Help-Seeking for Eating Pathology Among Collegiate Athletes: Examining Stigma and Perfectionism as Moderating and Mediating Mechanisms

Click name to view affiliation

Shelby J. Martin Ohio University

Search for other papers by Shelby J. Martin in
Current site
Google Scholar
PubMed
Close
*
and
Timothy Anderson Ohio University

Search for other papers by Timothy Anderson in
Current site
Google Scholar
PubMed
Close
*
Restricted access

Despite elevated risk of eating pathology (EP) among athletes, utilization of EP-treatment among athletes is low. Factors that may inhibit EP-help-seeking among athletes include perceived social stigma, self-stigma, and perfectionism. Heightened stigma associated with EP and sport climates may be exacerbated by negative perfectionism characteristic of athletes and decrease intentions to seek help for EP. We tested the following moderated-mediation model among a sample of collegiate athletes (N = 201) via online questionnaires: EP indirectly relates to EP help-seeking intentions through perceived and self-stigma and these relations are conditional on negative perfectionism. EP help-seeking intentions were negatively associated with EP severity, stigma, and negative perfectionism. EP was related to eating-specific help-seeking intentions through perceived social stigma, influencing self-stigma, but this was not moderated by negative perfectionism. Targeting mental-health treatment stigma among athletes may reduce risk of untreated EP among collegiate athletes.

The authors are with the Department of Psychology, Ohio University, Athens, OH.

Address author correspondence to Shelby J. Martin at sm221714@ohio.edu.
  • Collapse
  • Expand
  • Ali, K., Farrer, L., Fassnacht, D.B., Gulliver, A., Bauer, S., & Griffiths, K.M. (2017). Perceived barriers and facilitators towards help-seeking for eating disorders: A systematic review. International Journal of Eating Disorders, 50, 921. PubMed ID: 27526643 doi:10.1002/eat.22598

    • Crossref
    • Search Google Scholar
    • Export Citation
  • American Psychiatric Association Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: American Psychiatric Publishing.

    • Search Google Scholar
    • Export Citation
  • Arcelus, J., Mitchell, A.J., Wales, J., & Nielsen, S. (2011). Mortality rates in patients with anorexia nervosa and other eating disorders: A meta-analysis of 36 studies. Archives of General Psychiatry, 68, 724731. PubMed ID: 21727255 doi:10.1001/archgenpsychiatry.2011.74

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Atkinson, D.R., & Gim, R.H. (1989). Asian-American cultural identity and attitudes toward mental health services. Journal of Counseling Psychology, 36, 209212. doi: 10.1037/0022-0167.36.2.209

    • 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, 199215. PubMed ID: 27897463 doi:10.1080/10640266.2016.1258940

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Bardone-Cone, A.M., Wonderlich, S.A., Frost, R.O., Bulik, C.M., Mitchell, J.E., Uppala, S., & Simonich, H. (2007). Perfectionism and eating disorders: Current status and future directions. Clinical Psychology Review, 27, 384405. PubMed ID: 17267086 doi:10.1016/j.cpr.2006.12.005

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Becker, A.E., Hadley Arrindell, A., Perloe, A., Fay, K., & Striegel-Moore, R.H. (2010). A qualitative study of perceived social barriers to care for eating disorders: Perspectives from ethnically diverse health care consumers. International Journal of Eating Disorders, 43, 633647. PubMed ID: 19806607 doi:10.1002/eat.20755

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Blair, L., Aloia, C.R., Valliant, M.W., Knight, K.B., Garner, J.C., & Nahar, V.K. (2017). Association between athletic participation and the risk of eating disorder and body dissatisfaction in college students. International Journal of Health Sciences, 11, 812. PubMed ID: 29085261

    • Search Google Scholar
    • Export Citation
  • Clement, S., Schauman, O., Graham, T., Maggioni, F., Evans-Lacko, S., Bezborodovs, N., … Thornicroft, G. (2015). What is the impact of mental health-related stigma on help-seeking? A systematic review of quantitative and qualitative studies. Psychological Medicine, 45, 1127. PubMed ID: 24569086 doi:10.1017/S0033291714000129

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Demyan, A.L., & Anderson, T. (2012). Effects of a brief media intervention on expectations, attitudes, and intentions of mental health help seeking. Journal of Counseling Psychology, 59, 222229. doi: 10.1037/a0026541

