Emergent themes relating to diagnostic criteria for exercise dependence
| Raw data – examples | First order themes | Second order themes | General dimension |
|---|---|---|---|
| EDE, Eating disordres examination. | |||
| “I have to think that people have to sit down in an office day after day . . .it’s like a power of struggle and my brain’s never quiet, trying to reason . . .” | Intrusive thoughts/ruminations Salience of thoughts about exercising Anxiety, depression Anger, frustration, agitation, irritability Guilt, insomnia, lethargy, loss of motivation, Impaired concentration, feel confined | Psychological | Impaired functioning |
| “It’s exercise or nothing” “I’d always turn something down if it was going to interfere with my routine” “My exercise is my social life, I don’t have a social life outside that” | Salience of exercising above other activities Social isolation/withdrawal Inability to work, late for work, impaired concentration/functioning at work Irritability with colleagues, partners, friends, family. Conflict in relationships | Social and occupational | |
| “I went to the doctor and he said . . .you have got to slow down, don’t do so much exercise, erm, but I didn’t” | Medically contraindicated exercising Injury Illness Fatigue | Physical | |
| “I go (walking) at half past 7 and then I go at half past 10 and then I go at half past 1 and then I go at half past 4, so structured” “I sometimes really push myself . . .because I am bad, because I have done something that I shouldn’t have” | Stereotyped and inflexible behaviour Self harm/punishing | Behavioural | |
| “I wouldn’t think I deserved the food” “I should be feeling very depressed and angry and anxious . . .I would be ready to be hospitalised” | Change in eating behaviour/cognitions (e.g. bingeing, dietary restriction, fear eating) Fear weight gain Increase alcohol/substance use Severe anxiety, depression, loss motivation. | Adverse response to change in/interruption of exercise habits | Withdrawal |
| “I’d love to lie on the settee and watch video after video” “It (exercising) speeded up again and now I’m trying to cut down” | Fantasies about not exercising Desire to cut down Inability to cut down Feeling exercising is out of own control | Persistent desire and/or unsuccessful attempts to control/reduce exercise | |
| “The more I do it the more it seems that I need to do it” “It has a tendency to creep up” “If I start doing the exercising . . .I will start doing more and more of it” | Increased volume exercise (frequency, intensity, duration) Decreased exercise Fear of addiction Performance/non-performance related | Tolerance | Associated features |
| “4 and a half to 6 hours per day plus (horse) riding” “There aren’t many people in my front room at 5 am” | High volume Mode, frequency, duration, intensity Solitary exercising | Exercise behaviour | |
| “I probably underestimate it” “ . . .a bit economical with the truth . . .and I don’t tell then about the hill profiles and speed” | Lying about exercising Exercising in secret Denial – self/others Insight/awareness of problem | Deception/insight | |
| “my main reason for exercising is to be good, but I know that to be good I also need to be thin”. “control, control full stop.” “because I have to” | Performance Weight/shape control Mood, sleep Break from work Physical health Social Need to be active Feeling in control Self punishment Regulation emotions Physical self efficacy Sense of compulsion | Exercise motives | |
| Responses to each of the 36 EDE items “I always feel guilty after eating” “I feel fat and ugly and I hate myself at the moment” “It (weight) makes me feel awful, it just makes me feel really bad about myself.” | EDE interview questions e.g. “Have you felt guilty about eating?” “How have you been feeling about your weight?” | Clinical eating disorder Disordered eating No eating disorder | Presence of an eating disorder (primary or secondary dependence) |