Disordered Eating in Athletes
In a recent study of athletes, 17% showed a mental health illness, the second most prevalent being disordered eating. Disordered eating is particularly common in ascetic sports such as swimming, running, gymnastics, skating and combat sports. If you’re coaching an athletic team, or parenting an athlete, it’s critical to understand the impact of disordered eating in sport and how to recognize it.
Anorexia Nervosa (AN), Bulimia Nervosa (BN), and EDNOS (eating disorders not otherwise specified) are all forms of disordered eating. Anorexia Nervosa is characterized in two ways: restriction of food in-take and binge-purge eating. A person with a restrictive form of Anorexia will experience weight loss and maintain a low bodily weight through means of severe energy restriction and excessive exercise. Bulimia Nervosa is represented through binging and purging tendencies; massive amounts of food will be consumed and then excreted by an individual.
To an athlete struggling with Anorexia (Anorexia Athletica), achieving and maintaining an extremely low body weight is not a disorder but a mandate for optimal performance. Maintenance of weight becomes a huge part of defining athletic success. Furthermore, it is a sign of strength and self-discipline. The inability to control body weight is deemed failure: a sign of weakness and lack of self-control.
Regardless of whether or not you’re an athlete, persons suffering from anorexia nervosa tend to possess low self-esteem and lack a strong, holistic sense of self. Many athletes derive their self-identity from their sport. Consequently, their sense of self-worth and purpose cannot be differentiated from their athletic performance. This is particularly indicative of children who begin a sport at a young age, which consumes the majority of their adolescent years. Take for example a young gymnast who has trained vigorously at a gym, sacrificed a lot of play and social time over the years to achieve athletic success. She will find it difficult to acquire a sense of self away from gymnastics. This gymnast probably has little concept of herself outside of sport and therefore feels she has little to offer apart from her athletic ability. Athletic performance becomes the barometer by which she measures her worth. Thus, the athlete with AN views losing weight not only as a way to achieve that elusive “ideal” body weight but also as a means of improving performance and gaining self worth.
It’s often difficult to recognize AN among athletes because of their eccentric eating habits and rigorous training schedule. Sometimes athletes with AN will use the strenuous schedule as justification for poor eating habits. Furthermore, they often engage in additional exercise outside their regular training and will exercise through injury, and illness because of the fear associated with “taking time off.”
Individuals with Bulimia Nervosa (BN) are driven by a desire to lose weight and attain thinness, however, they often lack the rigid self-control of people struggling with Anorexia. It’s possible that those with Bulimia will appear self-confident and well adjusted, but harbor feelings of worthlessness and have low self-esteem. They may be able to keep their disordered eating habits hidden but their dissatisfaction over their body image will be evident in conversation. Athletes with BN mirror the behaviors of those who are non-athletic struggling with BN. Their moods, emotions, and body weight tend to be erratic just like their eating patterns characterized by repeated cycles of binging and purging.
It gets complicated with athletes because binge-purge cycles are less easy to define. According to DSM-IV, a binge is defined as eating “a large amount of food in a discrete period of time.” A large amount of food may be significantly different for an athlete as they consume more than average individuals. Their calorie intake must be significantly higher to match the energy outputted through exercise. What might be considered “overloading” in a normal circumstance may not be disordered eating but necessary refueling after a particularly intensive training session. For the athlete, the better indicator is not the amount it’s the athlete’s perception of the amount of food. (APA 1994 Fairburn and Brownell 2001)
Food restriction for an athlete with Bulimia Nervosa serves a dual purpose: weight loss and performance enhancement. A good performance can boost an athlete’s sense of self-worth, and therefore the athlete may reward him or herself with food, particularly forbidden foods. Indulging in ‘forbidden food” though may precipitate a binge and subsequent purge. A poor performance is a direct blow to the athlete’s fragile self-esteem and they may use food for comfort or to help ease the agony of defeat, which can motivate a binge and purge cycle. An athlete may also seek refuge in bingeing and purging behaviors to cope with the stress of performance, parental pressure, or difficulties with a coach or teammates.
The following questions when posed to your athlete may help to decipher whether or not they’re struggling or at risk of disordered eating:
1. What fills your thoughts?
Look for key words/ thoughts around image, weight control, fears and self-identity. A constant obsession with weight and body image can be indicators of disordered eating. Fears surrounding failure and a lack of self worth can be precursors or factors that motivate disordered eating behaviors.
2. When you think of “who you are” and “what you’re about” what fills your thoughts?
Look to see if your athlete has a strong sense of self- abilities, talents, beliefs and ideas outside of their sport, feeding their self-identity. If sport encompasses all their self worth, it’s time to encourage and engage the athlete in other endeavors that can expand their view of self.
3. What does failure at your sport mean?
Dealing with failure and disappointment in life is difficult for any person. Help an athlete cultivate a healthy understand of failure. Failure sets us on a trajectory of growth; it doesn’t make us less as individuals. Not being able to cope with the highs and lows of life can be crippling for someone’s mental health and lead them into unhealthy behaviors such as binge eating or purging.
Please remember that detecting disordered eating in athletes is a difficult thing to do. Talk to your family physician if you feel this is something impacting yourself, or a family member.
Additional Resources:
1. Kelty Mental Health
http://keltymentalhealth.ca/mental-health/disorders/eating-disorders
2. National Eating Disorder Information Center
http://www.nedic.ca/knowthefacts/definitions.shtml
3. Here to Help
http://www.heretohelp.bc.ca/publications/factsheets/eating-disorders
–Ashley Sherbino, Community Education Facilitator, CMHA Kelowna
Mental Core 