Psychological risk factors for compulsive exercise: A longitudinal investigation of adolescent boys and girls

Download Psychological risk factors for compulsive exercise: A longitudinal investigation of adolescent boys and girls

Post on 27-Dec-2016

217 views

Category:

Documents

4 download

TRANSCRIPT

esersitEating disorderLongitudinalociato rredeasismoyse, wexercise is required.cts cond is iical ea. Approcludinependremendered (Shroff et al., 2006) and non-clinical groups (Hausenblas &e, it is importantusing a loniated withboys and girls. Adolescents were chosen as the onset of psycholog-ical disorders is typically around early to mid-adolescence (Kessleret al., 2007), and also as this investigation extends previous workinto correlates of compulsive exercise (Goodwin, Haycraft, Willis,et al., 2011). Based on this previous work, and in line with themodel of compulsive exercise (Meyer et al., 2011), it was predictedthat eating psychopathology, negative affect, obsessivecompul-siveness, and perfectionism would signicantly and positively Corresponding author. Address: Loughborough University Centre for Researchinto Eating Disorders, School of Sport, Exercise and Health Sciences, LoughboroughUniversity, Leicestershire LE11 3TU, UK. Tel.: +44 (0)1509 228160; fax: +44 (0)1509223940.E-mail address: e.haycraft@lboro.ac.uk (E. Haycraft).Personality and Individual Differences 68 (2014) 8386Contents lists availabPersonality and Indijournal homepage: www.eexercise has been associated with increased anxiety, depression,obsessionality, and eating psychopathology among eating disor-The current study aimed to test the proposed associationsbetween compulsive exercise and psychological factors amongto: (a) mitigate the experience of extreme guilt and/or negativeaffect when unable to exercise; and (b) avoid the perceived nega-tive consequences of stopping.In line with Meyer and colleagues (2011) model, compulsivecise, or whether they simply co-occur. Thereforto examine the models hypothesised risk factorsnal design, to establish whether they are assoclevels of compulsive exercise.http://dx.doi.org/10.1016/j.paid.2014.03.0480191-8869/ 2014 Elsevier Ltd. All rights reserved.gitudi-futurefocus on qualitative (i.e., compulsivity) rather than on quantitative(i.e., volume) dimensions (Meyer & Taranis, 2011). Meyer, Taranis,Goodwin, and Haycraft (2011, p. 184) conceptualised it as a com-pulsive behaviour, which is characterised by an association withweight and shape concerns, and persistent continuation in orderand a drive for thinness (Goodwin, Haycraft, Willis, & Meyer,2011). These ndings support Meyer et al.s (2011) model of com-pulsive exercise, but given the cross-sectional design of Goodwin,Haycraft, Willis, et al.s (2011) study, it is unknown whether suchpsychological variables could be risk factors for compulsive exer-1. IntroductionUnhealthy excessive exercise affeLipsey, Barton, Hulley, & Hill, 2006) aopment and maintenance of clinKennedy, Ravelski, & Dionne, 1994)describe this unhealthy exercise, inexercise addiction, and exercise d2005). There is consensus that measu 2014 Elsevier Ltd. All rights reserved.mmunity samples (e.g.,mplicated in the devel-ting disorders (Davis,ximately 31 terms cang compulsive exercise,ence (Adkins & Keel,t of such exercise mustSymons Downs, 2002). Despite the problems associated with com-pulsive exercise, underpinning research is relatively scarce. In par-ticular, the specic risk factors for compulsive exercise remainunknown.A preliminary cross-sectional study found self-oriented perfec-tionism, socially prescribed perfectionism, obsessivecompulsive-ness and drive for thinness signicantly predicted compulsiveexercise among adolescent boys, while in girls compulsive exercisewas predicted by