Eating Disorders and Disordered Eating Disorders and Disordered Eating Among AthletesEating Among Athletes

OverviewOverview

Definitions, diagnostic criteriaDefinitions, diagnostic criteria

PrevalencePrevalence

Factors unique to athletesFactors unique to athletes

Warning signsWarning signs

InterventionIntervention

Diagnostic CriteriaDiagnostic Criteria

Anorexia NervosaAnorexia Nervosa

– Refusal to maintain minimally healthy Refusal to maintain minimally healthy body weight for age and heightbody weight for age and height

– Intense fear of gaining weight, even Intense fear of gaining weight, even though underweightthough underweight

– Disordered body imageDisordered body image– Amenorrhea (absence of 3 consecutive Amenorrhea (absence of 3 consecutive

menstrual cycles)menstrual cycles)

Diagnostic CriteriaDiagnostic CriteriaBulimia NervosaBulimia Nervosa

– Recurrent episodes of binge eatingRecurrent episodes of binge eating– Recurrent inappropriate compensatory Recurrent inappropriate compensatory

behavior in order to prevent weight gainbehavior in order to prevent weight gain– Binge eating and compensatory Binge eating and compensatory

behaviors occur on average twice a behaviors occur on average twice a week for 3 monthsweek for 3 months

– Self-evaluation unduly influenced by Self-evaluation unduly influenced by body shape and weightbody shape and weight

Diagnostic CriteriaDiagnostic Criteria

Eating Disorders Not Otherwise Eating Disorders Not Otherwise Specified (EDNOS)Specified (EDNOS)

– Atypical or subclinical eating disorderAtypical or subclinical eating disorderCriteria for anorexia met except amenorrhea Criteria for anorexia met except amenorrhea or weightor weight

Binge eating disorderBinge eating disorder

I worry about gaining weight.I worry about gaining weight.

I am preoccupied with losing weight.I am preoccupied with losing weight.

I frequently diet or feel the need to be I frequently diet or feel the need to be on a diet.on a diet.

My mood depends on my weight (e.g., if My mood depends on my weight (e.g., if I gain 1 pound I am depressed, irritable, I gain 1 pound I am depressed, irritable, etc.)etc.)

I feel bad about myself if I gain weight.I feel bad about myself if I gain weight.

I worry about gaining weight.I worry about gaining weight.

I am preoccupied with losing weight.I am preoccupied with losing weight.

I frequently diet or feel the need to be I frequently diet or feel the need to be on a diet.on a diet.

My mood depends on my weight (e.g., if My mood depends on my weight (e.g., if I gain 1 pound I am depressed, irritable, I gain 1 pound I am depressed, irritable, etc.)etc.)

I feel bad about myself if I gain weight.I feel bad about myself if I gain weight.

If I gain one pound, I worry that I will continue to gain weight.

I think of certain foods as being either “good” or “bad” and feel guilty about eating “bad” foods.

I use food to comfort myself. When I am eating I, at times, feel I

have lost control.

If I gain one pound, I worry that I will continue to gain weight.

I think of certain foods as being either “good” or “bad” and feel guilty about eating “bad” foods.

I use food to comfort myself. When I am eating I, at times, feel I

have lost control.

I spend a significant amout of time thinking about food and when I will eat.

I try to hide how much I eat. I have thought about (or have) self-

induced vomiting as a means of weight control.

I spend a significant amout of time thinking about food and when I will eat.

I try to hide how much I eat. I have thought about (or have) self-

induced vomiting as a means of weight control.

After eating, I may use laxatives, diuretics, exercise, etc. to prevent weight gain.

I am dissatisfied with my body size and shape.

I eat until I feel stuffed.

After eating, I may use laxatives, diuretics, exercise, etc. to prevent weight gain.

I am dissatisfied with my body size and shape.

I eat until I feel stuffed.

IS YOUR TOTAL > 5??IS YOUR TOTAL > 5??

