Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-78c5997874-8bhkd Total loading time: 0 Render date: 2024-11-05T13:58:03.139Z Has data issue: false hasContentIssue false

Chapter 7 - Eating Disorders and Over-Exercise

from Section 1 - From Exercise to Addiction: An Introduction to the Phenomenon

Published online by Cambridge University Press:  30 March 2023

By
Charlotte Taylor ,
Kate Brown  and
Konstantinos Ioannidis
Edited by
Ornella Corazza  and
Artemisa Rocha Dores
Ornella Corazza
Affiliation:
University of Hertfordshire and University of Trento, Italy
Artemisa Rocha Dores
Affiliation:
Polytechnic Institute of Porto and University of Porto, Portugal
Get access

Summary

Dysfunctional exercise is one of the most challenging behaviours in individuals with eating disorders, among whom it makes a significant contribution to morbidity and impaired quality of life. This chapter examines the prevalence of dysfunctional exercise symptoms in the context of an eating disorder, the neurobiological basis of dysfunctional exercise symptoms, and the various predisposing and maintaining factors that are involved. It then highlights the need for management and treatment of excessive exercise to address the neurobiological and psychological factors involved, and describes the evidence base for such treatments, especially physiotherapy-based psychological interventions. A multidisciplinary approach to management is recommended, so that treatment can be formulated within the wider context of the individual’s psychosocial difficulties, enabling them to challenge their exercise-related beliefs and behaviour. Finally, two semi-fictional case studies are presented that illustrate common presentations of dysfunctional exercise in eating disorder clinics.

Keywords

addictive behaviourbody imagedysfunctional exerciseeating disordermultidisciplinary treatment
Type
Chapter
Information
The Body in the Mind
Exercise Addiction, Body Image and the Use of Enhancement Drugs
 , pp. 103 - 120
Publisher: Cambridge University Press
Print publication year: 2023

