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A Literature Review of the Relationship between Obligatory

 Exercise and Eating Disorders

 

 Emily Slaff

 

For decades in contemporary society, much emphasis has been placed on women’s bodies and the achievement of the ideal.  The common concern for women is how to achieve the ideal or perfect body.  Most women compare themselves with the unattainable figure often seen in the media: fit, firm, sexy, shapely, and of course extremely thin (Krane et al., 2001).  Women are constantly bombarded with these images and messages and are encouraged to always try to better their appearance.  These cultural standards induce poor and distorted body images in most young women, which can lead to maladaptive behaviors such as eating disorders and excessive exercise.

 

Introduction:        Anorexia, Bulimia, and Exercise

 

Distorted body image and dissatisfaction is often a precursor to eating disorders such as anorexia and bulimia nervosa.  Anorexia nervosa is classified when a person, with an intense fear of gaining weight, an engagement in self-imposed starvation along with other coexisting behaviors in order to lose weight.  The anorexic refuses to maintain body weight at a normal rage for their age and height.  Anorexics have an extreme distortion in their body image and are in denial of their seriously low body weight (Matheson et al., 2000).  Bulimia nervosa is a disorder associated with a binge/purge cycle of food.  Those suffering from bulimia also share an intense fear of fat.  Many engross themselves with large amounts of food and use different purging mechanisms to relieve themselves of he food and the guilt associated with the binge behavior.  Different purging behaviors include self-induced vomiting, laxatives, diuretics, fasting, and excessive exercise (Hubbard et al., 1998).

            In most cases exercise is encouraged as a healthy habit, with many recognized health benefits.  Besides health benefits, women are socially rewarded for exercising as well.  But because of these positive reinforcements, exercise dependence and abuse can occur and is hard to recognize.  Excessive exercise can be very dangerous when the balance between healthy exercise and healthy living are neglected.  Exercisers with a preoccupation and drive for thinness feel that “if moderate exercise is good than excessive is better” (Oaks, 1999).  With this attitude, women can partake in obligatory exercise rituals, which own similar characteristics of addition.

            The difference with healthy exercisers and those doomed to abuse exercise remains in their attitudes towards exercise.  Instead of promoting exercise as a health requirement (healthy exercisers), exercise abusers smother their entire life with their preoccupation (obligatory exercisers) (Hubbard et al., 1998).  In order for exercise to be identified as a problem, a person must meet one or more of the following criteria.  Exercise becomes the first and sometimes only priority of the obligatory exerciser.  They also continue to push through their rigorous exercise routines regardless of injury or sickness.  Like substance abusers or other extreme addictions, most obligatory exercisers experience withdrawal symptoms if they cannot work out such as: anxiety, irritation, extreme mood swings and even depression (Oaks, 1999).  Although exercise abuse is extremely dangerous and can produce serious injuries, it is not considered a diagnosed addiction (Keski-Rahkonen, 2001).  Research shows little evidence of tolerance or severe withdrawal symptoms that induced psychological distress, which is needed to fulfill the criteria of a full-blown addiction. 

            With the prevalence of the dangers of eating disorders and exercise abuse, the question remains: “What is the relationship between the excessive exercisers and eating disorder patients?”  Are there similarities between the personalities of the different groups?  Is there a correlation between the eating disorder patients and obligatory exercisers?  What is the role of exercise in predicting dietary restraints?  Different research studies try to attack these questions to assess the relationship between exercise abuse and eating disorders.

 

Personality Traits in Eating Disordered Patients and the Obligatory Exerciser:      

 

Increasing evidence proves the accountability of certain personality traits in eating disordered patients.  Those who suffer from anorexia and bulimia generally have extreme body dissatisfaction, low self-esteem, feelings of losing control, and obsessive-compulsive behavior (Yates et al., 2001).  A study was performed by Marie Iannos and Mark Tiggemann (1997) to test the prevalence of these personality traits in excessive exercisers.  They assumed eating disorder patients and excessive exercisers would share similar personality traits.

            The chosen participants were 205 people (106 men and 99 women) who were considered recreational exercisers, those who exercised for personal reasons as opposed to competitive ones.  The subjects were recruited from 7 different gymnasiums.  Questionnaires were distributed throughout for those who chose to participate.  The questionnaire concentrated on exercise, personality, and disordered eating habits.  The exercise section first asked general questions about the amount of time engaged in exercise per week.   Then the subjects went on to more specific questions regarding attitudes towards their exercise regimes, with the criteria for an obligatory exerciser; assessing guilt if absent from exercise, refusal to discontinue exercise after sickness or injury, and willingness to continue despite a prior personal commitment.  Next the participants were to answer questions regarding personality; rating their self-esteem, ability to feel in control of their lives, and the degree of obsessive-compulsiveness in their daily thoughts and behaviors.  Finally, the participants answered the Eating Disorder Inventory, in order to assess psychological and behavioral characteristics associated with eating disorders.  This would also act as a control for subjects with eating disorders; therefore, the test would be directed just toward the personality traits of the excessive exerciser.

