Eating disorders (EDs) are common amongst athletes, yet few receive treatment. Given that athletes have a unique set of risk factors for eating disorders and are faced with additional barriers to treatment, new models outside of face-to-face treatment are necessary to reach the population and provide more affordable, tailored, evidence-based care. One solution is to use digital mental health programs to provide primary or supplemental therapy. Digital programs can provide accessibility and privacy, and recent advancements allow for more personalized online experiences. However, there have been no studies to date that integrate technology-based tools to address the especially high prevalence rates of EDs in athletes. This paper describes how an integrated model that includes online screening linked to guided self-help programs, all adapted specifically for athletes, can be used to provide prevention and intervention of EDs in athletes.
Rachael E. Flatt and Craig Barr Taylor
Jenny H. Conviser, Amanda Schlitzer Tierney, and Riley Nickols
It is estimated that 1.6 million people in the United States are currently diagnosed with an eating disorder. Eating disorders (EDs) have high rates of morbidity and mortality and remain the most severe mental illness. Unfortunately, rates of EDs and disordered eating behaviors (DEBs) among athletes appear to be increasing. In this study, authors summarize ED-related risks that pose compromises in psychological and social functioning, medical health, and overall quality of life. The importance of early detection and formal evaluation in preserving the athlete’s health, well-being and sustaining successful sport participation, and performance are highlighted. Athlete-specific factors, which challenge the ease and accuracy of ED detection and assessment, are noted. The recommended components of effective ED assessment are identified, including use of self-report measures and clinical interviews conducted by ED certified and licensed professionals. The importance of being well informed in tenets of ED awareness, prevention and supporting early detection, and referral for formal ED assessment are noted. Conclusions reflect the vital roles that both the multidisciplinary sport personnel and the sport environment/culture play in reducing the serious health risks of DEBs and EDs. Each is needed to protect an athlete’s well-being while fostering safe and successful sport participation.
Sasha Gorrell and Drew A. Anderson
Purpose: The current study evaluated associations between exercise identity (Exercise Identity Scale; EIS), compulsive exercise (Compulsive Exercise Test; CET), and their association with Eating Disorder Examination – Questionnaire (EDE-Q) scores among adult runners registered for mid- and long-distance races (N = 282, 48.2% male). Methods: Runners of half and full marathon races completed the EIS, CET, and EDE-Q. Results: Regression analyses indicated that increased EIS, b = −.21, and CET, b = −3.25, scores contribute to decreased eating pathology amongst half-marathon runners; a significant interaction effect emerged for EIS × CET scores, b = .08, such that relations between EIS and EDEQ scores were significant among runners reporting either lower or higher CET scores. These associations were not demonstrated in marathon runners. Conclusions: Results suggest that it is beneficial to consider running status when addressing the effect that exercise identity and compulsive exercise may have on eating pathology in competitive runners.
A.P. (Karin) de Bruin and Raôul R.D. Oudejans
The aim of the study was to investigate if and how body image, taken from a contextual perspective, contributes to the eating disorder history. This qualitative study investigated the process of eating disorder development in eight elite women athletes in at-risk sports. The results showed that the relationship between eating disorder symptomatology and the sports environment was clearly recognized by the elite women athletes. Contextual body image, more specifically negative body-evaluations and upward body comparisons, appeared as an important factor in the development of eating disorders, particularly in the athletic context. It became clear that the two aesthetic and two endurance athletes as well as the two weight-class athletes in rowing described quite negative body evaluations in the context of sport, while some of them also recognized an impact of body image experiences in daily life. However, for both judokas, their eating disorder had nothing to do with their body image but was attributed to the weight-classes in their sport and accompanying weight making. Several unique trajectories and individual eating disorder histories were distinguished which confirms the value of taking a qualitative approach in investigating eating disorders in sport. We also discovered links between what the athletes had reported as contributors to their eating disorder history and how they told their stories by combining content analysis and narrative inquiry. Furthermore, the present study also highlights several critical aspects for prevention and treatment that should support sport federations and clinical sport psychologists in taking appropriate actions to deal more effectively with eating disorders in athletes.
Hayley Perelman, Joanna Buscemi, Elizabeth Dougherty, and Alissa Haedt-Matt
Body dissatisfaction is associated with marked distress and often precipitates disordered eating symptomology. Literature on body dissatisfaction in athletes appears to be mixed, perhaps because athletes vary along several key characteristics related to how they experience their bodies. This study sought to investigate group differences in body dissatisfaction between sex (men vs. women), sport type (lean-promoting vs. non-lean-promoting), and division level (Division I vs. Division III). Collegiate athletes (N = 191) completed a self-report measure of body dissatisfaction, demographics, and sport characteristics. A factorial ANOVA revealed that women reported greater body dissatisfaction compared to men regardless of division level and sport type. There was an interaction between sex and sport type such that men in lean-promoting sports reported greater body dissatisfaction than men in non-lean-promoting sports. Findings suggest that some athletes participating in lean-promoting sports may be at risk of developing significant body dissatisfaction. Research on body dissatisfaction in collegiate athletes can be used to develop clinical interventions that aim to reduce body dissatisfaction and the potential of developing disordered eating and related psychopathology.
