The increased risk and difficult detection of eating disorders among athletes1 Opinion
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Tags:AnorexiaEating DisordersFeaturedMental HealthPsychology of SportSport PsychologySports Psychology
About Helen Oliver
Sport Psychology MSc student at Cardiff Metropolitan University, working with Golf Union Wales, and researching resilience and growth amongst injured athletes.
As a physically active population, athletes are typically viewed by the general public as healthy and strong, and so are not considered to be an at risk group for suffering from eating disorders. However this perception is part of the reason that eating disorders can be overlooked in sport.
The National Eating Disorders Association (NEDA) has reported that one-third of female athletes present with symptoms and attitudes which place them at risk for anorexia nervosa. Yet the problem is increasing in male athletes who are also presenting with extreme emotions and behaviours concerning weight and food issues. Particularly in sports such as wrestling and running, which have weight requirements or emphasise muscularity, pressure is placed upon the body shapes of athletes.
Although previous research reports no increased risk for athletes in eating disorders, it is beginning to be recognised that such findings may in fact reflect methodology rather than the phenomenon (Martinsen & Sundgot-Borden, 2013). Eating disorders may have a different presentation in athletes which diagnostic measures leading to such findings are not sensitive to. Therefore, using the same self-report questionnaires to identify athletes at risk of an eating disorder as nonathletes might breed inaccurate results because the specific psychological concerns at the centre of the disorder can differ. For example, in nonathletes disturbed behaviours are often associated with an undue importance of body shape in determining self-worth. However among adolescent athletes there is a tendency to remain satisfied with their body image, yet engage in disordered eating as it is viewed as a normal part of their sport (Martinsen & Sundgot-Borden, 2013). So, rather than report the dissatisfaction which typically suggests psychopathology, individuals may not realise they have an eating disorder as their behaviours instead reflect dedication to sport. Another factor making eating disorders harder to recognise among athletes comes from their strict training regimes. Signs of weight fluctuation indicating bingeing behaviours seen in bulimia nervosa can be difficult to see due to intense training retaining an appearance of normal weight. Athletes have also been found to underreport and mask their issues with eating to a higher degree than comparable populations when presented with questionnaires (Nattiv et al., 2007). Sport performers face repercussions such as being dropped from their sport or loss of contract upon revealing their disorder. Such threats to their identity can make athletes increasingly deceptive over eating behaviours.
Both difficult detection and underreporting in athletes suggests that the problem of eating disorders is much larger in sport than is currently recognised, and screening instruments should be reviewed to reflect these issues.
So what puts athletes in particular at risk?
The NEDA acknowledges that the pressures and stress presented by athletic competition in addition to the cultural emphasis for thinness poses an increased risk for athletes. With a belief that lower weight will improve performance, athletes may begin to restrict eating and engage in weight-control behaviours to achieve higher rankings in their sport. Furthermore, sports performers are judged on appearance, and wearing physique-revealing kits can increase the importance of body image. These factors put athletes at higher risk of eating disorder as they occur in addition to social influences which nonathletes already face. Another aspect which may cause food to be the centre of attention may be the lack of control which athletes have over other aspects of their lives. With coaches, managers, athletic trainers, nutritionists, physiotherapists and psychologists all outlining athlete’s schedules, sports performers may feel out of control of life decisions. Facing boundaries in these other areas can manifest into athletes taking charge of what they can – eating behaviours.
Eating disorders seriously compromise the health of the sufferer and so should be taken as a serious issue. Athletes should be educated on the consequences of eating disorders, such as stress fractures occurring from lack of calcium and insufficient nutrition. Raising awareness of the long-term consequences may prevent athletes for developing maladaptive behaviours and enable those suffering to recognise problems. There is also a need to promote team cultures where everyone is honest about eating habits, in order to avoid encouraging the deceptive behaviours typical of eating disorders. Such an environment can act as a protective factor where athletes feel supported. Sharing healthy attitudes towards size and shape will also prevent misperceptions of what actually leads to improved performances, and of what other athletes eat.