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An Examination of Eating Disorder Profiles in Student Obligatory and Non-Obligatory Exercisers.

Anne Crawford-Wright [**]

Much research has targeted the relationship between eating disorders and obligatory exercise in elite sport populations, but little has been done in the area of student populations. The aim of this study, therefore, was to highlight risk behaviors indicated in a student obligatory and non-obligatory exercise population and to compare results with previous research in the area. One thousand second and third year students at a large university in the Midlands were randomly selected and mailed the Obligatory Exercise Questionnaire (Pasman & Thompson, 1988% the Eating Disorder Inventory (Garner et al., 1983) and a demographic questionnaire. Two hundred and seventy four packets were returned (190 female, mean age 25; 81 male, mean age 27.04; three unspecified), with 32 students (16 female, 13 male, 3 unspecified) meeting the required score of 50 or greater for categorization as obligatory exercisers. Obligatory exercisers were significantly different from non-obligatory exercisers on the following EDI subscales: D rive for Thinness (t = -2.19,p [less than] .05), ineffectiveness (t = -2.01, p [less than] .05), Interpersonal Distrust (t = -2.56,p [less than] .05) and Interoceptive Awareness (t = -2.6,p [less than] .05) sub scales. The overall profile of the obligatory exercisers follows a similar pattern to that of a clinical population, as designated in the norm profiles by Garner et al. (1983). Based on the similarity in profiles, results are discussed in terms of risk behaviors that may be exhibited and their early detection as an aid to preventing future obsessive actions.

Much research has concentrated on the relationships between obligatory exercise and eating disorders and the incidence of these factors in athletes engaging in different sports at elite levels. Little research has been targeted at a general student population. The aim of this study, therefore, was to highlight what, if any, risk behaviors are indicated within a student obligatory and non-obligatory exercise population and to compare results with previous research in this area. In looking at eating disorders, and eating disorder profiles in this study, specific psychological and behavioral characteristics that are common to eating disorders, at both clinical and subclinical levels were examined.

Obligatory exercise is defined as continuing exercise despite pain, interference with significant relationships or work, lack of time for other leisure pursuits, recognized obsession with the activity, and other psychological problems (Polivy, 1994). Yates, Leehey and Shisslak (1983) proposed the concept of "obligatory runners" within a population of middle-aged male runners, and drew parallels between them and women with anorexia nervosa. It appeared that obligatory runners and anorexic women shared similar family backgrounds, socio-economic status and personality characteristics. These characteristics included aspects such as expression of anger, perfectionism and high self-expectations, a tendency for social isolation, tolerance of pain and physical discomfort, and a tendency toward depression.

De Coverley Veale (1987) further developed this concept through a dependency analogue, with the absence of exercise leading to negative affect for the individual. He suggested that for the exercise dependent, dieting may occur as a means of achieving athletic excellence, but the primary means is through exercise. For the anorexic, the opposite may be true; dieting is the primary means of losing weight and exercise dependence may occur as a secondary means of achieving weight loss. Coen and Ogles (1993) specifically explored this analogue of anorexia and exercise dependence in runners utilizing the Obligatory Exercise Questionnaire (Pasman & Thompson, 1988) and the Eating Disorder Inventory (Garner et al, 1983). Eating disorders, in general, are defined as gross disturbances in eating behavior in a variety of forms. Anorexia nervosa is characterized by a refusal to maintain body weight over a minimum level considered normal for age and height, while bulimia nervosa is characterized by recurrent episodes of bi nge eating and inappropriate weight control methods. Coen and Ogles (1993) came to the conclusion that the only significant differences between obligatory and nonobligatory exercisers were in the domain of perfectionism and higher levels of anxiety with obligatory exercisers scoring higher on both factors.

