Understanding Eating Disorders and Athletes

1. Understanding Eating Disorders and Athletes Stephanie Chervinko, Ph.D. University of West Florida Counseling Center

2. Overview • Definitions, diagnostic criteria • Prevalence • Factors unique to athletes • Warning signs • Intervention

3. Diagnostic Criteria • Anorexia Nervosa • Refusal to maintain minimally healthy body weight for age and height • Intense fear of gaining weight, even though underweight • Disordered body image • Amenorrhea (absence of 3 consecutive menstrual cycles)

4. Diagnostic Criteria • Bulimia Nervosa • Recurrent episodes of binge eating • Recurrent inappropriate compensatory behavior in order to prevent weight gain • Binge eating and compensatory behaviors occur on average twice a week for 3 months • Self-evaluation unduly influenced by body shape and weight

5. Diagnostic Criteria • Eating Disorders Not Otherwise Specified (EDNOS) • Atypical or subclinical eating disorder • Criteria for anorexia met except amenorrhea or weight • Binge eating disorder

6. Anorexia Athletica • Subclinical eating disorder frequently found in athletes • Individuals <5% of expected body weight • Fear of becoming fat • Restriction of food to <1200 kcal • Compulsive exercise • Amenorrhea • Occasional binge/purge

7. Female Athlete Triad • Disordered eating (AN, BN, EDNOS) • Amenorrhea • Osteoporosis – loss of bone density

8. Prevalence • Normative for young women to experience body dissatisfaction and desire weight loss • Sociocultural demands placed on women to be thin along with pressure from sport to meet weight standards or body size expectations of sport • ~33% of female college athletes report disordered eating

9. Prevalence and Men • Sociocultural demands placed on men to achieve a particular physique along with pressure from sport to meet weight standards or body size expectations of sport • ~16% of individuals with eating disorders are male (increasing) • ~25% of individuals with binge eating disorder are male • Gay men particularly at risk

10. NCAA Study on Athletes and Eating Disorders • 1,145 student athletes from 11 Division 1 schools • Females-mean desired body fat 13% & mean actual body fat 15.4% (healthy = 17% - 25%) • Females-173 had BMI 15-20 • Males-mean desired body fat 8.6% & mean actual body fat 10.5% (healthy = 10% - 15%)

11. Factors Unique to Athletes • No single cause for eating disorders • Sport body stereotype – “thin-build sports” • Expectation for athletes in certain sports to display a characteristic body size and shape • Fitted uniforms, body on display • Belief that thinness enhances performance

12. Factors Unique to Athletes • Symptoms vs desired characteristics of athletes • Driven personality • Perfectionists • People pleasers • Obsessive-compulsive tendencies • High pain tolerance • Size increase due to weight training

13. Factors Unique to Athletes • Stress of being in the spotlight • Balancing multiple role demands

14. Warning Signs • Physical • Intolerance to cold • Dizziness, fainting spells • Constipation • Loss of muscle tone • Frequent weight fluctuations • Impaired concentration • Swollen salivary glands, puffiness in cheeks • Broken blood vessels in eyes • Complains of sore throat, fatigue, & muscle aches • Tooth decay, receding gums

15. Warning Signs • Behavioral • Restricted food intake • Eliminating specific foods or whole food groups • Fear of food, avoiding situations where food is present • Excuse of “picky” eater, despite previous flexible eating • Excessive exercise • Regular weighing • Frequent comments about own weight, calories, food fat content • Frequent bathroom visits following meals • Moodiness • Withdrawal from others

16. Warning Signs • Attitudinal • Dichotomous thinking • Denial of eating problems • Perfectionistic standards • Harsh self-criticism • Self-worth determined by weight

17. Intervention: What to Do • Set aside time for a private, respectful meeting to discuss your concerns openly and honestly in a caring and supportive way. • Describe what you have seen and heard that has lead to your concerns. • Ask the person to explore these concerns with a counselor, doctor, or any health professional s/he feels comfortable enough to see. • Expect denial, rationalization, & anger.

18. Intervention: What to Do • Offer to accompany athlete to first medical or therapy appointment for support. • Emphasize place on team will not be endangered by admitting an eating disorder (coaches). • Add that participation will only be curtailed if eating disorder has compromised athlete’s health or put athlete at risk for injury (coaches). • Remember most athletes with eating disorders have tried and failed to solve the problem on their own.

19. Intervention: What to Do • Arrange for regular, private follow-up meetings apart from practice times. • Remember that many athletes who develop eating disorders have been told to lose weight. Past or present coaches may have contributed to eating disorder. • Let the athlete know that the demands of the sport may have played a role in the development of the problem. • When in doubt about how to intervene, consult, consult, consult

20. Intervention: What Not to Do • Don’t question teammates or talk to them about the athlete. Talk directly to athlete. • Don’t ignore the problem. Intervene • Never conclude that an athlete just isn’t trying hard enough to overcome an eating disorder. • Don’t try to keep the problem hidden or try to deal with it yourself.

21. Intervention: What Not to Do • Don’t get into a power struggle about whether there is a problem. • Don’t be deceived by excuses.

22. Questions?