The physical self, eating The physical self, eating disorders, and exercise disorders, and exercise

dependencedependence

OutlineOutline What is self-esteem?What is self-esteem? Structure of self-esteemStructure of self-esteem Importance of self-esteem in exerciseImportance of self-esteem in exercise Sonstroem’s model of self-esteemSonstroem’s model of self-esteem The eating disorders and exercise The eating disorders and exercise

addiction/activity disordersaddiction/activity disorders Anorexia and bulimiaAnorexia and bulimia Eating disorders in sportEating disorders in sport Exercise addiction and ‘obligatory Exercise addiction and ‘obligatory

runners’runners’ Interrelationship between the disordersInterrelationship between the disorders Factors affecting the disordersFactors affecting the disorders InterventionsInterventions

Self-concept and identitySelf-concept and identity

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

Stryker (1997)Stryker (1997)

Theories of self-esteem?Theories of self-esteem? What is self-concept, self-perception, self-description, What is self-concept, self-perception, self-description,

self-esteem?self-esteem? Self-esteem is descriptive Self-esteem is descriptive andand evaluative components evaluative components Descriptive (self-description/self-concept)Descriptive (self-description/self-concept)

– ““I am a student”I am a student”– ““I have brown hair”I have brown hair”

Evaluative (self-esteem)Evaluative (self-esteem)– ““I am a good tennis player”I am a good tennis player”– ““I like Italian cooking”I like Italian cooking”

Evolution of theory on self-conceptEvolution of theory on self-conceptUnidimensionalUnidimensionalMultidimensionalMultidimensionalHierarchicalHierarchical

The STRUCTURE of self-The STRUCTURE of self-esteem esteem

UnidimensionalUnidimensional model of self-esteem model of self-esteem

Coopersmith (1967)

Piers (1969)

SELF-ESTEEM= SELF-ESTEEM

STATEMENTS

Unidimensional Model ofUnidimensional Model ofSelf-EsteemSelf-Esteem

GLOBAL SELF-ESTEEM

Unidimensional ModelUnidimensional Model

Problems with the 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

The Multidimensional The Multidimensional Model of SELF-ESTEEMModel 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

Multidimensional ModelMultidimensional Model

GlobalSelf-

Esteem

Hierarchical Model of Self-Hierarchical Model of Self-EsteemEsteem

GlobalSelf-

Esteem

Hierarchical Model of Self-Hierarchical Model of Self-EsteemEsteem

“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

Hierarchical Model of Self-Hierarchical Model of Self-EsteemEsteem

Fox and Corbin’s (1989) Hierarchical Fox and Corbin’s (1989) Hierarchical Model of Physical Self-PerceptionsModel of Physical Self-Perceptions

PHYSICALSELF-WORTH

SportsCompetence

Physical Strength

Body Attractiveness

Physical Condition

APEX LEVEL

DOMAIN LEVEL

SUBDOMAIN LEVEL

GLOBALSELF-ESTEEM

How Positive Exercise How Positive Exercise Experiences Affect Self-EsteemExperiences Affect Self-Esteem

PHYSICALSELF-ESTEEM

SportsCompetence

Physical Appearance

Soccer Ability

General & Enduring

Specific and Changing

Figure/Physique

‘I can score this penalty’

Shooting Ability Slim Waistline

‘I feel trim today’

GLOBALSELF-ESTEEM

Physical Self-Esteem and ExercisePhysical Self-Esteem and Exercise

Physical self-esteem can distinguish between active and non-Physical self-esteem can distinguish between active and non-active individuals (e.g. Hagger et al., 1997)active individuals (e.g. Hagger et al., 1997)

Gender differences: physical conditioning in women and all Gender differences: physical conditioning in women and all scales in men except physical strength (Hayes et al., 1999)scales in men except physical strength (Hayes et al., 1999)

Need to identify mediating variables in relations between self-Need to identify mediating variables in relations between self-esteem and exercise behaviour (Biddle, 1997)esteem and exercise behaviour (Biddle, 1997)

Sonstroem and Morgan’s (1989) Sonstroem and Morgan’s (1989) Exercise and Self-Esteem ModelExercise and Self-Esteem Model

Bottom up processes:Bottom up processes:

self-efficacy self-efficacy competence competence self-esteem self-esteem

(dynamic model)(dynamic model)

Self-efficacy experiences lead to competenceSelf-efficacy experiences lead to competence

