Running up debt: A brief overview of our recent papers on exercise and shopping addictions

Following my recent blogs where I outlined some of the papers that my colleagues and I have published on mindfulness, Internet addiction, gaming addiction, youth gambling and other addictive behaviours, here is a round-up of recent papers that my colleagues and I have published on exercise addiction and shopping addictions (i.e., compulsive buying).

Griffiths, M.D., Urbán, R., Demetrovics, Z., Lichtenstein, M.B., de la Vega, R., Kun, B., Ruiz-Barquín, R., Youngman, J. & Szabo, A. (2015). A cross-cultural re-evaluation of the Exercise Addiction Inventory (EAI) in five countries. Sports Medicine Open, 1:5.

• Research into the detrimental effects of excessive exercise has been conceptualized in a number of similar ways, including ‘exercise addiction’, ‘exercise dependence’, ‘obligatory exercising’, ‘exercise abuse’, and ‘compulsive exercise’. Among the most currently used (and psychometrically valid and reliable) instruments is the Exercise Addiction Inventory (EAI). The present study aimed to further explore the psychometric properties of the EAI by combining the datasets of a number of surveys carried out in five different countries (Denmark, Hungary, Spain, UK, and US) that have used the EAI with a total sample size of 6,031 participants. A series of multigroup confirmatory factor analyses (CFAs) were carried out examining configural invariance, metric invariance, and scalar invariance. The CFAs using the combined dataset supported the configural invariance and metric invariance but not scalar invariance. Therefore, EAI factor scores from five countries are not comparable because the use or interpretation of the scale was different in the five nations. However, the covariates of exercise addiction can be studied from a cross-cultural perspective because of the metric invariance of the scale. Gender differences among exercisers in the interpretation of the scale also emerged. The implications of the results are discussed, and it is concluded that the study’s findings will facilitate a more robust and reliable use of the EAI in future research.

Mónok, K., Berczik, K., Urbán, R., Szabó^, A., Griffiths, M.D., Farkas, J., Magi, A., Eisinger, A., Kurimay, T., Kökönyei, G., Kun, B., Paksi, B. & Demetrovics, Z. (2012). Psychometric properties and concurrent validity of two exercise addiction measures: A population wide study in Hungary. Psychology of Sport and Exercise, 13, 739-746.

• Objectives: The existence of exercise addiction has been examined in numerous studies. However, none of the measures developed for exercise addiction assessment have been validated on representative samples. Furthermore, estimates of exercise addiction prevalence in the general population are not available. The objective of the present study was to validate the Exercise Addiction Inventory (EAI; Terry, Szabo, & Griffiths, 2004), and the Exercise Dependence Scale (EDS; Hausenblas & Downs, 2002b), and to estimate the prevalence of exercise addiction in general population. Design: Exercise addiction was assessed within the framework of the National Survey on Addiction Problems in Hungary (NSAPH), a national representative study for the population aged 18–64 years (N = 2710). Method: 474 people in the sample (57% males; mean age 33.2 years) who reported to exercise at least once a week were asked to complete the two questionnaires (EAI, EDS). Results: Confirmatory Factor Analysis (CFA) indicated good fit both in the case of EAI (CFI = 0.971; TLI = 0.952; RMSEA = 0.052) and EDS (CFI = 0.938; TLI = 0.922; RMSEA = 0.049); and confirmed the factor structure of the two scales. The correlation between the two measures was high (r = 0.79). Results showed that 6.2% (EDS) and 10.1% (EAI) of the population were characterized as nondependent-symptomatic exercisers, while the proportion of the at-risk exercisers were 0.3% and 0.5%, respectively. Conclusions: Both EAI and EDS proved to be a reliable assessment tool for exercise addiction, a phenomenon that is present in the 0.3–0.5% of the adult general population.

Szabo, A., Griffiths, M.D., de La Vega Marcos, R., Mervo, B. & Demetrovics, Z. (2015). Methodological and conceptual limitations in exercise addiction research. Yale Journal of Biology and Medicine, 86, 303-308.

• The aim of this brief analytical review is to highlight and disentangle research dilemmas in the field of exercise addiction. Research examining exercise addiction is primarily based on self-reports, obtained by questionnaires (incorporating psychometrically validated instruments), and interviews, which provide a range of risk scores rather than diagnosis. Survey methodology indicates that the prevalence of risk for exercise addiction is approximately 3 percent among the exercising population. Several studies have reported a substantially greater prevalence of risk for exercise addiction in elite athletes compared to those who exercise for leisure. However, elite athletes may assign a different interpretation to the assessment tools than leisure exercisers. The present paper examines the: 1) discrepancies in the classification of exercise addiction; 2) inconsistent reporting of exercise addiction prevalence; and 3) varied interpretation of exercise addiction diagnostic tools. It is concluded that there is the need for consistent terminology, to follow-up results derived from exercise addiction instruments with interviews, and to follow a theory-driven rationale in this area of research.

