Most athletes are highly competitive and self-disciplined and will go to great lengths to excel in their sports. Their personality traits and characteristics typically reflect obsessive-compulsive tendencies in the way in which they approach their sporting pursuits. The pressure they often experience with the expectations of teammates and coaches as well as spectators may make them at a higher risk for developing an eating disorder than the average person. Perhaps the self-imposed pressure to achieve their goals as an athlete makes them more predisposed to develop an eating disorder. Furthermore, athletes who compete in sports that emphasize appearance or require speed, lightness, agility and quickness (i.e., runners, ballerinas, and cyclists) are at higher risk for developing an eating disorder than are non-athletes or athletes in sports that require muscle mass and bulk (football players).
Eating disorders are most common in athletes that participate in the following sports:
- ballet and other dance
- figure skating or other types of competitive skating
- gymnastics
- running or marathon runners
- swimming / diving
- rowing
- horse racing
- wrestling
- race car drivers
Both men and women athletes are susceptible to eating disorders, although the female gender has a higher prevalence. However, our clinical experience and recent studies have shown that more male athletes are seeking out treatment for their eating disorders. More specifically, the male heterosexuals in general have often been misdiagnosed and are more likely to pursue treatment for a formal eating disorder. The three most common formal eating disorders found in athletes are:
- Anorexia Nervosa
- Bulimia
- Compulsive Exercise
The real threat to an athlete with an eating disorder is the extreme stress placed upon the body. The compensatory behaviors such as restricting, binging, purging or excessive exercise have detrimental effect on performance. The process of binging and purging results in loss of fluid and low potassium levels, which can cause extreme weakness, as well as dangerous and sometimes lethal heart rhythms.
The Female Athlete Triad
Women athletes with eating disorders often fit into a condition called the female athlete triad, a combination of:
- Depleted energy levels (eating disorders)
- Menstrual irregularities (amenorrhea which is defined as the cessation of at least 3 consecutive menstrual cycles)
- Weak bones (increased risk of stress fractures and osteoporosis)
The relentless pursuit to become thin and attempt to reduce body fat or adipose tissue by extreme measures has a negative impact on exercise performance and introduces a host of health complications. Nutrient deficiencies and fluid/electrolyte imbalance from restrictive caloric intake can lead to increased risk of fractures, illness, loss of reproductive function (amenorrhea) or infertility complications and serious medical conditions such as dehydration and starvation. The medical complications of this triad involve the majority of body functions and include the cardiovascular, endocrine, reproductive, skeletal, gastrointestinal, renal, and central nervous systems.
Many athletes mistakenly think they’re not at risk for osteoporosis because they exercise and exercise is known to strengthen bones. However, research shows that exercise alone does not prevent bone loss. Irreversible bone loss starts within six months to two years after the loss of menses. Comorbidity diagnoses such as depression, anxiety disorders and obsessive-compulsive disorders often coexist with formal eating disorders.
Warning Signals of an Eating Disorder
A number of factors predispose an athlete to developing an eating disorder. Risk factors include the following:
- Preoccupation with food and weight
- Repeatedly expressed concerns about being fat
- Pressure from influential people (coaches or parents) to lose weight to improve sports performance
- Increasing criticism of one’s body or distorted body image
- Over involvement in sports, with limited other social and recreational activities
- Frequent eating alone or social isolation
- Personality traits that are genetically predisposed such as perfectionism
- Higher levels of stress, anxiety and depression which can be genetically predisposed
- Training outside of scheduled practice times or more than other athletes on the team
- Use of laxatives or diuretics
- Trips to the bathroom during or following meals and purging
- Continuous drinking of diet soda or water
- Compulsive, excessive exercise
- Poor performance
- Complaining of always being cold
- Training even when sick or injured
- A traumatic event
- Consistent injuries