Eating Disorders in Sport: Comparing Eating Disorder Symptomatology in Athletes and Non-Athletes During Intensive Eating Disorder Treatment

in Journal of Clinical Sport Psychology
Restricted access

Purchase article

USD  $24.95

Student 1 year subscription

USD  $58.00

1 year subscription

USD  $77.00

Student 2 year subscription

USD  $110.00

2 year subscription

USD  $144.00

The current study tested if athlete patients differed from non-athlete patients in measures of eating disorder (ED) and related pathology. Athlete (n = 91 in Study 1; n = 39 in Study 2) and non-athlete (n = 76 in Study 1; n = 26 in Study 2) patients completed self-report measures, and body mass index (BMI) was calculated. Athlete patients had significantly lower ED symptomatology and depression than non-athlete patients (ps < .05). ED impairment, worry, psychosocial functioning, BMI, obsessive-compulsiveness, and compulsive exercise did not significantly differ between groups (ps > .08). Greater ED symptomatology was associated with higher psychosocial functioning among athlete patients and higher obsessive-compulsive symptoms and compulsive exercise among non-athlete patients. This is a novel study comparing ED symptomatology and related measures of mental health in athlete and non-athlete patients engaged in residential or partial hospitalization ED treatment. Future research should further investigate how participation in high-level sport impacts the presentation, treatment, and outcome of individuals with EDs.

Fewell is with the Dept. of Psychological Sciences, University of Missouri-St. Louis, St. Louis, MO. Nickols and Schlitzer Tierney are with The Victory Program, McCallum Place Eating Disorder Treatment Centers, St. Louis, MO. Levinson is with the Dept. of Psychological and Brain Sciences at University of Louisville, Louisville, KW.

Address author correspondence to Cheri A. Levinson at cheri.levinson@louisville.edu.
  • Aardoom, J.J., Dingemans, A.E., Slof Op’t Landt, M.C., & Van Furth, E.F. (2012). Norms and discriminative validity of the Eating Disorder Examination Questionnaire (EDE-Q). Eating Behaviors, 13(4), 305309. PubMed ID: 23121779 doi:10.1016/j.eatbeh.2012.09.002

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Aimé, A., Guitard, T., & Grousseaud, L. (2017). Anxiety and eating disorders in adult women. In I.J. Lobera (Ed.), Eating disorders-a paradigm of the biopsychosocial model of illness. InTech. doi:10.5772/65249

    • Search Google Scholar
    • Export Citation
  • Anderson, L.M., Reilly, E.E., Gorrell, S., & Anderson, D.A. (2016). Running to win or to be thin? An evaluation of body dissatisfaction and eating disorder symptoms among adult runners. Body Image, 17, 4347. PubMed ID: 26952015 doi:10.1016/j.bodyim.2016.02.003

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Arthur-Cameselle, J., Sossin, K., & Quatromoni, P. (2017). A qualitative analysis of factors related to eating disorder onset in female collegiate athletes and non-athletes. Eating Disorders, 25(3), 199215. PubMed ID: 27897463 doi:10.1080/10640266.2016.1258940

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Beck, A.T., Steer, R.A., & Brown, G.K. (1996). Manual for the beck depression inventory-II. San Antonio, TX: Psychological Corporation.

  • Bohn, K., & Fairburn, C.G. (2008). The Clinical Impairment Assessment questionnaire (CIA 3.0). In C.G. Fairburn (Ed.), Cognitive behavior therapy and eating disorders. New York, NY: Guilford Press. doi:10.1007/978-981-287-087-2_85-1

    • Search Google Scholar
    • Export Citation
  • Brewer, B.W., Van Raalte, J.L., & Linder, D.E. (1993). Athletic identity: Hercules’ muscles or Achilles heel? International Journal of Sport Psychology, 24(2), 237254.

    • Search Google Scholar
    • Export Citation
  • Carey, M., Small, H., Yoong, S.L., Boyes, A., Bisquera, A., & Sanson-Fisher, R. (2014). Prevalence of comorbid depression and obesity in general practice: A cross-sectional survey. British Journal of General Practice, 64(620), 122127. PubMed ID: 24567650 doi:10.3399/bjgp14X677482

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Cromer, L., Kaier, E., Davis, J., Stunk, K., & Stewart, S.E. (2017). OCD in college athletes. American Journal of Psychiatry, 174(6), 595597. PubMed ID: 28565946 doi:10.1176/appi.ajp.2017.16101124

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Davis, C., Katzman, D.K., Kaptein, S., Kirsh, C, Brewer, H, Kalmbach, K., . . . Kaplan, A.S. (1997). The prevalence of high-level exercise in the eating disorders: Etiological implications. Comprehensive Psychiatry, 38, 321326. PubMed ID: 9406737 doi:10.1016/S0010-440X(97)90927-5

