CE ACTIVITY

Compulsive Exercise: The Role of Personality,

Psychological Morbidity, and Disordered Eating
Huw Goodwin, BSc (Hons), MRes1
Emma Haycraft, PhD1*
Anne-Marie Willis, RMN2
Caroline Meyer, PhD1

ABSTRACT
Objective: Compulsive exercise has
been closely linked with eating disorders,
and has been widely reported in both
clinical and nonclinical settings. It has
been shown to have a negative impact
on eating disorder treatment and outcome. However, the risk factors for compulsive exercise have not been examined.
This study aimed to provide a rst step in
identifying potential cross-sectional predictors of compulsive exercise.
Method: The sample consisted of 1,488
male and female adolescents, aged 12
14 years old, recruited from schools in
the United Kingdom. Participants completed measures of compulsive exercise,
personality, psychological morbidity, and

Introduction
Eating Disorders (ED) comprise a variety of problematic behaviors, including bingeing, purging,
and restricting food consumption.1 Another such
problematic behavior that has been widely
reported in both clinical and nonclinical settings is
that of compulsive exercise. Compulsive exercise
has been dened as an intense drive to be active,
often in a rigid, routine-like fashion that is predominantly performed to manage weight and shape,
as well as alleviating negative emotions.2,3 It has
been found in as many as 39% of anorexia nervosa
(AN) patients and 23% of Bulimia Nervosa (BN)
patients at admission to an ED clinic4 and has been
linked with greater treatment time, poorer outcome, and increased chance of relapse.5,6

Accepted 16 November 2010

Supported by Loughborough University.
*Correspondence to: Emma Haycraft, Loughborough University
Centre for Research into Eating Disorders, School of Sport, Exercise
and Health Sciences, Loughborough University, Leicestershire
LE11 3TU, United Kingdom. E-mail: e.haycraft@lboro.ac.uk
1
Loughborough University Centre for Research into Eating
Disorders, Loughborough University, Leicestershire,
United Kingdom
2
Cotswold Spa, Huntercombe Hospitals, Worcestershire, United
Kingdom
Published online 14 February 2011 in Wiley Online Library
(wileyonlinelibrary.com). DOI: 10.1002/eat.20902
C 2011 Wiley Periodicals, Inc.
V

International Journal of Eating Disorders 44:7 655660 2011

disordered eating attitudes during a

school class period.
Results: Multiple stepwise regressions
showed that the strongest cross-sectional
predictors of compulsive exercise were a
drive for thinness, perfectionism, and
obsessive-compulsiveness.
Discussion: These results are discussed
in terms of the role that personal factors
may play in the development of compulC 2011 by Wiley Periodisive exercise. V
cals, Inc.
Keywords: compulsive exercise; adolescents; psychological; perfectionism; OCD
(Int J Eat Disord 2011; 44:655660)

Additionally, compulsive exercise has been found

in community samples,3 and has been implicated
in the etiology of ED.7 The development of ED
predominantly occurs around early adolescence,8
and yet little to no research on compulsive exercise
has been conducted among adolescent samples.
This age-group represents an important population
to study in risk factor research into ED and
compulsive exercise and, as such, investigations
are required to identify whether a compulsive drive
to exercise is directly linked to disordered eating
attitudes at this early age.
Importantly, not all individuals with ED pathology display a compulsive drive to exercise.
Therefore, it is likely that there are specic
psychological and personality differences that
render an individual at risk of specically
developing a compulsivity towards exercise. However, the risk factors for compulsive exercise are
poorly understood.
One possible personality trait linked to the
development of compulsive exercise is perfectionism, which has been reported as a risk factor
for both AN9 and BN.10 Perfectionism has already
been found to be an antecedent to obligatory
exercise,11 as well as exercise dependence;12
terms which encompass similar, if not the
same, constructs as compulsive exercising.
Another possible risk factor is obsessive-compulsiveness, which has also been strongly linked
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GOODWIN ET AL.