Andreassen, C.S., Griffiths, M.D., Pallesen, S., Bilder, R.M., Torsheim, T. Aboujaoude, E.N. (2015). The Bergen Shopping Addiction Scale: Reliability and validity of a brief screening test. Frontiers in Psychology, 6:1374. doi: 10.3389/fpsyg.2015.01374.

• Although excessive and compulsive shopping has been increasingly placed within the behavioral addiction paradigm in recent years, items in existing screens arguably do not assess the core criteria and components of addiction. To date, assessment screens for shopping disorders have primarily been rooted within the impulse-control or obsessive-compulsive disorder paradigms. Furthermore, existing screens use the terms ‘shopping,’ ‘buying,’ and ‘spending’ interchangeably, and do not necessarily reflect contemporary shopping habits. Consequently, a new screening tool for assessing shopping addiction was developed. Initially, 28 items, four for each of seven addiction criteria (salience, mood modification, conflict, tolerance, withdrawal, relapse, and problems), were constructed. These items and validated scales (i.e., Compulsive Buying Measurement Scale, Mini-International Personality Item Pool, Hospital Anxiety and Depression Scale, Rosenberg Self-Esteem Scale) were then administered to 23,537 participants (Mage = 35.8 years, SDage = 13.3). The highest loading item from each set of four pooled items reflecting the seven addiction criteria were retained in the final scale, The Bergen Shopping Addiction Scale (BSAS). The factor structure of the BSAS was good (RMSEA=0.064, CFI=0.983, TLI=0.973) and coefficient alpha was 0.87. The scores on the BSAS converged with scores on the Compulsive Buying Measurement Scale (CBMS; 0.80), and were positively correlated with extroversion and neuroticism, and negatively with conscientiousness, agreeableness, and intellect/imagination. The scores of the BSAS were positively associated with anxiety, depression, and low self-esteem and inversely related to age. Females scored higher than males on the BSAS. The BSAS is the first scale to fully embed shopping addiction within an addiction paradigm. A recommended cutoff score for the new scale and future research directions are discussed.

Davenport, K., Houston, J. & Griffiths, M.D. (2012). Excessive eating and compulsive buying behaviours in women: An empirical pilot study examining reward sensitivity, anxiety, impulsivity, self-esteem and social desirability. International Journal of Mental Health and Addiction, 10, 474-489.

• ‘Mall disorders’ such as excessive eating and compulsive buying appear to be increasing, particularly among women. A battery of questionnaires was used in an attempt to determine this association between specific personality traits (i.e., reward sensitivity, impulsivity, cognitive and somatic anxiety, self-esteem, and social desirability) and excessive eating and compulsive buying in 134 women. Reward sensitivity and cognitive anxiety were positively related to excessive eating and compulsive buying, as was impulsivity to compulsive buying. Somatic anxiety and social desirability were negatively related to compulsive buying. These preliminary findings indicate that excessive behaviours are not necessarily interrelated. The behaviours examined in this study appear to act as an outlet for anxiety via the behaviours’ reinforcing properties (e.g., pleasure, attention, praise, etc.). As a consequence, this may boost self-esteem. The findings also appear to indicate a number of risk factors that could be used as ‘warning signs’ that the behaviour may develop into an addiction.

Maraz, A., Eisinger, A., Hende, Urbán, R., Paksi, B., Kun, B., Kökönyei, G., Griffiths, M.D. & Demetrovics, Z. (2015). Measuring compulsive buying behaviour: Psychometric validity of three different scales and prevalence in the general population and in shopping centres. Psychiatry Research, 225, 326–334.

• Due to the problems of measurement and the lack of nationally representative data, the extent of compulsive buying behaviour (CBB) is relatively unknown. The validity of three different instruments was tested: Edwards Compulsive Buying Scale, Questionnaire About Buying Behavior and Richmond Compulsive Buying Scale using two independent samples. One was nationally representative of the Hungarian population (N=2710) while the other comprised shopping mall customers (N=1447). As a result, a new, four-factor solution for the ECBS was developed (Edwards Compulsive Buying Scale Revised (ECBS-R)), and confirmed the other two measures. Additionally, cut-off scores were defined for all measures. Results showed that the prevalence of CBB is 1.85% (with QABB) in the general population but significantly higher in shopping mall customers (8.7% with ECBS-R, 13.3% with QABB and 2.5% with RCBS-R). Conclusively, due to the diversity of content, each measure identifies a somewhat different CBB group.