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Davis, C., Katzman, D.K., & Kirsh, C. (1999). Compulsive physical activity in adolescents with anorexia nervosa: A psychobehavioral spiral of pathology. Journal of Nervous and Mental Disease, 187, 336342. PubMed ID: 10379720 doi:10.1097/00005053-199906000-00002

    • Crossref
    • Search Google Scholar
    • Export Citation
  • De Bruin, A.P., Oudejans, R.R., & Bakker, F.C. (2007). Dieting and body image in aesthetic sports: A comparison of Dutch female gymnasts and non-aesthetic sport participants. Psychology of Sport and Exercise, 8, 507520. doi:10.1016/j.psychsport.2006.10.002

    • Crossref
    • Search Google Scholar
    • Export Citation
  • De Bruin, A.P., Oudejans, R.R., Bakker, F.C., & Woertman, L. (2011). Contextual body image and athletes’ disordered eating: The contribution of athletic body image to disordered eating in high performance women athletes. European Eating Disorders Review, 19(3), 201215. PubMed ID: 21584913 doi:10.1002/erv.1112

    • Crossref
    • Search Google Scholar
    • Export Citation
  • De Bruin, A.P.K., Woertman, L., Bakker, F.C., & Oudejans, R.R. (2009). Weight-related sport motives and girls’ body image, weight control behaviors, and self-esteem. Sex Roles, 60(9–10), 628641. doi:10.1007/s11199-008-9562-8

    • Crossref
    • Search Google Scholar
    • Export Citation
  • DiBartolo, P.M., & Shaffer, C. (2002). A comparison of female college athletes and nonathletes: Eating disorder symptomatology and psychological well-being. Journal of Sport and Exercise Psychology, 24(1), 3341. doi:10.1123/jsep.24.1.33

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Fairburn, C.G. (2008). Cognitive behavior therapy and eating disorders. New York, NY: The Guilford Press.

  • Fewell, L.K., Levinson, C.A., & Stark, L. (2017). Depression, worry, and psychosocial functioning predict eating disorder treatment outcomes in a residential and partial hospitalization setting. Eating and Weight Disorders—Studies on Anorexia, Bulimia and Obesity, 22(2), 291301. doi:10.1007/s40519-016-0357-6

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Foa, E.B., Huppert, J.D., Leiberg, S., Langner, R., Kichic, R., Hajcak, G., & Salkovskis, P.M. (2002). The obsessive-compulsive inventory: Development and validation of a short version. Psychological Assessment, 14(4), 485496. PubMed ID: 12501574 doi:10.1037/1040-3590.14.4.485

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Forbush, K.T., Wildes, J.E., Pollack, L.O., Dunbar, D., Luo, J., Patterson, K., . . . Watson, D. (2013). Development and validation of the Eating Pathology Symptoms Inventory (EPSI). Psychological Assessment, 25(3), 859878. PubMed ID: 23815116 doi:10.1037/a0032639

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Galli, N., Reel, J.J., Petrie, T., Greenleaf, C., & Carter, J. (2011). Preliminary development of the weight pressures in sport scale for male athletes. Journal of Sport Behavior, 34(1), 47.

    • Search Google Scholar
    • Export Citation
  • Godart, N.T., Flament, M.F., Perdereau, F., & Jeammet, P. (2002). Comorbidity between eating disorders and anxiety disorders: A review. International Journal of Eating Disorders, 32(3), 253270. PubMed ID: 12210640 doi:10.1002/eat.10096

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Goodwin, H., Haycraft, E., & Meyer, C. (2016). Disordered eating, compulsive exercise, and sport participation in a UK adolescent sample. European Eating Disorders Review, 24(4), 304309. PubMed ID: 26892196 doi:10.1002/erv.2441

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Green, M.A., Scott, N.A., Cross, S.E., Liao, K.Y., Hallengren, J.J., Davids, C.M., . . . Jepson, A.J. (2009). Eating disorder behaviours and depression: A minimal relationship beyond social comparison, selfesteem, and body dissatisfaction. Journal of Clinical Psychology, 65, 989999. PubMed ID: 19388056 doi:10.1002/jclp.20586

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Grilo, C., White, M., & Masheb, R. (2009). DSM-IV psychiatric disorder comorbidity and its correlates in binge eating disorder. International Journal of Eating Disorders, 42, 228234. PubMed ID: 18951458 doi:10.1002/eat.20599

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Gritti, A., Salvati, T., Catone, G., Pisano, S., Salerno, F., Mastroianni, M., & Bove, D. (2016). Subject at risk for eating disorders: Study of a population of children aged between 8 and 13 years. Journal of Food and Nutritional Disorders, 5(3), 14. doi:10.4172/2324-9323.1000199

    • Search Google Scholar
    • Export Citation
  • Hainline, B. (2015). Mind, body & sport: Understanding and supporting student-athlete mental wellness [PowerPoint slides on NCAA Sport Science Institute data].

