Eating Disorders and Disordered
Eating Among Athletes
Overview
Definitions, diagnostic criteria
Prevalence
Factors unique to athletes
Warning signs
Intervention
Diagnostic Criteria
Anorexia Nervosa
– Refusal to maintain minimally healthy
body weight for age and height
– Intense fear of gaining weight, even
though underweight
– Disordered body image
– Amenorrhea (absence of 3 consecutive
menstrual cycles)
Diagnostic Criteria
Bulimia Nervosa
– Recurrent episodes of binge eating
– Recurrent inappropriate compensatory
behavior in order to prevent weight gain
– Binge eating and compensatory
behaviors occur on average twice a
week for 3 months
– Self-evaluation unduly influenced by
body shape and weight
Diagnostic Criteria
Eating Disorders Not Otherwise
Specified (EDNOS)
– Atypical or subclinical eating disorder
Criteria for anorexia met except amenorrhea
or weight
Binge eating disorder
I worry about gaining weight.
I am preoccupied with losing weight.
I frequently diet or feel the need to be on
a diet.
My mood depends on my weight (e.g., if
I gain 1 pound I am depressed, irritable,
etc.)
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.

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) selfinduced 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.

IS YOUR TOTAL > 5??
Anorexia Athletica
Subclinical eating disorder frequently
found in athletes
Individuals within 5% of expected body
weight
Fear of becoming fat
Restriction of food to <1200 kcal
Compulsive exercise
Amenorrhea
Occasional binge/purge
Female Athlete Triad
Research on the Prevalence of Eating Disorders
Athletes appear to have a greater occurrence of
eating-related problems than does the general
population.
significant percentage of athletes engage in
disordered eating or weight-loss behaviors (e.g.,
bingeing, fasting), although subclinical in
intensity
sport-specific prevalence (e.g., among wrestlers,
dancers, gymnasts etc.).
Pincay Overcomes Eating Disorder
Predisposing Factors
Prevalence
Normative for young women to experience
body dissatisfaction and desire weight loss
Sociocultural demands placed on women
to be thin along with pressure from sport
to meet weight standards or body size
expectations of sport
Up to 60% (!!)of female college athletes
report some type of disordered eating
 Distorted Body Image
Prevalence and Men
Sociocultural demands placed on men to achieve
a particular physique along with pressure from
sport to meet weight standards or body size
expectations of sport
~16% of individuals with eating disorders are
male (increasing)
~25% of individuals with binge eating disorder
are male
Gay men particularly at risk
“Reverse anorexia”
NCAA Study on Athletes and
Eating Disorders
Factors Unique to Athletes
No single cause for eating disorders
Sport body stereotype – “thin-build
sports”
– Expectation for athletes in certain sports
to display a characteristic body size and
shape
– Fitted uniforms, body on display
– Belief that thinness enhances
performance (e.g., running)
Factors Unique to Athletes
Symptoms vs desired characteristics
of athletes:
Factors Unique to Athletes
Stress of being in the spotlight
Balancing multiple role demands
Warning Signs
Physical
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Intolerance to cold
Dizziness, fainting spells
Constipation
Loss of muscle tone
Frequent weight fluctuations
Impaired concentration
Swollen salivary glands, puffiness in cheeks
Broken blood vessels in eyes
Complains of sore throat, fatigue, & muscle
aches
– Tooth decay, receding gums
Warning Signs
Behavioral
– Restricted food intake
– Eliminating specific foods or whole food groups
– Fear of food, avoiding situations where food is
present
– Excuse of “picky” eater, despite previous flexible
eating
– Excessive exercise
– Regular weighing
– Frequent comments about own weight, calories,
food fat content
– Frequent bathroom visits following meals
– Moodiness
– Withdrawal from others
Warning Signs
Attitudinal
– Dichotomous thinking
– Denial of eating problems
– Perfectionistic standards
– Harsh self-criticism
– Self-worth determined by weight
Intervention: What to Do
Set aside time for a private, respectful
meeting to discuss your concerns openly
and honestly in a caring and supportive
way.
Describe what you have seen and heard
that has led to your concerns.
Ask the person to explore these concerns
with a counselor, doctor, or any health
professional s/he feels comfortable
enough to see.
Intervention: What to Do
Arrange for regular, private follow-up
meetings apart from practice times
Let the athlete know that the
demands of the sport may have
played a role in the development of
the problem
Expect denial, rationalization, &
anger
Other Intervention Considerations
for 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 Not to Do
Don’t question teammates or talk to them about
the athlete. Talk directly to athlete
Don’t ignore the problem. Intervene
Never conclude that an athlete just isn’t trying
hard enough to overcome an eating disorder
Don’t try to keep the problem hidden or try to
deal with it yourself. When in doubt about how
to intervene, consult, consult, consult…
Intervention: What Not to Do
Don’t get into a power struggle about
whether there is a problem.
Don’t be deceived by excuses.
Other Body Image
Disorders
Preoccupation With
Appearance
Imagined Defect
 “Imagined” Ugliness
 Mirrors (Fixation or
Avoidance)
 - “muscle dysmorphia”
in body-builders