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This is the first study developed in Portugal which investigates specific characteristics of dance
and gymnastics environments that make them high-risk contexts for the development of eating
disorders. Four focus groups were conducted with thirteen ballet students from a professional
dance school and nine gymnasts from a gymnastics club (aged 12 to 17 years old), which were
subjected to an inductive-deductive analysis procedure. Specific risk and protective factors were
identified. Among their respective sources of influence, teachers and coaches are those who
exert a stronger influence upon young athletes. We also explored some themes related to the
influence of peers, parents, and environmental characteristics, which could have an important
role on the development or prevention of disordered eating.
Keywords: eating disorders, ballet, gymnastics, adolescents, focus group.
Este es el primer estudio realizado en Portugal que tiene como objetivo investigar las
características específicas que en el mundo de la danza y de la gimnasia pudieran ser factores
de alto riesgo para el desarrollo de trastornos de la conducta alimentaria. Se realizaron cuatro
grupos focales con trece estudiantes de danza profesional y nueve gimnastas (de 12 a 17 años).
Las transcripciones de los grupos focales fueron sometidas a un procedimiento de análisis
inductivo-deductivo. Se identificaron factores de riesgo y protectores específicos. Entre las
respectivas fuentes de influencia, los profesores y entrenadores son los que ejercen mayor
influencia sobre los jóvenes atletas. También se exploraron algunos temas relacionados con la
influencia que tienen compañeros, padres y las características del entorno deportivo; los cuales
pueden tener un importante rol tanto en el desarrollo como en la prevención de comportamientos
alimentarios alterados.
Palabras clave: trastornos de la conducta alimentaria, ballet, gimnasia, adolescentes, grupo
focal.
Aesthetic Sports as High-Risk Contexts for Eating
Disorders – Young Elite Dancers and Gymnasts Perspectives
Rita Francisco1, Madalena Alarcão2, and Isabel Narciso1
1Universidade de Lisboa (Portugal)
2Universidade de Coimbra (Portugal)
The Spanish Journal of Psychology Copyright 2012 by The Spanish Journal of Psychology
2012, Vol. 15, No. 1, 265-274 ISSN 1138-7416
http://dx.doi.org/10.5209/rev_SJOP.2012.v15.n1.37333
This study was supported by a PhD Grant (SFRH/BD/27472/2006) from Fundação para a Ciência e a Tecnologia, Portugal.
The authors are grateful to the gymnasts and ballet students for their participation and to the parents, coaches, and teachers.
Correspondence concerning this article should be adressed to Rita Francisco. Faculdade de Psicologia, Alameda da Universidade.
1649-013 Lisboa (Portugal). E-mail: rmfrancisco@fp.ul.pt
265
Eating Disorders (ED), defined as abnormal eating habits
associated with a permanent worry about weight and body
image, have been considered a public health threat, mainly
affecting female adolescents and young adults. Over the last
three decades, a great number of studies have documented a
higher risk, prevalence, and incidence of ED among athletes,
compared with the general population (e.g. Garner &
Garfinkel, 1980; Hausenblas & Carron, 1999; Toro et al.,
2005). Striegel-Moore, Silberstein, and Rodin (1986) compared
the sporting environment to a subculture where the influence
of environmental and sociocultural factors is amplified.
Today’s society constantly pushes individuals into achieving
an “ideal” body through diets and exercise. However, athletes
are also exposed to the internal pressures of their sport, which
often overemphasize the link between peak performance and
a specific weight (Hausenblas & Carron, 1999; Toro et al.,
2005). On the other hand, high expectations and pressure
from parents, coaches, and teammates are among the main
factors causing ED (Dosil & González-Oya, 2008).