            The sample results were divided into three groups; 69 people exercised 0-5 hours per week (light), 107 who exercised 5-11 hours per week (moderate), and 29 who exercised more than 11 hours per week (excessive).  The results showed no significant difference in the results between the excessive exercisers, who didn’t display high scores on the Eating Disorder Inventory, and the light and moderate exercisers.  Although it was assumed there would be a high correlation between the excessive exercisers, without the presence of eating disturbances, and low self-esteem, feelings of losing control, and obsessive-compulsiveness, the results did not significantly differ from the personality results of the light and moderate exerciser.  The majority of the subjects that qualified for excessive degree of exercise did share high scores on the Eating Disorder Inventory.  These subjects did share similar personality traits assigned to anorexic and bulimic patients.  They illustrated the same degree of obligatory attitudes with exercise, extreme feelings of body dissatisfaction, and a severe drive for thinness.

This correlation illustrates the risk of the obligatory exerciser in developing an eating disorder.  These obligatory exercisers should be closely observed in order to detect signs of an eating disorder.  The subjects should be tested again to determine the reliability of this experiment.  This experiment demanded introspective self-reports, which can add to the error in validity of the experiment.  The sample of subjects could have been dishonest or even in denial with their questionnaires.   In some cases these obligatory exercisers might have been in the early stages of developing the personality dysfunctions associated with developing eating disorders.

Another study, with similar personality results, equates exercise as a possible mediator between eating disorder patients, perfectionism, and a sense of control.  They predict that those who suffer from eating disorders use excessive exercise to heighten self-esteem and a sense of control.  Exercise would also then be a controlled outlet for the perfectionist if excessively allotted (McLaren et al., 2000). 

 

The Prevalence of Eating Disorders in Obligatory Exercisers:

 

Exercise abuse is categorized by the attitude a person owns towards their exercise regimes (Keski-Rahkonen, 2001).  Healthy exercisers (light and moderate) usually work out for the health and psychological benefits, such as more energy and lower risks of depression.  Exercise abusers share the same motivation as people with eating disorders, where there only objective is to lose weight and change their body shape (Hubbard et al., 1998).  Many researchers have concentrated their studies on the link and prevalence of eating disorders in excessive exercisers (obligatory) and the reverse, obligatory exercise in eating disordered patients.

A study from Sarah T. Hubbard, James J. Gray, and Scott Parker (1998) tested the differences among women who exercise for ‘food related’ and ‘non-food related’ reasons.  Women who exercise to work off the food they have consumed in order to control (lose or maintain) weight are defined as ‘food related’ exercisers.  Those who exercise for other objectives, such as physical health, are labeled ‘non-food related’ exercisers.  The study was performed to test the role of exercise in relation to eating disorders.

The subject sample was 49 females between the ages of 18-25.  In order to participate, the subjects needed to report exercising at least 30 min, 3 times a week, continually for 1 year.  Six different self-report questionnaires were to be answered.  The first assessed whether the degree of exercise is deemed obligatory or extreme.  The next questionnaire was the Eating Disorder Inventory-2 to measure the psychological traits and behaviors that are relevant to diagnosing eating disorders.  The next questionnaire assessed the extent of satisfaction with their bodies.  Depression was measured using the Beck Depression Inventory.  A self-esteem questionnaire was distributed to measure feelings of self worth.  Finally an exercise demographic questionnaire asked questions about amount of time the subjects exercised, their reasons for exercising, and their relationship between exercise and food intake.  The subjects were tested individually in a lab setting.

The results of the exercise demographic questionnaire allowed the subjects to be divided into two groups (‘food related’ and ‘non-food related’ exercisers).  33 subjects were classified as ‘food related’ and 16 subjects were classified as ‘non-food related’.  Results showed that food related group felt more obligatory about their exercise routines, showing complete reluctance to discontinue exercising.  The scores on the Eating Disorder Inventory were almost doubled for the food related group compared to the non-food related group.  The food related group illustrated a greater drive for thinness, body dissatisfaction, and disturbing eating behaviors.  The food related group experienced more feelings of physical unattractiveness, and their weight preoccupation scores were almost double to those in the non-food related group.  There was no significant difference in the measure of depression between the two groups.  Although the scores noted a greater risk of depression for the food related group, both groups were considered in normal, healthy range.  These results could have occurred due to exercise’s known ability to reduce the symptoms of depression.   Finally, the self-esteem questionnaire resulted in significantly lower self-esteem scores for the food related group.  The exercise demographic questionnaire illustrated the primary motivation for the food related group was losing weight, changing the body’s appearance, or compensating for consumed food.

The research suggests that the food related group possesses a greater risk of developing an eating disorder.  Twenty percent of the food related exercise group reported a history of anorexia and/or bulimia.  The other eighty percent has a high risk of this development.  Because the obligatory exercise routine is rooted in weight concerns, social reinforcement from losing the weight through exercise might further the exercise obsession.  This obsession could lead to destructive eating patterns such as starvation and binge/purge patterns.  This explanation assumes that exercise can become an encouraging precursor to developing eating disorders.  Although research displays many different factors in the development of an eating disorder, excessive and obligatory exercise can be noted as a possible factor for the onset of these eating disorders.

