Eating Behaviors 8 (2007) 143 – 147
Anxiety of young female athletes with disordered eating behaviors
Erdal Vardar a,⁎, Selma Arzu Vardar b , Cem Kurt c
a
Trakya University, School of Medicine, Department of Psychiatry 22030 Edirne, Turkey
b
Trakya University, School of Medicine, Department of Physiology Edirne, Turkey
c
Trakya University, Physical Education and Sport Department, Edirne, Turkey
Received 7 September 2005; received in revised form 22 February 2006; accepted 14 March 2006
Abstract
The aim of this study was to investigate the prevalence rate of disordered eating behaviors in young female athletes and to
compare the anxiety levels of the athletes with or without disordered eating behaviors. Female athletes (n = 243) of 15 to 25 years
old from the city, Edirne, in Turkey participated our study. Disordered eating behaviors and anxiety levels of participants were
evaluated by the Eating Attitudes Test (EAT-40) and State-Trait Anxiety Inventory. Disordered eating behaviors was reported as 40
(16.7%) among all athletes. Both state and trait anxiety scores were higher in athletes with disordered eating behaviors than the
athletes without disordered eating behaviors (p = 0.01). The athletes who engage in leanness and nonleanness sports were reported
as having similar EAT-40 scores and anxiety scores. In conclusion, athletes with disordered eating behaviors have higher state and
trait anxiety scores.
© 2006 Elsevier Ltd. All rights reserved.
Keywords: Anxiety; Eating; Exercise
1. Introduction
Unhealthy weight control practices and other abnormal eating habits are prevalent among athletes particularly in
female athletes (Sudi et al., 2004). It is generally accepted that the factors such as pressure of reducing weight, fear of
failing, injury or overtraining may cause disordered eating behaviors among the female athletes.
The term “disordered eating” can be considered as a spectrum of unhealthy weight control attitudes and behaviors
ranging from serious eating restrictions as witnessed in anorexia–bulimia to eating behaviors which help to lose weight
or maintain a thin physique. (Hobart & Smucker, 2000). Generally, disordered eating behaviors are accepted as a nonclinical concept and originate from self reported scales.
Physiological, genetic and psycho-social factors may produce disordered eating behaviors and/or lead to the clinical
spectrum of eating disorders. Recent studies suggest that disordered eating behaviors among male and female gender,
and also people from eastern culture show an increase in terms of prevalence (Eapen, Mabrouk, & Bin-Othman, 2006;
Jones, Bennett, Olmsted, Lawson, & Rodin, 2001; Jonat & Birmingham, 2004; Yannakoulia et al., 2004).
⁎ Corresponding author. Tel.: +90 284 2357641 4215; fax: +90 284 2353881.
E-mail address: erdalvardar@trakya.edu.tr (E. Vardar).
1471-0153/$ - see front matter © 2006 Elsevier Ltd. All rights reserved.
doi:10.1016/j.eatbeh.2006.03.002
144
E. Vardar et al. / Eating Behaviors 8 (2007) 143–147
The connection between anxiety traits and eating disorders is widely recognized by many investigations (Kaye,
Bulik, Thornton, Barbarich, & Masters, 2004). Comorbidity of eating and anxiety may be explained in five different
models (Bulik, 2002). Model one suggests that eating disorders is caused by anxiety symptoms. Model two puts
forward the idea that the converse of model one anxiety precedes eating disorders. Model three says that eating
disorders are expressions of underlying anxiety disorders. Model four points out that eating and anxiety disorders are
different expressions of the same underlying causal factors. According to model five, anxiety and eating disorders are
unique sets of conditions, and they may share some etiological factors (Bulik, 2002). Comorbidiy of eating disorders
and anxiety are complex conditions in clinical setting. Obsessive compulsive disorder and social anxiety disorder are
the most common anxiety disorders among eating disorders patients who seek for a treatment. Anxiety disorder and
symptoms of anxiety have been reported to precede the development of eating disorders in most subjects (Kaye et al.,
2004; Zaider, Jhonson, & Cockell, 2002). Anxiety symptoms may be vulnerable factors for developing eating
disorders.
Studies on eating disorder have shown that individuals with AN, BN and ENDOS are likely to have anxiety
symptoms (Becker, DeViva, & Zayfert, 2004; Kaye et al., 2004; Thompson & Chad, 2002). However, no study
examined the relationship between disordered eating and anxiety in female athletes. We hypothesized that high anxiety
levels may be a risk factor for developing disordered eating behaviors in female athletes. Our aim in this study was to
investigate the prevalence of disordered eating behaviors in young Turkish female athletes and to compare the state and
trait anxiety levels of the athletes with or without disordered eating behaviors.