with compulsive exercise in both clinical and

nonclinical ED samples. For example, compulsive
exercise has been related to obsessive-compulsiveness in a sample of health club exercisers
(Wyatt, Unpublished Doctoral Dissertation), and
to excessive exercise in clinical ED groups.13,14
A key feature of compulsive exercise is a negative
mood, such as, experiencing feelings of anxiety,
depression, and guilt, when deprived of exercising.15 However, other studies have found negative affect, in its various forms (i.e., anxiety and
depression), to be related to continued exercise
and not simply a resultant state of exercise deprivation. For example, Coen and Ogles11 found that
compulsive exercisers reported higher levels of
anxiety than non-compulsive exercisers. Similarly,
greater levels of depression have been related
to compulsive exercise in both clinical and nonclinical ED samples.16,17
In addition to general anxiety, social anxiety has
been associated with ED, with women with eating
disordered behavioral tendencies being more likely
to be fearful of negative evaluation and have a
greater sensitivity to the impressions of others.18
Specic to exercise, a tendency towards social
comparisons has been shown to have a stronger
impact on adolescent boys exercising than on their
eating.19 Previous research has also found that
social physique anxiety, a body specic form of
social anxiety, is positively related to greater
exercise frequency.20 However, no study has
focused on the role of social physique anxiety in
the development of compulsive exercise.
In summary, compulsive exercise is a problematic behavior that affects many individuals with
ED. A thorough review of previous research has
identied several personality traits and psychological states as potential correlates of compulsive
exercise,21 but relationships with compulsive exercise have yet to be tested in adolescents. It is also
not clear which of these potential predictors of
compulsive exercise are the most potent risk
factors for its development.
Using a nonclinical adolescent sample, this
study aims to identify which personality, psychological, and disordered eating factors are the best
cross-sectional predictors of compulsive exercise.
It is hypothesized that all signicant predictors
will be positively associated with compulsive
exercise. Given the paucity of previous research,
no predictions were made regarding which
variable would be the best predictor of compulsive exercise.

656

Method
Participants
This research was conducted in nine schools across
the United Kingdom as part of an ongoing larger scale
research project. This study reports on a sample of 1,488
participants, aged 1214 years old (mean age of 12.98
years; SD 5 0.73), with gender being equally distributed
(girls 5 54.1%; boys 5 45.9%). The sample predominantly
(95.3%) classied their ethnicity as White British, and
all the schools were from areas of average to low levels of
economic deprivation.22 Self-reported height and weight
information was converted into body mass index (BMI)
for each participant, which was then converted into a z
score, so that they were standardized for both age and
gender.23 The mean values for BMI z scores were 0.32
(SD 5 1.39) for boys and 0.08 (SD 5 1.34) for girls.

Measures and Procedure

Institutional Review Board ethical approval was
granted before questionnaire packs were sent to the
participating schools. Questionnaire packs were completed in a school class period by pupils aged between 12
and 14 years old. Following informed consent, the participants provided background information on nationality,
ethnicity, age, gender, height and weight, and then
completed the following validated measures:
Compulsive Exercise Test.3 The compulsive exercise
test (CET) is a 24-item measure that assesses the level of
compulsive exercise. It has ve subscales that represent
the ve core features of the behavior, namely: Avoidance
and Rule-Driven Behavior; Weight Control Exercise;
Mood Improvement; Lack of Exercise Enjoyment; and
Exercise Rigidity. Responses are scored on a six-point
Likert scale, anchored with 0never true and 5
always true. The level of compulsive exercise is then
identied by creating a total CET score, which is
calculated by summing the mean item score for each of
the ve subscales. Higher scores represent greater levels
of compulsive exercise. A psychometric evaluation of
the CET in these adolescents has already supported its
use.2 In the current sample, the total CET had a
Cronbachs alpha of 0.88.
Eating Disorder Inventory-2.24 The drive for thinness,
bulimia, and body dissatisfaction subscales of the eating
disorder inventory-2 (EDI-2) were administered to assess
disordered eating attitudes. The EDI-2 measures the
attitudes underpinning AN and BN and has been used
reliably among adolescents.25 The Cronbachs alpha
values found in this study were 0.84 (drive for thinness),
0.72 (bulimia), and 0.90 (body dissatisfaction).
Child and Adolescent Perfectionism Scale.26 The child
and adolescent perfectionism scale (CAPS) is a 22-item,
two-scaled measure of perfectionism specically worded
International Journal of Eating Disorders 44:7 655660 2011

