research issues and approaches in occupational therapy seminar presentation sarah caughy andrea ford...

Research Issues and Research Issues and Approaches in Occupational Approaches in Occupational

TherapyTherapy

Seminar PresentationSeminar PresentationSarah CaughySarah CaughyAndrea FordAndrea FordJenny KimJenny KimJeff MillsJeff Mills

Lisa PurdyLisa PurdyShannon Van de VenShannon Van de Ven

Outline of Seminar Outline of Seminar PresentationPresentation• Justification for Topic SelectionJustification for Topic Selection

• Change in Thought ProcessChange in Thought Process• Process for Finding Research PapersProcess for Finding Research Papers• Clarification of Definitions/Key ConceptsClarification of Definitions/Key Concepts• Relevance to Occupational Therapy & Relevance to Occupational Therapy &

Occupational ScienceOccupational Science• Initial ModelInitial Model• Review & Critique of ResearchReview & Critique of Research• Identification of Gaps Identification of Gaps • Future Research Occupational Science & Future Research Occupational Science &

Occupation TherapyOccupation Therapy• Final ModelFinal Model• ConclusionConclusion• DiscussionDiscussion

What Factors are Associated What Factors are Associated with Participation in Aesthetic with Participation in Aesthetic Sports and the Development Sports and the Development

of Eating Disorders in of Eating Disorders in Females?Females?

HypothesisHypothesis

There are several factors that There are several factors that contribute to an association between contribute to an association between the participation in aesthetic sports the participation in aesthetic sports and the development of eating and the development of eating disorders in females. disorders in females.

Rationale for TopicRationale for Topic

Why did we choose this topic?Why did we choose this topic?• Mostly Kinesiology backgroundsMostly Kinesiology backgrounds• A topic of interestA topic of interest• More questions need to be answered More questions need to be answered • Meta analysisMeta analysis

Change in Thought Change in Thought ProcessProcessOriginal Question: Original Question: How does having an eating How does having an eating

disorder affect the participation in occupations disorder affect the participation in occupations that involve physical activity?that involve physical activity?

Refined Question 1:Refined Question 1: How does having an How does having an eating disorder affect participation in the eating disorder affect participation in the occupation of figure skating?occupation of figure skating?

Refined Question 2:Refined Question 2: How does having an How does having an eating disorder affect participation in aesthetic eating disorder affect participation in aesthetic sports?sports?

FINAL QUESTION:FINAL QUESTION: What Factors are Associated What Factors are Associated with Participation in Aesthetic Sports and the with Participation in Aesthetic Sports and the Development of Eating Disorders in Females?Development of Eating Disorders in Females?

Process of Finding Process of Finding ResearchResearch

DisciplinesDisciplinesPsychology, Sociology, Recreation, Occupational Psychology, Sociology, Recreation, Occupational

TherapyTherapy

DatabasesDatabasesSports Discus, CINAHL, Cambridge Scientific, Sports Discus, CINAHL, Cambridge Scientific,

Pubmed, Ovid, ERIC, Journal of Sports Medicine, Pubmed, Ovid, ERIC, Journal of Sports Medicine, Sociological Abstract, PsycInfo, Medline, Sociological Abstract, PsycInfo, Medline, Psychology, Social ServicesPsychology, Social Services

KeywordsKeywords Figure Skating and eating disorders, anorexia, Figure Skating and eating disorders, anorexia,

aesthetic sports, disordered eating, gymnastics, aesthetic sports, disordered eating, gymnastics, ballet, bulimiaballet, bulimia

Clarification of Key ConceptsClarification of Key Concepts

Clinical Eating Disorders (DSM IV)Clinical Eating Disorders (DSM IV) Disorders that can manifest themselves as a refusal to Disorders that can manifest themselves as a refusal to maintain a minimally healthy body weight (i.e. 85% of maintain a minimally healthy body weight (i.e. 85% of expected body weight), dramatic weight loss, fear of gaining expected body weight), dramatic weight loss, fear of gaining weight even when underweight, preoccupation with food, weight even when underweight, preoccupation with food, abnormal food-consumption patterns, and/or the recently abnormal food-consumption patterns, and/or the recently added binge eating disorder associated with loss of control added binge eating disorder associated with loss of control and feelings of guilt. and feelings of guilt.

