Compulsive exercise and eating disorder related pathology

Compulsive exercise has been observed as a significant feature of the eating disorders throughout their history. It has variously been conceptualised as primarily an analogue of purgation, an emotion regulation strategy, an addiction, or an obsessivecompulsive behaviour, with evidence supporting each to varying degrees. The importance of compulsive exercise is underlined by the finding that it often precedes the onset of an eating disorder and is one of the last symptoms to subside. In addition, it is associated with a longer length of hospitalisation and higher rates of relapse. As a result, compulsive exercise is now recognised as a significant factor in the aetiology, development and maintenance of the eating disorders across diagnoses. Yet despite the importance of compulsive exercise and previous recommendations to target it, no clear conceptual model of compulsive exercise exists upon which an intervention could be based. This thesis has three broad aims: (1) critically review the evidence for and against factors implicated in the maintenance of compulsive exercise and propose a new theoretically coherent and empirically derived model of compulsive exercise that could be used to inform future cognitive-behavioural interventions; (2) develop and provide preliminary validation for a new measure of compulsive exercise; and (3) present six studies utilising the new measure of compulsive exercise to empirically test some of the relationships suggested by the proposed model. Main findings: The resulting Compulsive Exercise Test (CET) is a new multidimensional measure of compulsive exercise, consistent with the proposed cognitive-behavioural conceptualisation, and demonstrating good psychometric properties. Utilising the CET, the empirical chapters demonstrate that compulsive exercise was associated with (a) elevated levels of eating-disordered cognitions and increased frequency of eating-disordered behaviours, (b) avoidanceoriented coping and a range of difficulties in regulating emotions, and (c) perfectionism (particularly the self-critical dimension). Implications: The current findings provide preliminary support for the proposed cognitive-behavioural maintenance model of compulsive exercise. This may inform clinical interventions and prevention programs designed to address compulsive exercise, as well as enhancing current treatment efficacy by providing specific targets for intervention. In addition, the new measure of compulsive exercise is potentially a useful screening tool in formulating the maintenance of an individual’s exercise behaviour, and is further a potentially useful research and outcome tool.