COMPULSIVE EXERCISE

for use within child and adolescent samples. The two

scales are self-orientated perfectionism (CAPS-self) and
socially prescribed perfectionism (CAPS-social). The
former subscale assesses the degree to which an individual imposes self-directed levels of perfectionistic standards and behaviors on to his or her self (e.g., I try to be
perfect in everything I do). The latter subscale assesses
the degree to which an individual feels that their perfectionism is imposed on them by others (e.g., There are
people in my life who expect me to be perfect). The
CAPS has been previously used with adolescents
and demonstrated good reliability.27 Cronbachs alpha
values for this sample were 0.81 for CAPS-Self and 0.87
for CAPS-Social.
Spence Child Anxiety Scale.28,29 The Spence Child
Anxiety Scale (SCAS) is a measure of anxiety symptoms
among children. Only the obsessive-compulsive subscale
was used in this study (SCAS-OC). It comprises six items
assessing levels of obsessive-compulsiveness, which
includes items such as I cant seem to get bad or silly
thoughts out of my head and I have to do some things in
just the right way to stop bad things happening.
The SCAS has previously been reliably used with
adolescents.29 The internal reliability gure for the obsessive-compulsiveness subscale for the current sample
was 0.79.
Hospital Anxiety and Depression Scale.30 The Hospital
Anxiety and Depression Scale (HADS) is a 14-item
measure of anxiety and depression that is widely used in
clinical and nonclinical research and practice. The HADS
has been validated for use with adolescents,31 and
provided Cronbachs alpha values of 0.73 for anxiety and
0.56 for depression for the current sample.
Social Physique Anxiety Scale.32 The Social Physique
Anxiety Scale (SPAS) is a 9-item scale measuring a
respondents level of social physique anxiety, using such
questions as: In the presence of others, I feel apprehensive about my physique/gure. The SPAS has
displayed good psychometrics among adolescents,33 and
obtained a Cronbachs alpha level of 0.87 for the sample
in this current investigation.

Data Analysis
Data were initially screened for normality. As expected,
a series of Kolmogorov-Smirnov tests showed that all
variables were non-normally distributed, with the exception of the dependent variable, the CET Total score.
Importantly, the residuals were normally distributed and,
therefore, no transformations were made for the following regression analyses. Non-parametric tests were used,
where appropriate. Preliminary analysis also demonstrated that age appropriate body mass index (BMI zscores) was not signicantly correlated with CET Total
score for either boys (r 5 .02, p [.05) or girls (r 5 .06,
International Journal of Eating Disorders 44:7 655660 2011

TABLE 1. Means and standard deviations for study

variables by gender
Mean (SD)
Boys

Girls

Test of
Difference
z

10.01 (4.08)
2.82 (3.98)
1.99 (3.18)
4.97 (5.67)
34.05 (7.66)
25.15 (8.17)
0.91 (0.63)
7.48 (3.65)
4.24 (2.91)
21.61 (6.98)

9.94 (3.66)
6.13 (5.90)
2.41 (3.49)
10.56 (8.13)
32.91 (8.35)
23.70 (8.33)
1.00 (0.67)
8.67 (3.65)
3.92 (2.74)
28.01 (7.98)

0.32
10.40*
3.06*
13.02*
2.81*
3.51*
2.21
6.23*
3.64*
15.11*

Variables
CET total
EDI-drive for thinness
EDI-bulimia
EDI-body dissatisfaction
CAPS-self
CAPS-social
SCAS-OC
HADS-anxiety
HADS-depression
SPAS

Note: Samples sizes differed between tests due to missing data;

