(PS6-B40) Too Much of a Good Thing? Investigating the Potential Link Between Facets of Compulsive Exercise and Suicidal Behavior

Introduction:  While exercise is generally considered an adaptive, pro-health behavior, it can become compulsive and drive negative consequences, particularly in the context of restrictive-spectrum eating disorders (~50-80% of those with restrictive EDs report maladaptive exercise patterns). Compulsive exercise is associated with several negative ED outcomes, including increased suicidality. Recent research indicates that maladaptive exercise may have multiple functions, which vary across individuals, and investigation of how varying facets of compulsive exercise associate with suicidal behavior can aid in pinpointing specific mechanisms underlying the curious association between compulsive exercise and suicidal behavior. The current study thus assesses the differing functions of exercise and their relationships with suicidality.

Method: Participants include a pilot sample of young women (data collection ongoing) aged 14-22 years presenting with and without restrictive ED symptoms (n=23; 10 ED; 13 HC). Participants were interviewed using the Columbia-Suicide Severity Rating Scale (C-SSRS) to assess for suicidal ideation and behavior and self-reported their reasons for exercise engagement using the Compulsive Exercise Test (CET), which contains 5 factors ([1] avoidance and rule driven behavior, [2] weight control exercise, [3] mood improvement, [4] lack of enjoyment exercise, and [5] exercise rigidity) along with the Function of Exercise Scale (FES), which contains 2 factors ([1] weight and appearance and [2] health and enjoyment).

Results: 7/23 participants endorsed suicidal ideation. All CET and FES subscales had positive correlations (rs = 0.30 – 0.88) except for CET lack of enjoyment exercise, which was only associated with CET mood improvement (r = -0.38) and CET exercise rigidity (r = -0.33). In initial effect size estimations using a logistic regression model to predict suicidal ideation, the CET avoidance and rule driven behavior subscale demonstrated the largest effect size (Odds Ratio = 3.47), followed by CET lack of enjoyment (OR = 2.58), and CET exercise rigidity (OR = 1.87). Other subscales (FES weight and appearance: OR = 1.26; FES health and enjoyment: OR = 1.16; CET weight control exercise: OR = 1.13) demonstrated less robust effect sizes. Future analysis will include further clarification of effect size estimates, specificity of associations, and significance testing as power increases.

Conclusion: Initial examination of effect sizes supports previous research demonstrating associations between compulsive exercise and suicidality, but also suggests that associations between compulsive exercise and suicidal ideation may be quite specific to functions of exercise. Increased power will continue to clarify effects.