Sauchelli Sarah, Arcelus Jon, Granero Roser, Jiménez-Murcia Susana, Agüera Zaida, Del Pino-Gutiérrez Amparo, Fernández-Aranda Fernando
Department of Psychiatry, University Hospital of Bellvitge - Bellvitge Biomedical Research InstituteBarcelona, Spain; Centro de Investigación Biomédica en Red de la Fisiopatología Obesidad y Nutrición, Instituto de Salud Carlos IIIMadrid, Spain.
Institute of Mental Health, Faculty of Medicine & Health Sciences, University of NottinghamNottingham, UK; Leicester Eating Disorder Service, Leicester Glenfield HospitalLeicester, UK.
Front Psychol. 2016 Nov 24;7:1852. doi: 10.3389/fpsyg.2016.01852. eCollection 2016.
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. 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). 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. 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.
在饮食失调中,强迫性运动传统上被视为一种旨在控制体重/体型的行为。最近,有人推测可能存在其他因素驱动着强迫性运动的需求。这促使了强迫性运动测试(CET)的开发;这是一份自我报告问卷,旨在从多方面探讨强迫性运动的认知行为基础。本研究的目的有三个:(1)验证CET的西班牙语版本;(2)就CET所定义的驱动强迫性运动的因素,比较饮食失调诊断亚型和健康对照组;(3)探讨CET中评估的维度与饮食失调症状和一般精神病理学之间的关联。共157名饮食失调患者[40例神经性厌食症、56例神经性贪食症(BN)和61例未另行指定的饮食失调(EDNOS)]和128名健康体重/饮食对照组接受了CET测试。通过半结构化访谈对患者进行评估以得出DSM-IV-TR诊断。此外,所有参与者都完成了症状自评量表-90修订版(SCL-90R)和饮食失调问卷-2(EDI-2)。验证性因素分析表明,该模型与CET最初的五因素模型具有足够的拟合优度。与健康对照组相比,BN和EDNOS患者在回避和规则驱动行为、体重控制以及总CET量表上得分更高,与神经性厌食症患者相比,除运动僵化量表外,在所有量表上得分都更高。神经性厌食症患者的平均得分与对照组参与者的平均得分没有差异,除了情绪改善量表,神经性厌食症患者在该量表上的平均得分较低。BN和EDNOS患者之间的平均得分相当。CET量表中的回避和规则驱动行为、体重控制以及总CET得分与SCL-90R和EDI-2的临床评估指标呈正相关。强迫性运动是一个多维度的概念,驱动强迫性运动的因素因饮食失调诊断亚型而异。在饮食失调治疗中处理强迫性运动时应考虑到这一点。