*p \ .001 (two-tailed); CET, compulsive exercise test; EDI, eating
disorder inventory; CAPS, child and adolescent perfectionism scale;
SCAS-OC, spence child anxiety scale obsessive-compulsiveness subscale; HADS, hospital anxiety and depression scale; SPAS, social
physique anxiety scale.

p [.05). Therefore, BMI z scores were not included in any

subsequent analysis as a control variable.
Analyses were conducted separately for boys and girls
due to signicant differences on many study variables
(Table 1). For each gender, a multiple stepwise regression
was conducted to examine relationships between
compulsive exercise and the predictor variables (selforientated perfectionism, socially prescribed perfectionism, obsessive-compulsiveness, anxiety, depression,
social physique anxiety, drive for thinness, bulimic attitudes, and body dissatisfaction). Signicance was set at
p \ .001 due to the large sample size.

Results
Characteristics of the Sample

Descriptive statistics can be seen in Table 1. The

mean CET total score represents a mid-point scoring average for boys and girls, and is noticeably less
than has been reported in clinical samples. The
EDI subscale scores also represent average to low
levels of disordered eating attitudes. The HADS
subscale scores demonstrate normal levels of
depression (i.e., none), while the anxiety subscale
mean indicates mild levels of anxiety, according to
suggested norms.34 The SPAS scores, CAPS-self and
CAPS-social, and SCAS-OC scores all represent
normal levels for this age group.27,29,33
Regression Analysis

The nal model of the multiple stepwise regression for boys and girls can be seen in Table 2. For
boys, the nal multiple stepwise regression model
was signicant, accounting for 39% of the variance
657

GOODWIN ET AL.
TABLE 2. Final model for multiple stepwise regression
of personality, psychological, and disordered eating
variables (predictor variables) on to CET total score
(outcome) for boys and for girls
Predictors
Boys
Model
EDI-drive for thinness
CAPS-self
SCAS-OC
CAPS-social
Girls
Model
EDI-drive for thinness
CAPS-Self
SCAS-OC

F (df)

Adj r2

80.99 (4, 508)*

.39

108.47 (3, 621)*

Beta

0.29
0.27
0.17
0.14

7.48*
6.64*
4.29*
3.45*

0.34
0.31
0.15

9.69*
8.77*
3.97*

.34

Note: *p \ .001; CET, compulsive exercise test; Adj, adjusted; EDI,

eating disorder inventory; CAPS, child and adolescent perfectionism scale;
SCAS-OC, spence child anxiety scale obsessive-compulsiveness subscale.

of CET total score. In the nal model, EDI-drive for

thinness, CAPS-self, SCAS-OC, and CAPS-social
were the signicant predictors. The CET total score
was not statistically predicted by HADS-anxiety,
HADS-depression, SPAS, EDI-bulimia, or EDI-body
dissatisfaction.
The nal model of the multiple stepwise regression for the girls was signicant, and it accounted
for 34% of the variance of CET total score. The nal
model produced three unique signicant predictors. These were EDI-drive for thinness, CAPS-self,
and SCAS-OC. For girls, CET total was not statistically predicted by CAPS-social, HADS-anxiety,
HADS-Depression, SPAS, EDI-bulimia, or EDI-body
dissatisfaction.

Discussion
This study aimed to examine the best crosssectional predictors of compulsive exercise
among a sample of adolescents. The results indicate that for both boys and girls a drive for
thinness was the best predictor, along with selfperfectionism, and then obsessive-compulsiveness. For boys only, social perfectionism was also
an additional predictor, although it did not
explain as much variance as the other signicant
variables. The hypothesis that all signicant
predictors would be positively associated with
compulsive exercise was supported.
The signicant drive for thinness nding
supports the existing literature linking compulsive
exercise closely with ED.4 A key nding in this
sample, though, was that only a drive for thinness,
rather than bulimic attitudes and body dissatis658