The aims of the study were to examine risk factors exhibited by undergraduate obligatory exercisers and whether any differences in the profiles of undergraduate obligatory and non-obligatory exercisers were exhibited. These differences would be apparent on the profiles and scores obtained on the Eating Disorder Inventory (EDT) commonly used in clinical settings to obtain cognitive, behavioral, and affective or emotional profiles of people with eating disorders, especially anorexia nervosa, and the Obligatory Exercise Questionnaire (OEQ), a questionnaire developed to measure levels of obligatory exercise.

Method

One thousand second and third year students were randomly selected from the Faculty of Education and Health Sciences, using a specifically constructed computer program, and sent a packet of information including an introductory letter, demographic questions, OEQ, EDI and a pre-paid return envelope. Packets were sent out in two batches, one at the beginning of December and one in the middle of January. There was no difference in return rate.

Obligatory Exercise Questionnaire (OEQ) (Pasman & Thompson, 1987)

The Obligatory Exercise Questionnaire was developed to measure levels of obligatory exercise and was selected as it has reasonable reliability (Cronbach Alpha=.96) and validity coefficients (.72). It is also a general measure of sporting activity and can be completed by participants in all sports. It is a 20 item questionnaire scored on a Likert scale ranging from 1 = never to 4 = always. A score of 50 or greater is an indicator of exercise dependence. Respondents are asked to answer questions such as:

I engage in physical activity on a regular basis

When I don't exercise I feel guilty

I may miss a day of exercise for no good reason.

Eating Disorder Inventory (EDI) (Garner et al, 1983)

The Eating Disorder Inventory is a widely used clinical tool for measuring eating disorders to obtain cognitive, behavioral, and affective or emotional profiles of people with eating disorders, especially anorexia nervosa. It entails completing 91 questions that form 11 subscales. For the purposes of this study only eight were studied (Drive for Thinness, Bulimia, Body Dissatisfaction, Ineffectiveness, Perfectionism, Interpersonal Distrust, Interoceptive Awareness, Maturity Fears). Respondents answered questions such as:

I think my stomach is too big

I am open about my feelings

I trust others

I have extremely high goals

I feel trapped in relationships.

It is scored on a Likert scale ranging from A = (always) to N = (never). Each subscale is calculated separately and a profile developed.

Demographic information included questions on sex, age, degree program, place of residence, type, level and length of participation in preferred sport, seven day self-report of use of alcohol, and four week self-report of use of mood altering and ergogenic aids. For the purpose of this paper only age and sex will be referred to.

Results

Two hundred and seventy four packets were returned (190 female, mean age 25; 81 male, mean age 27.04, 3 unspecified). There were 32 students meeting the required score of 50 or greater and these were categorized as obligatory exercisers (Table 1).

It is clear that the obligatory exercisers recorded higher scores than non-obligatory exercisers in all but Body Dissatisfaction of the EDI sub scales (Figure 1). The higher the score on a subscale, the more problematic the area for the individual. Obligatory exercisers were significantly different from non-obligatory exercisers in the Drive for Thinness (t = -2.19, p [less than] .05), Ineffectiveness (t = -2.01, p [less than] .05), Interpersonal Distrust (t = -2.56, p [less than] .05) and Interoceptive Awareness (t = -2.6, p [less than] .05) sub scales. There were no significant differences between the groups in the Perfectionism, Maturity Fears, Body Dissatisfaction or Bulimia subscales.

When the EDI profile is compared with that of a clinical population (Figure 2) it can be seen that, while some of the subscales (Body Dissatisfaction, Maturity Fears, Perfectionism, Interpersonal Distrust, Interoceptive Awareness) for the obligatory exercise group are greater than the lower range of scores utilised for diagnostic purposes, the three subscales most usually associated with eating disorders (Drive for Thinness, Bulimia, Ineffectiveness) are below those values. The overall profile, however, follows a similar pattern to that of a clinical population.

