Download Module 14 PSYCHOLOGY 310

Eating Disorders & Body Image
Issues in Sport
MODULE 14
PSYCHOLOGY 310:
SPORT & INJURY PSYCHOLOGY
UNIVERSITY OF MARY
INSTRUCTOR:
DR. THERESA MAGELKY
Eating Disorders & Sport
 Healthy eating is a key factor in achieving peak athletic
performance
 When nutrition is not at its peak due to disordered eating
patterns, performance can be compromised & the overall
health of the athlete is at risk
 Restrictive dieting is not uncommon, especially in sports
such as gymnastics in which weight and body appearance
are central to performance
 Behaviors such as severely limiting calories while
increasing activity levels may seem like merely another
way to maintain or lose weight – but they can be
physically & emotionally damaging

These behaviors can become potentially life-threatening when
athletes get into patterns they are unable to discontinue on their own
Eating Disorders & Sport (etc.)
 Eating issues are viewed on a continuum
 On one end of the continuum are individuals who have no
symptoms of disordered eating
 Disordered-eating behavior – Individuals in the middle
of the continuum who demonstrate some characteristics of
eating disorders but not enough to warrant a diagnosis
Jut because it cannot be diagnosed it does not mean these issues
should be ignored
 Some studies indicate that more than 60% of the population
demonstrates some type of disordered-eating behavior

Eating Disorders & Sport (etc.)
 If athletes gain or lose too much weight then their
performance is compromised
 Not all athletes attain their outwardly healthy
appearance in healthy ways
 Athletes engage in a variety of unhealthy strategies to
reach their goals

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These behaviors can be harder to detect in athletes than in the
general population because of the unique athletic environment
Some athletes will hide disordered-eating behavior behind a healthy
eating façade
(e.g., gymnasts might appear to have a healthy diet but may actually
severely restrict their food intake)
 Because coaches encourage healthy diets, they may not see this
pattern as a problem

Eating Disorders
 Diagnosable Eating Disorders according to the
Diagnostic & Statistical Manual of Mental Disorders:
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Bulimia Nervosa – characterized by a cycle of binge eating
and purging. Binge eating involves eating huge quantities of
food in one sitting. A binge is often followed by a sense of guilt
which then leads to purging through self-induced vomiting,
fasting, misuses of laxatives, diuretics, enemas, or excessive
exercise
Anorexia Nervosa – characterized by a refusal to maintain a
minimally normal body weight based on age and height, an
intense fear of gaining weight, and a distorted perception of
one’s body shape and size
Eating Disorders

Two Types of Anorexia:
Restricting – lose weight through severe dieting, fasting, and
excessive exercise
 Binge-eating/purging – maintain a below-average weight and
engage in binge-eating, purging, or both
 Some may not binge but will purge even after eating small
amounts of food because they perceive all eating as a binge

 Eating Disorder, Not Otherwise Specified
(NOS) –for example, when someone might have all
the characteristics of anorexia but be of normal
weight
Non-Diagnosable Eating Disorders
 Non-Diagnosable Eating Disorders – athletes may
face these conditions which, although not clinically
diagnosable, are still related to disordered eating

Overeating – bingeing without a purging cycle. Overeating in
athletes is difficult to detect because many athletes need
thousands of calories per day due to high metabolism and
intensive training schedules
Other athletes eat for emotional reasons rather than hunger
 If coaches do not observe athletes at meals of listen to their
conversations about food, they may not detect there is a problem.
Appearance alone is not an indicator of overeating. Coaches
CANNOT assume an athlete is eating appropriately or is disorderfree because he/she looks okay

Non-Diagnosable Eating Disorders
 Non-Diagnosable Eating Disorders (cont)
 Female Athlete Triad – this condition consists of 3
interrelated components: disordered eating, amenorrhea (loss
of menstrual period), and osteoporosis (bone loss)
 Obligatory Exercise – (excessive or compulsive exercise) –
is physical activity that is extreme in frequency and duration
and done by people who are relatively resistant to change
Obsession with maintaining an exercise program and will exercise
even when injury, fatigue, or other personal demands persist
 These individuals display characteristics similar to those with
eating disorders including compulsions and rituals, rigid diets,
perfectionism, and control over their bodies

Eating Disorders
 Why eating disorders develop:
 Biogenetic Factors – Recent research examines whether
biological abnormalities are the outcomes of starvation and
disordered eating or if biology leads people to develop eating
disorders


