Exercise caution: over-exercise is associated with suicidality among individuals with disordered eating

April R Smith, Erin L Fink, Michael D Anestis, Jessica D Ribeiro, Kathryn H Gordon, Heather Davis, Pamela K Keel, Anna M Bardone-Cone, Carol B Peterson, Marjorie H Klein, Scott Crow, James E Mitchell, Ross D Crosby, Stephen A Wonderlich, Daniel le Grange, Thomas E Joiner Jr, April R Smith, Erin L Fink, Michael D Anestis, Jessica D Ribeiro, Kathryn H Gordon, Heather Davis, Pamela K Keel, Anna M Bardone-Cone, Carol B Peterson, Marjorie H Klein, Scott Crow, James E Mitchell, Ross D Crosby, Stephen A Wonderlich, Daniel le Grange, Thomas E Joiner Jr

Abstract

We conducted four studies to examine the relationship between over-exercise and suicidality. Study 1 investigated whether over-exercise predicted suicidal behavior after controlling for other eating disorder behaviors in a patient sample of 204 women (144 with Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) Bulimia Nervosa [BN]). Study 2 tested the prospective association between over-exercise and acquired capability for suicide (ACS) in a sample of 171 college students followed for 3-4 weeks. Study 3 investigated whether pain insensitivity accounted for the relationship between over-exercise and ACS in a new sample of 467 college students. Study 4 tested whether ACS accounted for the relationship between over-exercise and suicidal behavior in a sample of 512 college students. In Study 1, after controlling for key covariates, over-exercise was the only disordered eating variable that maintained a significant relationship with suicidal behavior. In Study 2, Time 1 over-exercise was the only disordered eating behavior that was associated with Time 2 ACS. In Study 3, pain insensitivity accounted for the relationship between over-exercise and ACS. In Study 4, ACS accounted for the relationship between over-exercise and suicidal behavior. Over-exercise appears to be associated with suicidal behavior, an association accounted for by pain insensitivity and the acquired capability for suicide; notably, this association was found across a series of four studies with different populations.

Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Figures

Fig. 1
Fig. 1
Proposed model for the relationship between over-exercise, pain insensitivity, acquired capability for suicide, and suicide attempts. Note: it is possible that over-exercise is also related to suicidality via thwarted belongingness and perceived burdensomeness; however, these pathways are not depicted as the focus of the current paper is on the acquired capability component of the IPTS.

