The Compulsive Exercise Test : confirmatory factor analysis and links with eating psychopathology among women with clinical eating disorders

Background: This study aimed to determine the psychometric properties of the Compulsive Exercise Test (CET) among an adult sample of patients with eating disorders. Method: Three hundred and fifty six patients and 360 non-clinical control women completed the CET and the Eating Disorders Examination questionnaire (EDE-Q). Results: A confirmatory factor analysis revealed that the clinical data showed a moderate fit to the previously published five factor model derived from a community sample (Taranis L, Touyz S, Meyer C, Eur Eat Disord Rev 19:256-268, 2011). The clinical group scored significantly higher than the non-clinical group on four of the five CET subscales, and logistic regression analysis revealed that the CET could successfully discriminate between the two groups. A Receiver Operating Curve analysis revealed that a cut-off score of 15 on the CET resulted in acceptable values of both sensitivity and specificity. Conclusions: The CET appears to have a factor structure that is acceptable for use with an adult sample of patients with eating disorders. It can identify compulsive exercise among patients with eating disorders and a cut-off score of 15 is acceptable as indicating an appropriate cut-off point

Dimensions of compulsive exercise across eating disorder diagnostic subtypes and the validation of the Spanish version of the compulsive exercise test

Objectives: Compulsive exercise in eating disorders has been traditionally considered as a behavior that serves the purpose of weight/shape control. More recently, it has been postulated that there may be other factors that drive the compulsive need to exercise. This has led to the development of the Compulsive Exercise Test (CET); a self-reported questionnaire that aims to explore the cognitive-behavioral underpinnings of compulsive exercise from a multi-faceted perspective. The objectives of this study were threefold: (1) to validate the Spanish version of the CET; (2) to compare eating disorder diagnostic subtypes and a healthy control group in terms of the factors that drive compulsive exercise as defined by the CET; (3) to explore how the dimensions evaluated in the CET are associated with eating disorder symptoms and general psychopathology. Methods: The CET was administered to a total of 157 patients with an eating disorder [40 anorexia nervosa, 56 bulimia nervosa (BN), and 61 eating disorder not-otherwise-specified (EDNOS)] and 128 healthy weight/eating controls. Patients were assessed via a semi-structured interview to reach a DSM-IV-TR diagnosis. Additionally, all participants completed the Symptom Checklist-90-Revised (SCL-90R) and the Eating Disorders Inventory-2 (EDI-2). Results: Confirmatory factor analysis demonstrated adequate goodness-of-fit to the original five-factor model of the CET. BN and EDNOS patients scored higher in the avoidance and rule-driven behavior, weight control, and total CET scales in comparison to the healthy controls, and higher across all scales apart from the exercise rigidity scale compared to the anorexia nervosa patients. Mean scores of the anorexia nervosa patients did not differ to those of the control participants, except for the mood improvement scale where the anorexia nervosa patients obtained a lower mean score. Mean scores between the BN and EDNOS patients were equivalent. The CET scales avoidance and rule-driven behavior, weight of control and total CET scores were positively correlated with the clinical assessment measures of the SCL-90R and EDI-2. Conclusion: Compulsive exercise is a multidimensional construct and the factors driving compulsive exercise differ according to the eating disorder diagnostic subtype. This should be taken into account when addressing compulsive exercise during the treatment of eating disorders

Compulsive exercise and eating disorder related pathology

Compulsive exercise has been observed as a significant feature of the eating disorders throughout their history. It has variously been conceptualised as primarily an analogue of purgation, an emotion regulation strategy, an addiction, or an obsessivecompulsive behaviour, with evidence supporting each to varying degrees. The importance of compulsive exercise is underlined by the finding that it often precedes the onset of an eating disorder and is one of the last symptoms to subside. In addition, it is associated with a longer length of hospitalisation and higher rates of relapse. As a result, compulsive exercise is now recognised as a significant factor in the aetiology, development and maintenance of the eating disorders across diagnoses. Yet despite the importance of compulsive exercise and previous recommendations to target it, no clear conceptual model of compulsive exercise exists upon which an intervention could be based. This thesis has three broad aims: (1) critically review the evidence for and against factors implicated in the maintenance of compulsive exercise and propose a new theoretically coherent and empirically derived model of compulsive exercise that could be used to inform future cognitive-behavioural interventions; (2) develop and provide preliminary validation for a new measure of compulsive exercise; and (3) present six studies utilising the new measure of compulsive exercise to empirically test some of the relationships suggested by the proposed model. Main findings: The resulting Compulsive Exercise Test (CET) is a new multidimensional measure of compulsive exercise, consistent with the proposed cognitive-behavioural conceptualisation, and demonstrating good psychometric properties. Utilising the CET, the empirical chapters demonstrate that compulsive exercise was associated with (a) elevated levels of eating-disordered cognitions and increased frequency of eating-disordered behaviours, (b) avoidanceoriented coping and a range of difficulties in regulating emotions, and (c) perfectionism (particularly the self-critical dimension). Implications: The current findings provide preliminary support for the proposed cognitive-behavioural maintenance model of compulsive exercise. This may inform clinical interventions and prevention programs designed to address compulsive exercise, as well as enhancing current treatment efficacy by providing specific targets for intervention. In addition, the new measure of compulsive exercise is potentially a useful screening tool in formulating the maintenance of an individual's exercise behaviour, and is further a potentially useful research and outcome tool.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Sociocultural risk factors for compulsive exercise : a prospective study of adolescents

