An examination of compulsive exercise in people with anorexia nervosa

Abstract

In anorexia nervosa (AN), compulsive exercise (CE) has severe physical and psychological implications, affecting treatment and outcome. A previous lack of a distinct conceptualization of CE hampered the field in that its measurement had been unclear. Specific facets of psychological and psychosocial functioning related to CE warrant further investigation, and limited research has explored exercise within recovery. The thesis aimed to: (1) explore role of exercise across time in adults with AN, and ascertain if healthy exercise can be re-established in recovery; (2) determine relationships between obsessive-compulsive disorder (OCD), obsessive-compulsive personality disorder (OCPD), and exercise in patients with AN; (3) assess the validity of common exercise measures; and (4) examine the associations between CE, quality of life (QOL) and motivation to change, and assess if CE predicts these outcomes in treatment. Four studies were undertaken, utilizing quantitative and qualitative methodology to examine CE phenomena. First, a qualitative study demonstrated that patients required interventions and appropriate support for balanced exercise to be re-established in recovery (Chapter 3). Second, a systematic literature review found a positive relationship between exercise and OCPD in AN, but the relationship between exercise and OCD was inconclusive (Chapter 4). Third, a validation study assessed commonly used measures of CE (Chapter 5). The Compulsive Exercise Test (CET) was a valid measure for adults with AN, and showed good concurrent and convergent validity with the Eating Disorder Examination (EDE). Finally, correlational analyses demonstrated that CE was related to higher obsessive-compulsive symptoms, poorer QOL and lower motivation to change pre-treatment (Chapter 6). CE predicted poorer motivation and higher obsessive-compulsive symptoms after treatment. CE must be assessed and addressed in treatment to improve outcomes for patients, and to assist in recovery.