Driven exercise among treatment-seeking youth with eating disorders

Abstract

Purpose This study evaluated the prevalence and clinical significance of driven exercise (DE) in treatment-seeking youth. Methods Participants were 380 consecutive referrals to a pediatric eating disorder program (90.8% female; M age=14.9±2.2). Spearman’s rho correlations examined the relation between DE frequency, and Beck Depression Inventory (BDI) and Eating Disorders Examination (EDE) Global Severity scores. ANOVA compared those reporting only DE, only vomiting, or both DE and vomiting on the aforementioned measures. Results 51.3% of participants (n=193) reported DE in the past 3 months, with an average of 21.8 (SD=32.6) episodes. Frequency of DE was related to EDE global severity score (Spearman’s rho=.46; p<.001) and BDI Total Score (Spearman’s rho=.33; p<.001). Participants reporting both vomiting and DE had the highest EDE global severity and BDI total scores. Conclusions DE is associated with greater eating disorder and depressive symptomatology, especially when paired with vomiting. The findings highlight the importance of assessing for DE in youth presenting for eating disorder treatment.

Developmental Trajectories of Boys’ Driven Exercise and Fasting During the Middle School Years

“…Second, we did not include a measure of body mass index (BMI). Although BMI did not discriminate between adolescents who did and did not engage in nonpurging compensatory behaviors in prior work (Stiles-Shields et al, 2011), we were not able to test this finding in the current study. In addition, the inclusion of BMI might also have clarified whether any of the participants were suffering from an established eating disorder (such as AN).…”

“…Driven exercise has been theorized as a gateway behavior to binge eating and purging by other investigators (Stiles-Shields et al, 2011). Unfortunately, our design does not permit a strong test of that possibility because our longitudinal window spanned only the 3 years of middle school.…”

“…In particular, males are more likely to engage in nonpurging compensatory behaviors such as driven exercise (Allen, Crosby, Oddy, & Byrne, 2013; Stiles-Shields, Goldschmidt, Boepple, Glunz, & le Grange, 2011) and fasting (Allen et al, 2013; Pisetsky, Chao, Dierker, May, & Striegel-Moore, 2008) compared to purging behaviors such as self-induced vomiting, for weight control. Driven exercise refers to intense physical activity designed to control one's weight or shape, or in response to an episode of excessive food consumption, and that is described as compelled or compulsive (Fairburn & Cooper, 1993).…”

Developmental trajectories of compensatory exercise and fasting behavior across the middle school years

“…Most often, engagement in the behaviors is studied in girls who are also engaging in binge eating and purging. In that context, the behaviors are associated with anxiety and depression (Allen, Crosby, Oddy, & Byrne, 2013; Stiles-Shields, Goldschmidt, Boepple, Glunz, & le Grange, 2011), substance abuse (Pisetsky, May Chao, Dierker, May, & Striegel-Mooore, 2008), suicidal ideation (Crow, Eisenberg, Story, & Neumark-Stzainer, 2008) and social distress (Neumark-Sztainer, Wall, Story, & Perry, 2003). In the context of AN, driven exercise (this term is closely related to compulsive exercise and is defined as intense exercise with a compulsive quality: Fairburn, Cooper, & O’Connor, 2008) is associated with poorer treatment outcomes (Stiles-Shields, Bamford, Lock & le Grange, 2015).…”

Prevalence of eating disorder attitudes among men and women with exercise dependence symptoms: a non-athlete population study

“…There has been a great deal of attention from exercise researchers over the last three decades on the connection between the compulsion to exercise and eating disorders COCKERILL;CARROLL, 2000;COCKERILL;CARROLL, 2003;ADAmS, 2009;BRATLAND-SANDA et al, 2010;STILES-SHIELDS et al, 2011). There is considerable clinical evidence that many patients with eating disorders also present with exercise hyperactivity.…”