self-perfectionism, obsessivecompulsiveness,ObsessivecompulsivenessPerfectionismpredictor. Compulsive exercise prevention work among boys may benet from targeting their levels ofobsessivecompulsiveness and self-perfectionism. For girls, further risk factor research into compulsiveShort CommunicationPsychological risk factors for compulsiveinvestigation of adolescent boys and girlHuw Goodwin, Emma Haycraft , Caroline MeyerLoughborough University Centre for Research into Eating Disorders, Loughborough Univa r t i c l e i n f oArticle history:Received 14 November 2013Received in revised form 24 March 2014Accepted 29 March 2014Keywords:Compulsive exercisea b s t r a c tCompulsive exercise is assulations. This study aimedacteristics as longitudinal pn = 148 male) completed mcompulsiveness, perfectioncise two years later. For bdicted compulsive exercisxercise: A longitudinaly, Leicestershire, UKted with unhealthy outcomes and is common among eating disorder pop-eplicate previous cross-sectional work by considering psychological char-ictors of compulsive exercise. A sample of 369 adolescents (n = 221 female,ures of compulsive exercise, eating disorder psychopathology, obsessive, anxiety, and depression at baseline, and a measure of compulsive exer-, greater obsessivecompulsiveness and self-oriented perfectionism pre-hilst among girls only baseline compulsive exercise was a signicantle at ScienceDirectvidual Differenceslsevier .com/locate /paidndivpredict compulsive exercise, and after controlling for baseline lev-els of compulsive exercise.2. Methods2.1. Participants148 boys and 221 girls (N = 369) from six UK schools completedbaseline (T1) and follow-up assessments 24 months later (T2). Thesample, aged 1214 years old at T1 (mean 12.89; SD .69), and1416 years old at T2 (mean 14.84; SD .67), was predominantlyWhite British (93.2%). Self-reported Body Mass Index (BMI) valueswere converted to age- and gender-adjusted z-scores (BMI z-scores; Child Growth Foundation, 1996). These BMI z-scores atT1 were 0.28 (SD 1.67) for boys and 0.10 (SD 1.31) for girls,and at T2 were 0.48 (SD 1.06) for boys and 0.17 (SD 1.13) for girls.Participating schools were in areas of average to low levels ofeconomic deprivation (Ofce for National Statistics, 2008).2.2. ProcedureFollowing ethical clearance, questionnaires were sent to partic-ipating schools. At T1, background/demographic information, andthe measures described below were included. At T2, compulsiveexercise, age, height and weight were assessed. Followinginformed consent, questionnaires were completed during a classperiod. Standardised instructions were given to administeringteachers. Completed packs were assigned an identication code,and the procedure was repeated approximately 24 months later.Participants at T1 and T2 were included in the analyses.2.3. Measures2.3.1. Compulsive Exercise Test (CET; Taranis, Touyz, & Meyer, 2011)The CET assesses an individuals compulsivity towards exercise(I feel extremely guilty if I miss an exercise session). CET totalscore was used, with higher scores representing greater compul-sive exercise. The CET is validated for adolescents (Goodwin,Haycraft, Taranis, & Meyer, 2011). Cronbachs alpha values forthe current sample were .89 (T1) and .88 (T2).2.3.2. Eating Disorder Inventory-2 (EDI-2; Garner, 1991)The EDI-2 Drive for Thinness, Bulimia, and Body Dissatisfactionsubscales were used to assess eating disorder psychopathology.The EDI-2 has been used with adolescents (Grylli, Hafferl-Gattermayer, Schober, & Karwautz, 2004). Cronbachs alpha valuesfor this sample were .86 (Drive for Thinness), .71 (Bulimia), and .90(Body Dissatisfaction).2.3.3. Child and Adolescent Perfectionism Scale (CAPS; Flett, Hewitt,Boucher, Davidson, & Munro, 1992)The CAPS comprises two subscales: Self-Oriented Perfectionism(CAPS-Self), measuring