    • Search Google Scholar
    • Export Citation
  • Harris, E.C., & Barraclough, B. (1998). Excess mortality of mental disorder. British Journal of Psychiatry, 173(1), 1153. doi:10.1192/bjp.173.1.11

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Hughes, L., & Leavey, G. (2012). Setting the bar: Athletes and vulnerability to mental illness. The British Journal of Psychiatry, 200(2), 9596. PubMed ID: 22297587 doi:10.1192/bjp.bp.111.095976

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Hulley, A.J., & Hill, A.H. (2001). Eating disorders and health in elite athlete runners. International Journal of Eating Disorders, 30(3), 312317. PubMed ID: 11746292 doi:10.1002/eat.1090

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Jewett, R., Sabiston, C.M., Brunet, J., O’Loughlin, E.K., Scarapicchia, T., & O’Loughlin, J. (2014). School sport participation during adolescence and mental health in early adulthood. Journal of Adolescent Health, 55(5), 640644. PubMed ID: 24928804 doi:10.1016/j.jadohealth.2014.04.018

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Jones, R.L., Glintmeyer, N., & McKenzie, A. (2005). Slim bodies, eating disorders and the coach-athlete relationship. International Review for the Sociology of Sport, 40, 377391. doi:10.1177/1012690205060231

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Kaye, W.H., Bulik, C.M., Thornton, L., Barbarich, N., & Masters, K. (2004). Comorbidity of anxiety disorders with anorexia and bulimia nervosa. American Journal of Psychiatry, 161(12), 22152221. PubMed ID: 15569892 doi:10.1176/appi.ajp.161.12.2215

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Kessler, R.C., Berglund, P., Demler, O., Jin, R., Merikangas, K.R., & Walters, E.E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62(6), 593602. PubMed ID: 15939837 doi:10.1001/archpsyc.62.6.593

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Levinson, C.A., Zerwas, S., Calebs, B., Forbush, K., Kordy, H., Watson, H., . . . Bulik, C.M. (2017). The core symptoms of bulimia nervosa, anxiety, and depression: A network analysis. Journal of Abnormal Psychology, 126(3), 340354. PubMed ID: 28277735 doi:10.1037/abn0000254

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Luce, K.H., & Crowther, J.H. (1999). The reliability of the Eating Disorder Examination Self-report Questionnaire Version (EDE-Q). International Journal of Eating Disorders, 25, 349351. PubMed ID: 10192002 doi:10.1002/(SICI)1098-108X(199904)25:3<349::AID-EAT15>3.0.CO;2-M

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Meng, X.L., Rosenthal, R., & Rubin, D.B. (1992). Comparing correlated correlation coefficients. Psychological Bulletin, 111(1), 172175. doi:10.1037/0033-2909.111.1.172

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Meyer, T.J., Miller, M.L., Metzger, R.L., & Borkovec, T.D. (1990). Development and validation of the Penn State Worry Questionnaire. Behaviour Research and Therapy, 28, 487495. PubMed ID: 2076086 doi:10.1016/0005-7967(90)90135-6

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Miller, P.R., Dasher, R., Collins, R., Griffiths, P., & Brown, F. (2001). Inpatient diagnostic assessments: 1. Accuracy of structured vs. unstructured interviews. Psychiatry Research, 105(3), 255264. PubMed ID: 11814544 doi:10.1016/S0165-1781(01)00317-1

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Mond, J.M., Hay, P., Rodger, B., Owen, C., & Beumont, P.J.V. (2004). Validity of the Eating Disorder Examination (EDE-Q) in screening for eating disorders in community samples. Behaviour Research and Therapy, 42, 551567. PubMed ID: 15033501 doi:10.1016/S0005-7967(03)00161-X

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Nemati, D., Rahmani-nia, F., & Mohebbi, H. (2018). Body dissatisfaction and pathogenic weight loss behaviors among Iranian women with different level of physical activity. PsyArXiy Preprints. doi:10.17605/OSF.IO/6X9AS

    • Search Google Scholar
    • Export Citation
  • Neves, C.M., Meireles, J.F.F., de Carvalho, P.H.B., Almeida, S.S., & Ferreira, M.E.C. (2016). Body dissatisfaction among artistic gymnasticsadolescent athletes and non-athletes. Revista Brasileira de Cineantropometria e Desempenho Humano, 18(1), 8292. doi:10.5007/1980-0037.2016v18n1p82

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Noetel, M., Miskovic-Wheatley, J., Crosby, R.D., Hay, P., Madden, S., & Touyz, S. (2016). A clinical profile of compulsive exercise in adolescent patients with anorexia nervosa. Journal of Eating Disorders, 4, 1. doi:10.1186/s40337-016-0090-6

