The physical self, eating disorders, and exercise dependence

1. The physical self, eating disorders, and exercise dependence

2. Outline • What is self-esteem? • Structure of self-esteem • Importance of self-esteem in exercise • Sonstroem’s model of self-esteem • The eating disorders and exercise addiction/activity disorders • Anorexia and bulimia • Eating disorders in sport • Exercise addiction and ‘obligatory runners’ • Interrelationship between the disorders • Factors affecting the disorders • Interventions

3. Self-concept and identity “If the point of social psychology is to deal with the reciprocal relationship of society and person, then social psychology must incorporate a concept of self, or the equivalent of self, to get very far…it is the set of self-conceptions…that mediate the relation of society to behaviour and of behaviour to society” Stryker (1997)

4. Theories of self-esteem? • What is self-concept, self-perception, self-description, self-esteem? • Self-esteem is descriptive and evaluative components • Descriptive (self-description/self-concept) • “I am a student” • “I have brown hair” • Evaluative (self-esteem) • “I am a good tennis player” • “I like Italian cooking” • Evolution of theory on self-concept UnidimensionalMultidimensionalHierarchical

5. The STRUCTURE of self-esteem • Unidimensional model of self-esteem Coopersmith (1967) Piers (1969) • SELF-ESTEEM= SSELF-ESTEEM • STATEMENTS

6. Unidimensional Model ofSelf-Esteem GLOBAL SELF-ESTEEM

7. Unidimensional Model • Problems with the Unidimensional Model: • ignored the importance of EVALUATIONS • ignored relations between self-esteem statements • Did not include different aspects/facets of Global Self-Esteem

8. The Multidimensional Model of SELF-ESTEEM • Overall, general concept was labelled “GLOBAL SELF-ESTEEM” Harter (1988) • Accounted for the IMPORTANCE of different situations and contexts • Different facets or dimensions within the GLOBAL construct identified

9. Multidimensional Model Global Self- Esteem

10. Hierarchical Model of Self-Esteem Global Self- Esteem

11. Hierarchical Model of Self-Esteem • “GLOBAL SELF-ESTEEM” governs several FIRST-ORDER general DOMAINS of self-esteem Marsh and Shavelson (1985) • Each DOMAIN split into further facets or SUB-DOMAINS

12. Hierarchical Model of Self-Esteem

13. Fox and Corbin’s (1989) Hierarchical Model of Physical Self-Perceptions GLOBAL SELF-ESTEEM APEX LEVEL PHYSICAL SELF-WORTH DOMAIN LEVEL Sports Competence Physical Strength Body Attractiveness Physical Condition SUBDOMAIN LEVEL

14. How Positive Exercise Experiences Affect Self-Esteem GLOBAL SELF-ESTEEM General & Enduring PHYSICAL SELF-ESTEEM Sports Competence Physical Appearance Soccer Ability Figure/Physique Shooting Ability Slim Waistline Specific and Changing ‘I can score this penalty’ ‘I feel trim today’

15. Physical Self-Esteem and Exercise • Physical self-esteem can distinguish between active and non-active individuals (e.g. Hagger et al., 1997) • Gender differences: physical conditioning in women and all scales in men except physical strength (Hayes et al., 1999) • Need to identify mediating variables in relations between self-esteem and exercise behaviour (Biddle, 1997)

16. Sonstroem and Morgan’s (1989) Exercise and Self-Esteem Model • Bottom up processes: self-efficacy competence  self-esteem (dynamic model) • Self-efficacy experiences lead to competence • Effects of self-efficacy on self-esteem mediated by competence (Sonstroem et al., 1991) • Extended self-esteem model found that self-efficacy predicted behaviour and mediated influence of self-esteem and competence (Sonstroem et al., 1994)

17. INTERVENTION Self- esteem Self- esteem Physical Competence Physical Appearance Physical Competence Physical Appearance Physical self-efficacy Physical self-efficacy Physical measures Sonstroem and Morgan’s (1989) Exercise and Self-Esteem Model General Self-perceptions Specific Test 1 Test 2…. nth Test

18. Eating Disorders in Sport and Exercise • Disordered behaviours e.g. compulsions and obsessions occur frequently in sports people, may be competitive arena and value attached to success • Exercise ‘disordered behaviours’ also rife: exercise seen as weight management • Eating disordered behaviours apparent in athletic populations and interact with the exercise-related behaviours