self-imposed levels of perfectionistic stan-dards and behaviours; and, Socially Prescribed Perfectionism(CAPS-Social), measuring the degree to which perfectionism isimposed on individuals by external sources (parents, friends,and/or teachers). The CAPS has been used with adolescents(Hewitt, Newton, Flett, & Callander, 1997), and demonstratedsatisfactory reliability among the current sample (CAPS-Selfa .82; CAPS-Social a .87).2.3.4. Spence Child Anxiety ScaleObsessive Compulsive Subscale84 H. Goodwin et al. / Personality and I(SCAS-OC; Spence, 1998)The SCAS-OC comprises six items assessing levels of obsessivecompulsiveness (e.g., I cant seem to get bad or silly thoughts outof my head). The SCAS-OC has good reliability among adolescents(Spence, 1998) and in the current sample (a .79).2.3.5. Hospital Anxiety and Depression Scale (HADS; Zigmond &Snaith, 1983)The HADS measures anxiety (Worrying thoughts go throughmy mind) and depression (I feel as if I am slowed down). Ithas been validated for adolescents (White, Leach, Sims, Atkinson,& Cottrell, 1999). The anxiety subscale demonstrated satisfactoryreliability in the current sample (a .73) but reliability of thedepression subscale was .60, so caution regarding interpretationis advised.3. Data analysisAs levels of T2 CET were found to differ across participatingschools (F = 7.05(5, 362), p < .001), school was re-coded intodummy variables, which were included in the regressions. T-testsfound signicant gender differences on the outcome variable(CET). Therefore, all subsequent analyses were conducted sepa-rately for boys and girls. BMI z-scores were not signicantly asso-ciated with CET and so were not entered into the regressions. Ahierarchical multiple regression was performed with T2 CET asthe outcome variable. The school dummy variables were enteredin the rst step, baseline compulsive exercise score (T1 CET) wasentered into the second step, and all other predictors were enteredin the third step of the model. Signicance was set at p < .05.4. Results4.1. Descriptive statisticsThe variables mean scores are presented in Table 1. The meansfor T1 and T2 CET for boys and girls demonstrate low to mid-pointscoring (sometimes true of me) and therefore do not reect highlevels of compulsive exercising. These values are lower thanexpected in a clinical sample (Naylor, Mountford, & Brown,2011). EDI scores were below clinical cut-offs (Grylli et al., 2004).In comparison to norms (Snaith & Zigmond, 1994), levels of anxietywere mild, whereas levels of depression were healthy. CAPS-Self,CAPS-Social and SCAS scores are similar to comparable data (e.g.,Spence, 1998).4.2. Risk factors for compulsive exercise4.2.1. BoysThe nal regression model for boys (Table 2) was signicant,accounting for 47% of T2 CET variance. In the rst two steps, theschool dummy variables contributed signicantly to the outcomevariance (R2 change = .07; F(3, 110) change = 2.73, p < .05), as didthe addition of baseline CET scores (R2 change = .29; F(1, 109)change = 48.13, p < .001). The psychological predictors also pro-duced a signicant change in the model (R2 change = .17; F(8, 101)change = 4.51, p < .001). In the nal model, SCAS and CAPS-Selfwere signicant positive predictors of T2 CET, in addition to thesignicant predictors of T1 CET, and two school dummy variables.Anxiety was also a signicant, negative predictor of T2 CET.4.2.2. GirlsThe nal hierarchical regression model for girls (Table 2) wassignicant, with the overall model accounting for 24% of T2 CETvariance. School dummy variables contributed signicantly to the2idual Differences 68 (2014) 8386outcome variance (R change = .08; F(5, 162) change = 2.88, p < .05)in step 1, as did the addition of baseline CET scores in step 2 (R2change = .16; F(1, 161) change = 34.79, p < .001). The addition