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Austin, SB. A public health approach to eating disorders prevention: it’s time for public health professionals to take a seat at the table. BMC Public Health 2012; 12: 854.Google Scholar
Erskine, HE, Whiteford, HA, Pike, KM. The global burden of eating disorders. Curr Opin Psychiatry 2016; 29: 346–53.CrossRefGoogle ScholarPubMed
Arcelus, J, Mitchell, AJ, Wales, J, Nielsen, S. Mortality rates in patients with anorexia nervosa and other eating disorders. A meta-analysis of 36 studies. Arch Gen Psychiatry 2011; 68: 724–31.Google Scholar
Smink, FRE, Van Hoeken, D, Hoek, HW. Epidemiology of eating disorders: incidence, prevalence and mortality rates. Curr Psychiatry Rep 2012; 14: 406–14.Google Scholar
Treasure, J, Zipfel, S, Micali, N et al. Anorexia nervosa. Nat Rev Dis Primers 2015; 1: 15074.CrossRefGoogle ScholarPubMed
Scharmer, C, Gorrell, S, Schaumberg, K, Anderson, D. Compulsive exercise or exercise dependence? Clarifying conceptualizations of exercise in the context of eating disorder pathology. Psychol Sport Exerc 2020; 46: 101586.CrossRefGoogle ScholarPubMed
Meyer, C, Taranis, L, Goodwin, H, Haycraft, E. Compulsive exercise and eating disorders. Eur Eat Disord Rev 2011; 19: 174–89.Google Scholar
El Ghoch, M, Calugi, S, Dalle Grave, R. Management of severe rhabdomyolysis and exercise-associated hyponatremia in a female with anorexia nervosa and excessive compulsive exercising. Case Rep Med 2016; 2016: 8194160.Google Scholar
Peñas-Lledó, E, Vaz Leal, FJ, Waller, G. Excessive exercise in anorexia nervosa and bulimia nervosa: relation to eating characteristics and general psychopathology. Int J Eat Disord 2002; 31: 370–5.Google Scholar
Delimaris, I. Potential adverse biological effects of excessive exercise and overtraining among healthy individuals. Acta Medica Martiniana 2014; 14: 5–12.Google Scholar
Mitchison, D, Mond, J. Epidemiology of eating disorders, eating disordered behaviour, and body image disturbance in males: a narrative review. J Eat Disord 2015; 3: 1–9.Google Scholar
Rizk, M, Lalanne, C, Berthoz, S, Kern, L, Godart, N. Problematic exercise in anorexia nervosa: testing potential risk factors against different definitions. PLoS ONE 2015; 10: e0143352.Google Scholar
Strober, M, Freeman, R, Morrell, W. The long-term course of severe anorexia nervosa in adolescents: survival analysis of recovery, relapse, and outcome predictors over 10–15 years in a prospective study. Int J Eat Disord 1997; 22: 339–60.Google Scholar
Tsai, G. Eating disorders in the Far East. Eat Weight Disord 2000; 5: 183–97.Google Scholar
Miller, MN, Pumariega, AJ. Culture and eating disorders: a historical and cross-cultural review. Psychiatry 2001; 64: 93–110.CrossRefGoogle ScholarPubMed
Holderness, C, Brooks-Gunn, J, Warren, M. Eating disorders and substance use. Med Sci Sport Exerc 1994; 26: 297–302.CrossRefGoogle ScholarPubMed
Garner, DM, Garfinkel, PE. Socio-cultural factors in the development of anorexia nervosa. Psychol Med 1980; 10: 647–56.Google Scholar
Mond, JM, Hay, PJ, Rodgers, B, Owen, C. An update on the definition of “excessive exercise” in eating disorders research. Int J Eat Disord 2006; 39: 147–53.Google Scholar
Mountjoy, M, Sundgot-Borgen, J, Burke, L et al. The IOC consensus statement: beyond the Female Athlete Triad—Relative Energy Deficiency in Sport (RED-S). Br J Sports Med 2014; 48: 491–7.Google Scholar
Guisinger, S. Adapted to flee famine: adding an evolutionary perspective on anorexia nervosa. Psychol Rev 2003; 110: 745–61.Google Scholar
Dietrich, A, Audiffren, M. The reticular-activating hypofrontality (RAH) model of acute exercise. Neurosci Biobehav Rev 2011; 35: 1305–25.Google Scholar
Egorov, AY, Szabo, A. The exercise paradox: an interactional model for a clearer conceptualization of exercise addiction. J Behav Addict 2013; 2: 199–208.CrossRefGoogle ScholarPubMed
Klump, KL, Strober, M, Bulik, CM et al. Personality characteristics of women before and after recovery from an eating disorder. Psychol Med 2004; 34: 1407–18.CrossRefGoogle ScholarPubMed
Adams, J, Kirkby, RJ. Exercise dependence and overtraining: the physiological and psychological consequences of excessive exercise. Sports Med Train Rehabil 2010; 10: 199–222.Google Scholar
Fessler, DMT. The implications of starvation induced psychological changes for the ethical treatment of hunger strikers. J Med Ethics 2003; 29: 243–7.Google Scholar