Anorexia AthleticaAnorexia AthleticaSubclinical eating disorder frequently Subclinical eating disorder frequently found in athletesfound in athletes

Individuals within 5% of expected body Individuals within 5% of expected body weightweight

Fear of becoming fatFear of becoming fat

Restriction of food to <1200 kcalRestriction of food to <1200 kcal

Compulsive exerciseCompulsive exercise

AmenorrheaAmenorrhea

Occasional binge/purgeOccasional binge/purge

Female Athlete TriadFemale Athlete Triad

Research on the Prevalence of Research on the Prevalence of Eating DisordersEating Disorders

Athletes appear to have a greater Athletes appear to have a greater occurrence of eating-related problems occurrence of eating-related problems than does the general population.than does the general population.

significant percentage of athletes engage significant percentage of athletes engage in disordered eating or weight-loss in disordered eating or weight-loss behaviors (e.g., bingeing, fasting), behaviors (e.g., bingeing, fasting), although subclinical in intensityalthough subclinical in intensity

sport-specific prevalence (e.g., among sport-specific prevalence (e.g., among wrestlers, dancers, gymnasts etc.).wrestlers, dancers, gymnasts etc.).

Pincay Overcomes Eating DisorderPincay Overcomes Eating Disorder

Predisposing FactorsPredisposing Factors

PrevalencePrevalenceNormative for young women to experience Normative for young women to experience body dissatisfaction and desire weight lossbody dissatisfaction and desire weight loss

Sociocultural demands placed on women Sociocultural demands placed on women to be thin along with pressure from sport to be thin along with pressure from sport to meet weight standards or body size to meet weight standards or body size expectations of sportexpectations of sport

Up to 60% (!!)of female college athletes Up to 60% (!!)of female college athletes report some type of report some type of disordered eatingdisordered eating

Distorted Body Image Distorted Body Image

Prevalence and MenPrevalence and MenSociocultural demands placed on men to achieve Sociocultural demands placed on men to achieve a particular physique along with pressure from a particular physique along with pressure from sport to meet weight standards or body size sport to meet weight standards or body size expectations of sportexpectations of sport

~16% of individuals with eating disorders are ~16% of individuals with eating disorders are male (increasing)male (increasing)

~25% of individuals with binge eating disorder ~25% of individuals with binge eating disorder are maleare male

Gay men particularly at riskGay men particularly at risk

“Reverse anorexia”

NCAA Study on Athletes and NCAA Study on Athletes and Eating DisordersEating Disorders

Factors Unique to AthletesFactors Unique to Athletes

No single cause for eating disordersNo single cause for eating disorders

Sport body stereotype – “thin-build Sport body stereotype – “thin-build sports”sports”– Expectation for athletes in certain sports Expectation for athletes in certain sports

to display a characteristic body size and to display a characteristic body size and shapeshape

– Fitted uniforms, body on displayFitted uniforms, body on display– Belief that thinness enhances Belief that thinness enhances

performance (e.g., running)performance (e.g., running)

Factors Unique to AthletesFactors Unique to Athletes

Symptoms vs desired characteristics Symptoms vs desired characteristics of athletes:of athletes:

Factors Unique to AthletesFactors Unique to Athletes

Stress of being in the spotlightStress of being in the spotlight

Balancing multiple role demandsBalancing multiple role demands

Warning SignsWarning SignsPhysicalPhysical– Intolerance to coldIntolerance to cold– Dizziness, fainting spellsDizziness, fainting spells– ConstipationConstipation– Loss of muscle toneLoss of muscle tone– Frequent weight fluctuationsFrequent weight fluctuations– Impaired concentrationImpaired concentration– Swollen salivary glands, puffiness in cheeksSwollen salivary glands, puffiness in cheeks– Broken blood vessels in eyesBroken blood vessels in eyes– Complains of sore throat, fatigue, & muscle Complains of sore throat, fatigue, & muscle

