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

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

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)

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

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

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

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

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

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

NCAA Study on Athletes and Eating Disorders 1,145 student athletes from 11 Division 1 schools 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 Males-mean desired body fat 8.6% & mean actual body fat 10.5% (healthy = 10% - 15%)

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

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

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

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

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

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

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.

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.

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

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.

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

Questions?