Mia Beck Lichtenstein

Quality of life in eating disorders: A meta-analysis

Eating disorders (EDs) comprise a variety of symptoms and have a profound impact on everyday life. They are associated with high morbidity and mortality. The objective of this study was to analyse published data on health-related quality of life (HRQoL) in EDs so as to compare the results to general population norm data and to investigate potential differences between ED diagnostic groups. A systematic review of the current literature was conducted using a keyword-based search in PubMed and PsychInfo. The search covered anorexia nervosa (AN), bulimia nervosa (BN), eating disorders not otherwise specified (EDNOS) and binge eating disorder (BED) and used the Medical Outcomes Study Short Form-36 Health Survey (SF-36) as a measure of HRQoL. Of the 102 citations identified, 85 abstracts were reviewed and seven studies were included in the meta-analysis. AN patients were included in five studies (n=227), BN in four studies (n=216), EDNOS in two studies (n=166) and BED in four studies (n=148). We tested for between-study variation and significant differences between the diagnostic groups. The results confirmed a significantly lower level of HRQoL in all EDs compared to a population mean. It was not possible to establish any differences between the diagnostic groups.

Exercise addiction: A study of eating disorder symptoms, quality of life, personality traits and attachment styles

Exercise addiction is characterized by excessive exercise patterns with potential negative consequences such as overuse injuries. The aim of this study was to compare eating disorder symptoms, quality of life, personality traits and attachments styles in exercisers with and without indications of exercise addiction. A case-control study with 121 exercisers was conducted. The exercisers were categorized into an addiction group (n=41) or a control group (n=80) on the basis of their responses to the Exercise Addiction Inventory. The participants completed the Eating Disorder Inventory 2, the Short-Form 36, the NEO Personality Inventory Revised and the Adult Attachment Scale. The addiction group scored higher on eating disorder symptoms, especially on perfectionism but not as high as eating disorder populations. The characteristic personality traits in the addiction group were high levels of excitement-seeking and achievement striving whereas scores on straightforwardness and compliance were lower than in the exercise control group. The addiction group reported more bodily pain and injuries. This study supports the hypothesis that exercise addiction is separate to an eating disorder, but shares some of the concerns of body and performance. It is driven by a striving for high goals and excitement which results in pain and injuries from overuse.

Exercise addiction in team sport and individual sport: Prevalences and validation of the exercise addiction inventory

Exercise addiction is characterized by increasing exercise amounts which take priority over other areas of life. It is mostly observed in individual sports, such as running and weight-lifting, whereas addiction in team sport has not previously been investigated. The aim of this study was to estimate the prevalence of exercise addiction in a team sport (football) compared to an individual sport (fitness) and to test the psychometric properties of the Exercise Addiction Inventory in these populations. The Exercise Addiction Inventory was completed by 274 men in the age group of 16–39 years (98 football players and 176 fitness exercisers). The prevalence of exercise addiction was statistically equal in the two groups (7.1% in football and 9.7% in fitness). The Cronbachs alpha showed good internal reliability in both groups and factor analysis found one underlying factor interpreted as exercise addiction. Less of the variance was explained in the football sample with low loading on item 2: conflicts (0.2). We compared the structure of the scale between the two groups by using structural equation models and we found that exercise addiction can explain the six Exercise Addiction Inventory (EAI) variables. Thus, the EAI is recommended for identification of addiction in both populations but in football players the item of conflicts could be replaced. Motivation for exercise in the football group seemed to be enjoyment and competition, while the fitness group exercised for health and weight reasons. Different motivation for exercise might explain the psychometric differences of the scale, but further studies are warranted.

A cross-cultural re-evaluation of the Exercise Addiction Inventory (EAI) in five countries

Research into the detrimental effects of excessive exercise has been conceptualized in a number of similar ways, including ‘exercise addiction’, ‘exercise dependence’, ‘obligatory exercising’, ‘exercise abuse’, and ‘compulsive exercise’. Among the most currently used (and psychometrically valid and reliable) instruments is the Exercise Addiction Inventory (EAI). The present study aimed to further explore the psychometric properties of the EAI by combining the datasets of a number of surveys carried out in five different countries (Denmark, Hungary, Spain, UK, and US) that have used the EAI with a total sample size of 6,031 participants. A series of multigroup confirmatory factor analyses (CFAs) were carried out examining configural invariance, metric invariance, and scalar invariance. The CFAs using the combined dataset supported the configural invariance and metric invariance but not scalar invariance. Therefore, EAI factor scores from five countries are not comparable because the use or interpretation of the scale was different in the five nations. However, the covariates of exercise addiction can be studied from a cross-cultural perspective because of the metric invariance of the scale. Gender differences among exercisers in the interpretation of the scale also emerged. The implications of the results are discussed, and it is concluded that the study’s findings will facilitate a more robust and reliable use of the EAI in future research.

