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Cognitive and Behavioral Inflexibility as a Transdiagnostic Process Underpinning Exercise Dependence

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Abstract

Cognitive and behavioral inflexibility are hallmark executive function abnormalities in diverse psychopathologies, including eating disorders and substance addictions, and an important transdiagnostic mechanism that accounts for the high degree of comorbidity between these disorders. Emerging evidence suggests that inflexibility also plays a role in the development and maintenance of behavioral addictions. Exercise dependence is a proposed new diagnostic category in the behavioral addictions and commonly comorbid with eating disorders. We assess associations between objective and subjective measures of cognitive inflexibility and exercise dependence. Undergraduate students (n = 578) completed the Exercise Dependence Scale (EDS-21), Eating Disorder Flexibility Index (EDFLIX), a self-report measure of general and eating disorder-specific flexibility, and the Wisconsin Card Sorting Task (WCST), an objective test of cognitive and behavioral flexibility. EDS-21 scores were significantly associated with self-report and objective assessments of flexibility in linear regression models. Those “at risk for dependence” made significantly more WCST perseveration errors than the “nondependent” groups. The “nondependent asymptomatic” group endorsed significantly greater eating disorder-specific flexibility, compared to symptomatic respondents. Results suggest that inflexibility plays a role in addition-like exercise behaviors and provide further evidence for inflexibility as a transdiagnostic mechanism linking addictive and eating disorders.

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Data Availability

The data that support the findings of this study are available from the corresponding author [MM], upon reasonable request.

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Authors and Affiliations

  1. Department of Psychology, University at Albany, State University of New York, Albany, NY, 12222, USA

    McKenzie L. Miller & Julia M. Hormes

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  1. McKenzie L. Miller
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  2. Julia M. Hormes
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by MM. The first draft of the manuscript was written by MM and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to McKenzie L. Miller.

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All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000 (5). The authors have no relevant financial or non-financial interests to disclose. Thank you.

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The authors declare no conflicts of interest. 

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Informed consent was obtained from all patients for being included in the study.

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Miller, M.L., Hormes, J.M. Cognitive and Behavioral Inflexibility as a Transdiagnostic Process Underpinning Exercise Dependence. Int J Ment Health Addiction 21, 3446–3457 (2023). https://doi.org/10.1007/s11469-022-00802-4

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