Hina Akram Caroline Davis

Worcester College

Discuss the associations between excessive exercising and eating disorders with particular emphasis on possible causal mechanisms.
Eating disorders highlight a prominent conflict between biological processes and cultural pressures in today s society. Being thin has become inherent to the notion of female attractiveness. Alongside this, dieting and exercise have become as a sign of healthy living and as a means to achieving weight loss, as promoted by the media. The focus of exercise has now become that of physical image as opposed to physical health, emphasised by the mirrored walls in gyms and tight outfits worn. Excessive exercising is now commonly seen in patients with eating disorders, most commonly with restrictor types of anorexia nervosa (AN) (Grave, Calugi and Marchesini, 2008). This essay seeks to assess the associations between eating disorders and exercising, focusing on the impact of personality factors. Animal models have shown activity-based anorexia can be induced in rats very simply. Restriction of food and unlimited access to a running wheel leads to the rat decreasing food intake and increasing wheel running. Over the course of a few days this leads to weight loss and loss of estrous cycle function as seen in patients with AN. If continued the rat will eventually run itself to death. This is evidence of the self-perpetuating cycle that can begin and leads to extreme weight loss in patients. As the two behaviours increase they function synergistically so this cycle continues and becomes resistant to change. What drives this cycle is that both activities increase circulating levels of endogenous opiates, betaendorphins, which are potentially as addictive as illegal drugs such as heroin, because of their ability to stimulate dopamine in the brain s mesolimbic reward centres (Davis, Katzman and Kirsh, 1999). It has been shown in animal models that biological drive states

Hina Akram Caroline Davis

Worcester College

(such as hunger) can influence homeostatic control by increasing the reinforcing effects of incentive stimuli. This adaptive process also then increases vulnerability to the rewarding and addictive properties of alcohol and cocaine, and relevant here, exercise. As a result of the addictive nature of the behaviours, patients with weight issues who have a vulnerability to addiction will be more likely to be excessive exercisers. Davis and Claridge (1998) found that among a sample of patients with eating disorders those who were excessive exercisers scored more highly on addictive personality ratings than their nonexercising counterparts. In conjunction with severe calorie restriction excessive physical activity plays a major role in the progressive psychopathology of AN. The increased state of sensitivity induced by starvation leads to excessive exercise becoming a behavioural addiction. Further links have been found between AN, excessive exercise and obsessive compulsive personality (OCP) traits. It has been found that OCP traits are more prominent in those who excessively exercise than those who are moderate/non-exercising types (Davis and Kaptein, 2006). Obsessive compulsive disorder (OCD) symptoms were also more pronounced in exercisers but these characteristics appeared to diminish after weight was restored. Personality traits of this nature include perfectionism and a preoccupation with order which are often seen in AN patients. Such tendencies might lead women to be more inclined to engage in exercise in order to achieve a body ideal , and further lead to calorific restriction. Some have gone so far as to argue that AN is largely a modern variant of OCD (Holden, 1990). They have suggested that the socio-cultural context of the past three to four decades has simply altered the form of certain OCD symptoms in a susceptible cohort of the population. As preoccupation with weight builds, they engage in compulsive behaviours

Hina Akram Caroline Davis

Worcester College

such as weight-checking, dieting and exercise routines. Obsessional tendencies such as intrusive thoughts about dirt and germs may be equivalent to ideas of fat as repulsive and unhealthy, a modern version of contamination obsessions. The excessive exercising could be seen as analogous to compulsive cleaning and washing rituals, to rid the body of the germs, in this case the fat. However, whether this is a consequence of the mental state induced by starvation or a causal mechanism is unclear. Yet, we can see a strong association between OCP traits and excessive exercisers with AN. Furthermore, OCP traits suggest that individuals are more susceptible to social influence and pressures to conform and be successful within society. This creates increasing vulnerability to AN with route through exercising, which is often viewed as an admirable trait, until it becomes excessive. It is interesting to note, that patients who are excessive exercisers often report high levels of childhood activity (Davis, Katzman, Kaptein, Brewer, Kalmbach, Olmsted, Woodside and Kaplan, 1997). From this it seems that those who are highly physically active as children are more likely to use exercise as a means of expending calories should they wish to lose weight at a later point. Furthermore, such activity can foster the desire for weight loss. Family influences are also important, with exercise levels of both parents being related significantly to patients activity levels (Davis, Blackmore, Katzman and Fox, 2005). In this same study, dramatic increase in exercise level was observed approximately one year before the onset of the disorder in most cases. This suggests enhanced physical activity may be a precipitating factor in the development of AN. That once exercise does not result in weight loss, calorie restriction is imposed, which then begins the cycle and increase of both behaviours, which can eventually lead to hospitalisation.

Hina Akram Caroline Davis

Worcester College

Davis et al, (1999) proposed a structural-equation model for excessive exercise status, which summarises the associations reviewed here aptly. The model below clearly illustrates the contributing factors to excessive exercising types in AN.

Addictive personality Exercise attitudes Exercise behaviour Childhood OCP activity status

It is clear that confounding personality factors and childhood activity levels contribute to attitudes towards exercise. As a result when combined with a desire for weight loss, these lead to excessive exercising. Due to the nature of the processes of calorie restriction and exercise when combined create this unrelenting cycle which becomes highly addictive leading to the extreme weight loss seen in cases of AN.