achesaches– Tooth decay, receding gumsTooth decay, receding gums

Warning SignsWarning SignsBehavioralBehavioral

– Restricted food intake Restricted food intake – Eliminating specific foods or whole food groupsEliminating specific foods or whole food groups– Fear of food, avoiding situations where food is Fear of food, avoiding situations where food is

presentpresent– Excuse of “picky” eater, despite previous flexible Excuse of “picky” eater, despite previous flexible

eatingeating– Excessive exerciseExcessive exercise– Regular weighingRegular weighing– Frequent comments about own weight, calories, Frequent comments about own weight, calories,

food fat contentfood fat content– Frequent bathroom visits following mealsFrequent bathroom visits following meals– MoodinessMoodiness– Withdrawal from othersWithdrawal from others

Warning SignsWarning Signs

AttitudinalAttitudinal– Dichotomous thinkingDichotomous thinking– Denial of eating problemsDenial of eating problems– Perfectionistic standardsPerfectionistic standards– Harsh self-criticismHarsh self-criticism– Self-worth determined by weightSelf-worth determined by weight

Intervention: What to DoIntervention: What to DoSet aside time for a private, respectful Set aside time for a private, respectful meeting to discuss your concerns openly meeting to discuss your concerns openly and honestly in a caring and supportive and honestly in a caring and supportive way.way.

Describe what you have seen and heard Describe what you have seen and heard that has led to your concerns.that has led to your concerns.

Ask the person to explore these concerns Ask the person to explore these concerns with a counselor, doctor, or any health with a counselor, doctor, or any health professional s/he feels comfortable enough professional s/he feels comfortable enough to see.to see.

Intervention: What to DoIntervention: What to DoArrange for regular, private follow-up Arrange for regular, private follow-up meetings apart from practice timesmeetings apart from practice times

Let the athlete know that the Let the athlete know that the demands of the sport may have demands of the sport may have played a role in the development of played a role in the development of the problemthe problem

Expect denial, rationalization, & Expect denial, rationalization, & angeranger

Other Intervention Considerations Other Intervention Considerations for Coachesfor Coaches

Offer to accompany athlete to first medical or therapy appointment for support.

Emphasize place on team will not be endangered by admitting an eating disorder

emphasize fitness and de-emphasize weight, especially as it relates to performance

avoid weigh-ins or negative comments about weight

Remember that many athletes who develop eating disorders have been told to lose weight. Past or present coaches may have contributed to problem… Coaches alone should not be making “weight” decisions...

participation will only be cut/decreased if eating disorder has compromised athlete’s health or put athlete at risk for injury.

Intervention: What Intervention: What NotNot to Do to DoDon’t question teammates or talk to them about Don’t question teammates or talk to them about the athlete. Talk directly to athletethe athlete. Talk directly to athlete

Don’t ignore the problem. InterveneDon’t ignore the problem. Intervene

Never conclude that an athlete just isn’t trying Never conclude that an athlete just isn’t trying hard enough to overcome an eating disorderhard enough to overcome an eating disorder

Don’t try to keep the problem hidden or try to Don’t try to keep the problem hidden or try to deal with it yourself. deal with it yourself. When in doubt about how When in doubt about how to intervene, consult, consult, consult…to intervene, consult, consult, consult…

Intervention: What Not to DoIntervention: What Not to Do

Don’t get into a power struggle about Don’t get into a power struggle about whether there is a problem.whether there is a problem.

Don’t be deceived by excuses.Don’t be deceived by excuses.

Other Body Image Other Body Image DisordersDisorders

Preoccupation With Preoccupation With AppearanceAppearance

– Imagined DefectImagined Defect “ “Imagined” UglinessImagined” Ugliness Mirrors (Fixation or Mirrors (Fixation or

Avoidance)Avoidance) - “muscle dysmorphia”- “muscle dysmorphia”

in body-buildersin body-builders