faction, signicantly predicted compulsive exercise,

for both boys and girls. This drive for thinness is
analogous to symptoms of AN, and so this nding
concurs with previous literature identifying
compulsive exercise as more prevalent among AN
patients than other ED diagnoses.4,7 This compulsivity towards exercise could be a key marker in the
development of AN, particularly as this association
with a drive for thinness has been found in a generally healthy, nonclinical group of young adolescents. Further research is needed to identify how
compulsive exercise interacts with a drive for
thinness over time, and whether the exercise
compulsivity puts individuals at increased risk of
subsequently developing AN.
High levels of perfectionism and obsessivecompulsiveness were also linked to compulsive
exercise. The nding that perfectionism was
among the best predictors of compulsive
exercise is consistent with previous investigations.12,14 Although both subscales of perfectionism were signicant for the boys, there was a
greater association with the self-orientated form
of perfectionism. Likewise, for the girls, it was
self-perfectionism and not social perfectionism
that was found to be a signicant predictor of
compulsive exercise. Castro and her colleagues27
found that self-orientated perfectionism was
more strongly associated with ED than socially
prescribed perfectionism. This is also in accordance with a previous study that had shown AN
patients to experience their perfectionism as
self-imposed.35 Therefore, this would suggest
that self-perfectionism could be inuential in
the development of ED, and specically AN, and
that it could be operating through compulsive
exercise. The results from the current study
demonstrate that this association between selfperfectionism and compulsive exercise occurs
even in an adolescent school-based population,
where levels of disordered eating symptoms
were relatively low. Therefore, if replicated longitudinally, this nding could represent a key area
for early intervention and/or prevention work of
compulsive exercise attitudes, whereby the individuals self-imposed high standards could be
targeted with the aim of reducing the compulsivity towards exercise.
The close link between compulsive exercise and
obsessive-compulsiveness has been widely established in previous research (Wyatt, Unpublished
Doctoral Dissertation).13 The ndings from this
investigation demonstrate that a compulsivity
towards exercise is associated with obsessivecompulsive symptoms even in a community
International Journal of Eating Disorders 44:7 655660 2011

COMPULSIVE EXERCISE

sample of adolescent boys and girls. This close and

direct association could indicate another possible
area for prevention work of compulsive exercise;
work that could target certain individuals with
greater
levels
of
obsessive-compulsiveness.
However, it is uncertain whether the compulsivity
towards exercise actually develops into a wider
obsessive-compulsiveness, or whether the causal
direction is in fact the reverse, with individuals
with obsessive-compulsive symptoms being at
greater risk for developing compulsive exercise.
An interesting result from the present study was
the lack of association between compulsive exercise and the psychological factors of anxiety and
depression, as well as social physique anxiety. This
is contrary to previous literature,16 although it is
possible that in a nonclinical adolescent sample,
the level of psychological morbidity may not yet be
closely linked with exercising. Further research
would be needed to identify whether the association between compulsive exercise and these
psychological factors only occurs in specic samples, such as in a clinical ED or adult population.
This study has certain limitations that need to be
highlighted. First, the cross-sectional nature of the
design prevents causal attributions. Future research
needs to replicate these ndings using a longitudinal
and/or experimental design to further establish
causality. Second, the self-report nature of the measures could have been susceptible to reporter bias, as
well as response error, particularly given the relatively
young age of the sample. This is particularly true of
the self-report nature of height and weight information. The use of self-report BMI data has been
previously used in this age group,36 although it is
accepted that self-report BMI in adolescents must be
viewed with caution and objective BMI measurement would be preferable in future research.
Overall, the current study ndings support a
model where drive for thinness, perfectionism, and
obsessive-compulsiveness all predict compulsive
exercise in adolescents. The amount of variance
accounted for by these personality predictors was
large, with almost 40% of compulsive exercise in
boys being explained by these variables. This
suggests that compulsive exercise is largely a selfdriven behavior that is affected by personal attributes and, as such, any potential prevention work
needs to target the individuals existing personality
motivations and general beliefs. Future research
is also required to test the longitudinal associations
between these personality traits and compulsive
exercise.
International Journal of Eating Disorders 44:7 655660 2011

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International Journal of Eating Disorders 44:7 655660 2011