2. Method
2.1. Participants
The female athletes (n = 243) from the city of Edirne in Turkey participated in our study. All subjects' age ranged
from 15 to 25. Participants were consisted of competition athletes from regional sport clubs, high schools, and
university sports teams of different branches. The athletes in our sample were from 10 different sports: basketball
(n = 80, 32.9%), handball (n = 49, 20.2%), running (n = 24, 9.9%), swimming (n = 23, 9,5%), rhythmic gymnastics
(n = 1, 0.4%), wrestling (n = 5, 2,1%), tennis (n = 3, 0,8%), volleyball (n = 39, 16.0%), taekwondo (n = 15, 6.2%), and
dancing (n = 5, 2,1%). Age, height, weight, and body mass index (BMI) averaged 19.59 ± 2.52 (± SD) years, 168.07 ±
6.79 cm, 57.55 ± 7.11 kg and 20.34 ± 2.10 kg/m2 respectively.
2.2. Measures
A self-administered questionnaire was used to assess age, weight, height, with their beginning age to sports and
amount of training in a week. BMI was calculated as weight in kilograms per height in square meter.
2.2.1. Eating Attitudes Test (EAT-40)
Disordered eating behaviors were assessed by the EAT-40 (Garner & Garfinkel, 1979). A Turkish translation,
reliability and validity of the EAT-40 were performed in a Turkish sample (Erol & Savasir, 1989). EAT-40 is a
widely used, standardized, self-report questionnaire designed to assess pathological eating behaviors, attitudes, and
thoughts.
2.2.2. State and trait anxiety inventory (STAI)
State and trait anxiety was assessed by the 40 item state portion of the STAI of Spielberger, Gorsuch, and Lushene
(1970). STAI measures the subjective level of anxiety both in special and in general stations. Each of the state and trait
portions of the inventory consists of 20 items in Likert format statements. Higher STAI results indicating higher level of
anxiety. The inventory has been validated by Oner and Lecompte (1985) in Turkish sample.
2.3. Procedure
Disordered eating group (n = 40) was constituted of the athletes who have EAT-40 results above the 30 points. Also,
participants were divided into two groups as leanness sports (n = 72) and nonleanness sports (n = 168) to compare the
E. Vardar et al. / Eating Behaviors 8 (2007) 143–147
145
Table 1
Comparison of general characteristics and anxiety scores of the athletes with and/or without disordered eating behaviors
Age (yr)
Height (cm)
Weight (kg)
BMI (kg/m2)
Participation age to sports (yr)
Duration of training (yr)
Amount of training (h/week)
EAT-40 score
State anxiety
Trait anxiety
Disordered eating group (n = 40)
Normal eating group (n = 200)
P
19.0 ± 2.5
169.2 ± 7.1
59.7 ± 7.3
20.9 ± 2.4
11.5 ± 3.1
6.3 ± 3.4
6.2 ± 4.0
37.4 ± 8.8
42.8 ± 13.2
47.2 ± 11.8
19.6 ± 2.5
167.8 ± 6.7
56.3 ± 9.8
20.2 ± 2.0
11.4 ± 2.9
6.8 ± 3.4
6.3 ± 5.1
16.1 ± 6.2
36.4 ± 10.5
41.9 ± 8.6
NS
NS
.03
NS
NS
NS
NS
.01
.01
.01
BMI: Body Mass Index; EAT-40: Eating Attitudes Test-40.
anxiety levels of different sport groups. Running, swimming, rhythmic gymnastics, dancing, wrestling and taekwondo
were described as leanness sports because of the leanness and/or specific weight was considered to be important.
Basketball, handball, tennis, volleyball were described as nonleanness sports similar to previous study (Torstveit &
Sundgot-Borgen, 2005) because of leanness and/or specific weight was considered to be less important. The current
prevalence study consists of cross-sectional analyses. The study was approved by the local ethics committee of Trakya
University and carried out between the February 2004 and June 2004. Details of the study were explained to each
subject and informed consent was obtained.
2.4. Statistical analysis
Values are given mean ± SD. Student's T test was performed to evaluate continuous variables and Chi-square
methods was used to evaluate the relationships between nominal variables. A p-value of below 0.05 was considered to
be significant.
3. Results
Three athletes who could not complete EAT-40 questionnaire properly excluded from the study. Therefore, 240
participants were evaluated in our study. The athletes who had EAT-40 scores equal to 30 or above 30 points were
accepted as subjects who had disordered eating behaviors. Elevated EAT-40 scores were reported by 40 (16.7%) of all
athletes. Age, height, BMI, participation age to sports and amount of training in a week of the athletes who had elevated
EAT-40 or normal EAT-40 scores were compared (Table 1). Both the state and trait anxiety scores were higher in
elevated EAT-40 group (Table 1).
EAT-40 and STAI scores of the athletes dealing with leanness or nonleanness sports were similar (Table 2).
