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The Diagnostic Accuracy of Screening Tools to Detect Eating Disorders in Female Athletes

Alyssa J. Wagner, Casey D. Erickson, Dayna K. Tierney, Megan N. Houston, and Cailee E. Welch Bacon

Clinical Scenario:

Eating disorders in female athletes are a commonly underdiagnosed condition. Better screening tools for eating disorders in athletic females could help increase diagnosis and help athletes get the treatment they need.

Focused Clinical Question:

Should screening tools be used to detect eating disorders in female athletes?

Summary of Key Findings:

The literature was searched for studies that included information regarding the sensitivity and specificity of screening tools for eating disorders in female athletes. The search returned 5 possible articles related to the clinical question; 3 studies met the inclusion criteria (2 cross-sectional studies, 1 cohort study) and were included. All 3 studies reported sensitivity and specificity for the Athletic Milieu Direct Questionnaire version 2, the Brief Eating Disorder in Athletes Questionnaire version 2, and the Physiologic Screening Test to Detect Eating Disorders Among Female Athletes. All 3 studies found that the respective screening tool was able to accurately identify female athletes with eating disorders; however, the screening tools varied in sensitivity and specificity values.

Clinical Bottom Line:

There is strong evidence to support the use of screening tools to detect eating disorders in female athletes. Screening tools with higher sensitivity and specificity have demonstrated a successful outcome of determining athletes with eating disorders or at risk for developing an eating disorder.

Strength of Recommendation:

There is grade A evidence available to demonstrate that screening tools accurately detect female athletes at risk for eating disorders.

Cover Journal of Sport Rehabilitation

In Journal of Sport Rehabilitation Volume 25 (2016): Issue 4 (Jan 2016)

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Chilly Scenes of the 1992 Winter Games: The Mass Media and the Marginalization of Female Athletes

Gina Daddario

This article examines television’s portrayal of female athletes during the 1992 winter Games. Although women are depicted in physically challenging events that defy stereotypical notions of femininity, such as mogul skiing, luge, and the biathlon, rhetorical analysis suggests that the sports media reinforce a masculine sports hegemony through strategies of marginalization. These include the application of condescending descriptors, the use of compensatory rhetoric, the construction of female athletes according to an adolescent ideal, and the presentation of female athletes as driven by cooperation rather than competition.

Cover Sociology of Sport Journal

In Sociology of Sport Journal Volume 11 (1994): Issue 3 (Jan 1994)

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Athletic Body Image: Exploratory Interviews with Former Competitive Female Athlete

Christy Greenleaf

The purposes of this exploratory study were to examine athletic body image and social body image among former competitive female athletes. Additionally, the perceived influence of past competitive experiences on current body image was explored. In-depth interviews were conducted with six former competitive collegiate athletes. The participants ranged in age from 23 to 31, with a mean age of 26. Common factors reported as influencing how participants felt about their bodies as athletes included uniforms, teammates, appearance, fitness, and coach attitudes and behaviors. Participants’ experiences and feelings about their bodies in athletic and social settings varied. Participants recognized some conflict between their athletic body and social ideals, however this incongruence did not seem problematic for most of the participants. Across participants, their current feelings and thoughts about their bodies were based on their former competitive athletic bodies.

Cover Women in Sport and Physical Activity Journal

In Women in Sport and Physical Activity Journal Volume 11 (2002): Issue 1 (Apr 2002)

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Nutritional Aspects of Amenorrhea in the Female Athlete Triad

Joan E. Benson, Kathryn A. Engelbert-Fenton, and Patricia A. Eisenman

Female athletes experience a high incidence of menstrual abnormalities. This has critical health consequences because amenorrhea athletes are at greater risk of developing osteopenia and bone injury compared to normally menstruating athletes or nonathletic normally cycling females. Female performers and athletes are also at risk for developing disordered eating behaviors. There appears to be a connection between menstrual dysfunction, athletic training, and disordered eating, but how they relate is not fully understood. In this paper we explore how low calorie intakes, nutritional inadequacies, vegetarianism, low body fat stores, and specific training behaviors may contribute to the abnormal menstrual patterns seen in this population. Recommendations for the detection and prevention of eating and training problems and consequent menstrual abnormalities are included.

Cover International Journal of Sport Nutrition and Exercise Metabolism

In International Journal of Sport Nutrition and Exercise Metabolism Volume 6 (1996): Issue 2 (Jun 1996)

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Shot in Black and White: Visualized Framing in ESPN’s The Body Issue

Gregory A. Cranmer, Alexander L. Lancaster, and Tina M. Harris

The disparity in framing in sport media based on athlete race has historically garnered extensive attention. In the past, the media promoted historical stereotypes of Black athletes that emphasized their physical prowess and diminished their intellectual capacity. However, recent research provides evidence that these traditional frames are changing and that recent media coverage is more racially equitable or even contradicts old patterns. Advancing this critique further, the current study examined novel visual frames (i.e., the emphasis of athleticism, sporting context, and sexualization) of White and Black athletes in ESPN’s The Body Issue. The findings contradict historical patterns of representations of Black athletes through the identification of a shift in the framing patterns for Black male athletes, whereas Black female athletes still face frames that portray them in a stereotypical manner. This study recognizes these tensions while successfully illustrating the importance of examining the intersections of difference for revealing and confronting the unique portrayals of Black female athletes.