References

    1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th. APA; Washington, DC: 2000. Text Revision.
    1. Anestis MS, Bagge CL, Tull MT, Joiner TE. Clarifying the role of emotion dysregulation in the interpersonal-psychological theory of suicidal behavior in an undergraduate sample. Journal of Psychiatric Research. 2011;45:603–611.
    1. Anestis MS, Fink EL, Bender TW, Selby EA, Smith AR, Witte TW, Joiner TE. Re-considering the association between negative urgency and suicidality. Personality and Mental Health. 2011;6:138–146.
    1. Bender TW, Gordon KH, Bresin K, Joiner TE. Impulsivity and suicidality: the mediating role of painful and provocative experiences. Journal of Affective Disorders. 2011;129:301–307.
    1. Broman-Fulks JJ, Berman ME, Rabian BA, Webster MJ. Effects of aerobic exercise on anxiety sensitivity. Behaviour Research and Therapy. 2004;42:125–136.
    1. Brown DR, Blanton CJ. Physical activity, sports participation, and suicidal behavior among college students. Medicine and Science in Sports and Exercise. 2002;34:1087–1096.
    1. Bryan C, Anestis M. Reexperiencing symptoms and the interpersonal-psychological theory of suicidal behavior among deployed service members evaluated for traumatic brain injury. Journal of Clinical Psychology. 2011;67:856–865.
    1. Bulik CM, Sullivan PF, Joyce PR. Temperament, character and suicide attempts in anorexia nervosa, bulimia nervosa and major depression. Acta Psychiatrica Scandinavica. 1999;100:27–32.
    1. Calogero RM, Pedrotty KN. The practice and process of healthy exercise: an investigation of the treatment of exercise abuse in women with eating disorders. Eating Disorders: The Journal of Treatment and Prevention. 2004;12:273–291.
    1. Carter JC, Blackmore E, Sutandar-Pinnock K, Woodside DB. Relapse in anorexia nervosa: a survival analysis. Psychological Medicine. 2004;34:671–679.
    1. Carter JC, Stewart DA, Fairburn CG. Eating disorder examination questionnaire: norms for young adolescent girls. Behavior Research and Therapy. 2001;39:625–632.
    1. Capron DW, Cougle JR, Ribeiro JD, Joiner TE, Schmidt NB. An interactive model of anxiety sensitivity relevant to suicide attempt history and future suicidal ideation. Journal of Psychiatric Research. 2012;46:174–180.
    1. Capron DW, Gonzalez A, Parent J, Zvolensky MJ, Schmidt NB. Suicidality and anxiety sensitivity in adults with HIV. AIDS Patient Care and STDs. 2012;26:298–303.
    1. Chen E, Matthews L, Allen C, Kuo JR, Linehan MM. Dialectical behavior therapy for clients with binge-eating disorder or bulimia nervosa and borderline personality disorder. International Journal of Eating Disorders. 2008;41:505–512.
    1. Committee on Sports Medicine Fitness. Intensive training and sports specialization in young athletes. Pediatrics. 2000;106:154–157.
    1. Corcos M, Taieb O, Benoit-Lamy S, Paterniti S, Jeammet P, Flament MF. Suicide attempts in women with bulimia nervosa: frequency and characteristics. Acta Psychiatrica Scandinavica. 2002;106:381–386.
    1. Crow S, Peterson CB, Swanson SA, Raymond NC, Specker S, Eckert ED, Mitchell JE. Increased mortality in bulimia nervosa and other eating disorders. American Journal of Psychiatry. 2009;166:1342–1346.
    1. Davidson CL, Wingate LR, Grant DM, Judah MR, Mills AC. Interpersonal suicide risk and ideation: the influence of depression and social anxiety. Journal of Social and Clinical Psychology. 2011;30:842–855.
    1. Davis C, Katzman DK, Kaptein S, Kirsh C, Brewer H, Kalmbach K, Olmsted MP, Woodside DB, Kaplan AS. The prevalence of high-level exercise in the eating disorders: etiological implications. Comprehensive Psychiatry. 1997;38:321–326.
    1. Davis C, Kennedy SH, Ravelski E, Dionne M. The role of physical activity in the development and maintenance of eating disorders. Psychological Medicine. 1994;24:957–967.
    1. Fairburn CG, Beglin SJ. Assessment of eating disorders: interview or self-report questionnaire? International Journal of Eating Disorders. 1994;16:363–370.
    1. Fairburn CG, Cooper Z. The Eating Disorder Examination. In: Fairburn CG, Wilson GT, editors. Binge Eating: Nature, Assessment and Treatment. 12th. Guilford Press; New York: 1993.
    1. Favaro A, Santonastaso P. Suicidality in eating disorders: clinical and psychological correlates. Acta Psychiatrica Scandinavica. 1997;95:508–514.
    1. Fink EL, Anestis MD, Selby EA, Joiner TE. Negative urgency fully mediates the relationship between alexithymia and dysregulated behaviours. Personality and Mental Health. 2010;4:284–293.
    1. First MB, Spitzer RL, Gibbon M, Williams JW. Structured Clinical Interview for DSM-IV-TR Axis I Disorders, Research Version, Patient Edition (SCID-I/P) Biometrics Research, New York State Psychiatric Institute; New York, NY: 2002.
    1. Franko D, Keel P. Suicidality in eating disorders: occurrence, correlates, and clinical implications. Clinical Psychology Review. 2006;26:769–782.
    1. Gordon K, Smith AR. Psychometric properties of the eating disorder painful and provocative events scale. in preparation.
    1. Jenkins GR, Hale R, Papanastassiou M, Crawford MJ, Tyrer P. Suicide rate 22 years after parasuicide: cohort study. British Medical Journal. 2002;325:1155.
    1. Joiner TE. Why People Die by Suicide. Harvard University Press; Massachusetts Cambridge, MA: 2005.
    1. Joiner TE, Tickle JJ. Exercise and depressive and anxious symptoms: what is the nature of their interrelations? Journal of Occupational Rehabilitation. 1998;8:191–198.
    1. Joiner TE, Van Orden KA, Witte TK, Selby EA, Ribeiro JD, Lewis R, Rudd MD. Main predictions of the interpersonal-psychological theory of suicidal behavior: empirical tests in two samples of young adults. Journal of Abnormal Psychology. 2009;118:634–646.