American Psychiatric Association. American Psychiatric Association. Diagnostic and Diagnostic and Statistical Manual of Mental Disorders, Statistical Manual of Mental Disorders, (4th ed.) (DSM-IV), 1-2 (4th ed.) (DSM-IV), 1-2

American Psychiatric Association, Washington DC, 1994American Psychiatric Association, Washington DC, 1994 Williams et al., 2003Williams et al., 2003

““Subclinical Eating Disorder”/“Disordered Subclinical Eating Disorder”/“Disordered Eating”Eating”

Any student-athlete meeting or exceeding the pre-existing cut Any student-athlete meeting or exceeding the pre-existing cut points on the EAT-26, the Body Dissatisfaction (BD) subscale, points on the EAT-26, the Body Dissatisfaction (BD) subscale, or the Drive for thinness (DT) subscale. Referred to a wide or the Drive for thinness (DT) subscale. Referred to a wide range of abnormal behaviors that do not meet the clinical range of abnormal behaviors that do not meet the clinical DSM- IV diagnosisDSM- IV diagnosis

Williams et al., Williams et al., 20032003

Key Concepts contd.Key Concepts contd.

Anorexia Anorexia is an eating disorder characterized by self-induced weight is an eating disorder characterized by self-induced weight loss of at least 25% of original body weight through loss of at least 25% of original body weight through excessive dieting and/or exercise, refusal to maintain a excessive dieting and/or exercise, refusal to maintain a body weight over a minimal normal weight for age and body weight over a minimal normal weight for age and height, amenorrhea, a morbid fear of becoming obese, height, amenorrhea, a morbid fear of becoming obese, and a disturbance of body image. and a disturbance of body image.

Stoutjesdyk & Jevne, 1993Stoutjesdyk & Jevne, 1993

High Performance AthleteHigh Performance Athletean athlete that trains a minimum of 11 hr/week and have an athlete that trains a minimum of 11 hr/week and have competed at provincial, national or international levels competed at provincial, national or international levels

Stoutjesdyk & Jevne, 1993Stoutjesdyk & Jevne, 1993

Activities Emphasizing Leanness Activities Emphasizing Leanness tthose in which appearance is considered very important hose in which appearance is considered very important for success for success

Stoutjesdyk & Jevne, Stoutjesdyk & Jevne,

19931993

How Does This Relate to How Does This Relate to Occupational Therapy & Occupational Therapy & Occupational Science?Occupational Science?

• Complex nature of the impact that Complex nature of the impact that participation in occupations may participation in occupations may have on health and well-being of the have on health and well-being of the personperson

• Understanding a diverse client Understanding a diverse client populationpopulation

Initial Model

Aesthetic Sports

Eating Disorders

STUDY REVIEWSTUDY REVIEW

Stoutjesdyk, D., & Jevne, R. (1993). Eating Stoutjesdyk, D., & Jevne, R. (1993). Eating disorders among high performance athletes. disorders among high performance athletes.

Journal of Youth and Adolescence, 22Journal of Youth and Adolescence, 22(3),(3), 271-284.271-284.

