Table 2

Emergent themes relating to diagnostic criteria for exercise dependence

Raw data – examplesFirst order themesSecond order themesGeneral 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 confinedPsychologicalImpaired 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 relationshipsSocial 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 
“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/punishingBehavioural
“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 habitsWithdrawal
“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 controlPersistent 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 relatedToleranceAssociated 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 exercisingExercise 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 problemDeception/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 
 Need to be active 
 Feeling in control 
 Self punishment 
 Regulation emotions 
 Physical self efficacy 
 Sense of compulsionExercise 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 disorderPresence of an eating disorder (primary or secondary dependence)