Effects of self-efficacy on self-esteem mediated Effects of self-efficacy on self-esteem mediated by competence (Sonstroem et al., 1991)by competence (Sonstroem et al., 1991)

Extended self-esteem model found that self-Extended self-esteem model found that self-efficacy predicted behaviour and mediated efficacy predicted behaviour and mediated influence of self-esteem and competence influence of self-esteem and competence (Sonstroem et al., 1994)(Sonstroem et al., 1994)

Sonstroem and Morgan’s (1989) Sonstroem and Morgan’s (1989) Exercise and Self-Esteem ModelExercise and Self-Esteem Model

Physical Competence

Physical self-efficacy

Physical Competence

Physical Appearance

INTERVENTION Physical self-

efficacy

Physical Appearance

Self-esteem

Self-esteem

Physical measures

Sel

f-pe

rcep

tions

General

Specific

Test 1 Test 2…. nth Test

Eating Disorders in Sport and Eating Disorders in Sport and ExerciseExercise

Disordered behaviours e.g. compulsions and obsessions occur frequently Disordered behaviours e.g. compulsions and obsessions occur frequently in sports people, may be competitive arena and value attached to in sports people, may be competitive arena and value attached to successsuccess

Exercise ‘disordered behaviours’ also rife: exercise seen as weight Exercise ‘disordered behaviours’ also rife: exercise seen as weight managementmanagement

Eating disordered behaviours apparent in athletic populations and Eating disordered behaviours apparent in athletic populations and interact with the exercise-related behavioursinteract with the exercise-related behaviours

What is Anorexia?What is Anorexia? Anorexia nervosa is a psychobiological disease Anorexia nervosa is a psychobiological disease

characterised by an intense fear of becoming characterised by an intense fear of becoming obese, a disturbed body image, a significant obese, a disturbed body image, a significant weight loss, the refusal to maintain normal body weight loss, the refusal to maintain normal body weight, and amenorrheaweight, and amenorrhea

Diagnostic criteria for anorexia:Diagnostic criteria for anorexia:– Refusal to maintain a minimal body weight Refusal to maintain a minimal body weight

(clinically defined below 85% of ‘average’)(clinically defined below 85% of ‘average’)– Intense fear of gaining weight or becoming fatIntense fear of gaining weight or becoming fat– Disturbance in body shape, size, or shape (i.e. Disturbance in body shape, size, or shape (i.e.

feeling fat when one is clearly underweight)feeling fat when one is clearly underweight)

Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) (1994)Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) (1994)

What is Bulimia?What is Bulimia? Bulimia is an episodic eating pattern of uncontrollable Bulimia is an episodic eating pattern of uncontrollable

food bingeing followed by purging; it is characterised food bingeing followed by purging; it is characterised by an awareness that the pattern is abnormal, fear of by an awareness that the pattern is abnormal, fear of being unable to stop eating voluntarily, depressed being unable to stop eating voluntarily, depressed mood, and self-deprecationmood, and self-deprecation

Diagnostic criteria for anorexia:Diagnostic criteria for anorexia:– Recurrent episodes of binge eatingRecurrent episodes of binge eating– Feelings of lack of control over eating behaviour during bingesFeelings of lack of control over eating behaviour during binges– Engaging in regular ‘purging’ to prevent weight gainEngaging in regular ‘purging’ to prevent weight gain– An average minimum of 2 binge-eating episodes a week for at An average minimum of 2 binge-eating episodes a week for at

least 3 monthsleast 3 months– Persistent over-concern with body shape and weightPersistent over-concern with body shape and weight

DSM-IV (1994)DSM-IV (1994)

Eating Disorders in SportEating Disorders in Sport

““It is difficult to judge It is difficult to judge how prevalent eating how prevalent eating disorders are in sport”disorders are in sport”

Weinberg and Gould (2003)Weinberg and Gould (2003)

Eating Disorders in SportEating Disorders in Sport

Competitive aspects may predispose people e.g. Competitive aspects may predispose people e.g. Martin and Hausenblas (1998) found low levels of Martin and Hausenblas (1998) found low levels of eating disorders symptoms in aerobic instructorseating disorders symptoms in aerobic instructors

Borgen and Corbin (1987) found that 6% of non-Borgen and Corbin (1987) found that 6% of non-athletes, 10% of athletes and 20% of athletes in athletes, 10% of athletes and 20% of athletes in sports ‘emphasising leanness’ were exceptionally sports ‘emphasising leanness’ were exceptionally preoccupied with weight or had an eating preoccupied with weight or had an eating disorderdisorder

