Academic journal article Journal of Eating Disorders

The Compulsive Exercise Test: Confirmatory Factor Analysis and Links with Eating Psychopathology among Women with Clinical Eating Disorders

Academic journal article Journal of Eating Disorders

The Compulsive Exercise Test: Confirmatory Factor Analysis and Links with Eating Psychopathology among Women with Clinical Eating Disorders

Article excerpt

Author(s): Caroline Meyer[sup.1,2,3], Carolyn R. Plateau[sup.4], Lorin Taranis[sup.4], Nicola Brewin[sup.5], Jackie Wales[sup.5] and Jon Arcelus[sup.5,6,7]

Background

Compulsive exercise is an important component of eating psychopathology. Previously, the Compulsive Exercise Test (CET) was developed to assess this characteristic. This study aimed to determine the psychometric properties of the Compulsive Exercise Test (CET) among an adult sample of patients with eating disorders.

A recent review reported that up to 85 % of eating disordered patients engage in compulsive exercise [16]. Compulsive exercise has been defined as a rigid and highly driven urge to be physically active, in association with a perceived inability to stop exercising despite the individual being aware of the possible negative consequences [45]. Patients who engage in such behaviour tend to have a worse outcome and require longer hospitalisation than non-exercising patients (e.g., [6, 11, 41]). Therefore, it is essential that we can adequately operationalise and measure this construct within the context of eating disorder patients.

Until relatively recently, compulsive exercise had been conceptualised as a uni-dimensional construct (typically centred on its utility in managing shape and weight; e.g., [13]). In addition, it had often been measured via quantitative (i.e. frequency, duration and intensity of exercise), rather than qualitative metrics (i.e. the psychological experience of exercise; [32]). However, it is clear from numerous research studies that this early conceptualisation is inadequate to fully assess the underlying features of compulsive exercise within the context of the eating disorders [33]. Specifically, in addition to the control of weight and shape, compulsive exercise involves components of both mood improvement (positive reinforcement) and affective avoidance (negative reinforcement; e.g., [8, 9]). Exercising is commonly associated with positive affect, and models of exercise dependence have suggested that exercise-induced euphoric states are highly positively reinforcing [19]. However, exercising for negative affect regulation has been consistently identified as contributory factor to the development and maintenance of eating disorders [22, 46]. Specifically, experiencing affective withdrawal symptoms when unable to exercise has been identified as a central characteristic of psychological dependence on exercise [21]. The experience of withdrawal symptoms from exercise has been shown to discriminate between eating disordered and non-clinical groups [7]. In addition, compulsive exercise is typified by a compulsive rigidity and a lack of intrinsic enjoyment (e.g., [4, 7, 34]).

In recognition of the multi-dimensional nature of compulsive exercise, a new self-report measure; The Compulsive Exercise Test (CET) was developed and initially psychometrically tested within a group of non-clinical exercising women [45]. The CET is based on a maintenance model that was developed in the context of the eating disorders [33], and measures compulsive exercise in a multi-dimensional way. An initial factor analysis conducted with the CET identified five distinct subscales [45]: Avoidance and rule-driven behaviour (continuing to exercise despite injury or illness, making up for missed sessions, experiencing exercise withdrawal symptoms, and feeling extremely guilty when unable to exercise); Weight control exercise (exercising to modify or control weight and shape, engaging in compensatory exercise to account for calorie intake); Mood improvement (experiencing the positive, mood enhancing effects of exercise); Lack of exercise enjoyment (experiencing exercise as a chore rather than a pleasure), and Exercise rigidity (maintaining a strict and repetitive exercise schedule). Subsequently, this initial factor structure was supported for use with a community sample of male and female adolescents [20], and a slightly revised version has been published for use with athletes [39]. …

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