PurposePurpose- To examine whether athletes in sports that To examine whether athletes in sports that

emphasize leanness differ from athletes in emphasize leanness differ from athletes in other sports with regard to eating attitudes other sports with regard to eating attitudes and disposition toward eating disordersand disposition toward eating disorders

Stoutjesdyk & Jevne (1993)Stoutjesdyk & Jevne (1993)

Relevant LiteratureRelevant Literature- Features shared between females with Features shared between females with

Anorexia and female athletesAnorexia and female athletes- Differences between females with Anorexia Differences between females with Anorexia

and female athletes concerning motivation to and female athletes concerning motivation to be thinbe thin

Study DesignStudy Design- quantitative quantitative - level 1 question- level 1 question

Theoretical ApproachTheoretical Approach- Psychological perspectivePsychological perspective

Data CollectionData Collection- Survey formatSurvey format- EAT= Likert ScaleEAT= Likert Scale

Stoutjesdyk & Jevne (1993)Stoutjesdyk & Jevne (1993)SampleSample

- postsecondary-level male and female high postsecondary-level male and female high performance athletes from colleges/universities performance athletes from colleges/universities and various clubs across Canadaand various clubs across Canada

- mailed out demographic questionnaires and mailed out demographic questionnaires and EAT’s to be completed voluntarily and EAT’s to be completed voluntarily and anonymously by athletesanonymously by athletes

- 3 groups including3 groups includinga) sports emphasizing leanness (gymnastics & a) sports emphasizing leanness (gymnastics &

diving) diving) n = 46 (females = 26, males = 20)n = 46 (females = 26, males = 20)

b) sports requiring specific weight for b) sports requiring specific weight for participation (lightweight rowing & judo)participation (lightweight rowing & judo)

n = 54 (females= 32 males= 22)n = 54 (females= 32 males= 22)c) sports that do not emphasize leanness c) sports that do not emphasize leanness

(volleyball & heavyweight rowing)(volleyball & heavyweight rowing)n = 91 (females = 46, males = 45)n = 91 (females = 46, males = 45)


Data AnalysisData Analysis- Descriptive statistical analysisDescriptive statistical analysis

SpecificallySpecifically: one-way analysis of variance : one-way analysis of variance between and within sample groupsbetween and within sample groups

FindingsFindings- Sports emphasizing leanness had Sports emphasizing leanness had

significantly higher EAT scoressignificantly higher EAT scores highest % of scores > 30 (= anorexic highest % of scores > 30 (= anorexic

range)range)

STUDY CRITIQUESTUDY CRITIQUE


PurposePurpose -- Clearly stated following literature review Clearly stated following literature review

Review of LiteratureReview of Literature –– Comprehensive; discussed Comprehensive; discussed current current research and opposing research and opposing viewsviews

Key ConceptsKey Concepts - - All relevant concepts clearly defined All relevant concepts clearly defined within within introduction introduction

Sample Limitation - Sample Limitation - Inconsistent sample sizes may Inconsistent sample sizes may cause a cause a misrepresentation of groups 1 misrepresentation of groups 1 & 2 in & 2 in comparison to group 3 comparison to group 3


DataData CollectionCollectionSelf-report limitations:Self-report limitations:

under-representation of population under-representation of population

due to “secretive” nature of eating due to “secretive” nature of eating

disordersdisorders

under-representation due to voluntary under-representation due to voluntary participationparticipation

Inappropriate use of EAT:Inappropriate use of EAT:

non-clinical setting = false-positive resultsnon-clinical setting = false-positive results

changing diagnostic criteria for anorexiachanging diagnostic criteria for anorexia


Data AnalysisData Analysis Descriptive statistics are relevant to the Descriptive statistics are relevant to the

level of questioning in this studylevel of questioning in this study

Use of contingency chart is appropriateUse of contingency chart is appropriate

Relation to PurposeRelation to Purpose Results specifically answered the research Results specifically answered the research

questionquestion


GeneralizabilityGeneralizability

Study is generalizable among high Study is generalizable among high performance athletes across Canada, at performance athletes across Canada, at the post secondary levelthe post secondary level

Other LimitationsOther Limitations

Timing of study was post-season Timing of study was post-season

a) Difficulty found in locating athletesa) Difficulty found in locating athletes

b) Eating habits may have changedb) Eating habits may have changed


ConclusionConclusion

Authors referred back to results and Authors referred back to results and addressed trends foundaddressed trends found

Addressed two limitations:Addressed two limitations:- self-reportself-report- timingtiming

Addressed areas for future researchAddressed areas for future research

STUDY REVIEWSTUDY REVIEW

Williams, P. L., Sargent, R. G., & Durstine, L. Williams, P. L., Sargent, R. G., & Durstine, L. J. (2003). Prevalence of subclinical eating J. (2003). Prevalence of subclinical eating disorders in collegiate female athletes. disorders in collegiate female athletes.