Hally and HillHally and Hill (2001 found that eating-disordered (2001 found that eating-disordered athletes had much lower self-esteem, mental athletes had much lower self-esteem, mental health, and placed considerable emphasis on a health, and placed considerable emphasis on a leannessleanness

Eating Disorders in SportEating Disorders in SportSocial factors may be important influential factors:Social factors may be important influential factors: Significant others’ behaviours:Significant others’ behaviours: Coaches, and Coaches, and

parents may unintentionally link performance parents may unintentionally link performance with physique (Griffin & Harris, 1996)with physique (Griffin & Harris, 1996)

Nature of the sport:Nature of the sport: Sports such as gymnastics, Sports such as gymnastics, figure-skating, ice-dance, and diving there is figure-skating, ice-dance, and diving there is external judging criteria and demands which external judging criteria and demands which may provide additional external pressuresmay provide additional external pressures

Low self-esteem:Low self-esteem: at-risk groups tend to have low at-risk groups tend to have low self-esteem (Hausenblas and Mack, 1999)self-esteem (Hausenblas and Mack, 1999)

Personality traits:Personality traits: C Compulsive personality traits ompulsive personality traits (Yates, 1991)(Yates, 1991)

Factors Affecting Factors Affecting Development of Eating Development of Eating Disorders in AthletesDisorders in Athletes

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

Gould, Jackson and Finch (1993)Gould, Jackson and Finch (1993)

Interventions and Therapies Interventions and Therapies Focus on prevention:Focus on prevention:Promote proper nutritional practicesPromote proper nutritional practices

Correct nutritional adviceCorrect nutritional adviceFocus on fitness, not body weight/body fatFocus on fitness, not body weight/body fat

No ‘ideal’ weightNo ‘ideal’ weight Ideal range preferredIdeal range preferred Health and fitness focusHealth and fitness focus

Be sensitive about weight issuesBe sensitive about weight issues Coaches not to make ‘off the cuff’ remarks about weightCoaches not to make ‘off the cuff’ remarks about weight Setting weight goals, having weigh-ins and associating weight loss with Setting weight goals, having weigh-ins and associating weight loss with

performanceperformancePromote healthy ‘weight management’Promote healthy ‘weight management’

““Coaches and fitness leaders Coaches and fitness leaders often exert a powerful often exert a powerful influence on individuals, and influence on individuals, and they should exercise care they should exercise care when making remarks about when making remarks about weight control.”weight control.”

Weinberg and Gould (2003)Weinberg and Gould (2003)

Interventions and Therapies Interventions and Therapies

Interventions and Therapies Interventions and Therapies Focus on dealing with eating disorders:Focus on dealing with eating disorders:DosDos Don’tsDon’ts

Do get advice from specialistsDo get advice from specialists Don’t ask the athlete to leave Don’t ask the athlete to leave the team or curtail the team or curtail participation unless instructed participation unless instructed by specialistby specialist

Do be supportive and empathicDo be supportive and empathic Don’t recommend weight loss Don’t recommend weight loss or gainor gain

Do express concerns about Do express concerns about feelings, not about weightfeelings, not about weight

Don’t hold team weigh-insDon’t hold team weigh-ins

Do make referrals to a specific Do make referrals to a specific personperson

Don’t single out or treat the Don’t single out or treat the individual unlike other individual unlike other athletesathletes

Do emphasise importance of Do emphasise importance of good nutritiongood nutrition

Don’t talk about the problem Don’t talk about the problem with no professionals who are with no professionals who are not directly involvednot directly involved

Do provide information about Do provide information about eating disorderseating disorders

Don’t demand the problem be Don’t demand the problem be stopped immediatelystopped immediately

Don’t make insensitive Don’t make insensitive remarks about individuals remarks about individuals weightweight

A psychological or physiological (or A psychological or physiological (or psychological psychological andand physiological) physiological) dependence on a regular regimen of dependence on a regular regimen of exercise that is characterised by exercise that is characterised by withdrawal symptoms after 24-36 hours withdrawal symptoms after 24-36 hours elapse without exerciseelapse without exercise

Sachs (1981) Sachs (1981) Forced withdrawal from exercise for an Forced withdrawal from exercise for an

exercise addict is characterised by: exercise addict is characterised by: Anxiety, irritability, guilt, muscle twitching, Anxiety, irritability, guilt, muscle twitching, a bloated feeling, and nervousnessa bloated feeling, and nervousness

What is Exercise ‘Addiction’?What is Exercise ‘Addiction’?