of theIndivTable 1Characteristics of the sample and gender differences.H. Goodwin et al. / Personality andpsychological predictors did not produce a signicant change inthe model (R2 change = .06; F(8, 153) change = 1.54, p > .05). In thenal model, only T1 CET and one school dummy variable were sig-nicant predictors of T2 CET.Variables Mean (SD) T-testBoys Girls t (df)SCAS-OC 0.95 (0.57) 1.01 (0.69) .93 (332)CAPS-Self 34.90 (7.77) 33.48 (8.48) 1.56 (334)CAPS-Social 25.37 (7.89) 23.28 (8.50) 2.28 (334)*HADS Anxiety 7.96 (3.52) 8.22 (3.57) .67 (351)HADS Depression 4.28 (2.86) 3.53 (2.77) 2.45 (351)*Drive for Thinness 2.94 (4.10) 5.28 (5.87) 4.12 (309)***Bulimia 2.10 (3.24) 2.04 (3.06) 0.18 (309)Body Dissatisfaction 5.04 (5.57) 9.14 (7.97) 5.33 (309)***T1 CET 10.52 (4.12) 10.04 (3.89) 1.02 (302)T2 CET 7.96 (3.42) 9.78 (3.38) 5.05 (366)***Note: SCAS-OC = Spence Child Anxiety Scale-ObsessiveCompulsive Subscale;CAPS = Child and Adolescent Perfectionism Scale; HADS = Hospital Anxiety andDepression Scale; EDI = Eating Disorder Inventory; CET = Compulsive Exercise Test;T1/T2 = Time 1/Time 2.* p < .05 (one-tailed).*** p < .001 (one-tailed).Table 2Final model of hierarchical multiple regression of T2 CET score (outcome) for boys andgirls.Model Beta t F (df) R2 AdjustedR2BoysOverall model 9.28***(12, 101) .52 .47School Dummy 1 v 2 .11 1.46School Dummy 1 v 6 .19 2.59*School Dummy 1 v 7 .19 2.68**T1 CET .47 5.05***SCAS-OC .35 4.05***CAPS-Self .18 2.16*CAPS-Social .04 0.44HADS-Anxiety .21 2.48*HADS-Depression .14 1.72EDI-Drive for Thinness .08 0.82EDI-Bulimia .12 1.42EDI-BodyDissatisfaction.11 1.34GirlsOverall model 4.71***(14, 153) .30 .24School Dummy 1 v 2 .08 1.15School Dummy 1 v 3 0.3 0.35School Dummy 1 v 6 .17 2.30*School Dummy 1 v 7 .12 1.63School Dummy 1 v 9 .08 1.14T1 CET .36 3.79***SCAS-OC .12 1.22CAPS-Self .12 1.25CAPS-Social 0.7 0.83HADS-Anxiety .16 1.64HADS-Depression .13 1.63EDI-Drive for Thinness .07 0.59EDI-Bulimia .15 1.87EDI-BodyDissatisfaction.09 0.91Note: CET = Compulsive Exercise Test; School Dummy = Dummy variable createdfor original categorical school variable; SCAS-OC = ObsessiveCompulsive Subscale;CAPS = Child and Adolescent Perfectionism Scale; HADS = Hospital Anxiety andDepression Scale.* p < .05.** p < .01.*** p < .001.5. DiscussionResults for boys supported Meyer et al.s (2011) compulsiveexercise model by demonstrating that obsessivecompulsivenessand self-perfectionism predicted compulsive exercise, even aftercontrolling for baseline levels of the outcome variable. This sug-gests that these variables lead to increased compulsive exerciseover a two year period, rather than simply being associated withcompulsive exercise levels. This nding extends previous cross-sectional research (Goodwin, Haycraft, Willis, et al., 2011).Among boys, anxiety was also a signicant predictor but in theopposite direction to our hypotheses, with lower anxiety actuallypredicting greater compulsive exercise. This may be due to theanxiolytic benets of exercise (Wipi, Rethorst, & Landers, 2008),demonstrating the importance of exercise in a non-clinical samplefor regulating emotions. Further research should determinewhether a reliance on exercise to manage anxiety develops overtime, and if so, whether it leads to the maintenance of more prob-lematic compulsive exercise, as stipulated by Meyer et al.s model(2011).For girls, psychological predictors did not predict compulsiveexercise. Baseline compulsive exercise was a signicant predictor,possibly demonstrating some temporal stability of compulsiveexercise among girls of this age. Alternatively, it is possible thatrisk factors for compulsive exercise are less about psychologicalcharacteristics, such as obsessivecompulsiveness, perfectionism,or eating disorder psychopathology (as hypothesised by Meyeret al., 