A meta-analysis of 34 studies ranging from 1975 to 1999
concerning female athletes and eating problems revealed
that elite athletes are more at risk of suffering from ED than
nonathletes or nonelite athletes, especially those from sports
in which the required body aesthetic demands thinness
(Smolak, Murnen, & Ruble, 2000). In fact, aesthetic sports,
such as rhythmic and artistic gymnastics, ice-skating, or
dance, are considered by Dosil and Díaz (2008), according
to the United States Olympic Committee criteria, as high-
risk sports for ED (as well as weight division sports, gym
sports, or endurance sports). The judges’ criteria which stress
thinness are another essential factor in the etiology of ED
in some sports (Thompson & Sherman, 1993). Therefore,
ballet dancers and gymnasts, for example, are more prone
to engaging in extreme and unhealthy eating and weight-
control behaviors (Engel et al., 2003; Petrie, 1993) in the
name of commitment and competition (Gvion, 2008;
Thompson & Sherman, 1999).Classical dance is considered
an art more than a sport by those who practice it. However,
as ballet is also the most physical of the performing arts
(Aalten, 2004), dancers can also be considered special
athletes. The long hours of daily physical training, the
pressure to maintain an extremely thin body to achieve
aesthetic and performance ideals, as well as the need to be
technically, artistically and aesthetically excellent (Davis &
Strachan, 2001; Koutedakis & Jamurtas, 2004; Krasnow,
2005; Schluger, 2010), are similar in both ballet and
gymnastics and make these activities interesting contexts
for the study of ED development risk.
In Portugal there are no studies reporting levels of
prevalence of ED among dancers or gymnasts. The latest
study showed that the prevalence of all ED was 3.06%
among female adolescents (0.39% for Anorexia Nervosa,
0.30% for Bulimia Nervosa, and 2.37% for Eating Disorders
Not Otherwise Specified––EDNOS) (Machado, Machado,
Gonçalves, & Hoek, 2007).
Toro and his colleagues (2005) studied Spanish athletes
from different sports and found a ratio of athletes with some
type of ED five times higher than that in the general
population (22.6% vs. 4.1%). Athletes competing in rhythmic
sports, such as gymnasts, displayed the highest percentages.
Another study (Dosil & Díaz, 2008) which analyzed the
relationships between athletes’ ideal and real weight reached
the conclusion that rhythmic gymnasts show high levels of
weight dissatisfaction (77.2% of them considered that their
real weight was above their ideal weight, according to the
weight required for their discipline, in which competition
judges reward an exceptionally thin body, when compared
with the ideal weight for the normal population). A study
of female ballet dancers (Ringham et al., 2006) revealed
that 83% of them reported some form of eating pathology,
including Anorexia Nervosa (6.9%), Bulimia Nervosa
(10.3%), and EDNOS (55%). Thomas, Keel, and Heatherton
(2005), upon comparing the prevalence of disordered eating
attitudes and behaviors among adolescent ballet dancers at
national, regional, and local schools, suggested a combination
of individual (e.g., perfectionism) and environmental (e.g.,
competition) variables as mediators of the phenotypic
expression of ED. Despite the fact that a dancer’s extra-thin
body is looked upon as a sign of ultimate control and
professional achievement (Gvion, 2008), it is necessary to
have an accurate understanding of the aspects of the dance
school environment and relationships established there, as
well as at gymnastics clubs, that may inhibit or contribute
to the development of an ED. It is well known that the
prevalence of ED is substantially higher among females
than males. For this reason, male athletes are rarely included
in studies of athletes’ eating behaviors (dancers are also
excluded because there are far fewer male than female
dancers). However, some of these few studies show that the
male athletes competing in sports that emphasize a lean
body shape or a low body weight also evidenced a
significantly higher prevalence of ED than other athletes
and non-athletes (e.g. Byrne & McLean, 2002). On the other
hand, male dancers and gymnasts are part of the systems
studied, so they can influence the development of ED among
girls’ counterparts positively or negatively, and should be
taken into account.
The purpose of this study was to understand the specifics
of dance and gymnastics’ environments that make them
high-risk contexts for the development of ED among female
and male adolescents, adopting a qualitative methodological
approach. We tried to investigate (a) specific types of
pressures and characteristics young Portuguese dancers and
gymnasts found within their contexts; (b) the way
teachers/coaches, peers/teammates, and parents sway their
body image and weight attitudes and behaviors; and (c)
specific environmental characteristics that could protect
young dancers and gymnasts from developing ED. The
ecological perspective, which considers the systems that
surround these adolescents and specifically understands the
FRANCISCO, ALARCÃO, AND NARCISO
266
Table 1
Focus group questions
1. When you hear about dance/gymnastics, what comes to your mind?
2. What would an ideal dancer/gymnast's body look and be like?
3. You live in an environment that greatly values the body and the physical appearance—does this have any impact on your life?