Women in Sport & Physical Activity Journal, Women in Sport & Physical Activity Journal, 1212(2), 127-139.(2), 127-139.

PurposePurpose- explore associations among female athlete sport explore associations among female athlete sport

groups and their self-reported disordered eating, groups and their self-reported disordered eating, desire for thinness, and body satisfactiondesire for thinness, and body satisfaction

Williams et al., 2003Williams et al., 2003

HypothesisHypothesis- female athletes would be at greatest risk for female athletes would be at greatest risk for

disordered eating:disordered eating:- whose performance is subjectively scored whose performance is subjectively scored

(diving, (diving, gymnasticsgymnastics))- who compete in a sport where a low body who compete in a sport where a low body

weight is considered advantageous weight is considered advantageous (cross-(cross-country, country, gymnasticsgymnastics))

- who must wear body contour-revealing who must wear body contour-revealing clothing clothing (volleyball, track & field, swimming, (volleyball, track & field, swimming, crew, diving, crew, diving, gymnasticsgymnastics, cross-country), cross-country)

Williams et al., 2003Williams et al., 2003RelevantRelevant LiteratureLiterature

- past researchers’ reportspast researchers’ reports- ““subclinical eating disorder” (SED) & “disordered subclinical eating disorder” (SED) & “disordered eating”eating”

- at risk for developing a wide range of eating pattern at risk for developing a wide range of eating pattern disordersdisorders

- difficulties in obtaining accurate data on eating difficulties in obtaining accurate data on eating disordersdisorders- Sundgot-Borgen, 1994 – anorexia n. = 1.3%, bulimia Sundgot-Borgen, 1994 – anorexia n. = 1.3%, bulimia n. = 8%n. = 8%

- NCAA, 1999 – anorexia n. = 2.8%, bulimia n. = 9.2%NCAA, 1999 – anorexia n. = 2.8%, bulimia n. = 9.2%- identified risk factorsidentified risk factors

- etiologyetiology- dual-roledual-role

Williams et al., 2003Williams et al., 2003StudyStudy DesignDesign

- quantitative (with some minor qualitative aspects)quantitative (with some minor qualitative aspects)- surveysurvey- level 2level 2

TheoreticalTheoretical ApproachApproach- psychological perspectivepsychological perspective

SampleSample- convenience-sample, n = 587 female student-convenience-sample, n = 587 female student-

athletesathletes- 9 colleges/universities in Virginia, 14 sports9 colleges/universities in Virginia, 14 sports


DataData CollectedCollected– 3-section survey3-section survey

• 1. demographics, height, weight, 1. demographics, height, weight, dieting/weight-control, concern(s) from othersdieting/weight-control, concern(s) from others

• 2. EAT-26 (standardized, 26 Q’s)2. EAT-26 (standardized, 26 Q’s)– identify eating/weight concerns, food identify eating/weight concerns, food

preoccupation, behaviours associated with preoccupation, behaviours associated with eating disorderseating disorders

• 3. EDI-2 (non-standardized, 91 Q’s, 11 3. EDI-2 (non-standardized, 91 Q’s, 11 subscales)subscales)

– assess attitudes regarding body image, assess attitudes regarding body image, eating/dieting, psychological traits clinically eating/dieting, psychological traits clinically relevant to eating disordersrelevant to eating disorders


Results/Conclusions/ImplicationsResults/Conclusions/Implications– 118 of 587 (20.1%) were classified as having a 118 of 587 (20.1%) were classified as having a

SEDSED• gymnastics (n=19) gymnastics (n=19) 4 4

– EAT-26: swimming EAT-26: swimming mean 6.6 (score mean 6.6 (score 20 = “at 20 = “at risk”)risk”)

– EDI-2: no sport met overall mean at-risk criteria EDI-2: no sport met overall mean at-risk criteria for BD for BD & DT & DT

Results/Conclusions/Implications Results/Conclusions/Implications contd.contd.