Laura K. Fewell, Riley Nickols, Amanda Schlitzer Tierney, and Cheri A. Levinson
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.
Uta Kraus, Sophie Clara Holtmann, and Tanja Legenbauer
Disordered eating in athletes has been frequently studied with a particular emphasis on aesthetic sports. Lately, competitive rowing has come into the focus. It has been supposed that in competitive rowers eating disturbances occur more frequently compared to non-competitive rowers. The aim of the present study therefore is to investigate eating disturbances and mental health related issues in competitive and non-competitive rowers. N = 45 lightweight (LWR), n = 31 heavyweight (HWR) and n = 37 non-competitive rowers (NCR) participated in an online based survey during the beginning of the on-season asking for eating behaviour (SCOFF, EDI-2) and mental health problems (PHQ). Results showed that competitive rowers reported more eating disturbances and risky attitudes/behaviour compared to non-competitive rowers. LWR showed higher Drive for thinness compared to HWR. The regression analysis revealed that Drive for thinness and Bulimia predict eating disorder symptoms in rowers. These results emphasize the presence of serious eating disturbances in competitive rowing.
Jenny H. Conviser, Amanda Schlitzer Tierney, and Riley Nickols
Eating disorders (EDs) and disordered-eating behaviors (DEBs), pose a high risk of morbidity and mortality, threatening physical health, emotional health, and overall quality of life. Unfortunately, among athletes, prevalence rates continue to increase. This document summarizes the challenges of establishing and navigating the multidisciplinary care needed to effectively treat EDs and DEBs among athletes. The benefits of timely and frequent communication within the multidisciplinary treatment team (MDTT) are emphasized and discussed. Authors advise who should be selected as members of the MDTT and suggest that all personnel, including athletic coaches, athletic trainers, physical therapists, and certified fitness professionals be ED-informed and ED-sensitive. Vital components of care are noted including use of a variety of evidence-based psychotherapeutic modalities, interventions which target emotional regulation, and prioritize values based compassionate care. Authors caution that performance decrements and medical/physiological changes are not always easily observable in individuals with EDs and DEBs and therefore, attuned, consistent, and ongoing monitoring is needed. Consensus regarding previously established parameters for return to play and careful titration of physical activity throughout the ED recovery process are suggested as important for preserving health, preventing re-injury, or relapse and facilitating successful return to sport participation.
Andrea S. Hartmann, Florian Steenbergen, Silja Vocks, Dirk Büsch, and Manuel Waldorf
Fitness training to attain the lean body ideal is becoming increasingly popular among women. However, it remains unclear how the drive for leanness (DL), as compared to the drives for thinness (DT) and muscularity (DM), relates to body image pathology and substance use in female weight-trainers. Participants (N = 168) completed a survey assessing DL, DT, DM, eating and body dysmorphic disorder pathology, and substance use. DT and DM were related to eating disorder and body dysmorphic disorder symptoms (all r ≥ .29; all ps < .01), while DL only to the former (r = .19, p < .05). Supplement use was associated with DL and DM (r = .17 and .55; both p < .01) and pharmaceutical use with DT and DM (r ≥ .21; both p < .01). Female weight-trainers should not be neglected in body image disorder prevention, with a particular focus on DT and DM.
Dana K. Voelker and Justine J. Reel
The purpose of this qualitative investigation was to examine male competitive figure skaters’ experiences of weight pressure in sport. Specifically, male skaters’ perceptions of the ideal skating body, sources of weight pressure in elite figure skating, and the perceived role of their sport in shaping body image, athletic performance, eating, and exercise behaviors were explored. Through a social constructivist lens, an inductive thematic analysis was used to examine the contextual influences of the skating environment. Thirteen male figure skaters ages 16–24 (M = 18.53, SD = 3.33) with an average 10.38 years of skating experience (SD = 4.05) were interviewed. Skaters identified the parameters for the ideal body in skating along with specific weight pressures, body image concerns, and weight management strategies. Similar to female skaters, male skaters perceived that body image affected psychological factors that influence sport performance. Sport psychologists and consultants should be attentive to the skating environment and how specific performance and appearance demands may influence an athlete’s mindset.