Discussion

The purpose of this study was to examine the EDI profiles of student obligatory and non-obligatory exercisers. Results indicated that obligatory exercisers differed significantly from non-obligatory exercisers on four subscales (Drive for Thinness, Ineffectiveness, Interpersonal Distrust, Interoceptive Awareness). Previous studies have indicated that exercise dependent individuals shared similar characteristics as anorexic women (Yates, Leehey & Shisslak, 1983). This study partially supports these findings in terms of social isolation, as measured through Interpersonal Distrust, and high anxiety, partly measured through Interoceptive Awareness. However, the factors of perfectionism and high self-expectations were not highlighted. This may have been a function of the questionnaires utilized or it may be that the obligatory exercise population did not meet the criteria for clinically diagnosed anorexics, in that the subjects had not previously been identified as being either obligatory exercisers or having an eating disorder.

Parker, Lambert and Burlingame (1994) indicated that female runners who use similar weight control techniques, as diagnosed eating-disordered patients, may not suffer from the same psychopathology. They continue, however, by stating that "the runner whose natural body build does not match the ideal characteristics of a long distance runner may exert extra effort to remain chin" (p 132). While this observation may also be true for the obligatory exercise sample in the present study, there is concern that such behaviors are risky, should a propensity for developing an eating disorder be present. Dieting may provide a means for early identification of such individuals.

Coen and Ogles (1993) utilized the Obligatory Exercise Questionnaire (Pasman & Thompson, 1988) and the EDT (Garner et al. 1983) and came to the conclusion that the only differences between obligatory and non-obligatory exercisers were in terms of perfectionism and anxiety levels. The student population in the present study did not produce the same findings, as there was no significant difference in perfectionism scores (Figure 1) but the higher levels of anxiety might be endorsed through the differences in Interoceptive Awareness scores as this subscale measures confusion and apprehension in recognizing and responding to emotional states. The differences between the two studies may relate to the fact that the samples in the current study compared obligatory and non-obligatory exercisers, groups which Coen and Ogles (1993) indicated could offer a better comparison than obligatory and sedentary populations. They also stated that obligatory status may have little to do with eating disturbances and body dissatis faction because these factors may be elevated in all exercisers. If this is true, comparing obligatory and non-obligatory exercisers would ensure a direct comparison between groups on those factors. Such a comparison could highlight elevated levels of eating disturbance and/or body dissatisfaction in a particular individual that may be a risk behavior associated with future eating disordered behavior.

It was also clear that, while the obligatory exercisers did not meet the clinical criteria for diagnosis as having an eating disorder, the profiles of the two groups (obligatory exercisers, clinical population) followed a similar pattern (Figure 2). The similar pattern is important to note because, while it does not point to specific eating disordered behavior, it may be an indicator for such behaviors to exist. The recorded scores for Drive for Thinness and Bulimia for obligatory exercisers were well below that of a clinical population but the profile that emerges is a mirror image that could be symptomatic of dieting within this group. Dieting is closely linked with the onset of eating disorders. Male and female athletes are likely to engage in such behaviors but females are more susceptible to becoming overconcerned about appearance and body shape. In this respect the results are similar to those of Parker, Lambert and Burlingame (1994) who found that female distance runners "utilize pathological weight c ontrol techniques similar to diagnosed eating disordered patients" (p 131). Petrie (1996) stated that low bulimia scores indicated a lack of pursuit for thinness through bingeing but that it does not rule out the presence of other weight control behaviors. Therefore, it could be that these results support those of Black and Burckes-Miller (1988) who found that lean sport athletes are more likely to engage in weight control measures such as excessive exercise and strict dieting. While this might seem unimportant, it could be that the identification of such a profile will highlight "at risk" individuals and suitable intervention techniques may be provided before behaviors become too far entrenched. This identification of behaviors and profiles may also serve as a check list for all staff who work in a counseling role with students.

The study highlighted the fact that 16 of the obligatory exercisers were female and 13 male. This difference in number was small and supports the notion that both male and female athletes are likely to engage in abnormal eating and weight control behavior. Due to the small number of males and females it was not possible to determine whether those athletes participating in lean sport or weight control activities were different in responses to those participating in non lean sport or non-weight control activities. This is an area for further research and it is an aspect that will be followed up during the interview phase of the study.