2011), and more about other unknown variables. Further-more, the signicant differences in compulsive exercise betweenschools may indicate environment-specic variables, requiring fur-ther investigation.The ndings have important implications for professionalsworking with adolescents. Specically, an alarming number of ado-lescent boys have potentially undiagnosed eating psychopathology(Kjelsas, Bjornstrom, & Gotestam, 2004); and our ndings couldinform prevention programmes, directing practitioners towardsboys obsessivecompulsiveness and self-perfectionism levels.Given that high levels of perfectionism are associated with anxiety,depression, and stress (e.g., Schweitzer & Hamilton, 2002), furtherwork should look to focus on boys achievement orientation anddrive to succeed. Another noteworthy nding is that baseline levelsof compulsive exercise were signicantly related to compulsiveexercise two years later. This temporal stability, alongside thegreater number of personal correlates identied cross-sectionally(Goodwin, Haycraft, Willis, et al., 2011), could suggest that theserisk factors are still related to compulsive exercise, but that theirassociation occurred prior to the current baseline age here. Giventhat compulsive exercise is often the rst symptom of eating disor-ders to appear (Davis et al., 1994), compulsive exercise could occurat an earlier age than was sampled in the current study. Therefore,prevention should target pre-adolescents.This study had limitations. First, it is unknownwhether baselinecompulsive exercise led to increases in the predictor variables,including eating psychopathology, as these were not measured atT2. Second, the sample comprised primarily white British adoles-cents, hence replication in more diverse samples is needed. Finally,actual exercise behaviours were not measured, therefore preclud-ing discussion of whether compulsive exercise attitudes lead tounhealthy volumes or types of exercise behaviour.In summary, this is the rst investigation to assess longitudinalpredictors of compulsive exercise. The ndings indicate that obses-sivecompulsiveness and self-oriented perfectionism are risk fac-tors for compulsive exercise among boys, while further researchidual Differences 68 (2014) 8386 85is needed to elucidate risk factors among girls. These ndings couldinform compulsive exercise prevention work.ReferencesAdkins, E. C., & Keel, P. K. (2005). Does excessive or compulsive best describeexercise as a symptom of bulimia nervosa? International Journal of EatingDisorders, 38, 2429.Child Growth Foundation (1996). Cross sectional stature and weight reference curvesfor the UK. London, United Kingdom: Child Growth Foundation.Davis, C., Kennedy, S. H., Ravelski, E., & Dionne, M. (1994). The role of physicalactivity in the development and maintenance of eating disorders. PsychologicalMedicine, 24, 957967.Flett, G. L., Hewitt, P. L., Boucher, D. J., Davidson, L. A., & Munro, Y. (1992). The ChildAdolescent Perfectionism Scale: Development, validation, and association withadjustment. York University Psychology Department Report No. 203, NorthYork, Ontario, Canada.Garner, D. M. (1991). EDI-2: Professional manual. Odessa, FL: PsychologicalAssessment Resources.Goodwin, H., Haycraft, E., Taranis, L., & Meyer, C. (2011). Psychometric evaluation ofthe Compulsive Exercise Test (CET) in an adolescent population: Links witheating psychopathology. European Eating Disorders Review, 19, 269279.Goodwin, H., Haycraft, E., Willis, A., & Meyer, C. (2011). Compulsive exercise: Therole of personality, psychological morbidity, and disordered eating. InternationalJournal of Eating Disorders, 44, 655660.Grylli, V., Hafferl-Gattermayer, A., Schober, E., & Karwautz, A. (2004). Prevalenceand clinical manifestations of eating disorders in Austrian adolescents withtype-1 diabetes. Wiener Klinische Wwochenschrift, 116(78), 230234.Hausenblas, H. A., & Symons Downs, D. (2002). Exercise dependence: A systematicreview. Psychology of Sport and Exercise, 3, 89123.Hewitt, P. L., Newton, J., Flett, G. L., & Callander, L. (1997). Perfectionism and suicideideation in adolescent psychiatric patients. Journal of Abnormal Child Psychology,25, 95101.Kessler, R. C., Amminger, P. G., Aguilar-Gaxiola, S., Alonso, J., Lee, S., & Ustun, B. T.