Maraz, A., Griffiths, M.D., & Demetrovics, Z. (2016). The prevalence of compulsive buying in non-clinical populations: A systematic review and meta-analysis. Addiction, 111, 408-419.

• Aims: To estimate the pooled prevalence of compulsive buying behaviour (CBB) in different populations and to determine the effect of age, gender, location and screening instrument on the reported heterogeneity in estimates of CBB and whether publication bias could be identified. Methods: Three databases were searched (Medline, PsychInfo, Web of Science) using the terms ‘compulsive buying’, ‘pathological buying’ and ‘compulsive shopping’ to estimate the pooled prevalence of CBB in different populations. Forty studies reporting 49 prevalence estimates from 16 countries were located (n = 32 000). To conduct the meta-analysis, data from non-clinical studies regarding mean age and gender proportion, geographical study location and screening instrument used to assess CBB were extracted by multiple independent observers and evaluated using a random-effects model. Four a priori subgroups were analysed using pooled estimation (Cohen’s Q) and covariate testing (moderator and meta-regression analysis). Results: The CBB pooled prevalence of adult representative studies was 4.9% (3.4–6.9%, eight estimates, 10 102 participants), although estimates were higher among university students: 8.3% (5.9–11.5%, 19 estimates, 14 947 participants) in adult non-representative samples: 12.3% (7.6–19.1%, 11 estimates, 3929 participants) and in shopping-specific samples: 16.2% (8.8–27.8%, 11 estimates, 4686 participants). Being young and female were associated with increased tendency, but not location (United States versus non-United States). Meta-regression revealed large heterogeneity within subgroups, due mainly to diverse measures and time-frames (current versus life-time) used to assess CBB. Conclusions: A pooled estimate of compulsive buying behaviour in the populations studied is approximately 5%, but there is large variation between samples accounted for largely by use of different time-frames and measures.

Dr. Mark Griffiths, Professor of Behavioural Addiction, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Allegre, B., Souville, M., Therme, P. & Griffiths, M.D. (2006). Definitions and measures of exercise dependence, Addiction Research and Theory, 14, 631-646.

Allegre, B., Therme, P. & Griffiths, M.D. (2007). Individual factors and the context of physical activity in exercise dependence: A prospective study of ‘ultra-marathoners’. International Journal of Mental Health and Addiction, 5, 233-243.

Berczik, K., Szabó, A., Griffiths, M.D., Kurimay, T., Kun, B. & Demetrovics, Z. (2012). Exercise addiction: symptoms, diagnosis, epidemiology, and etiology. Substance Use and Misuse, 47, 403-417.

Berczik, K., Griffiths, M.D., Szabó, A., Kurimay, T., Kökönyei, G., Urbán, R. and Demetrovics, Z. (2014). Exercise addiction – the emergence of a new disorder. Australasian Epidemiologist, 21(2), 36-40.

Berczik, K., Griffiths, M.D., Szabó, A., Kurimay, T., Urban, R. & Demetrovics, Z. (2014). Exercise addiction. In K. Rosenberg & L. Feder (Eds.), Behavioral Addictions: Criteria, Evidence and Treatment (pp.317-342). New York: Elsevier.

Griffiths, M.D. (1997). Exercise addiction: A case study. Addiction Research, 5, 161-168.

Griffiths, M.D., Szabo, A. & Terry, A. (2005). The Exercise Addiction Inventory: A quick and easy screening tool for health practitioners. British Journal of Sports Medicine, 39, 30-31.

Kurimay, T., Griffiths, M.D., Berczik, K., & Demetrovics, Z. (2013). Exercise addiction: The dark side of sports and exercise. In Baron, D., Reardon, C. & Baron, S.H., Contemporary Issues in Sports Psychiatry: A Global Perspective (pp.33-43). Chichester: Wiley.

Szabo, A. & Griffiths, M.D. (2007). Exercise addiction in British sport science students. International Journal of Mental Health and Addiction, 5, 25-28.

Terry, A., Szabo, A. & Griffiths, M.D. (2004). The Exercise Addiction Inventory: A new brief screening tool, Addiction Research and Theory, 12, 489-499.

Warner, R. & Griffiths, M.D. (2006). A qualitative thematic analysis of exercise addiction: An exploratory study. International Journal of Mental Health and Addiction, 4, 13-26.