• ““expressed concern from others”expressed concern from others”– statistically significant association between those statistically significant association between those

who had heard expressed concerns from who had heard expressed concerns from coaches, parents, teammates, etc. regarding coaches, parents, teammates, etc. regarding body weight and the presence of a SEDbody weight and the presence of a SED

• analyses (chi-square & logistical regression) analyses (chi-square & logistical regression) showed no increased risk for a SED in the three showed no increased risk for a SED in the three sport groupssport groups

STUDY CRITIQUESTUDY CRITIQUE

Williams et al., (1993)Williams et al., (1993)PurposePurpose

- mentioned in Introduction section succeeding Literature mentioned in Introduction section succeeding Literature ReviewReview

Literature ReviewLiterature Review- sufficient amount of informationsufficient amount of information

- outlined difficulties with obtaining data (self-report of outlined difficulties with obtaining data (self-report of sensitive topic)sensitive topic)

- two well-designed studies (reported on prevalence of two well-designed studies (reported on prevalence of anorexia/bulemia)anorexia/bulemia)

- risk factorsrisk factorsKeyKey ConceptsConcepts

- defined clearly throughout studydefined clearly throughout study


Sample SelectionSample Selection- convenience-samplingconvenience-sampling

- easily accessible group of people chosen and everyone in easily accessible group of people chosen and everyone in group surveyedgroup surveyed

- AdvantagesAdvantages: easy to organize & quick: easy to organize & quick- DisadvantagesDisadvantages: biased sample? no guarantee the : biased sample? no guarantee the

attitude(s)/behaviour(s) of attitude(s)/behaviour(s) of the sample represent the sample represent behaviours of others behaviours of others

Data CollectionData Collection- EAT-26EAT-26 – standardized, internal consistency, reliability, and – standardized, internal consistency, reliability, and

validity validity good; however, false-positive’s may good; however, false-positive’s may occuroccur

- EDI-2EDI-2 – reliability and content validity satisfactory – reliability and content validity satisfactory


Data AnalysisData Analysis- Data analyses (chi-square & Data analyses (chi-square &

logistical regression) appropriatelogistical regression) appropriate

RelationRelation toto PurposePurpose- Study findings pertained to its Study findings pertained to its

initial purposeinitial purpose


GeneralizabilityGeneralizability- Variety of sports (14)Variety of sports (14)- Female student-athletesFemale student-athletes- Division I Division I III schools/sports III schools/sports

Other LimitationsOther Limitations- Although variety of sports, representation variedAlthough variety of sports, representation varied- Cross-sectional, non-random design (limit Cross-sectional, non-random design (limit

generalizability)generalizability)- ParticipantsParticipants 90.1% Caucasian, Virginia 90.1% Caucasian, Virginia- 6 of 12 Division I, 3 of 11 Division II & III schools6 of 12 Division I, 3 of 11 Division II & III schools


ConclusionConclusion- Was significant association between Was significant association between

expressed concerns from others and a expressed concerns from others and a SEDSED

- Mean scores indicative of risk on either Mean scores indicative of risk on either the EAT-26 or the EDI-2 subscales not the EAT-26 or the EDI-2 subscales not present in any sportpresent in any sport

- Area for future researchArea for future research- use of prospective study design aimed at use of prospective study design aimed at

identifying athletes who could be at risk for identifying athletes who could be at risk for the later development of an ED or SEDthe later development of an ED or SED

Gap 1Gap 1

The research does not address The research does not address how & whyhow & why specific factors are associated with the specific factors are associated with the development of eating disorders and development of eating disorders and participation in aesthetic sportsparticipation in aesthetic sports

Directions for occupational science Directions for occupational science researchresearch