The risk factors for compulsive exercise are unknown. This study aims to explore longitudinal sociocultural risk factors for compulsive exercise, using a 12-month prospective design. A sample of 332 male and female adolescents (aged 13–15 years at baseline) completed self-report measures of sociocultural risk factors and compulsive exercise at baseline and eating disorder psychopathology and compulsive exercise at 12-month follow-up assessment. Hierarchical regressions found that family and peer messages to become more muscular predicted compulsive exercise in boys, whereas feeling pressure from the media to be thin was a significant predictor of compulsive exercise in girls. These relationships remained significant when controlling for eating disorder psychopathology but became nonsignificant when initial levels of compulsive exercise were entered into the model. The findings suggest that sociocultural risk factors may contribute to the development of compulsive exercise but future research should utilise a younger sample and employ a longer follow-up period to identify true longitudinal effects

Emotion regulation styles as longitudinal predictors of compulsive exercise : a twelve month prospective study

Exercise can be used as a mood regulator but, in the eating disorder literature, exercise has sometimes been found to be compulsive, detrimental to physical health, and regarded as one maladaptive strategy used to regulate emotions. This study examined longitudinal associations between emotion regulation styles and this compulsive exercise in 572 adolescents who completed measures of compulsive exercise and emotion regulation. Twelve months later they completed measures of compulsive exercise. Compulsive exercise was predicted by Internal Dysfunctional emotion regulation in girls and boys, even after controlling for initial levels of compulsive exercise. Adolescents displaying compulsivity to exercise may require intervention programmes to alter their emotion regulation strategies

En litteraturstudie om algebrans historiska utveckling och elevers förståelse om bokstavssymboler

Den här litteraturstudien innefattar elevers uppfattningar och förståelse kring bokstavssymboler, samt en inblick i hur algebra har utvecklats historiskt. Historiskt sett har algebra utvecklats från en retorisk till en symbolisk algebra, samt från elementär till abstrakt. Utvecklingen till att få den algebra som används i skolorna idag är en process som etablerades på 200 talet och har tagit hundratals år att utveckla. Det började med att den retoriska algebran utvecklades till det som kallas för synkoperad algebra, som sen utvecklat till nästa fas som kallas symbolisk algebra. Alla dessa faser bidrog sedan till utvecklingen av den abstrakta algebran. Elevers uppfattningar och förståelse kring bokstavssymboler kan kategoriseras in i antingen sex olika användningsområden för bokstavssymboler eller i olika nivåer av elevers förståelse. De sex användningsområdena kallas för Bokstaven ges ett värde, Bokstaven används inte, Bokstaven som ett objekt, Bokstaven som specifik okänd, Bokstaven som generellt tal och Bokstaven som en variabel. De olika nivåerna är hierarkiskt ordnade och beskriver vilken förståelse elever behöver uppnå för att kunna lösa specifika uppgifter. Forskare har använt dessa kategorier för att förklara sina egna studier. De har sedan kommit fram till att det är på grund av att bokstavssymboler kan användas i så många olika sammanhang som det skapas missuppfattningar och svårigheter för eleverna

Predictors of Positive Treatment Outcome in People With Anorexia Nervosa Treated in a Specialized Inpatient Unit: The Role of Early Response to Treatment

This is the peer reviewed version of the following article: WALES, J. ...et al., 2016. Predictors of positive treatment outcome in people with anorexia nervosa treated in a specialized inpatient unit: The role of early response to treatment. European Eating Disorders Review, 24 (5), pp.417-424, which has been published in final form at http://dx.doi.org/10.1002/erv.2443. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving.o investigate factors which predict positive treatment outcome in inpatients with anorexia nervosa (AN), particularly the role of early treatment response. METHOD: 102 patients entering specialist inpatient treatment were assessed for eating disorder history, psychopathology and motivation to change. Predictive factors assessed were: early treatment response defined as weight increase of at least 0.5-1 kg/week during the first six weeks of treatment; admission BMI; onset age; chronicity; motivation to change; diagnosis; and previous hospitalization for AN. Positive treatment outcome was defined as achieving BMI 17.5 kg/m2 within an individual timeframe. RESULTS: Logistic regression indicated that patients were 18 times more likely to reach positive treatment outcome if they met NICE weight guidelines within the first six weeks of hospitalization. Higher admission BMI was also found to predict positive treatment outcome. DISCUSSION: Higher entry BMI and early weight gain predict positive treatment outcome in individuals receiving specialist AN inpatient treatment