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Delenardo, S., & Terrion, J.L. (2014). Suck it up: Opinions and attitudes about mental illness stigma and help-seeking behaviour of male varsity football players. Canadian Journal of Community Mental Health, 33, 4356. doi:10.7870/cjcmh-2014-023

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Eisenberg, D., Downs, M.F., Golberstein, E., & Zivin, K. (2009). Stigma and help seeking for mental health among college students. Medical Care Research and Review, 66, 522541. PubMed ID: 19454625 doi:10.1177/1077558709335173

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Evans, E.J., Hay, P.J., Mond, J., Paxton, S.J., Quirk, F., Rodgers, B., … Sawoniewska, M.A. (2011). Barriers to help-seeking in young women with eating disorders: A qualitative exploration in a longitudinal community survey. Eating Disorders, 19, 270285. PubMed ID: 21516551 doi:10.1080/10640266.2011.566152

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Fairburn, C.G., & Beglin, S.J. (1994). Assessment of eating disorders: Interview or self-report questionnaire? The International Journal of Eating Disorders, 16, 363370. PubMed ID: 7866415 doi:10.1002/1098-108X(199412)

    • Search Google Scholar
    • Export Citation
  • Fedewa, B.A., Burns, L.R., & Gomez, A.A. (2005). Positive and negative perfectionism and the shame/guilt distinction: Adaptive and maladaptive characteristics. Personality and Individual Differences, 38, 16091619. doi:10.1016/j.paid.2004.09.026

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Fulkerson, J.A., Keel, P.K., Leon, G.R., & Dorr, T. (1999). Eating‐disordered behaviors and personality characteristics of high school athletes and nonathletes. International Journal of Eating Disorders, 26, 7379. PubMed ID: 10349586 doi:10.1002/(SICI)1098-108X(199907)26:1<73::AID-EAT9>3.0.CO;2-F

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Gulliver, A., Griffiths, K.M., & Christensen, H. (2010). Perceived barriers and facilitators to mental health help-seeking in young people: A systematic review. BMC Psychiatry, 10, 113. PubMed ID: 21192795 doi:10.1186/1471-244X-10-113

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Gulliver, A., Griffiths, K.M., & Christensen, H. (2012). Barriers and facilitators to mental health help-seeking for young elite athletes: A qualitative study. BMC Psychiatry, 12, 157. PubMed ID: 23009161 doi:10.1186/1471-244X-12-157

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Gulliver, A., Griffiths, K.M., Christensen, H., Mackinnon, A., Calear, A.L., Parsons, A., … Stanimirovic, R. (2012). Internet-based interventions to promote mental health help-seeking in elite athletes: An exploratory randomized controlled trial. Journal of Medical Internet Research, 14, e69. PubMed ID: 22743352 doi:10.2196/jmir.1864

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Haase, A.M., Prapavessis, H., & Owens, R.G. (2002). Perfectionism, social physique anxiety and disordered eating: A comparison of male and female elite athletes. Psychology of Sport and Exercise, 3, 209222. doi:10.1016/S1469-0292(01)00018-8

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Hackler, A.H., Vogel, D.L., & Wade, N.G. (2010). Attitudes toward seeking professional help for an eating disorder: The role of stigma and anticipated outcomes. Journal of Counseling & Development, 88, 424431. doi:10.1002/j.1556-6678.2010.tb00042.x

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Hayes, A.F. (2013). Introduction to mediation, moderation, and conditional process analysis: A regression-based approach. New York, NY: Guilford Press.

    • Search Google Scholar
    • Export Citation
  • Jorm, A.F., Medway, J., Christensen, H., Korten, A.E., Jacomb, P.A., & Rodgers, B. (2000). Public beliefs about the helpfulness of interventions for depression: Effects on actions taken when experiencing anxiety and depression symptoms. The Australian And New Zealand Journal Of Psychiatry, 34, 619626. PubMed ID: 10954393 doi:10.1080/j.1440-1614.2000.00761.x

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Katzman, D.K. (2005). Medical complications in adolescents with anorexia nervosa: A review of the literature. International Journal of Eating Disorders, 37, S52S59. doi:10.1002/eat.20118