(2007). Age of onset of mental disorders: A review of recent literature. CurrentOpinions in Psychiatry, 20, 359364.Kjelsas, E., Bjornstrom, C., & Gotestam, K. G. (2004). Prevalence of eating disorders infemale and male adolescents (1415 years). Eating Behaviors, 5, 1325.Lipsey, Z., Barton, S. B., Hulley, A., & Hill, A. J. (2006). After a workout. . . beliefsabout exercise, eating and appearance in female exercisers with and withouteating disorder features. Psychology of Sport and Exercise, 7, 425436.Meyer, C., & Taranis, L. (2011). Exercise in the eating disorders: Terms anddenitions. European Eating Disorders Review, 19, 169173.Meyer, C., Taranis, L., Goodwin, H., & Haycraft, E. (2011). Compulsive exercise andeating disorders. European Eating Disorders Review, 19, 174189.Naylor, H., Mountford, V., & Brown, G. (2011). Beliefs about excessive exercise ineating disorders: The role of obsessions and compulsions. European EatingDisorders Review, 19, 226236.Ofce for National Statistics (2008). Neighbourhood statistics. Ofce for NationalStatistics. Retrieved 15.02.2009.Schweitzer, R., & Hamilton, T. J. (2002). Perfectionism and mental health inAustralian university students: Is there a relationship? Journal of College StudentDevelopment, 43, 684695.Shroff, H., Reba, L., Thornton, L. M., Tozzi, F., Klump, K. L., Berrettini, W. H., & Bulik, C.(2006). Features associated with excessive exercise in women with eatingdisorders. International Journal of Eating Disorders, 39, 454461.Snaith, R. P., & Zigmond, A. S. (1994). The hospital anxiety and depression scale withthe irritabilitydepressionanxiety scale and the leeds situational anxiety scale:Manual. Windsor, England: The NFER-NELSON Publishing Company.Spence, S. H. (1998). A measure of anxiety symptoms among children. BehaviourResearch and Therapy, 36, 545566.Taranis, L., Touyz, S., & Meyer, C. (2011). Disordered eating and exercise:Development and preliminary validation of the Compulsive Exercise Test(CET). European Eating Disorders Review, 19, 256268.White, D., Leach, C., Sims, R., Atkinson, M., & Cottrell, D. (1999). Validation of thehospital anxiety and depression scale for use with adolescents. British Journal ofPsychiatry, 175, 452454.Wipi, B. M., Rethorst, C. D., & Landers, D. M. (2008). The anxiolytic effects ofexercise: A meta-analysis of randomised trials and doseresponse analysis.Journal of Sport & Exercise Psychology, 30, 392410.Zigmond, A. S., & Snaith, R. P. (1983). The hospital anxiety and depression scale. ActaPsychiatrica Scandinavica, 67, 361370.86 H. Goodwin et al. / Personality and Individual Differences 68 (2014) 8386Psychological risk factors for compulsive exercise: A longitudinal investigation of adolescent boys and girls1 Introduction2 Methods2.1 Participants2.2 Procedure2.3 Measures2.3.1 Compulsive Exercise Test (CET; Taranis, Touyz, & Meyer, 2011)2.3.2 Eating Disorder Inventory-2 (EDI-2; Garner, 1991)2.3.3 Child and Adolescent Perfectionism Scale (CAPS; Flett, Hewitt, Boucher, Davidson, & Munro, 1992)2.3.4 Spence Child Anxiety ScaleObsessive Compulsive Subscale (SCAS-OC; Spence, 1998)2.3.5 Hospital Anxiety and Depression Scale (HADS; Zigmond & Snaith, 1983)3 Data analysis4 Results4.1 Descriptive statistics4.2 Risk factors for compulsive exercise4.2.1 Boys4.2.2 Girls5 DiscussionReferences

Recommended

View more >