19. What is Anorexia? • Anorexia nervosa is a psychobiological disease characterised by an intense fear of becoming obese, a disturbed body image, a significant weight loss, the refusal to maintain normal body weight, and amenorrhea • Diagnostic criteria for anorexia: • Refusal to maintain a minimal body weight (clinically defined below 85% of ‘average’) • Intense fear of gaining weight or becoming fat • Disturbance in body shape, size, or shape (i.e. feeling fat when one is clearly underweight) Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) (1994)

20. What is Bulimia? • Bulimia is an episodic eating pattern of uncontrollable food bingeing followed by purging; it is characterised by an awareness that the pattern is abnormal, fear of being unable to stop eating voluntarily, depressed mood, and self-deprecation • Diagnostic criteria for anorexia: • Recurrent episodes of binge eating • Feelings of lack of control over eating behaviour during binges • Engaging in regular ‘purging’ to prevent weight gain • An average minimum of 2 binge-eating episodes a week for at least 3 months • Persistent over-concern with body shape and weight DSM-IV (1994)

21. Eating Disorders in Sport “It is difficult to judge how prevalent eating disorders are in sport” Weinberg and Gould (2003)

22. Eating Disorders in Sport • Competitive aspects may predispose people e.g. Martin and Hausenblas (1998) found low levels of eating disorders symptoms in aerobic instructors • Borgen and Corbin (1987) found that 6% of non-athletes, 10% of athletes and 20% of athletes in sports ‘emphasising leanness’ were exceptionally preoccupied with weight or had an eating disorder • Hally and Hill (2001 found that eating-disordered athletes had much lower self-esteem, mental health, and placed considerable emphasis on a leanness

23. Eating Disorders in Sport Social factors may be important influential factors: • Significant others’ behaviours: Coaches, and parents may unintentionally link performance with physique (Griffin & Harris, 1996) • Nature of the sport: Sports such as gymnastics, figure-skating, ice-dance, and diving there is external judging criteria and demands which may provide additional external pressures • Low self-esteem: at-risk groups tend to have low self-esteem (Hausenblas and Mack, 1999) • Personality traits: Compulsive personality traits (Yates, 1991)

24. Factors Affecting Development of Eating Disorders in Athletes “Skating is such an appearance sport. You have to go up there with barely anything on… I’m definitely aware of my weight. I mean, I have dreams about it sometimes. So it’s hard having people look at my thigh and saying ‘Oops, she’s an eighth of an inch bigger’ or something. It’s hard… Weight is continually on my mind. I am never, never allowed to be on vacation.” Gould, Jackson and Finch (1993)

25. Interventions and Therapies Focus on prevention: • Promote proper nutritional practices • Correct nutritional advice • Focus on fitness, not body weight/body fat • No ‘ideal’ weight • Ideal range preferred • Health and fitness focus • Be sensitive about weight issues • Coaches not to make ‘off the cuff’ remarks about weight • Setting weight goals, having weigh-ins and associating weight loss with performance • Promote healthy ‘weight management’

26. Interventions and Therapies “Coaches and fitness leaders often exert a powerful influence on individuals, and they should exercise care when making remarks about weight control.” Weinberg and Gould (2003)

27. Interventions and Therapies Focus on dealing with eating disorders:

28. What is Exercise ‘Addiction’? • A psychological or physiological (or psychological and physiological) dependence on a regular regimen of exercise that is characterised by withdrawal symptoms after 24-36 hours elapse without exercise Sachs (1981) • Forced withdrawal from exercise for an exercise addict is characterised by: Anxiety, irritability, guilt, muscle twitching, a bloated feeling, and nervousness

29. Addiction, Obsession or Obligation? • Addiction is often characterised by a biological basis for dependence e.g., becoming addicted to dopamine responses given by ingestion of opiates • Little evidence for a biological addiction due to exercise because exercise does not upset the balance of endogenous opiates and neurotransmitters e.g. serotonin (Pierce et al., 1993) • Exercise addiction is therefore clinically not an ‘addiction’, rather a compulsion (Yates, Leehey and Shisslak, 1983)

30. Positive or Negative Addiction? • Glasser (1976) characterises activities like running as ‘positive addictions’ because they enhance or promote better psychological functioning • Exercise is viewed as a ‘healthy habit’ and is an important part of their everyday lives CONTRAST WITH: • Morgan (1979) who stated that for some people, exercise controlled their lives – a negative addiction • All other life events friends, family, work, diet and personal relationships revolve around exercise • Withdrawal symptoms and quality of life become parallel with other disorders like anorexia – ‘activity disordered’