Addiction is often characterised by a biological Addiction is often characterised by a biological basis for dependence e.g., becoming addicted to basis for dependence e.g., becoming addicted to dopamine responses given by ingestion of opiatesdopamine responses given by ingestion of opiates

Little evidence for a biological addiction due to Little evidence for a biological addiction due to exercise because exercise does not upset the exercise because exercise does not upset the balance of endogenous opiates and balance of endogenous opiates and neurotransmitters e.g. serotonin (Pierce et al., neurotransmitters e.g. serotonin (Pierce et al., 1993)1993)

Exercise addiction is therefore clinically not an Exercise addiction is therefore clinically not an ‘addiction’, rather a compulsion (Yates, Leehey ‘addiction’, rather a compulsion (Yates, Leehey and Shisslak, 1983)and Shisslak, 1983)

Addiction, Obsession or Addiction, Obsession or Obligation?Obligation?

Glasser (1976) characterises activities like running as ‘positive addictions’ because they enhance or promote Glasser (1976) characterises activities like running as ‘positive addictions’ because they enhance or promote better psychological functioningbetter psychological functioning

Exercise is viewed as a ‘healthy habit’ and is an important part of their everyday livesExercise is viewed as a ‘healthy habit’ and is an important part of their everyday lives

CONTRAST WITH:CONTRAST WITH:

Morgan (1979) who stated that for some people, exercise controlled their lives – a negative addictionMorgan (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 exerciseAll 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 Withdrawal symptoms and quality of life become parallel with other disorders like anorexia – ‘activity disordered’disordered’

Positive or Negative Positive or Negative Addiction?Addiction?

The Obligatory RunnerThe Obligatory Runner

“ “An obligatory runner An obligatory runner is an individual that is an individual that will not and cannot will not and cannot moderate their running moderate their running in spite of clear in spite of clear contraindications such contraindications such as a stress fracture or as a stress fracture or threatened divorce”threatened divorce”

Yates et al. (1991)Yates et al. (1991)

The Obligatory RunnerThe Obligatory RunnerYates et al. (1991) identified the ‘obligatory Yates et al. (1991) identified the ‘obligatory

runner’ – an exercise ‘addict’/activity disordered runner’ – an exercise ‘addict’/activity disordered individual that typically:individual that typically:

Compromise their bodies by running when Compromise their bodies by running when injuredinjuredForfeit jobs, marriages, friends, and other Forfeit jobs, marriages, friends, and other pleasures due to their running regimepleasures due to their running regimeStructure their life events around running Structure their life events around running e.g. diet, holidayse.g. diet, holidays

The Obligatory RunnerThe Obligatory Runner

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

(Yates, 1991, p. 29)(Yates, 1991, p. 29)

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

Case Studies of Exercise Addicts: Case Studies of Exercise Addicts: Obligatory Runners Obligatory Runners

Marilyn:Marilyn:““Marilyn…reinforced her self discipline…by diet and Marilyn…reinforced her self discipline…by diet and exercise. It is through diet and exercise that she exercise. It is through diet and exercise that she alleviates her depression. Yet her balance appears quite alleviates her depression. Yet her balance appears quite fragile: Marilyn is afraid she will stop and afraid she can’t fragile: Marilyn is afraid she will stop and afraid she can’t stop. She must relentlessly drive herself toward her stop. She must relentlessly drive herself toward her goals, or she may fail completely. Marilyn is locked into goals, or she may fail completely. Marilyn is locked into running and she gives a history of being locked into running and she gives a history of being locked into dieting ”.dieting ”.