Other research suggests bulimia is a variant of a depressive
disorder, which also can be hereditary
Psychological Factors – Some psychological characteristics
have been related to disordered eating such as perfectionism
and obsessive-compulsive traits
Some researchers view eating disorders as an addiction, similar to
substance-abuse disorders with food being the substance abused
 Food can be used to cope with strong emotion or as a replacement
for emotional expression

Eating Disorders
 Why eating disorders develop (cont):
 Environmental Factors: the development of eating
disorders seems to be most affected by the environment. All
athletes feel pressure to achieve a particular body type or
weight consistent with their sport, although some athletes can
find it impossible to achieve that ideal. Several sociological
environmental factors contribute to these pressures, including:

Culture – Preferred shape for women in Western culture has
shifted toward a thin, lean ideal. Athletes face additional pressures
concerning ideal body size, shape, and weight, especially for
activities and sports that emphasize a small size or thin shape such
as dancing, figure skating, diving, gymnastics, and ballet
Eating Disorders
 Athletes at Risk
 Athletes may be more at risk than most people for the
development of eating disorders, especially those in sports in
which weight or appearance are emphasized, such as
gymnastics or wrestling
 Some initial studies have indicated that some types of sports
have a higher prevalence of eating disorders than the general
population
Specifically, female aesthetic sport athletes (e.g., gymnasts, divers,
synchronized swimmers) have a greater tendency toward anorexia
than ball-game athletes or endurance athletes
 These aesthetic sports involve subjective scoring systems that can
be affected by grace and body appearance

Eating Disorders
 Athletes at Risk (cont)
 In males, both aesthetic and weight-dependent
athletes had more symptoms of bulimia than
endurance athletes
 Wrestlers, for example, are at risk due to the sport’s
use of weight categories and the athletes’ desire to
make weight in the lightest category possible
Eating Disorders
Identifying Disordered Eating
 The following signs can help coaches detect possible
disordered-eating behavior:
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Repeatedly expressed concerns about being or feeling fat even
when weight is below average (distorted body image)
Fears of becoming obese that do not diminish even with weight
loss
Discomfort with compliments - For example, if the athlete
hears, “You look nice,” he or she might respond, “No I don’t.
I’m fat.”
Dichotomous thinking – Athlete views everything as either
“good” or “bad” (nothing in the middle) and can’t see choices
Eating Disorders
 Identifying Disordered Eating
 The following signs can help coaches detect possible
disordered-eating behavior (cont):


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Depressed Mood
Negative thoughts about self or guilt, especially after eating
Avoidance of, or even disdain for fat, protein, and dairy
products
Eating Disorders
The following signs could indicate anorexia:
 Weight loss
 Extremely thin appearance
 Lanugo (fine, downy hair that grows in facial area)
 Refusal to maintain a minimal normal weight consistent with
sport, age, and height
 Denial that he or she is thin and talk of losing more weight
 Avoidance of eating with others
 Refusal to eat and stating, “I’m not hungry.”
 Eating only tiny portions of meals and then possibly moving
food around on plate
 Hair loss
 Complaints of being cold all the time
Eating Disorderes
The following signs could indicate bulimia:
 Wide fluctuations in weight over short time spans.
Bulimics can be normal weight, slightly overweight, or
underweight, so weight fluctuations are better indicators
than actual weight
 May wear baggy clothes to camouflage weight changes
 “Chipmunk cheeks” (swollen salivary glands)
 Sores on the back of the hands from purging
 Candy or laxative wrappers or excess food containers in
the trash can
 Patterns of eating large quantities of food and then
disappearing into the bathroom
 Bloodshot eyes, especially after trips to the bathroom
Eating Disorders
The following signs are things you might not see and would
need to rely on the athlete’s report for. Sometimes a
medical evaluation would be necessary to detect these
signs, which can become severe physical & medical
complications:
 Laxative abuse or dependence
 Diet-pill abuse or dependence
 Hair loss
 Brittle Nails
 Diminished muscle mass
 Loss of menstrual periods (in women)
 Dizziness or fainting
Eating Disorders
Signs of eating disorders in athletes (cont):
 Gastrointestinal problems including bleeding
 Tooth-enamel loss or tooth decay
 Difficulty absorbing fat, protein, and calcium
 Tears in the esophagus
 Anemia
 Ulcers
 Cardiac complications
 Bone loss
 Electrolyte imbalance
 Dehydration
 Heart arrhythmias
Risk-Reduction Strategies for Eating Disorders
The following are strategies for risk reduction in
preventing eating disorders:
 De-emphasize weight – the simplest way is to refrain
from weighing athletes. Coaches should keep the focus
on physical conditioning and strength as well as
increasing mental toughness for performance (rather
than focus on weight)
 Eliminate group weigh-ins – Weigh-ins are potentially
the most destructive form of monitoring. For athletes
self-conscious about their weight, this type of public
exposure can be degrading and embarrassing

