The Compulsive Exercise Test: confirmatory factor analysis and links with eating psychopathology among women with clinical eating disorders

Caroline Meyer, Carolyn R Plateau, Lorin Taranis, Nicola Brewin, Jackie Wales, Jon Arcelus, Caroline Meyer, Carolyn R Plateau, Lorin Taranis, Nicola Brewin, Jackie Wales, Jon Arcelus

Abstract

Background: This study aimed to determine the psychometric properties of the Compulsive Exercise Test (CET) among an adult sample of patients with eating disorders.

Method: Three hundred and fifty six patients and 360 non-clinical control women completed the CET and the Eating Disorders Examination questionnaire (EDE-Q).

Results: A confirmatory factor analysis revealed that the clinical data showed a moderate fit to the previously published five factor model derived from a community sample (Taranis L, Touyz S, Meyer C, Eur Eat Disord Rev 19:256-268, 2011). The clinical group scored significantly higher than the non-clinical group on four of the five CET subscales, and logistic regression analysis revealed that the CET could successfully discriminate between the two groups. A Receiver Operating Curve analysis revealed that a cut-off score of 15 on the CET resulted in acceptable values of both sensitivity and specificity.

Conclusions: The CET appears to have a factor structure that is acceptable for use with an adult sample of patients with eating disorders. It can identify compulsive exercise among patients with eating disorders and a cut-off score of 15 is acceptable as indicating an appropriate cut-off point.

Keywords: Compulsive exercise; Detection; Eating disorders; Measurement; Screening.

