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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 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: 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: 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): 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: 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.)