31. The Obligatory Runner “An obligatory runner is an individual that will not and cannot moderate their running in spite of clear contraindications such as a stress fracture or threatened divorce” Yates et al. (1991)

32. The Obligatory Runner • Yates et al. (1991) identified the ‘obligatory runner’ – an exercise ‘addict’/activity disordered individual that typically: • Compromise their bodies by running when injured • Forfeit jobs, marriages, friends, and other pleasures due to their running regime • Structure their life events around running e.g. diet, holidays

33. The Obligatory Runner “They [obligatory runners] almost always run alone. There is nothing in their lives that can equal the experience of running. Although the description of an obligatory runner suggests that such individuals pay a price, the price is well worth it to the runner. These runners explicitly state that they are not sick in any way and that they feel great because they are able to run.” (Yates, 1991, p. 29)

34. Case Studies of Exercise Addicts: Obligatory Runners Clint: “Clint’s homeostasis is delicately balanced between feeling strong and potent or weak and lazy. Each and everyday he struggles to maintain a positive sense of self. He does this through running and by denying himself many pleasures such as eating, taking days off, and spending time with friends”. Max: “Max describes substantial, long-term problems within himself and in interpersonal relationships. He often feels angry. Running is an obstacle to building or maintaining relationships and it sets him apart from other people. On the other hand, running provides him with a workable adaptation and it enables him to fashion his life more than he would like it”

35. Case Studies of Exercise Addicts: Obligatory Runners Marilyn: “Marilyn…reinforced her self discipline…by diet and exercise. It is through diet and exercise that she alleviates her depression. Yet her balance appears quite fragile: Marilyn is afraid she will stop and afraid she can’t stop. She must relentlessly drive herself toward her goals, or she may fail completely. Marilyn is locked into running and she gives a history of being locked into dieting ”. • Summary: • Obligatory runners define themselves buy their relentless exercise routine • The routine is all consuming and the periods without exercise are punctuated by self-doubt • They have a fragile self-esteem that is reinforced by running but have an obsessive need to maintain a positive figure

36. Evidence That Exercise Addiction and Eating Disorders Have Similar Pathology Similarities: • Solitary behaviours – belief in control, behaviours is controlling them • Dissatisfaction with self- and body appearance • Exercise and dietary manipulation have a clearly defined goal – lose weight – inextricably linked to self-image • Gain a sense of emotional and psychological stability from their behaviour • Uncomfortable with concept of ‘leisure time’ – leads to complicating thoughts about eating, self-image etc. • When unable to exercise or diet individuals suffer withdrawal symptoms e.g. anxiety, depression, confusion, psychic fragmentation and feelings of bloatedness (Pillay and Crisp, 1977)

37. Interrelationship between Exercise Addiction and Eating Disorders • Estimated that 1 in 10 female athletes have an eating disorder • 20-30% have abnormal eating behaviours • Excessive activity is reported in 38-75% of anorexics (Kron et al., 1978) • Eating disordered individuals favour individual and highly controllable exercise types • Eating disordered women often cite high levels of social physique anxiety (Fredrick and Morrison, 1996)

38. Factors Affecting Activity/Eating Disorders Personality and social factors linked to the development of activity disorders: • obsessive-compulsive tendency (Davis, 1999) • extroversion (Yates, 1991) • trait anxiety (Spano, 2001) • perfectionism (Hausenblas & Symons-Downs, 2002b) • parental influence and emphasis on achievement (Yates, 1991) • low self-esteem (Hausenblas & Symons-Downs, 2002a)

39. Interventions and Therapies Treatments for ‘activity disordered’ patients mirrors those used for eating disordered: (1) Hospitalization – in extreme cases, last resort • Patients placed on strict diet regime/activity regime under observation • Therapy provided to ‘recognise’ and ‘confront’ strategies to ‘defeat’ supervision (2) Family Therapy • Families encouraged to formulate ‘dependent’ relationships • Family members attain responsibility

40. Interventions and Therapies (3) Group therapy • Disordered patients required to identify and express feelings • Teaches assertiveness and competence, replaces that found in activity • Ongoing support is necessary (4) Cognitive Behavioural Therapy • Initial behavioural control • Modification of ‘dysfunctional perceptions’ • Maintaining improvements • e.g., activity disordered individuals verbalise concerns about stemming exercise