Compulsive exercise in eating disorders: proposal for a definition and a clinical assessment
Compulsive exercise in eating disorders: proposal for a definition and a clinical assessment
复制标题
DOI：
10.1186/s40337-018-0219-x
复制
发表时间：
2018-11-28
影响因子：
4.1
通讯作者：
Voderholzer, Ulrich
中科院分区：
文献类型：
--
作者：
Dittmer, Nina;Jacobi, Corinna;Voderholzer, Ulrich
背景：100多年来，强迫运动一直被认为是饮食失调(ED)的一种高度流行的症状，并与短期和长期治疗结果差有关。在现有文献的基础上，我们的目标是提出一个适用于青少年和成人ED患者的强迫运动的跨诊断定义和临床评估。方法：在一家高度专业化的饮食障碍医院举行的一系列有经验的临床医生会议上，我们在ED中阐述了强迫运动的跨诊断定义和临床评估。结果：定义和评估强迫运动的核心标准是一种病理性增加的运动模式，其特征是：1)患者为应对强迫症或按照必须严格执行的规则而感到被迫进行的过度运动；2)旨在预防或减少痛苦或防止某些可怕后果的运动。第二个必要的标准是强制性锻炼造成的身体或心理负担，即锻炼耗费时间，严重干扰患者的日常生活、职业功能或社会关系，或者尽管受到医疗伤害、疾病或缺乏享受，但仍继续进行。强迫运动是否过度或不合理是一个可选的标准。强迫运动表现为三种不同的亚型：1)剧烈运动，2)日常运动显著增加，或3)运动不宁。上述标准必须在过去6个月内与强迫运动的三种亚型之一一起满足。结论：拟议的标准旨在促进围绕强迫运动的定义和评估的讨论，以期在不久的将来达成国际共识。为研究人员和临床医生提供一个一致的框架，将大大促进对强迫运动的理解和治疗。
Background: Compulsive exercise has been recognized as a highly prevalent symptom in eating disorders (ED) for over 100 years and is associated with poor short-term and long-term treatment outcome. Progress in understanding and treatment of compulsive exercise will remain limited as long as no consensus framework for definition and assessment of compulsive exercise exists, as results cannot be compared across clinical studies.Based on existing literature, it was our aim to propose a transdiagnostic definition and a clinical assessment for compulsive exercise, that can be applied to adolescent and adult patients with ED.Method: During a series of meetings of experienced clinicians at a highly specialized hospital for eating disorders, we elaborated a transdiagnostic definition of compulsive exercise in ED. Additionally, we derived a clinical interview for the assessment of compulsive exercise and its different subtypes.Results: The core criterion when defining and assessing compulsive exercise is a pathologically increased exercise pattern characterized by 1) excessive exercise that a patient feels driven to perform in response to an obsession or according to rules that must be applied rigidly, and 2) exercise that is aimed at preventing or reducing distress or at preventing some dreaded consequence. A second necessary criterion is the physical or psychological burden caused by compulsive exercise, i.e., that it is time-consuming, significantly interferes with the patient's daily routine, occupational functioning or social relationships or is continued despite medical injury, illness, or lack of enjoyment. Insight that compulsive exercise is excessive or unreasonable was added as an optional criterion.Compulsive exercise manifests itself in three different subtypes: 1) vigorous exercise, 2) marked increase in daily movement, or 3) motor restlessness.The above criteria must be met during the past 6 months, together with one of the three subtypes of compulsive exercise.Conclusions: The proposed criteria aim to foster the discussion around definition and assessment of compulsive exercise with the goal of reaching an international consensus in the near future.Providing a consistent framework for researchers and clinicians would considerably advance understanding and treatment of compulsive exercise in ED patients.