Table 2
Comparison of general characteristics, EAT-40 scores and anxiety levels of the athletes dealing with leanness and nonleaness sports
Age (yr)
Height (cm)
Weight (kg)
BMI (kg/m2)
Participation age to sports (yr)
Duration of training (yr)
Amount of training (h/week)
EAT-40 score
State Anxiety
Trait Anxiety
Leanness sports group (n = 72)
Nonleanness sports group (n = 168)
P
19.3 ± 2.7
164.4 ± 5.7
55.4 ± 6.9
20.4 ± 2.3
11.7 ± 3.8
6.7 ± 3.6
9.5 ± 7.0
20.1 ± 10.5
36.3 ± 10.0
43.0 ± 8.5
19.6 ± 2.4
169.6 ± 6.6
57.4 ± 10.4
20.2 ± 1.9
11.3 ± 2.5
6.7 ± 3.3
5.0 ± 2.9
19.5 ± 10.4
37.9 ± 11.8
42.7 ± 9.7
NS
.01
NS
NS
NS
NS
.01
NS
NS
NS
BMI: Body Mass Index; EAT-40: Eating Attitudes Test-40.
146
E. Vardar et al. / Eating Behaviors 8 (2007) 143–147
4. Discussion
We found the prevalence rate of disordered eating behaviors as 16.7% in female athletes in the present study. Our
study demonstrated that female athletes who have disordered eating behaviors had higher state and trait anxiety levels
than the athletes who do not have disordered eating behaviors.
Disordered eating can occur in female athletes participating in a wide range of different sport activities (Otis,
Drinkwater, Johnson, Loucks, & Wilmore, 1997). Existing studies have produced inconsistent results about the
frequency of disordered eating behaviors among the athletes (Byrne, 2002). The reported prevalence of disordered
eating in some college and elite athletes was found to be equal or higher than the general population (Otis et al., 1997).
From the general point of view, the occurrence of disordered eating behaviors has been reported in 15% to 62% of
female athletes (Beals & Manore, 2002; Sundgot-Borgen, 1994a,b; Sundgot-Borgen & Torstveit, 2004). Significant
study results conducted by Beals and Manore (2002) have shown that 15.2% of 425 female college athletes had
disordered eating behaviors. We found the similar prevalence rate of this study. In a study done among 980 Turkish
university students, 7.4% of them scored above the cut-off scores on the EAT-40 (Kugu, Akyüz, Dogan, Ersan, & Izgic,
2002). Our results in young female athlete population were higher than the university student population.
Our results indicated that female athletes who had disordered eating behaviors had higher anxiety scores than the
athletes who had normal eating behaviors. High anxiety levels of athletes may be a trigger condition for the
development of disordered eating behaviors. However, anxiety of the subjects was observed to be in higher levels even
after the recovery period of eating disorders. Anxiety may be a triggering factor; on the other hand, it may occur as an
independent situation as well. It is also suggested that anxious and obsessive compulsive symptoms may be caused by
personality trait in eating disorder subjects (Holtkamp, Müller, Heussen, Remschmidt, & Herpertz-Dahlmann, 2005).
A previous study reported that for a people with the eating disorder has 63.5% rate of anxiety disorder prevalence at
least once throughout their lives (Kaye et al., 2004). Pathologic high anxiety levels may affect negatively the eating
behaviors of athletes.
Social physique anxiety and negative perfectionism attitudes would be related to disordered eating behaviors in female
athletes. Disordered eating behaviors may be considered as a factor for compensating peoples' inability to have a desired
perfect physique (Haase, Prapavessis, & Owens, 2002). Thome and Espelage (2004) depicted that exercise and eating
behaviors were complex issues in females. They showed that women with disordered eating behaviors suffer more from
anxiety and depression (Thome & Espelage, 2004). Our results are consistent with the study of Thome and Espelage (2004).
Many of sport activities that require a lean body shape or low body weight are considered to be at particular risk for
developing eating disorders (Byrne, 2002). Mark (2004) reported that ballet dancers with disordered eating behaviors
have more psychopathologic symptoms. Pressure of perfectionist behaviors and fear of failure would lead to anxiety
and maladaptive eating habits in athletes. Low levels of body esteem, body dissatisfaction (Engel et al., 2003; Muris,
Meesters, van de Blom, & Mayer, 2005), neuroticism, introversion (Miler, Schmidt, Vaillancourt, McDougall, &
Laliberte, 2006) and high levels of various personality pathology dimensions were each used to predict cluster
membership in disordered eating female students (McLaren, Gauvin, & Steiger, 2001).
Previous studies suggest that athletes who participated in leanness sports activities are under a more risk of
disordered eating compared to the ones dealing with nonleanness sport activities (Beals & Manore, 2002; SundgotBorgen, 1994b; Torstveit & Sundgot-Borgen, 2005). We could not compare each of the different leanness or
nonleanness sports in this study. We grouped sports as leanness and nonleanness and compared them in our study. It
was interesting that we could not find any differences in EAT-40, state and trait anxiety scores of the athletes engaged in
leanness or nonleanness sports. Further investigations related to anxiety and eating habits are needed in different groups
of the leanness or nonleanness sports.
In summary, we found 16.7% as the prevalence rate of disordered eating behaviors among young female Turkish
athletes in our study. With the same study we found out that disordered eating behaviors were accompanied by the
higher state and trait anxiety scores. The athletes who engage in leanness and nonleanness sports were reported to have
similar eating and anxiety traits.
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