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Kessler, R.C., Berglund, P.A., Bruce, M.L., Koch, J.R., Laska, E.M., Leaf, P.J., … Wang, P.S. (2001). The prevalence and correlates of untreated serious mental illness. Health Services Research, 36, 9871007. PubMed ID: 11775672

    • Search Google Scholar
    • Export Citation
  • Lipson, S.K., Jones, J.M., Taylor, C.B., Wilfley, D.E., Eichen, D.M., Fitzsimmons-Craft, E.E., & Eisenberg, D. (2017). Understanding and promoting treatment-seeking for eating disorders and body image concerns on college campuses through online screening, prevention and intervention. Eating Behaviors, 25, 6873. PubMed ID: 27117825 doi:10.1016/j.eatbeh.2016.03.020

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Luce, K.H., Crowther, J.H., & Pole, M. (2008). Eating Disorder Examination Questionnaire (EDE-Q): Norms for undergraduate women. International Journal of Eating Disorders, 41, 273276. PubMed ID: 18213686 doi:10.1002/eat.20504

    • Crossref
    • Search Google Scholar
    • Export Citation
  • MacKinnon, D.P., Lockwood, C.M., & Williams, J. (2004). Confidence limits for the indirect effect: Distribution of the product and resampling methods. Multivariate Behavioral Research, 39, 99128. doi:10.1207/s15327906mbr3901_4

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Martin, S.J., & Anderson, T. (2019). Increasing help-seeking for disordered eating and exercise among collegiate athletes: An examination of a novel, customized intervention. Manuscript in preparation.

    • Search Google Scholar
    • Export Citation
  • Mills, J.S., & Blankstein, K.R. (2000). Perfectionism, intrinsic vs extrinsic motivation, and motivated strategies for learning: A multidimensional analysis of university students. Personality and Individual Differences, 29, 11911201. doi: 10.1016/S0191-8869(00)00003-9

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Mond, J.M., Hay, P.J., Rodgers, B., & Owen, C. (2007). Health service utilization for eating disorders: Findings from a community‐based study. International Journal of Eating Disorders, 40, 399408. PubMed ID: 17497708 doi:10.1002/eat.20382

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Mond, J.M., Hay, P.J., Rodgers, B., Owen, C., & Beumont, P.J.V. (2004). Validity of the eating disorder examination questionnaire (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
  • Nam, S.K., Choi, S.I., Lee, J.H., Lee, M.K., Kim, A.R., & Lee, S.M. (2013). Psychological factors in college students’ attitudes toward seeking professional psychological help: A meta-analysis. Professional Psychology: Research and Practice, 44, 3745. doi:10.1037/a0029562

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Norcross, D.R., & Wampold, B.E. (2011). Evidence-based therapy relationships: Research conclusions and clinical practices. Psychotherapy, 48, 98102. doi: 10.1037/0022-0167.36.2.209

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Oakley Browne, M.A., Wells, J.E., Scott, K.M., & Mcgee, M.A. (2006). Lifetime prevalence and projected lifetime risk of DSM‐IV disorders in Te Rau Hinengaro: The New Zealand mental health survey. Australian and New Zealand Journal of Psychiatry, 40, 865874. PubMed ID: 16959012 doi:10.1080/j.1440-1614.2006.01905.x

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Peterson, S.L., Weber, J.C., & Trousdale, W.W. (1967). Personality traits of women in team sports vs. women in individual sports. Research Quarterly. American Association for Health, Physical Education and Recreation, 38, 686690. doi:10.1080/10671188.1967.10616513

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Rao, D., Feinglass, J., & Corrigan, P. (2007). Racial and ethnic disparities in mental illness stigma. The Journal of Nervous and Mental Disease, 195, 10201023. PubMed ID: 18091196 doi:10.1097/NMD.0b013e31815c046e

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Rice, S.M., Purcell, R., De Silva, S., Mawren, D., McGorry, P.D., & Parker, A.G. (2016). The mental health of elite athletes: A narrative systematic review. Sports Medicine, 46, 13331353. PubMed ID: 26896951 doi:10.1007/s40279-016-0492-2

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Rome, E.S., & Ammerman, S. (2003). Medical complications of eating disorders: An update. Journal of Adolescent Health, 33, 418426. PubMed ID: 14642704 doi: 10.1016/j.jadohealth.2003.07.002