Validation of the exercise addiction inventory in a Danish sport context

Exercise addiction is characterized by excessive exercise behavior with potential negative consequences. The symptoms consist of salience, mood modification, tolerance, withdrawal symptoms, conflicts, and relapse. The purpose of this study was to test the psychometric properties of the exercise addiction inventory (EAI) and to estimate the prevalence of exercise addiction in a Danish normal weight sport population. A sample of 780 habitual fitness and football exercisers were contacted and 590 completed the EAI and an in‐house questionnaire containing questions about variables related to exercise addiction: (a) exercise frequency; (b) continuance despite injuries; and (c) personal perception of addiction. The results demonstrated an overall prevalence of exercise addiction of 5.8%. There was no significant difference between fitness and football prevalences. The internal reliability of EAI was acceptable with a Cronbachs α of 0.66. The criterion validity was tested toward the three variables related to exercise addiction. The dependent group had significantly higher scores on the three variables than the non‐dependent group. Exercise addiction seems to exist in both fitness and football. The EAI is a useful screening tool and might be applicable in future screening and prevention of exercise addiction. However, further investigation about the population is needed to understand the phenomenon and to identify the risk group.

Purging behavior in anorexia nervosa and eating disorder not otherwise specified: A retrospective cohort study

Purging behavior in eating disorders is associated with medical risks. We aimed to compare remission rates in purging and non-purging females with anorexia nervosa (AN) and eating disorder not otherwise specified (EDNOS) in a large retrospective single center cohort. A total of 339 patients with AN and 266 patients with EDNOS were included in the study. The proportion of subjects with purging behavior at least once a week during the last 3 months was similar in the two groups: 22% in AN and 24% in EDNOS. Remission was defined by a goal weight ≥85% of ideal body weight and no reported purging behavior in the last 6 months. The median time from onset to remission for patients with AN was 7 years for the non-purging vs. 11 years for the purging patients. The purging AN patients with both vomiting and laxative abuse displayed the poorest course. Among EDNOS patients, the time to remission was also significantly longer for purging patients compared to non-purging patients. Thus, in line with previous studies, we found that purging behavior is associated with delayed time to remission in treatment-seeking AN and EDNOS patients. This study provides evidence to support the retention of the diagnostic sub-typing in AN.

Exercise addiction in CrossFit: Prevalence and psychometric properties of the Exercise Addiction Inventory

Introduction CrossFit is a mix of aerobic and anaerobic exercise regimes with the stated goal of improving fitness and physical performance. It is growing in popularity and has a strong community known to motivate and push the participants to maximal performance. The negative consequences of these extreme exercise patterns have rarely been described. The prevalence of injuries in CrossFit is high but exercise addiction and harmful exercise attitudes have not yet been assessed. The aim of this study was to measure the prevalence of exercise addiction in CrossFit and to evaluate the reliability and validity of the Exercise Addiction Inventory (EAI) in a CrossFit population. Methods We invited crossfitters to participate in an online survey using Facebook groups. A total of 603 regular crossfitters completed the EAI and additional questions concerning exercise amounts and negative exercise attitudes and beliefs. We used principal component analyses and structural equation models to test the psychometric properties of the EAI and to describe the characteristics of the addicted crossfitters. Results We found that 5% of the crossfitters were addicted to exercise and that young males had a higher risk. The EAI had good internal reliability (0.73) and construct validity. Thus we found significant positive associations between exercise addiction and the tendency to exercise in spite of injury, feelings of guilt when unable to exercise, passion turning into obsession and taking medication to be able to exercise. Conclusions Exercise addiction is prevalent in CrossFit and needs further exploration. The EAI is recommended for research in CrossFit communities and applied settings.

Exercise addiction in men is associated with lower fat-adjusted leptin levels.