 

Is Exercise Dependence Independent from Eating Disorders?

 

In an eating disorder review, Anna Keski-Rahkonen (2001) investigates whether exercise dependence can stand alone as a primary, independent diagnosis, or if exercise dependence is just a symptom of an eating disorder.  Exercise dependence was defined as compulsive, obsessive, and abusive exercise regimes.  Keski-Rahkonen further suggests that in order for excessive exercise (exercise that meets all of the obligatory exercise criteria) to become its’ own independent diagnosis, findings must appear separate from eating disorders.  Research found that those who exercised with an absence of eating disturbances did not qualify for the obligatory criteria.  Exercisers who did meet the obligatory criteria did include finding of eating disturbances.  Thus Keski-Rahkonen’s study proposes that exercise dependence was revealed only in the context of an eating disorder, thus suggesting that exercise dependence is NOT independent from eating disorders.   She suggests if a person claims to be an obligatory exerciser, “delve deeper-look for an eating disorder.”  The review, however, noted the lack of research on the subject of obligatory exercise and eating disorders.

 

 

ConclusionExcessive Exercise is a Symptom of Eating Disorders

 

            Many studies have researched the correlation between obligatory exercisers and eating disorders.  Some studies assume similarities between the personalities of the exercisers and eating disordered patients.  There seems to be traces of similar personality symptoms such as body dissatisfaction, low self-esteem, perfectionism, and obsessive-compulsive disorder within people who partake in excessive exercise; however, without the prevalence of an eating disorder, these personality traits are not comparable (Davis et al., 1995). 

            Review papers and primary research experiments offer high reliability in the coexistence of obligatory exercise and eating disorders.  Most suggest exercise abuse can act as a precursor in developing eating disorders.  Research suggests that over-exercising and under-eating can become mutually reinforcing behaviors (Davis et al., 1995).  As a person’s obligatory commitment to exercise increases, so does the danger of developing pathological attitudes and behaviors associated with eating disorders.  People with eating disorders typically try to hide their obsession.  With the evidence of the reciprocal relationship between exercise and eating disorders, extreme dietary restraints and dysfunctions can also be detected through demonstrations of excessive exercise (Yates et al., 2001).  

            The development of eating disorders such as anorexia and bulimia nervosa are blamed by multiple factors of a person’s life, ranging from genetic, psychological, personality, sociocultural, and family predispositions; however, research suggests obligatory exercise should be included as an additional factor (Hubbard et al., 1998).  With the coexistence of exercise in eating disordered patients, observation during recovery should focus on the control of exercise dependence as well.  As a patient is recovering from an eating disorder, he or she might participate in more, extreme, drastic, and dangerous levels of exercise to compensate for the consumption of food.  This behavior may inhibit the recovery process.  

More research should study the effects on a person’s obligatory exercise level while in recovery.  More research should also concentrate on a greater understanding of the causes that lead to such high-risk behaviors.  If investigations can find these antecedents, prevention measures can be implemented.  Since obligatory exercise is a salient feature among a high percentage of eating disordered patients, further research should concentrate on specific behaviors of the actual obligatory exercise routine.  With these findings, eating disorders may be easier to detect, and therefore intervention can occur earlier, and recovery might be quicker and more successful.   

             

 References

Davis, C., Kennedy, S.H., Ralevski, E., Dionne, M., Brewer, H., Neitzert, C., Ratusny, D., 1995. Obsessive compulsiveness and physical activity in anorexia nervosa and high-level exercising. Journal of Psychsomatic Research 39, No. 8, 967-976.

 

Hubbard, S.T., Gray, J.J., Parker, S., 1998. Differences among women who exercise for ‘food related’ and ‘non-food related’ reasons. European Eating Disorders Review 6, 255-265.

 

Iannos, M., Tiggerman, M., 1997. Personality of the excessive exerciser. Personality and Individual Differences 22, No. 5, 775-778.

 

Keski-Rahkonen, A., 2001. Exercise dependence- a myth or a real issue?. European Eating Disorders Review 9, 279-283.

 

Krane, V., Waldron, J., Stiles-Shipley, J., Michalenok, J., 2001. Relationships among body satisfaction, social physique anxiety, and eating behaviors in female athletes and exercisers. Journal of Sport Behavior 24, 247-264.

 

Matheson, H., Crawford-Wright, A., 2000. An examination of eating disorder profiles in student obligatory and non-obligatory exercisers. Journal of Sport Behavior 23, 42-50.

 

McLaren, L., Gauvin, L., White, D., 2001. The role of perfectionism and excessive commitment to exercise in explaining dietary restraint: replication and extension. International Journal of Eating Disorders 29, 307-313.

 

Oats, S., 1999. Addicted to sweat. American Fitness 17, 64-66.

 

Yates, A., Edman, J.D., Crago, M., Crowell, D., 2001. Using an exercise-based instrument to detect signs of an eating disorder. Psychiatric Research 105, 231-241.

 

 

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