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Shim, S.S., Rubenstein, L.D., & Drapeau, C.W. (2016). When perfectionism is coupled with low achievement: The effects on academic engagement and help seeking in middle school. Learning and Individual Differences, 45, 237244. doi:10.1016/j.lindif.2015.12.016

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Sirey, J.A., Bruce, M.L., Alexopoulos, G.S., Perlick, D.A., Raue, P., Friedman, S.J., & Meyers, B.S. (2001). Perceived stigma as a predictor of treatment discontinuation in young and older outpatients with depression. American Journal of Psychiatry, 158, 479481. PubMed ID: 11229992 doi:10.1176/appi.ajp.158.3.479

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Stewart, M.C., Keel, P.K., & Schiavo, R.S. (2006). Stigmatization of anorexia nervosa. International Journal of Eating Disorders, 39, 320325. PubMed ID: 16523470 doi:10.1002/eat.20262

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

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Sundgot-Borgen, J., & Torstveit, M.K. (2010). Aspects of disordered eating continuum in elite high‐intensity sports. Scandinavian Journal of Medicine & Science in Sports, 20, 112121. doi: 10.1111/j.1600-0838.2010.01190.x

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Terry-Short, L.A., Owens, R.G., Slade, P.D., & Dewey, M.E. (1995). Positive and negative perfectionism. Personality and Individual Differences, 18, 663668. doi:10.1016/0191-8869(94)00192-U

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Thompson, A., Petrie, T., & Anderson, C. (2017). Eating disorders and weight control behaviors change over a collegiate sport season. Journal of Science and Medicine in Sport, 20, 808813. PubMed ID: 28416353 doi:10.1016/j.jsams.2017.03.005

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Thompson, R.A., & Sherman, R.T. (2011). Eating disorders in sport. New York, NY: Routledge, Taylor & Francis Group.

  • Topkaya, N. (2014). Gender, self-stigma, and public stigma in predicting attitudes toward psychological help-Seeking. Educational Sciences: Theory and Practice, 14, 480487. doi:10.12738/estp.2014.2.1799

    • Search Google Scholar
    • Export Citation
  • Tuliao, A.P., & Velasquez, P.A. (2014). Revisiting the general help seeking questionnaire: Adaptation, exploratory factor analysis, and further validation in a Filipino college student sample. Philippine Journal of Psychology, 47, 117.

    • Search Google Scholar
    • Export Citation
  • Vogel, D.L., Wade, N.G., & Ascheman, P.L. (2009). Measuring perceptions of stigmatization by others for seeking psychological help: Reliability and validity of a new stigma scale with college student. Journal of Counseling Psychology, 56, 301308. doi:10.1037/a0014903

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Vogel, D.L., Wade, N.G., & Haake, S. (2006). Measuring the self-stigma associated with seeking psychological help. Journal of Counseling Psychology, 53, 325337. doi:10.1037/0022-0167.53.3.325

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Vogel, D.L., Wade, N.G., & Hackler, A.H. (2007). Perceived public stigma and the willingness to seek counseling: The mediating roles of self-stigma and attitudes toward counseling. Journal of Counseling Psychology, 54, 4050. doi:10.1037/0022-0167.54.1.40

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Vogel, D.L., Wester, S.R., Wei, M., & Boysen, G.A. (2005). The role of outcome expectations and attitudes on decisions to seek professional help. Journal of Counseling Psychology, 52, 459470. doi:10.1037/0022-0167.52.4.459

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Wang, P.S., Lane, M., Olfson, M., Pincus, H.A., Wells, K.B., & Kessler, R.C. (2005). Twelve-month use of mental health services in the United States: Results from the National Comorbidity Survey Replication. Archives of General Psychiatry, 62, 629640. PubMed ID: 15939840 doi:10.1001/archpsyc.62.6.629

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Wilson, C.J., Deane, F.P., & Ciarrochi, J. (2005). Can hopelessness and adolescents’ beliefs and attitudes about seeking help account for help negation? Journal of Clinical Psychology, 61, 15251539. PubMed ID: 16173086 doi:10.1002/jclp.20206

    • Crossref
    • Search Google Scholar
    • Export Citation
All Time Past Year Past 30 Days
Abstract Views 2901 676 24
Full Text Views 236 164 35
PDF Downloads 111 41 4