Objective:To test a hypothesized association between resting leptin levels (adjusted for body fat percentage) and symptoms of primary exercise addiction. Design:Cross-sectional design. Setting:Habitual amateur exercisers participating in running, fitness, weight training, and biking. Participants:Twenty men with exercise addiction as defined by the Exercise Addiction Inventory (EAI scores 24-30) and 20 men in an exercise control group (EAI scores 6-16) matched on body mass index. Main Outcome Measures:Plasma leptin and sex hormones were measured in blood samples collected under fasting and resting conditions. Body composition was assessed by dual-energy x-ray absorptiometry. Eating disorder symptoms were identified by the Eating Disorder Inventory 2. Results:The exercise addiction group had significantly (P < 0.001) lower leptin levels (1.1 &mgr;g/L, SD = 1.3) than controls (4.3 &mgr;g/L, SD = 2.9). Even when adjusted for body fat percentage, the addiction group had significantly (P < 0.001) lower leptin levels (0.1 &mgr;g/L, SD = 0.1) than the controls (0.2 &mgr;g/L, SD = 0.1). Body fat–adjusted leptin correlated with free bioavailable testosterone, but it was only significant in nonaddictive exercisers. None of the exercisers seemed to suffer from an eating disorder. Conclusions:This is the first study showing that excessive training in exercise addiction is associated with low levels of body fat–adjusted leptin levels. Clinical relevance:Hypoleptinemia could be involved in the pathogenesis of exercise addiction. However, further studies are needed to explore the potential causal relationship.

Compulsive exercise: links, risks and challenges faced

Compulsive exercise is a condition described since 1970s. It is characterized by a craving for physical training, resulting in uncontrollable excessive exercise behavior with harmful consequences, such as injuries and impaired social relations. It has not been accepted as a mental disorder in either International Classification of Diseases or Diagnostic and Statistical Manual of Mental Disorders. The aim of this literature review was to critically examine the research on links (comorbidity), risks (negative consequences), and challenges faced (problems in a treatment context). This review found that compulsive exercise is associated with eating disorder pathology, perfectionism, neuroticism, narcissism, and obsessive compulsive traits. The most prominent negative consequences were injuries, social impairment, and depression, but more research is needed to uncover the potential dysfunction resulting from compulsive exercise. As the condition is not recognized as a psychiatric disorder, studies on treatment interventions are sparse. Problems with compliance have been reported; therefore, motivational interviewing has been proposed as a treatment approach, in combination with cognitive behavioral therapy. This review summarizes and discusses findings on links/comorbidity, risks/negative consequences, and treatment challenges. We suggest that future studies should pay attention to both prevention and counseling in sports settings, where compulsive exercise appears, as the condition may be associated with harmful consequences.

Do Exercisers With Musculoskeletal Injuries Report Symptoms of Depression and Stress

CONTEXT Sports injuries in athletes can lead to negative emotional responses in terms of anger, anxiety, confusion, and sadness. Severe injuries can be understood as a stressful life event with increased levels of psychological distress, but injury assessment and rehabilitation typically focus on somatic symptoms. OBJECTIVE The primary aim of this study was to estimate the prevalence of depression and emotional stress and to measure self-rated health in regular exercisers presenting to a sports medicine clinic with musculoskeletal injury. The secondary aim was to identify psychosocial factors associated with depression in injured exercisers and the potential need for psychological counseling. DESIGN A cross-sectional survey study. SETTING A sports medicine clinic for injuries of the foot, knee, or shoulder. PARTICIPANTS Regular exercisers with present injuries (N = 694) and exercisers without injuries (N = 494). Regular exercisers were defined as those undertaking moderate exercise at least once a week. INTERVENTION A questionnaire survey completed on paper by patients in a sports medicine clinic and a web-based version completed by online sports communities. MAIN OUTCOME MEASURES Participants completed the Major Depression Inventory, Perceived Stress Scale, health-related quality of life, and questions on sociodemographics, exercise habits, and injury history. RESULTS Symptoms of depression were reported by 12% of injured exercisers and 5% of noninjured controls (P < .001). Clinical stress was found in 30% of injured exercisers and 22% of controls (P = .002), and the EQ-5D-5L Visual Analog Scale score was lower for injured (69 [SD = 19]) than noninjured exercisers (87 [SD = 13], P < .001). Injured exercisers with symptoms of depression reported high stress levels and impaired daily functioning, were younger, and were more likely to have over 10 days injury-related work absence. CONCLUSIONS The authors recommend psychological assessment of exercisers attending a sports medicine clinic for musculoskeletal injury and a supplemental clinical psychological interview for suspected depression or stress-related psychopathology.