- Top of page
- Earn CE credit for this article!
Eating Disorders (ED) comprise a variety of problematic behaviors, including bingeing, purging, and restricting food consumption.1 Another such problematic behavior that has been widely reported in both clinical and nonclinical settings is that of compulsive exercise. Compulsive exercise has been defined as an intense drive to be active, often in a rigid, routine-like fashion that is predominantly performed to manage weight and shape, as well as alleviating negative emotions.2, 3 It has been found in as many as 39% of anorexia nervosa (AN) patients and 23% of Bulimia Nervosa (BN) patients at admission to an ED clinic4 and has been linked with greater treatment time, poorer outcome, and increased chance of relapse.5, 6
Additionally, compulsive exercise has been found in community samples,3 and has been implicated in the etiology of ED.7 The development of ED predominantly occurs around early adolescence,8 and yet little to no research on compulsive exercise has been conducted among adolescent samples. This age-group represents an important population to study in risk factor research into ED and compulsive exercise and, as such, investigations are required to identify whether a compulsive drive to exercise is directly linked to disordered eating attitudes at this early age.
Importantly, not all individuals with ED pathology display a compulsive drive to exercise. Therefore, it is likely that there are specific psychological and personality differences that render an individual at risk of specifically developing a compulsivity towards exercise. However, the risk factors for compulsive exercise are poorly understood.
One possible personality trait linked to the development of compulsive exercise is perfectionism, which has been reported as a risk factor for both AN9 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 the same, constructs as compulsive exercising. Another possible risk factor is obsessive-compulsiveness, which has also been strongly linked with compulsive exercise in both clinical and nonclinical ED samples. For example, compulsive exercise has been related to obsessive-compulsiveness in a sample of health club exercisers (Wyatt, Unpublished Doctoral Dissertation), and to excessive exercise in clinical ED groups.13, 14
A key feature of compulsive exercise is a negative mood, such as, experiencing feelings of anxiety, depression, and guilt, when deprived of exercising.15 However, other studies have found negative affect, in its various forms (i.e., anxiety and depression), to be related to continued exercise and not simply a resultant state of exercise deprivation. For example, Coen and Ogles11 found that compulsive exercisers reported higher levels of anxiety than non-compulsive exercisers. Similarly, greater levels of depression have been related to compulsive exercise in both clinical and nonclinical ED samples.16, 17
In addition to general anxiety, social anxiety has been 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 Specific to exercise, a tendency towards social comparisons has been shown to have a stronger impact on adolescent boys' exercising than on their eating.19 Previous research has also found that social physique anxiety, a body specific form of social anxiety, is positively related to greater exercise frequency.20 However, no study has focused on the role of social physique anxiety in the development of compulsive exercise.
In summary, compulsive exercise is a problematic behavior that affects many individuals with ED. A thorough review of previous research has identified several personality traits and psychological states as potential correlates of compulsive exercise,21 but relationships with compulsive exercise have yet to be tested in adolescents. It is also not clear which of these potential predictors of compulsive exercise are the most potent risk factors for its development.
Using a nonclinical adolescent sample, this study aims to identify which personality, psychological, and disordered eating factors are the best cross-sectional predictors of compulsive exercise. It is hypothesized that all significant predictors will be positively associated with compulsive exercise. Given the paucity of previous research, no predictions were made regarding which variable would be the best predictor of compulsive exercise.
- Top of page
- Earn CE credit for this article!
This study aimed to examine the best cross-sectional predictors of compulsive exercise among a sample of adolescents. The results indicate that for both boys and girls a drive for thinness was the best predictor, along with self-perfectionism, and then obsessive-compulsiveness. For boys only, social perfectionism was also an additional predictor, although it did not explain as much variance as the other significant variables. The hypothesis that all significant predictors would be positively associated with compulsive exercise was supported.
The significant drive for thinness finding supports the existing literature linking compulsive exercise closely with ED.4 A key finding in this sample, though, was that only a drive for thinness, rather than bulimic attitudes and body dissatisfaction, significantly predicted compulsive exercise, for both boys and girls. This drive for thinness is analogous to symptoms of AN, and so this finding concurs with previous literature identifying compulsive exercise as more prevalent among AN patients than other ED diagnoses.4, 7 This compulsivity towards exercise could be a key marker in the development of AN, particularly as this association with a drive for thinness has been found in a generally healthy, nonclinical group of young adolescents. Further research is needed to identify how compulsive exercise interacts with a drive for thinness over time, and whether the exercise compulsivity puts individuals at increased risk of subsequently developing AN.
High levels of perfectionism and obsessive-compulsiveness were also linked to compulsive exercise. The finding that perfectionism was among the best predictors of compulsive exercise is consistent with previous investigations.12, 14 Although both subscales of perfectionism were significant for the boys, there was a greater association with the self-orientated form of perfectionism. Likewise, for the girls, it was self-perfectionism and not social perfectionism that was found to be a significant predictor of compulsive exercise. Castro and her colleagues27 found that self-orientated perfectionism was more strongly associated with ED than socially prescribed perfectionism. This is also in accordance with a previous study that had shown AN patients to experience their perfectionism as self-imposed.35 Therefore, this would suggest that self-perfectionism could be influential in the development of ED, and specifically AN, and that it could be operating through compulsive exercise. The results from the current study demonstrate that this association between self-perfectionism and compulsive exercise occurs even in an adolescent school-based population, where levels of disordered eating symptoms were relatively low. Therefore, if replicated longitudinally, this finding could represent a key area for early intervention and/or prevention work of compulsive exercise attitudes, whereby the individual's self-imposed high standards could be targeted with the aim of reducing the compulsivity towards exercise.
The close link between compulsive exercise and obsessive-compulsiveness has been widely established in previous research (Wyatt, Unpublished Doctoral Dissertation).13 The findings from this investigation demonstrate that a compulsivity towards exercise is associated with obsessive-compulsive symptoms even in a community sample of adolescent boys and girls. This close and direct association could indicate another possible area for prevention work of compulsive exercise; work that could target certain individuals with greater levels of obsessive-compulsiveness. However, it is uncertain whether the compulsivity towards exercise actually develops into a wider obsessive-compulsiveness, or whether the causal direction is in fact the reverse, with individuals with obsessive-compulsive symptoms being at greater risk for developing compulsive exercise.
An interesting result from the present study was the lack of association between compulsive exercise and the psychological factors of anxiety and depression, as well as social physique anxiety. This is contrary to previous literature,16 although it is possible that in a nonclinical adolescent sample, the level of psychological morbidity may not yet be closely linked with exercising. Further research would be needed to identify whether the association between compulsive exercise and these psychological factors only occurs in specific samples, such as in a clinical ED or adult population.
This study has certain limitations that need to be highlighted. First, the cross-sectional nature of the design prevents causal attributions. Future research needs to replicate these findings using a longitudinal and/or experimental design to further establish causality. Second, the self-report nature of the measures 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 information. The use of self-report BMI data has been previously used in this age group,36 although it is accepted that self-report BMI in adolescents must be viewed with caution and objective BMI measurement would be preferable in future research.
Overall, the current study findings support a model where drive for thinness, perfectionism, and obsessive-compulsiveness all predict compulsive exercise in adolescents. The amount of variance accounted for by these personality predictors was large, with almost 40% of compulsive exercise in boys being explained by these variables. This suggests that compulsive exercise is largely a self-driven behavior that is affected by personal attributes and, as such, any potential prevention work needs to target the individual's existing personality motivations and general beliefs. Future research is also required to test the longitudinal associations between these personality traits and compulsive exercise.