Cover International Journal of Sport Communication

In International Journal of Sport Communication Volume 9 (2016): Issue 2 (May 2016)

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Disordered Eating in Female Collegiate Gymnasts: Prevalence and Personality/Attitudinal Correlates

Trent A. Petrie

This study extended the examination of the eating disorders continuum to the population of female athletes. Participants (215 collegiate gymnasts) were classified as normal/nondisordered eaters, exercisers, bingers, dieter/restricters, subthreshold bulimics, or bulimics and were then compared on several personality and attitudinal measures. Results revealed that (a) over 60% of the gymnasts met the criteria for one of the intermediate disordered eating categories, (b) only 22% reported eating behaviors that could be classified as normal or nondisordered, and (c) higher levels of disordered eating disturbance, particularly bulimia nervosa, were associated with a desire to weigh less, lower body satisfaction, lower self-esteem, and greater endorsement of sociocultural values regarding women's attractiveness. The findings provide partial support for the eating continuum in female athletes, and suggest that disordered eating may be the normative behavior in this population. Implications for interventions as well as directions for future research are provided.

Cover Journal of Sport and Exercise Psychology

In Journal of Sport and Exercise Psychology Volume 15 (1993): Issue 4 (Jan 1993)

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Self-Presentation of Female Athletes: A Content Analysis of Athlete Avatars

Megan B. Shreffler, Meg G. Hancock, and Samuel H. Schmidt

Unlike traditional media, which frames female athletes in sexualized manners and in socially accepted roles such as mothers and girlfriends, user-controlled social-media Web sites allow female athletes to control the image and brand they wish to portray to the public. Using Goffman’s theory of self-presentation, the current study aimed to investigate how female athletes were portraying themselves via their Twitter avatar pictures. A total of 207 verified Twitter avatars of female athletes from 6 sports were examined through a content analysis. The avatars from each player were coded using the following themes: athlete as social being, athlete as promotional figure, “selfie,” athletic competence, ambivalence, “girl next door,” and “sexy babe.” The results revealed that athletic competence was the most common theme, followed by selfie and athlete as social being. Thus, when women have the opportunity to control their image through social media they choose to focus on their athletic identities.

Cover International Journal of Sport Communication

In International Journal of Sport Communication Volume 9 (2016): Issue 4 (Dec 2016)

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The Prevalence and Consequences of Subclinical Eating Disorders in Female Athletes

Katherine A. Beals and Melinda M. Manore

A growing body of evidence suggests that the prevalence of eating disorders and excessive concerns regarding body weight in certain subpopulations of female athletes are increasing. The pressure on female athletes to improve their performances and physiques, coupled with the general sociocultural demand placed on all women to be thin, often results in attempts to achieve unrealistic body size and body weight goals. For some female athletes the pressure to achieve and maintain a low body weight leads to potentially harmful patterns of restrictive eating or chronic dieting. This paper seeks to further delineate the characteristics of a recently identified subclinical eating disorder in female athletes: anorexia athletica. Research studies that support the existence of subclinical eating disorders will be reviewed. In addition, the possible physiological and psychological consequences of subclinical eating disorders will be explored.

Cover International Journal of Sport Nutrition and Exercise Metabolism

In International Journal of Sport Nutrition and Exercise Metabolism Volume 4 (1994): Issue 2 (Jun 1994)

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Policies on Screening Female Athletes for Iron Deficiency in NCAA Division I-A Institutions

Brandy S. Cowell, Christine A. Rosenbloom, Robert Skinner, and Stephanie H. Summers

Iron deficiency is the most prevalent nutritional deficiency in the United States. This condition has been reported to affect 60% of female athletes. The Centers for Disease Control and Prevention emphasize screening for anemia in women of childbearing age. The purpose of this study was to determine the number of National Collegiate Athletic Association (NCAA) Division I-A schools that implement screening for iron deficiency in female athletes as well as the screening policies for those who do. A link to an online survey was sent to 94 NCAA Division I-A schools to determine current practices concerning screening and treating female athletes for iron deficiency. There was a 58% response rate. Frequencies for each response were computed. Forty-three percent of responding institutions report screening female athletes for iron deficiency. This study suggests that screening for iron deficiency in female athletes at NCAA Division I-A schools is not a routine procedure and, for those who do screen, variability exists in the criteria for diagnosis, as well as in treatment protocols. Standard protocols for assessment and treatment of iron deficiency in female athletes need to be developed and implemented.

Cover International Journal of Sport Nutrition and Exercise Metabolism

In International Journal of Sport Nutrition and Exercise Metabolism Volume 13 (2003): Issue 3 (Sep 2003)

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Prevalence of Eating Disorders in Elite Female Athletes

Jorunn Sundgot-Borgen

This study examined the prevalence of eating disorders (ED) and the possible difference between ED symptoms and true ED by using questionnaires as compared with an interview and clinical evaluation in Norwegian elite female athletes (n=522) from 35 sports and nonathletic controls (n=448). In addition to the 117 athletes classified as "at risk" to develop ED, 90 subjects were randomly chosen, comprising 30 athletic controls, 30 at-risk nonathletes, and 30 nonathletic controls. All weIe interviewed and clinically examined. A significantly higher number of athletes (18%) than controls (5%) were found to actually suffer from ED, particularly athletes competing in sports in which leanness or a specific weight were considered important. When results from the screening study were compared to those from the interviews and clinical examinations, a significant underreporting of ED among athletes was demonstrated. The athletes also reported the use of other pathogenic methods in the screening study compared to what they reported in the interview. Nonathletes more correctly reported the use of pathogenic methods but overreported the prevalence of ED. Thus the issue of using questionnaires alone or in combination with personal interview/clinical examination merits further investigation.

Cover International Journal of Sport Nutrition and Exercise Metabolism

In International Journal of Sport Nutrition and Exercise Metabolism Volume 3 (1993): Issue 1 (Mar 1993)