Behavioral reinforcement of pathological exercise in anorexia nervosa

Abstract

Pathological exercise in anorexia nervosa (AN) is a harmful behavior associated with a chronic course and poor prognosis. To date, no comprehensive theoretical model exists to describe pathological exercise in the context of AN, and as such, few treatments are effective at promoting direct and sustained pathological exercise extinction.Using a framework put forth by Wise & Koob (2014), debating the relative importance of positive and negative reinforcement in substance use, we present three hypotheses of behavioral reinforcement of exercise, encompassing biological, psychological, and environmental influences. Specifically, we argue that exercise is positively reinforced through receipt of biological and behavioral rewards, negatively reinforced through avoidance of aversive emotions, and that these two systems work in tandem over time to engrain pathological exercise as a habit. We then present suggestions for testing each of these hypotheses as future directions for the field.

Psychometric properties of the Compulsive Exercise Test in a large sample of female adolescent and adult inpatients with anorexia nervosa and bulimia nervosa

“…This suggests that lack of exercise enjoyment might not be relevant in compulsive exercise for AN and BN. Furthermore, recent theoretical proposals also suggest improving models for a better understanding of compulsive exercise in EDs (e.g., Coniglio, Cooper, & Selby, 2022; Kolar & Gorrell, 2020).…”

On the pitfalls of conceptualizing excessive physical exercise as an addictive disorder: Commentary on Dinardi et al. (2021)

“…However, these validation studies did report positive correlations between physical exercise addiction symptoms and eating disorder symptoms (for the EDS and CET; the EAI did not include such measures). It is thus likely that even when what is measured by such scales is genuinely problematic, it is impossible to ascertain that what is measured is not just a potentially maladaptive strategy displayed to cope with symptoms of an eating disorder ( Bamber, Cockerill, Rodgers, & Carroll, 2000 , 2003 ; Coniglio, Cooper, & Selby, 2021 ). Such an account is in line with data showing that the association between physical exercise addiction and reduced quality of life does not hold after statistically controlling for the effects of eating disorder psychopathology ( Mond, Hay, Rodgers, & Owen, 2006 ).…”

Better understanding change processes and mechanisms: A commentary on “treatment of compulsive exercise in eating disorders and muscle dysmorphia: A systematic review and meta-analysis”.

“…Intervention studies can also serve to provide evidence for and against particular mechanisms. For example, Coniglio et al (2021) indicated that if compulsive exercise is best explained as a habit maintained by positive and negative reinforcement, then habit reversal training may be an effective treatment. The recent interest in ketamine therapy for obsessive-compulsive disorder (OCD), substance use disorders, and eating disorders is a clear example of how we can leverage mechanistic studies to augment existing treatment.…”