Case Studies of Exercise Addicts: Case Studies of Exercise Addicts: Obligatory Runners Obligatory Runners

Summary:Summary:Obligatory runners define themselves buy their Obligatory runners define themselves buy their relentless exercise routinerelentless exercise routineThe routine is all consuming and the periods without The routine is all consuming and the periods without exercise are punctuated by self-doubtexercise are punctuated by self-doubtThey have a fragile self-esteem that is reinforced by They have a fragile self-esteem that is reinforced by running but have an obsessive need to maintain a running but have an obsessive need to maintain a positive figurepositive figure

Evidence That Exercise Addiction Evidence That Exercise Addiction and Eating Disorders Have Similar and Eating Disorders Have Similar

Pathology Pathology Similarities:Similarities:

Solitary behaviours – belief in control, behaviours is controlling themSolitary behaviours – belief in control, behaviours is controlling themDissatisfaction with self- and body appearanceDissatisfaction with self- and body appearanceExercise and dietary manipulation have a clearly defined goal – lose Exercise and dietary manipulation have a clearly defined goal – lose weight – inextricably linked to self-imageweight – inextricably linked to self-imageGain a sense of emotional and psychological stability from their Gain a sense of emotional and psychological stability from their behaviourbehaviourUncomfortable with concept of ‘leisure time’ – leads to complicating Uncomfortable with concept of ‘leisure time’ – leads to complicating thoughts about eating, self-image etc.thoughts about eating, self-image etc.When unable to exercise or diet individuals suffer withdrawal When unable to exercise or diet individuals suffer withdrawal symptoms e.g. anxiety, depression, confusion, psychic symptoms e.g. anxiety, depression, confusion, psychic fragmentation and feelings of bloatedness (Pillay and Crisp, 1977)fragmentation and feelings of bloatedness (Pillay and Crisp, 1977)

Interrelationship between Interrelationship between Exercise Addiction and Eating Exercise Addiction and Eating

Disorders Disorders Estimated that 1 in 10 female athletes have Estimated that 1 in 10 female athletes have an eating disorderan eating disorder20-30% have abnormal eating behaviours20-30% have abnormal eating behavioursExcessive activity is reported in 38-75% of Excessive activity is reported in 38-75% of anorexics (Kron et al., 1978)anorexics (Kron et al., 1978)Eating disordered individuals favour Eating disordered individuals favour individual and highly controllable exercise individual and highly controllable exercise typestypesEating disordered women often cite high Eating disordered women often cite high levels of social physique anxiety (Fredrick levels of social physique anxiety (Fredrick and Morrison, 1996)and Morrison, 1996)

Factors Affecting Activity/Eating Factors Affecting Activity/Eating DisordersDisorders

Personality and social factors linked to the development Personality and social factors linked to the development of activity disorders:of activity disorders:

• obsessive-compulsive tendency (Davis, 1999)obsessive-compulsive tendency (Davis, 1999)• extroversion (Yates, 1991)extroversion (Yates, 1991)• trait anxiety (Spano, 2001)trait anxiety (Spano, 2001)• perfectionism (Hausenblas & Symons-Downs, 2002b)perfectionism (Hausenblas & Symons-Downs, 2002b)• parental influence and emphasis on achievement parental influence and emphasis on achievement

(Yates, 1991)(Yates, 1991)• low self-esteem (Hausenblas & Symons-Downs, low self-esteem (Hausenblas & Symons-Downs,

2002a)2002a)

Interventions and Therapies Interventions and Therapies

Treatments for ‘activity disordered’ patients mirrors Treatments for ‘activity disordered’ patients mirrors those used for eating disordered:those used for eating disordered:

(1) Hospitalization – in extreme cases, last resort(1) Hospitalization – in extreme cases, last resortPatients placed on strict diet regime/activity regime under Patients placed on strict diet regime/activity regime under observationobservationTherapy provided to ‘recognise’ and ‘confront’ strategies Therapy provided to ‘recognise’ and ‘confront’ strategies to ‘defeat’ supervisionto ‘defeat’ supervision

(2) Family Therapy(2) Family TherapyFamilies encouraged to formulate ‘dependent’ relationshipsFamilies encouraged to formulate ‘dependent’ relationshipsFamily members attain responsibilityFamily members attain responsibility

(3) Group therapy(3) Group therapyDisordered patients required to identify and express feelingsDisordered patients required to identify and express feelingsTeaches assertiveness and competence, replaces that found Teaches assertiveness and competence, replaces that found in activityin activityOngoing support is necessaryOngoing support is necessary

(4) Cognitive Behavioural Therapy(4) Cognitive Behavioural TherapyInitial behavioural controlInitial behavioural controlModification of ‘dysfunctional perceptions’Modification of ‘dysfunctional perceptions’Maintaining improvementsMaintaining improvementse.g., activity disordered individuals verbalise concerns about e.g., activity disordered individuals verbalise concerns about stemming exercisestemming exercise

Interventions and Therapies Interventions and Therapies