Griffiths, S, Mond, JM, Murray, SB, Touyz, S. Positive beliefs about anorexia nervosa and muscle dysmorphia are associated with eating disorder symptomatology. Aust N Z J Psychiatry 2015; 49: 812–20.Google Scholar
Waller, G, Cordery, H, Corstorphine, E et al. Case formulation. In: Cognitive Behavioral Therapy for Eating Disorders: A Comprehensive Treatment Guide. Cambridge University Press, 2013: 96–113.Google Scholar
Fairburn, CG, Cooper, Z, Shafran, R. Cognitive behaviour therapy for eating disorders: a “transdiagnostic” theory and treatment. Behav Res Ther 2003; 41: 509–28.CrossRefGoogle Scholar
Leuenberger, A. Endorphins, exercise, and addictions: a review of exercise dependence. Impulse 2006; 3: 1–9.Google Scholar
Riley, AL. The paradox of drug taking: the role of the aversive effects of drugs. Physiol Behav 2011; 103: 69–78.Google Scholar
Giuliano, C, Cottone, P. The role of the opioid system in binge eating disorder. CNS Spectr 2015; 20: 537–45.Google Scholar
Weinstein, A, Weinstein, Y. Exercise addiction - diagnosis, bio-psychological mechanisms and treatment issues. Curr Pharm Des 2014; 20: 4062–9.CrossRefGoogle ScholarPubMed
Everitt, BJ, Robbins, TW. Neural systems of reinforcement for drug addiction: from actions to habits to compulsion. Nat Neurosci 2005; 8: 1481–9.Google Scholar
Brand, M, Wegmann, E, Stark, R et al. The Interaction of Person-Affect-Cognition-Execution (I-PACE) model for addictive behaviors: update, generalization to addictive behaviors beyond internet-use disorders, and specification of the process character of addictive behaviors. Neurosci Biobehav Rev 2019; 104; 1–10.Google Scholar
Ioannidis, K, Chamberlain, SR. Digital hazards for feeding and eating: what we know and what we don’t. Curr Psychiatry Rep 2021; 23: 1–8.Google Scholar
Carrotte, ER, Vella, AM, Lim, MSC. Predictors of “liking” three types of health and fitness-related content on social media: a cross-sectional study. J Med Internet Res 2015; 17: e205.Google Scholar
Quesnel, DA, Cook, B, Murray, K, Zamudio, J. Inspiration or thinspiration: the association among problematic internet use, exercise dependence, and eating disorder risk. Int J Ment Health Addict 2018; 16: 1113–24.CrossRefGoogle Scholar
Corazza, O, Simonato, P, Demetrovics, Z et al. The emergence of Exercise Addiction, Body Dysmorphic Disorder, and other image-related psychopathological correlates in fitness settings: a cross sectional study. PLoS ONE 2019; 14: e0213060.Google Scholar
Almenara, CA, Machackova, H, Smahel, D. Sociodemographic, attitudinal, and behavioral correlates of using nutrition, weight loss, and fitness websites: an online survey. J Med Internet Res 2019; 21: e10189.Google Scholar
Embacher Martin, K, McGloin, R, Atkin, D. Body dissatisfaction, neuroticism, and female sex as predictors of calorie-tracking app use amongst college students. J Am Coll Health 2018; 66: 608–16.Google Scholar
Levinson, CA, Fewell, L, Brosof, LC. My Fitness Pal calorie tracker usage in the eating disorders. Eat Behav 2017; 27: 14–16.Google Scholar
Linardon, J, Messer, M. My Fitness Pal usage in men: associations with eating disorder symptoms and psychosocial impairment. Eat Behav 2019; 33: 13–17.Google Scholar
Simpson, CC, Mazzeo, SE. Calorie counting and fitness tracking technology: associations with eating disorder symptomatology. Eat Behav 2017; 26: 89–92.Google Scholar
Ioannidis, K, Taylor, C, Holt, L et al. Problematic usage of the internet and eating disorder and related psychopathology: a multifaceted, systematic review and meta-analysis. Neurosci Biobehav Rev 2021; 125: 569–81.Google Scholar
Catalani, V, Negri, A, Townshend, H et al. The market of sport supplement in the digital era: a netnographic analysis of perceived risks, side-effects and other safety issues. Emerg Trends Drugs Addict Health 2021; 1; 100014.Google Scholar
Cataldo, I, De Luca, I, Giorgetti, V et al. Fitspiration on social media: body-image and other psychopathological risks among young adults. A narrative review. Emerg Trends Drugs Addict Health 2021; 1; 100010.Google Scholar
Rodgers, RF, Slater, A, Gordon, CS et al. A biopsychosocial model of social media use and body image concerns, disordered eating, and muscle-building behaviors among adolescent girls and boys. J Youth Adolesc 2020; 49: 399–409.CrossRefGoogle ScholarPubMed
Mooney, R, Simonato, P, Ruparelia, R et al. The use of supplements and performance and image enhancing drugs in fitness settings: an exploratory cross-sectional investigation in the United Kingdom. Hum Psychopharmacol 2017; 32: e2619.Google Scholar