Research should explore the meaning and Research should explore the meaning and significance that female athletes associate significance that female athletes associate

with the identified factorswith the identified factors

Gap 2Gap 2

The research fails to address a potential The research fails to address a potential interaction between the identified factorsinteraction between the identified factors


Research needs to investigate the interplay Research needs to investigate the interplay of the identified factorsof the identified factors

Gap 3Gap 3

The research focuses on psychological The research focuses on psychological constructs of the person and fails to explore constructs of the person and fails to explore

the occupation and environmentthe occupation and environment

Directions for occupational therapy Directions for occupational therapy researchresearch

Research should investigate the occupation Research should investigate the occupation and environment as points for intervention and environment as points for intervention

and treatment and treatment

Gap 4Gap 4The research is unclear about the level of The research is unclear about the level of

participation in aesthetic sports that is participation in aesthetic sports that is associated with the development of eating associated with the development of eating

disordersdisorders

Directions for occupational science researchDirections for occupational science researchResearch should investigate specific aspects of Research should investigate specific aspects of

participation:participation:– Frequency and intensity of trainingFrequency and intensity of training– Duration of involvement in sportDuration of involvement in sport

– Athlete’s perceptions of participation in sportAthlete’s perceptions of participation in sport

Gap 5Gap 5The research fails to acknowledge the role The research fails to acknowledge the role

culture may play in the association between culture may play in the association between participation in aesthetic sports and the participation in aesthetic sports and the

development of eating disordersdevelopment of eating disorders


Research should investigate participation in Research should investigate participation in aesthetic sports and prevalence of eating aesthetic sports and prevalence of eating

disorders among diverse cultures disorders among diverse cultures

Final ModelFinal Model

Eating Disorders

Aesthetic Sports

Age

SES

Level of Competition

Body Dissatisfactio

n

Coach Pressure

ConclusionConclusion

• In conclusion, several factors are In conclusion, several factors are associated with participation in associated with participation in aesthetic sports and the aesthetic sports and the development of eating disorders in development of eating disorders in females. These factors include: body females. These factors include: body dissatisfaction, level of competition, dissatisfaction, level of competition, age, socioeconomic status, and age, socioeconomic status, and pressure from coaches.pressure from coaches.

Questions?Questions?

DiscussionDiscussion

1.1. Given the factors that we have Given the factors that we have found in our research, what unique found in our research, what unique approaches can be brought to this approaches can be brought to this issue by occupational therapists?issue by occupational therapists?

2.2. Who in the class has participated in Who in the class has participated in an aesthetic sport? What factors in an aesthetic sport? What factors in your environment do you feel could your environment do you feel could potentially contribute to the potentially contribute to the development of eating disorders?development of eating disorders?

Thank YouThank You

ReferencesReferencesAnshel, M.H. (2004). Sources of Disordered Eating Patterns Anshel, M.H. (2004). Sources of Disordered Eating Patterns Between Ballet Between Ballet Dancers and Non-Dancers. Dancers and Non-Dancers. Journal of Sport Journal of Sport Behavior. 27(2). Behavior. 27(2). 115-134. 115-134.

Davison, K. K., Earnest, M. B., & Birch, L. L. (2002). Participation Davison, K. K., Earnest, M. B., & Birch, L. L. (2002). Participation in in aesthetic sports and girls’ weight concerns at ages 5 and 7 aesthetic sports and girls’ weight concerns at ages 5 and 7 years. years. International Journal of Eating Disorders, 31, International Journal of Eating Disorders, 31, 312-317.312-317.

Fulkerson, J. A., Keel, P. A., Leon, G. R. & Dorr, T. (1999). Eating-Fulkerson, J. A., Keel, P. A., Leon, G. R. & Dorr, T. (1999). Eating-disordered behaviors and personality characteristics of high disordered behaviors and personality characteristics of high school athletes school athletes and non athletes. and non athletes. International Journal of International Journal of Eating Disorders, 26,Eating Disorders, 26, 73-79. 73-79.