Similar Body Dissatisfaction scores were recorded for male and female obligatory and non-obligatory exercise groups. This may be related to the fact that social norms are now as pressured for males as they are for females, even though the pressures are different. For males it is more related to possessing a body shape defined by an increase in strength and muscle mass, while for females thinness and body shape are more important (Petrie, 1996).

De Coverley Veale's (1987) concept of primary dependency of eating disorder or exercise was not explored in this study but will be addressed with those students who indicated a willingness to be interviewed. The identification of the function of exercise in both obligatory and non-obligatory exercisers could perhaps indicate whether sports themselves create problems, or whether individuals have particular psychological predisposing factors that produce difficulties in the form of either obligatory exercise or eating disorders.

Summary

In summary it can be stated that this study highlighted several risk factors present in a student obligatory exercise population which may signify behaviors related to future compulsive exercise or disordered eating. These risk factors included a feeling of social isolation, high anxiety, body dissatisfaction which could be specifically related to body build required for a particular activity (e.g. long distance running, body building), general eating disturbance and dieting, and excessive exercise. While it is not being suggested that the presence of one or more of these behaviors may lead to compulsive exercise or eating disorders, they are risk factors which need to be considered and included with additional information available to counselors or teaching staff.

Clearly more research needs to be completed in this area both to confirm the findings of this study and develop a greater understanding of the causes that may lead to such risk behaviors being exhibited. It is anticipated that the follow-up interview with a cross section of the subjects from this study may begin to explore this aspect further, together with the exercise analogue put forward by de Coverley Veale (1987).

The authors would like to acknowledge the grant received from the Psychology Division, University of Wolverhampton, which made the completion of the study possible.

References

Black, D. and Burckes-Miller, M. (1988) Male and female college athletes: use of anorexia nervosa and bulimia nervosa weight loss methods. Research Quarterly for Exercise and Sport, 59, 252-256

Coen, S. and Ogles, B. (1993) Psychological characteristics of the obligatory runner: a critical examination of the anorexia analogue hypothesis. Journal of Sport and Exercise Psychology, 15, 338-354

De Coverley Veale, D. (1987) Exercise dependence. British Journal of Addiction , 82, 735-740.

Garner, D.M., Olmstead, M.P. & Polivy, J. (1983) Development and validation of a multidimensional eating disorder inventory for anorexia nervosa and bulimia. International Journal of Eating Disorders, 2, 15-34

Parker, R.M., Lambert, M.J., & Burlingame, G.M. (1994) Psychological features of female runners presenting with pathological weight control behaviors. Journal of Sport and Exercise Psychology, 16, 119-134

Pasman, L. and Thompson, J. (1988) Body image and eating disturbance in obligatory runners, obligatory weight lifters and sedentary individuals. International Journal of Eating Disorders, 7, 759-769

Petrie, T.A. (1996) Differences between male and female college lean sport athletes, nonlean sport athletes, and nonathletes on behavioral and psychological indices of eating disorders. Journal of Applied Sport Psychology, 8, 218-230.

Poliy, J. (1994) Physical activity, fitness, and compulsive behaviors. In C. Bouchard, R.J. Shephard, & T. Stephens (Eds. ), Physical activity, fitness, and health: International proceedings and consensus statement, 883-897. Champaign, IL: Human Kinetics

Yates, A., Leehey, K., and Shisslak, C. (1983) Running - an analogue of anorexia? New England Journal of Medicine, 308, 251-255
 Descriptives for Obligatory and Non-Obligatory Exercisers
 Age
 N M SD
Obligatory exercisers 32 21.8 2.25
(f=16, m=13, unspecified=3)
Non-obligatory exercisers 242 26.1 8.38
(f=174, m=68)
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Author:Matheson, Hilary; Crawford-Wright, Anne
Publication:Journal of Sport Behavior
Geographic Code:1USA
Date:Mar 1, 2000
Words:2842
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