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Pearlstein, T. (2016). Eating disorders and comorbidity. Archives of Women’s Mental Health, 4(3), 6778. PubMed ID: 29888799 doi:10.1007/s007370200002

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Penas-Lledo, E., Bulik, C.M., Lichtenstein, P., Larsson, H., & Baker, J.H. (2015). Risk for self-reported anorexia or bulimia nervosa based on drive for thinness and negative affect clusters/dimensions during adolescence: A three-year prospective study of the TChAD cohort. International Journal of Eating Disorders, 48(6), 692699. PubMed ID: 26013185 doi:10.1002/eat.22431

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Plateau, C.R., Arcelus, J., Leung, N., & Meyer, C. (2017). Female athlete experiences of seeking and receiving treatment for an eating disorder. Eating Disorders, 25(3), 273277. PubMed ID: 28051927 doi:10.1080/10640266.2016.1269551

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Reel, J.J., SooHoo, S., Petrie, T.A., Greenleaf, C., & Carter, J.E. (2010). Slimming down for sport: Developing a weight pressures in sport measure for female athletes. Journal of Clinical Sport Psychology, 4(2), 99111. doi:10.1123/jcsp.4.2.99

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Rosenbaum, P.R., & Rubin, D.B. (1983). The central role of the propensity score in observational studies for causal effects. Biometrika, 70(1), 4155. doi:10.1093/biomet/70.1.41

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Ruscio, A.M., Stein, D.J., Chiu, W.T., & Kessler, R.C. (2010). The epidemiology of obsessive-compulsive disorder in the National Comorbidity Survey Replication. Molecular Psychiatry, 15(1), 5363. PubMed ID: 18725912 doi:10.1038/mp.2008.94

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Stöber, J. (1998). Reliability and validity of two widely-used worry questionnaires: Self-report and self-peer convergence. Personality and Individual Differences, 24, 887890. doi:10.1016/S0191-8869(97)00232-8

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Storch, E.A., Roberti, J.W., & Roth, D.A. (2004). Factor structure, concurrent validity, and internal consistency of the beck depression inventory—Second edition in a sample of college students. Depression and Anxiety, 19, 187189. PubMed ID: 15129421 doi:10.1002/da.20002

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Sundgot-Borgen, J. (1993). Prevalence of eating disorders in elite female athletes. International Journal of Sport Nutrition, 3(1), 2940. PubMed ID: 8499936 doi:10.1123/ijsn.3.1.29

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Sundgot-Borgen, J., & Torstveit, M.K. (2004). Prevalence of eating disorders in elite athletes is higher than in the general population. Clinical Journal of Sport Medicine, 14(1), 2532. PubMed ID: 14712163 doi:10.1097/00042752-200401000-00005

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Taranis, L., Touyz, S., & Meyer, C. (2011). Disordered eating and exercise: Development and preliminary validation of the Compulsive Exercise Test (CET). European Eating Disorders Review, 19(3), 256268. PubMed ID: 21584918 doi:10.1002/erv.1108

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Thompson, R.A., & Sherman, R.T. (1999). Athletes, athletic performance, and eating disorders: Healthier alternatives. Journal of Social Issues, 55(2), 317337. doi:10.1111/0022-4537.00118

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Thompson, R.A., & Sherman, R.T. (2010). Eating disorders in sportNew York, NY: Taylor & Francis.

  • Turton, R., Goodwin, H., & Meyer, C. (2017). Athletic identity, compulsive exercise and eating psychopathology in long-distance runners. Eating Behaviors, 26, 129132. PubMed ID: 28325645 doi:10.1016/j.eatbeh.2017.03.001

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Ustün T.B., Kostanjsek N., Chatterji S., & Rehm J. (Eds.). (2010). Measuring health and disability: Manual for WHO Disability Assessment Schedule (WHODAS 2.0). Geneva, Switzerland: World Health Organization.

    • Search Google Scholar
    • Export Citation
  • Vannucci, A., Kass, A.E., Sinton, M.M., Aspen, V., Weisman, H., Bailey, J.O., . . . Taylor, C.B. (2012). An examination of the clinical impairment assessment among women at high risk for eating disorder onset. Behaviour Research and Therapy, 50, 407414. PubMed ID: 22516320 doi:10.1016/j.brat.2012.02.009

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Wollenberg, G., Shriver, L.H., & Gates, G.E. (2015). Comparison of disordered eating symptoms and emotion regulation difficulties between female college athletes and non-athletes. Eating Behaviors, 18, 16. PubMed ID: 25841217 doi:10.1016/j.eatbeh.2015.03.008

    • Crossref
    • Search Google Scholar
    • Export Citation
All Time Past Year Past 30 Days
Abstract Views 49 1 0
Full Text Views 2819 2806 70
PDF Downloads 351 351 20