Corazza, O, Roman-Urrestarazu, A. Handbook of Novel Psychoactive Substances: What Clinicians Should Know about NPS. Routledge, 2019.Google Scholar
Dores, AR, Carvalho, IP, Burkauskas, J et al. Exercise and use of enhancement drugs at the time of the COVID-19 pandemic: a multicultural study on coping strategies during self-isolation and related risks. Front Psychiatry 2021; 12: 648501.CrossRefGoogle Scholar
Hampshire, A, Hellyer, PJ, Soreq, E et al. Associations between dimensions of behaviour, personality traits, and mental-health during the COVID-19 pandemic in the United Kingdom. Nat Commun 2021; 12: 4111.CrossRefGoogle ScholarPubMed
Ioannidis, K, Hook, RW, Wiedemann, A et al. Associations between COVID-19 pandemic impact, dimensions of behavior and eating disorders: a longitudinal UK-based study. Compr Psychiatry 2022; 115: 152304.CrossRefGoogle ScholarPubMed
Ioannidis, K, Hook, RW, Grant, JE et al. Eating disorders with over-exercise: a cross-sectional analysis of the mediational role of problematic usage of the internet in young people. J Psychiatr Res 2021; 132: 215–22.Google Scholar
Bardone-Cone, AM, Higgins, MK, St George, SM et al. Behavioral and psychological aspects of exercise across stages of eating disorder recovery. Eat Disord 2016; 24: 424–39.CrossRefGoogle ScholarPubMed
Bratland-Sanda, S, Sundgot-Borgen, J, Rø, Ø et al. Physical activity and exercise dependence during inpatient treatment of longstanding eating disorders: an exploratory study of excessive and non-excessive exercisers. Int J Eat Disord 2010; 43: 266–73.Google Scholar
National Institute for Health and Care Excellence. Eating Disorders: Recognition and Treatment. NICE guideline [NG69]. National Institute for Health and Care Excellence, 2020. www.nice.org.uk/guidance/ng69Google Scholar
Hay, P. A systematic review of evidence for psychological treatments in eating disorders: 2005–2012. Int J Eat Disord 2013; 46: 462–9.Google Scholar
De Jong, M, Schoorl, M, Hoek, HW. Enhanced cognitive behavioural therapy for patients with eating disorders: a systematic review. Curr Opin Psychiatry 2018; 31: 436–44.CrossRefGoogle ScholarPubMed
Dalle Grave, R, Calugi, S, Sartirana, M, Sermattei, S, Conti, M. Enhanced cognitive behaviour therapy for adolescents with eating disorders: a systematic review of current status and future perspectives. IJEDO 2021; 3; 1–11.Google Scholar
Atwood, ME, Friedman, A. A systematic review of enhanced cognitive behavioral therapy (CBT-E) for eating disorders. Int J Eat Disord 2020; 53: 311–30.CrossRefGoogle ScholarPubMed
Richard, M, Bauer, S, Kordy, H. Relapse in anorexia and bulimia nervosa—a 2.5-year follow-up study. Eur Eat Disord Rev 2005; 13: 180–90.CrossRefGoogle Scholar
Vancampfort, D, Vanderlinden, J, De Hert, M et al. A systematic review of physical therapy interventions for patients with anorexia and bulimia nervosa. Disabil Rehabil 2014; 36: 628–34.CrossRefGoogle Scholar
Ng, LWC, Ng, DP, Wong, WP. Is supervised exercise training safe in patients with anorexia nervosa? A meta-analysis. Physiotherapy 2013; 99: 1–11.Google Scholar
Quesnel, DA, Libben, M, Oelke, ND et al. Is abstinence really the best option? Exploring the role of exercise in the treatment and management of eating disorders. Eat Disord 2018; 26: 290–310.Google Scholar
Davis, C, Kennedy, SH, Ravelski, E, Dionne, M. The role of physical activity in the development and maintenance of eating disorders. Psychol Med 1994; 24: 957–67.CrossRefGoogle ScholarPubMed
Carter, JC, Blackmore, E, Sutandar-Pinnock, K, Woodside, DB. Relapse in anorexia nervosa: a survival analysis. Psychol Med 2004; 34: 671–9.Google Scholar
Cook, BJ, Wonderlich, SA, Mitchell, JE et al. Exercise in eating disorders treatment: systematic review and proposal of guidelines. Med Sci Sports Exerc 2016; 48: 1408–14.CrossRefGoogle ScholarPubMed
Scottish Intercollegiate Guidelines Network. SIGN164: Eating Disorders. A National Clinical Guideline. NHS Scotland., 2022. www.sign.ac.uk/media/1920/sign-164-eating-disorders.pdfGoogle Scholar
Dobinson, A, Cooper, M, Quesnel, D. Safe Exercise at Every Stage (SEES) Guideline: A Clinical Tool for Treating and Managing Dysfunctional Exercise in Eating Disorders. SEES, 2020.Google Scholar
Calogero, RM, Pedrotty-Stump, KN. Incorporating exercise into eating disorder treatment and recovery: cultivating a mindful approach. In: Maine, M, Hartman McGilley, B, Bunnell, D, eds. Treatment of Eating Disorders: Bridging the Research-Practice Gap. Academic Press, 2010: 425–41.Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×