References

    1. Aardoom JJ, Dingemans AE, Slof Op’t Landt MCT, Van Furth EF. Norms and discriminative validity of the Eating Disorder Examination Questionnaire (EDE-Q) Eating Behaviours. 2012;13(4):305–309. doi: 10.1016/j.eatbeh.2012.09.002.
    1. American Psychiatric Association . Diagnostic and Statistical Manual of Mental Disorders 4th ed. Text Revision (DSM-IV-TR) Washington, DC: American Psychiatric Publishing; 2000.
    1. Arbuckle JL. IBM SPSS Amos 20 user’s guide. Amos Development Corporation, SPSS Inc. 2011.
    1. Bamber D, Cockerill IM, Rodgers S, Carroll D. Diagnostic criteria for exercise dependence in women. Br J Sports Med. 2003;37(5):393–400. doi: 10.1136/bjsm.37.5.393.
    1. Bentler PM. EQS 6 structural equations program manual. Encino: Multivariate Software; 2005.
    1. Beumont PJ, Arthur B, Russell JD, Touyz SW. Excessive physical activity in dieting disorder patients: Proposals for a supported exercise programme. Int J Eat Disord. 1994;15:21–36. doi: 10.1002/1098-108X(199401)15:1<21::AID-EAT2260150104>;2-K.
    1. Boyd C, Abraham S, Luscombe G. Exercise behaviours and feelings in eating disorder and non-eating disorder groups. Eur Eat Disord Rev. 2007;15:112–118. doi: 10.1002/erv.769.
    1. Bratland-Sanda S, Sundgot-Borgen J, Rø O, Rosenvinge JH, Hoffart A, Martinsen EW. “I’m not physically active…I only go for walks”: physical activity in patients with longstanding eating disorders. Int J Eat Disord. 2010;43:88–92.
    1. Bratland-Sanda S, Sundgot-Borgen J, Rø O, Rosenvinge JH, Hoffart A, Martinsen EW. Physical activity and exercise dependence during inpatient treatment of longstanding eating disorders: an exploratory study of excessive and non-excessive exercisers. Int J Eat Disord. 2010;43(3):266–273.
    1. Browne MW, Cudeck R. Alternative ways of assessing model fit. In: Bollen KA, Long JS, editors. Testing structural equation models. Newbury Park: Sage; 1993.
    1. Carter JC, Blackmore E, Sutandar-Pinnock K, Woodside DB. Relapse in anorexia nervosa: A survival analysis. Psychol Med. 2004;34:671–79.
    1. Darcy AM, Hardy KK, Crosby RD, Lock J, Peebles R. Factor structure of the Eating Disorder Examination Questionnaire (EDE-Q) in male and female college athletes. Body Image. 2013;10(3):399–405. doi: 10.1016/j.bodyim.2013.01.008.
    1. Davis C, Kennedy SH, Ralevski E, Dionne M. The role of physical activity in the development and maintenance of eating disorders. Psychol Med. 1994;24(4):957–967. doi: 10.1017/S0033291700029044.
    1. Davis C, Katzman DK, Kaptein S, Kirsh C, Brewer H, Kalmbach K, Olmstead MF, Woodside DB, Kaplan AS. The prevalence of high-level exercise in the eating disorders: etiological implications. Compr Psychiatry. 1997;38(6):321–326. doi: 10.1016/S0010-440X(97)90927-5.
    1. Fairburn CG, Beglin S. Eating Disorder Examination Questionnaire (EDE-Q 6.0) In: Fairburn CG, editor. Cognitive behavior therapy and eating disorders. New York: Guildford Press; 2008. pp. 309–314.
    1. Fietz M, Touyz S, Hay P. A risk profile of compulsive exercise among adolescents with an eating disorder: A systematic review. Advances in Eating DIsorders: Theory, Research and Practice. 2014;2:241–263. doi: 10.1080/21662630.2014.894470.
    1. Ford JK, MacCallum RC, Tait M. The application of exploratory factor-analysis in applied psychology: a critical review and analysis. Pers Psychol. 1986;39:291–314. doi: 10.1111/j.1744-6570.1986.tb00583.x.
    1. Formby P, Watson HJ, Hilyard A, Martin K, Egan SJ. Psychometric properties of the Compulsive Exercise Test in an adolescent eating disorder population. Eating Behaviours. 2014;15(4):555–557. doi: 10.1016/j.eatbeh.2014.08.013.
    1. Freimuth M, Moniz S, Kim SR. Clarifying exercise addiction: differential diagnosis, co-occurring disorders, and phases of addiction. Int J Environ Res Public Health. 2011;8(10):4069–4081. doi: 10.3390/ijerph8104069.
    1. Goodwin H, Haycraft E, Taranis L, Meyer C. Psychometric evaluation of the compulsive exercise test (CET) in an adolescent population: links with eating psychopathology. Eur Eat Disord Rev. 2011;19(3):269–279. doi: 10.1002/erv.1109.
    1. Hausenblas H, Downs DS. Exercise dependence: a systematic review. Psychology of Sport and Exercise. 2002;3(2):89–123. doi: 10.1016/S1469-0292(00)00015-7.
    1. Holtkamp K, Hebebrand J, Herpertz-Dahlmann B. The contribution of anxiety and food restriction on physical activity levels in acute anorexia nervosa. Int J Eat Disord. 2004;36(2):163–171. doi: 10.1002/eat.20035.
    1. Hooper D, Coughlan J, Mullen MR. Structural equation modelling: guidelines for determining model fit. Electronic Journal of Business Research Methods. 2008;6(1):53–60.