    1. Keel PK, Heatherton TF. Weight suppression predicts maintenance and onset of bulimic syndromes at 10-year follow-up. Journal of Abnormal Psychology. 2010;119:268–275.
    1. Long CG, Hollin Clive R. Assessment and management of eating disordered patients who over-exercise: a four-year follow-up of six single case studies. Journal of Mental Health. 1995;4:309–317.
    1. MacKinnon DP, Fritz MS, Williams J, Lockwood CM. Distribution of the product confidence limits for the indirect effect: program PRODLIN. Behavior Research Methods. 2007;39:384–389.
    1. MacKinnon DP, Lockwood CM, Hoffman JM, West SG, Sheets V. A comparison of methods to test mediation and other intervening variable effects. Psychological Methods. 2002;7:83–104.
    1. McKenzie DC. Markers of excessive exercise. Canadian Journal of Applied Physiology. 1999;24:66–73.
    1. Mechanic D, Hansell S. Adolescent competence, psychological well-being, and self-assessed physical health. Journal of Health and Social Behavior. 1987;28:364–374.
    1. Mehler PS, Weiner KL. Frequently asked medical questions about eating disorder patients. Eating Disorders: The Journal of Treatment and Prevention. 1994;2:22–30.
    1. Milos G, Spindler A, Hepp U, Schnyder U. Suicide attempts and suicidal ideation: links with psychiatric comorbidity in eating disorder subjects. General Hospital Psychiatry. 2004;26:129–135.
    1. Mond JM, Hay PJ, Rodgers B, Owen C. Eating Disorder Examination Questionnaire (EDE-Q): norms for young adult women. Behavior Research and Therapy. 2004;44:53–62.
    1. Mota-Pereira J, Silverio J, Carvalho S, Ribeiro JC, Fonte D, Ramos J. Moderate exercise improves depression parameters in treatment-resistant patients with major depressive disorder. Journal of Psychiatric Research. 2011;45:1005–1011.
    1. North Dakota State University Student Demographic Information. 2008 Available From: < >.
    1. Paparizos AL, Tripp DA, Sullivan ML, Rubenstein M. Catastrophizing and pain perception in recreational ballet dancers. Journal of Sport Behaviour. 2005;28:35–50.
    1. Pettit JW, Joiner TE, Rudd DM. Kindling and behavioral sensitization: are they relevant to recurrent suicide attempts? Journal of Affective Disorders. 2004;83:249–252.
    1. Pettit JW, Paukert AL, Joiner TE, Rudd DM. Pilot sample of very early onset bipolar disorder in a military population moderates the association of negative life events and non-fatal suicide attempts. Bipolar Disorders. 2006;8:475–484.
    1. Preti A, Rocchi MBL, Sisti D, Camboni MV, Miotto P. A comprehensive meta-analysis of the risk of suicide in eating disorders. Acta Psychiatrica Scandinavica. 2011;124:6–17.
    1. Reneman RS. The anterior and the lateral compartmental syndrome of the leg due to intensive use of muscles. Clinical Orthopedics and Related Research. 1975;113:69–80.
    1. Rosotto E, Yager J, Rorty M. The impulsive behavior scale. In: Vanderlin-den J, Vandereycken W, editors. Trauma, Dissociation, and Impulsive Dyscontrol in Eating Disorders. Brunner/Mazel; Pennsylvania: 1998.
    1. Ryan ED, Kovacic CR. Pain tolerance and athletic participation. Perceptual and Motor Skills. 1966;22:383–390.
    1. Safer DL, Telch CF, Agras WS. Dialectical behavior therapy for bulimia nervosa. The American Journal of Psychiatry. 2001;158:632–634.
    1. Selby E, Smith AR, Bulik CM, Olmsted MP, Thornton L, McFarlane TL, Berrettini WH, Brandt HA, Crawford S, Fichter MM, Halmi KA, Jacoby GE, Johnson CL, Jones I, Kaplan AS, Mitchell JE, Nutzinger DO, Strober M, Treasure J, Woodside DB, Kaye WH, Joiner TE., Jr Habitual starvation and provocative behaviors: two potential routes to extreme suicidal behavior in Anorexia Nervosa. Behavior Research and Therapy. 2010;48:634–645.
    1. Shroff H, Reba L, Thornton LM, Tozzi F, Klump KL, Berrettini WH, Brandt H, Crawford S, Crow S, Fichter MM, Halmi KA, Johnson C, Kaplan AS, Keel P, LaVia M, Mitchell J, Rotondo A, Strober M, Treasure J, Woodside DB, Kaye WH, Bulik CM. Features associated with excessive exercise in women with eating disorders. International Journal of Eating Disorders. 2006;39:454–461.
    1. Sidiropoulos M. Anorexia nervosa: the physiological consequences of starvation and the need for primary prevention efforts. McGill Journal of Medicine. 2007;10:20–25.
    1. Smith LL. Overtraining, excessive exercise, and altered immunity. Sports Medicine. 2003;33:347–364.
    1. Solenberger SE. Exercise and eating disorders: a 3-year inpatient hospital records analysis. Eating Behaviors. 2001;2:151–168.
    1. Tanasescu M, Leitzmann MF, Rimm EB, Willett WC, Stampfer MJ, Hu FB. Exercise type and intensity in relation to coronary heart disease in men. Journal of the American Medical Association. 2002;288:1994–2000.
    1. Thompson JK, Pasman L. The Obligatory Exercise Questionnaire. Behavior Therapist. 1991;14:137.
    1. Unger JB. Physical activity, participation in team sports, and risk of suicidal behavior in adolescents. American Journal of Health Promotion. 1997;12:90–93.
    1. Wade TD, Crosby RD, Martin NG. Use of latent profile analysis to identify eating disorder phenotypes in an adult Australian twin cohort. Archives of General Psychiatry. 2006;63:1377–1384.
    1. Van Orden KA, Witte TK, Gordon KH, Bender TW, Joiner TE. Suicidal desire and the capability for suicide: tests of the interpersonal-psychological theory of suicidal behavior among adults. Journal of Consulting and Clinical Psychology. 2008;76:72–83.
    1. Van Orden KA, Witte TK, Cukrowicz KC, Braithwaite SR, Selby EA, Joiner TE. The interpersonal theory of suicide. Psychological Review. 2010;117:575–600.
    1. Veale DMW. Exercise dependence. British Journal of Addiction. 1987;82:735–740.

Source: PubMed

스폰서 및 공동 작업자

건강 상태

약물 개입

3
구독하다