Johnson, C., Powers, P. S., & Dick, R. (1999). Athletes and eating Johnson, C., Powers, P. S., & Dick, R. (1999). Athletes and eating disorders: The national collegiate athletic association studydisorders: The national collegiate athletic association study . . International International Journal of Eating Disorders, 26, Journal of Eating Disorders, 26, 179-188.179-188.

References References contd.contd.Jones, J. M., Bennett, S., Olmsted, M. P., Lawson, M. L., & Rodin, Jones, J. M., Bennett, S., Olmsted, M. P., Lawson, M. L., & Rodin, G. (2001). G. (2001). Disordered eating attitudes and behaviours in Disordered eating attitudes and behaviours in teenage girls: A school-based teenage girls: A school-based study. study. Canadian Medical Canadian Medical Association, 165Association, 165(5), 547-552.(5), 547-552.

O’Connor, P. J., Lewis, R. D., Kirchner, E. M., & Cook, D. B. O’Connor, P. J., Lewis, R. D., Kirchner, E. M., & Cook, D. B. (1996). Eating (1996). Eating disorder symptoms in former college disorder symptoms in former college gymnasts: Relations with body gymnasts: Relations with body composition. composition. The American The American Journal of Clinical Nutrition, 64Journal of Clinical Nutrition, 64(6), 840-845.(6), 840-845.

Rogers, L., Resnick, M. D., Mitchell, J. E., & Blum, R. W. (1997). Rogers, L., Resnick, M. D., Mitchell, J. E., & Blum, R. W. (1997). The The relationship between socioeconomic status and eating-relationship between socioeconomic status and eating- disordered behaviours disordered behaviours in a community sample of adolescent in a community sample of adolescent girls. girls. International Journal of Eating International Journal of Eating Disorders, 22Disorders, 22(1), 15-23.(1), 15-23.

Smolak, L., Murnen, S. K., & Ruble, A. E. (2000). Female athletes Smolak, L., Murnen, S. K., & Ruble, A. E. (2000). Female athletes and eating and eating problems: A meta-analysis. problems: A meta-analysis. International International Journal of Eating Disorders, 27,Journal of Eating Disorders, 27, 371- 371-380.380.

References References contd.contd.Stoutjesdyk, D., & Jevne, R. (1993). Eating disorders among high Stoutjesdyk, D., & Jevne, R. (1993). Eating disorders among high performance athletes. performance athletes. Journal of Youth and Adolescence, Journal of Youth and Adolescence, 2222(3), (3), 271-283.271-283.

Taylor, G. M., & Ste-Marie, D. M. (1992). Eating disorders Taylor, G. M., & Ste-Marie, D. M. (1992). Eating disorders symptoms in symptoms in Canadian female pair and dance figure skaters. Canadian female pair and dance figure skaters. International International Journal of Sport Psychology, 22Journal of Sport Psychology, 22(3), 21-28.(3), 21-28.

Williams, P. L., Sargent, R. G., & Durstine, L. J. (2003). Prevalence Williams, P. L., Sargent, R. G., & Durstine, L. J. (2003). Prevalence of of subclinical eating disorders in collegiate female athletes. subclinical eating disorders in collegiate female athletes. Women Women in Sport & Physical Activity Journal, 12in Sport & Physical Activity Journal, 12(2), 127-138.(2), 127-138.

Ziegler, P., Hensley, S., Roepke, J. B., Whitaker, S. H., Craig, B. Ziegler, P., Hensley, S., Roepke, J. B., Whitaker, S. H., Craig, B. W., W., & & Drewnowski, A. (1997). Eating attitudes and energy Drewnowski, A. (1997). Eating attitudes and energy intakes intakes of female skaters. of female skaters. Medicine and Science in Sports Medicine and Science in Sports and Exercise, and Exercise, 3030(4), 583-586.(4), 583-586.

research issues and approaches in occupational therapy seminar presentation sarah caughy andrea ford...

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