    1. Kline RB. Principles and practice of structural equation modeling. 2. New York: The Guilford Press; 2005.
    1. Luce KH, Crowther JH, Pole M. Eating Disorder Examination Questionnaire (EDE-Q): norms for undergraduate women. Int J Eat Disord. 2008;41(3):273–276. doi: 10.1002/eat.20504.
    1. MacCallum RC, Browne MW, Sugawara HM. Power analysis and determination of sample size for covariance structure modelling. Psychol Methods. 1996;1(2):130–149. doi: 10.1037/1082-989X.1.2.130.
    1. Mardia KV. Applications of some measures of multivariate skewness and kurtosis in testing normality and robustness studies. Sankhya. 1974;B36:115–128.
    1. Marsh HW. Application of confirmatory factor analysis and structural equation modeling in sport and exercise psychology. In: Tenenbaum G, Eklund RC, editors. Handbook of sport psychology. 3. Hoboken: Wiley; 2007.
    1. Marsh HW, Hau KT, Wen Z. In search of golden rules: comment on hypothesis-testing approaches to setting cutoff values for fit indexes and dangers in overgeneralizing Hu and Bentler’s findings. Struct Equ Model. 2004;11(3):320–341. doi: 10.1207/s15328007sem1103_2.
    1. Metz CE. Basic principles of ROC analysis. Semin Nucl Med. 1978;VIII(4):283–298. doi: 10.1016/S0001-2998(78)80014-2.
    1. Meyer C. The balancing act of incorporating exercise into eating disorder treatment. Plenary paper presented at the International Conference on Eating Disorders: Academy for Eating Disorders, Boston, April; 2015
    1. Meyer C, Taranis L. Exercise in the eating disorders: terms and definition. Eur Eat Disord Rev. 2011;19(3):169–173. doi: 10.1002/erv.1121.
    1. Meyer C, Taranis L, Goodwin H, Haycraft E. Compulsive exercise and eating disorders. Eur Eat Disord Rev. 2011;19:174–189. doi: 10.1002/erv.1122.
    1. Mond JM, Hay PJ, Rodgers B, Owen C, Beumont PJV. Relationships between exercise behaviour, eating-disordered behaviour and quality of life in a community sample of women. When is exercise “excessive”? Eur Eat Disord Rev. 2004;12(4):265–272. doi: 10.1002/erv.579.
    1. Mond JM, Hay PJ, Rodgers B, Owen C, Beumont PJV. Validity of the Eating Disorders Examination Questionnaire (EDE-Q) in screening for eating disorders in community samples. Behav Res Ther. 2004;42(5):551–567. doi: 10.1016/S0005-7967(03)00161-X.
    1. Mond JM, Hay PJ, Rodgers B, Owen C, Beumont PJV. Temporal stability of the Eating Disorder Examination Questionnaire. Int J Eat Disord. 2004;36(2):195–203. doi: 10.1002/eat.20017.
    1. Mond JM, Hay PJ, Rodgers B, Owen C. Eating Disorder Examination Questionnaire (EDE-Q): norms for young adult women. Behav Res Ther. 2006;44(1):53–62. doi: 10.1016/j.brat.2004.12.003.
    1. Mond JM, Myers TC, Crosby RD, Hay PJ, Rodgers B, Morgan JF, Lacey JH, Mitchell JE. Screening for eating disorders in primary care: EDE-Q versus the SCOFF. Behaviour Research & Therapy. 2008;46(5):612–622. doi: 10.1016/j.brat.2008.02.003.
    1. Plateau CR, Shanmugam V, Duckham RL, Goodwin H, Jowett S, Brooke-Wavell KSF, Arcelus J, Meyer C. Use of the Compulsive Exercise Test with athletes: norms and links with eating psychopathology. Journal of Applied Sport Psychology. 2014;26(3):287–301. doi: 10.1080/10413200.2013.867911.
    1. Schafer JL. Multiple imputation: a primer. Stat Methods Med Res. 1999;8:3–15. doi: 10.1191/096228099671525676.
    1. Strober M, Freeman R, Morrell W. The long-term course of severe anorexia nervosa in adolescents: Survival analysis of recovery, relapse and outcome predictors over 10–15 years in a prospective study. Int J Eat Disord. 1997;22:339–360. doi: 10.1002/(SICI)1098-108X(199712)22:4<339::AID-EAT1>;2-N.
    1. Taranis L, Meyer C. Perfectionism and compulsive exercise among female exercisers: high personal standards or self-criticism? Personal Individ Differ. 2010;49(1):3–7. doi: 10.1016/j.paid.2010.02.024.
    1. Taranis L, Meyer C, Touyz S. Activity and exercise: clinical implications. Workshop presented at: The 9th London International Eating Disorders Conference; 2009
    1. Taranis L, Meyer C, Arcelus J. Treatment of compulsive exercise within eating disordered patients. Workshop presented at: Eating Disorders International Conference 2010; 2010
    1. Taranis L, Touyz S, Meyer C. Disordered eating and exercise: development and preliminary validation of the Compulsive Exercise Test (CET) Eur Eat Disord Rev. 2011;19(3):256–268. doi: 10.1002/erv.1108.
    1. Thome JL, Espelage DL. Relations among exercise, coping, disordered eating, and psychological health among college students. Eating Behaviours. 2004;5(4):337–351. doi: 10.1016/j.eatbeh.2004.04.002.

Source: PubMed

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