# Associations between compulsive exercise and mental health constructs in eating disorders

## TL;DR

This study explores how compulsive exercise relates to eating disorder symptoms and other mental health factors in over 3,000 individuals.

## Contribution

The study identifies unique associations between compulsive exercise and psychological features like perfectionism and OCD symptoms in eating disorders.

## Key findings

- Higher compulsive exercise is uniquely linked to more eating disorder symptoms, perfectionism, and OCD symptoms.
- Depressive symptoms show a negative association with compulsive exercise when other factors are controlled.
- Each subscale of compulsive exercise shows distinct patterns of association with psychological features.

## Abstract

Compulsive exercise (CE) is commonly observed in eating disorders (ED) and is associated with a more severe clinical picture. Including 3105 participants from the Eating Disorders Genetics Initiative-Sweden, the aim of this cross-sectional study was to expand the knowledge of how CE relates to ED symptoms and other core psychological features.

Through multiple linear regression analyses, we investigated simple and unique associations between CE, measured with the Compulsive Exercise Test (CET) including its subscales and ED symptoms, obsessive compulsive disorder (OCD) symptoms, anxiety, perfectionism, depression, and health-related quality of life.

Results suggested that ED symptoms, OCD symptoms, and perfectionism all have unique positive associations with CE, and depressive symptoms a negative association when controlling for the other constructs. Each CET subscale showed its own specific pattern of associations with the examined constructs.

Overall, results were consistent with previous research and the proposed cognitive-behavioral model of CE. Implications support the idea that CE may not be clinically relevant in the absence of ED symptoms, but an important symptom domain when they are present. Future research should focus on the directionality of associations between OCD symptoms, perfectionism, and CE, including samples without ED experience.

The online version contains supplementary material available at 10.1186/s40337-025-01517-2.

Compulsive exercise is a common symptom in eating disorders, but less is known about its associations with other core psychological features including obsessive compulsive disorder (OCD) symptoms, anxiety, perfectionism, depression, and health-related quality of life. Even less is known about associations between specific aspects of compulsive exercise and these other features. Such knowledge could be important in treatment. In this study, we examined these associations in 3105 individuals with ongoing eating disorder pathology. We found that higher levels of compulsive exercise were uniquely associated with more eating disorder symptoms, perfectionism, and OCD symptoms. We also found some unique associations between specific compulsive exercise aspects and other core psychological features.

The online version contains supplementary material available at 10.1186/s40337-025-01517-2.