If there is legitimate reason for weigh-ins, the athletes should be
weighed privately by a sport professional other than the coach
Risk Reduction Strategies for Eating Disorders
The following are strategies for risk reduction in
preventing eating disorders (cont):
 Eliminate unhealthy subculture aspects – some
disordered eating and weight-loss patterns become
accepted and even valued in a sport community (for
example, wrestling)
 Treat each athlete individually, especially when
dealing with weight. Weight is determined by a
complex interaction of genetics and biological
processes rather than willpower. Some athletes may
try to achieve a shape and size that cannot be done in
a healthy manner
Risk Reduction Strategies for Eating Disorders
The following are strategies for risk reduction in
preventing eating disorders (cont):
 Offer guidelines for appropriate weight loss. It is
recommended that athletes not be asked to diet.
However, in reality, athletes will diet so here are some
helpful guidelines to follow:
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Consult a healthcare professional to determine whether the athlete is
at risk for developing an eating disorder as a result of a weight-loss
program.
The athlete should agree with the decision to lose weight.
A dietitian should be responsible for determining the target weight
and the eating plan.
The weight-loss program should be discontinued if any weight,
eating, or psychological issues emerge.
The athlete’s performance should be closely monitored to determine
that performance improves with weight loss.
Eating Disorders
Things to do when talking with athletes who may have eating
disorders:
 Learn more about eating disorders before talking with an
athlete
 Stress that you care and that you are approaching the athlete
out of your concern for his/her well-being as a person and an
athlete
 Suggest seeking professional help and have some referral
options ready. Offer support, but realize that ultimately the
responsibility to get help rests with the athlete
 Discuss feelings. Eating-disorder behaviors are not usually
about food per se but are more coping with intense emotions
or pressures that an athlete might experience
 Give encouragement. Tell the athlete, “I have faith in you.”
Eating Disorders
Things NOT to do when talking with athletes who may
have eating disorders:
 Do not discuss weight, calories, or eating habits
 Do not comment on appearance. Concern about
weight loss may be heard as a compliment, and
comments about weight gain may be interpreted as
criticism
 Do not get into a power struggle. You cannot force
anyone to eat or stop purging
 Do not expect instant results from counseling.
Athletes in therapy may get worse before they get
better as they tackle some difficult issues.
Eating Disorders
Treatment Options:
 Individual interventions – Individual therapy is generally
suggested for eating disorders. Most therapists focus on the
person and how he/she copes with emotions rather than
talking about food, diet, and weight because doing so only
reinforces an obsession with eating.
 Medication – Antidepressant medications can be helpful in
reducing disordered-eating behaviors. Of course, the use of
medication can have implications for drug testing, and
athletes must consult medical professionals who know the
guidelines for restricted drugs in their level of sport
 Group Therapy – Group therapy has proven effective in
treating eating disorders as an adjunct to other therapies. A
group setting provides athletes with support and a sense that
they are not alone in dealing with eating issues.
Eating Disorders
Treatment Options (cont):
 Family therapy – Often eating disorders are due to
conflicts within the family and are a manifestation of
these relationship dynamics. In such cases, family
therapy is an option, which might involve the athletic
“family” as well
 Treatment team – Athletes often benefit from a
treatment team composed of professionals who are
knowledgeable about different components of eating
disorders (sport psychologist, therapist, dietitian or
nutritionist, an athletic trainer, a physician)
 Inpatient treatment – If eating disorders become
severe and the medical risk to the athlete is great,
hospitalization may be necessary
References
 Cogan, K. D. (2005). Eating Disorders: When
Rations Become Irrational. The Sport Psych
Handbook. Shane Murphy (ed.)