in psychological factors, such as perfectionism, obsessive-compulsive tendencies, or low self-esteem (Stollarrf, 2003; Berczik et al., Asp, 2012).
urge to exercise in eating disorders-
Anorexia nervosa is characterised by drive for thinness, weight loss, food restriction
and fear of weight gain.
* Unexpected relationship between undernutrition and underweight with desire and
ability for movement in those with anorexia nervosa (e.g., Gull, 1874; Lasegue,
1873).
* Davis et al., (1997) – increases in exercise prior to, and in the acute phases of an ED.
* Association between food restriction and recorded physical activity and degree of
restlessness in AN. High levels of ‘fidgeting’ (Belak et al., 2017).
Casper et al., (2020).
* N = 83 adolescent patients with AN.
* Measures - Reactions to weight loss questionnaire; measures of eating psychopathology;
Compulsive Exercise Test; information on physical activity behaviours.
* Most (>80%) reported increased desire or urge for movement, physical restlessness, or
mental restlessness after significant weight loss
* Increased urge for movement co-existed with feelings of lethargy and fatigue.
problematic exercise in ED
- Up to 80% of ED patients present with compulsive exercise (Shroff et al., 2006).
- Eating disorders are common among athletes (Sundgot-Borgen & Torstveit, 2004).
- Exercise attitudes/behaviours change in the early stages of an eating disorder.
- Notion of “excessive exercise”
*Exercise for calorie burning & weight loss
*Frequency/duration of activity unrelated to eating psychopathology
Transdiagnostic definition of Compulsive Exercise in EDs
Dittmer, Jacobi & Voderholzer (2018
A(1) Excessive exercise that the patient feels driven to perform in response to
an obsession or according to rules that must be applied rigidly.
A(2) The exercise aims to prevent some dreaded consequence or reducing
distress, often based on distorted beliefs about exercise.
B The exercise is time-consuming (> 1 hour a day), significantly interferes
with the person’s daily routine, occupational functioning or social
relationships or is continued despite medical injury, illness, or lack of
enjoyment.
(OPTIONAL)
C The patient recognises that the compulsive exercising is excessive or
unreasonable.
cognitive behavioural model of CE
Cognitive behavioural components; multi-faceted (Meyer et al., 2011).
* Rigidity towards exercise (e.g., routes, calories)
* Feeling guilty when unable to exercise
* Exercising despite illness or injury
* Exercising to avoid negative feelings or moods.
* Exercise to manage shape and weight.
Evidence for the model
1. Exercise as a form of emotion regulation – e.g., Bratland-Sanda et al., 2010
2. Compulsivity for exercise (e.g., feeling guilty) – e.g., Cook & Hausenblas (2008).
3. Perfectionism – e.g., Egan et al. (2017).
4. Rigidity – e.g., Boyd et al. (2007).
E.g., Exercising for affect regulation
* Emotion regulation difficulties common in ED
(particularly binge-purge).
* Dysfunctional emotion regulation
prospectively linked to CE (e.g., Goodwin, Haycraft
& Meyer, 2014).
* Exercising for emotion regulation (specifically,
avoidance of low mood) a primary feature
among patients (Bratland-Sanda et al., 2010).
* Negative rather than positive reinforcement
mechanism.
measures
Compulsive Exercise Test
* Developed in accordance with the multi-dimensional
model (Taranis, Touyz & Meyer, 2011).
* 24 item measure with five subscales:
* Avoidance and rule driven behaviour
* Mood improvement
* Lack of exercise enjoyment
* Exercise rigidity
* Weight control exercise
* CET scores elevated in clinical groups
* Scoring above 15 indicative of problematic exercise in
clinical samples (Meyer et al., 2016).
more severe ED?
Compulsive exercise is linked to more severe eating disorder psychopathology and
poorer outcomes in therapy (Monell et al., 2018).
Longer hospitalisation (Solenberger, 2001)
Higher rates of relapse (Carter et al., 2004).
Impact on remission & treatment outcome (Dalle Grave et al., 2008; Levallius et al., 2017)
Increase in psychiatric co-morbidity (e.g., self-critical perfectionism, suicidality, self-harm;
QoL).
Compulsive exercise and ED trajectory
Elevated global EDE-Q; dietary restraint; purge frequency & negative perfectionism among
CE patients.
Female CE patients were younger, had shorter ED duration and lower BMI than non-CE
patients.
CE category Remission rate
Never engaged in CE 62.1%
Ceased CE during treatment 64.5%
Started CE during treatment 28.2%
Continued CE during treatment 33.8%
Reproduced from Monell et al., (2018
treating compulsive exercise
Largely conducted within ED settings
* “LEAP” – CompuLsive Exercise Activity Therapy.
* 8x50min sessions embedded within CBT-AN (Hay et al., 2018).
* Structured, supervised and progressive exercise may be positive adjunct to therapy (Cook et al.,
2016).
Noetel et al., (2017).
* Challenges in treating CE.
* Lack of evidence-based interventions
* Using exercise as a ‘reward’ during treatment, while avoiding colluding with the ED
* Managing the distress that results from reducing exercise
* Treating exercise behaviours for those who are competitive athletes.
Paslakis et al., (2017).
* 30 ED patients wore VR goggles and watched a jogger’s
running track from the first-person perspective (as if they
were jogging).
* Rated urge to be active at regular intervals.
* A reduction in urge to be active from baseline to post
exposure was observed
link to social media
Really interesting review looking into social media- Minutillo et al., 2024
- Nice overview of PA and SA- The excessive involvement in physical activity without stopping in between sessions despite injuries, the continuous thinking to exercise feeling insane thoughts and experiencing withdrawal symptoms are all characteristics of the Exercise Addiction (EA), an addictive behavior. While the primary exercise addiction is directly caused by compulsive exercise, many studies highlighted the relationship between Eating Disorders (ED) and EA, defining the secondary EA. The correlation between EA, social media use (SMU) and other individual traits remains a relatively underexplored domain. Therefore, this review aimed to examine the latest evidence on the relationship between EA, SMU, and some personality traits such as perfectionism and body image.
- * There are increasing concerns about how EA interacts with social media and mental health.
- “Fitspiration” content on social media (meant to encourage fitness) may actually contribute to body image issues and exercise addiction, just as “thinspiration” (promoting thinness) has been linked to eating disorders (EDs).
- EA is also associated with depression, anxiety, and obsessive-compulsive traits, suggesting that vulnerable individuals may be at higher risk of addiction-like behaviors.
- * Lack of Specific Diagnostic Tools for EA
- EA is often measured using tools adapted from gambling or gaming addiction, rather than its own validated diagnostic framework.
- This makes it difficult to distinguish EA from other disorders (like EDs) or to determine whether EA is a cause or consequence of other mental health issues.
- * Limitations in Research
- The small sample sizes and lack of standardized research protocols make it hard to draw firm conclusions.
- Most studies focus on adults, while adolescents (who are at risk for early behavioral addictions) are understudied.