4. How is your relationship with your teachers/coaches?
5. How do your parents deal with the Dance School/Gym Club demands?
6. How do you live through auditions/competition exams?
forces shaping adolescents’ development (and possible ED)
in their environments, is an adequate theoretical frame to
answer these questions (Bronfenbrenner, 1979). As “seeing
research participants’ lives from the inside often gives a
researcher otherwise unobtainable views” (Charmaz, 2006,
p. 14), qualitative research is considered the best way to
explain processes and phenomena from specific contexts
(Miles & Huberman, 1994).
Method
Participants
The participants ( = 22; 11 females and 11 males) were
13 female and male ballet students (M= 14.6 years, SD =
1.56) from a professional Portuguese dance school, and 9
gymnasts (M= 15.1 years, SD = 1.27) from a Portuguese
gymnastics club, who compete at national and international
level.
Ballet students from different classes were separated
into two focus groups (FG) according to their artistic level
(FG1: 3rd to 5th levels; FG2: 6th to 8th levels), and gymnasts
were also separated according to their gymnastics disciplines
(FG3: artistic and rhythmic gymnastics; FG4: acrobatic
gymnastics). All of the participants’ parents gave written
authorization for their children to participate in the research,
and all of them signed informed consent.
Procedure
Focus groups were selected as a data collection method
because they are particularly useful for exploratory research
when little is known about the context (e.g. James, Rienzo,
& Frazee, 1997; Tiggemann, Gardiner, & Slater, 2000). The
goal is not to generalize to larger populations; instead, our
intention is to fully understand particular aspects through
the different ideas that emerge. The interaction between
participants enables them to express their views of the world
where they live, their beliefs and attitudes in their own
words. Thus, the participants were recruited through
purposive sampling, according to the project’s goal of
generating the most productive discussions possible with
the focus groups (Morgan, 1998). The session with each
group (60-90 min) was based on the questioning route with
open-ended questions developed for that purpose (see Table
1). The study was part of a PhD project (about the
individual, family, and environmental characteristics that
put young dancers and gymnasts at higher risk or protect
them from the development of ED) and as such was
scrutinized by the appropriate university research committees
and the Foundation for Science and Technology (Portugal).
The focus group discussions were recorded and
transcribed verbatim and subjected to an inductive-deductive
content analysis procedure. First, the focus groups’ data were
analyzed deductively for meaningful units (references), which
were defined as sets of phrases about the same topic. Then,
meaningful units that shared common features were identified
and organized into distinct categories and were combined to
form more abstract categories, as engaged in successive levels
of analysis (Charmaz, 2006), based on new labels or pre-
existing concepts in the literature. Triangulation by the
researchers helps to ensure the credibility and validity of the
research (Miles & Huberman, 1994). Therefore, raw data
responses were individually identified and grouped into
themes and subthemes developed by the first researcher and
checked for reliability and validity by a second researcher
until a consensus was reached. The QSR Nvivo7 software
(QSR, 2006) was used to search, store, explore, and organize
the qualitative material.
Results
The content analyses of the focus groups’ responses
yielded 84 interrelated categories, organized in a hierarchical
system. Two main categories were seen as having the most
potential for the purpose of the study:
1) Factors of Influence among dancers’ and gymnasts’
attitudes, behaviors, and well-being. They were separated
into risk factors for the development of problems among
young elite athletes (corresponding to 58% of the coded
references), protective factors (29%), and ambiguous factors
(because the type of the influence was not clarified by the
participants or it is not referred to in the literature; 13%).
Among the risk and protective factors, we have distinguished
those specifically related to ED and those related to problems
in general. The inclusion criteria in each category were a
AESTHETIC SPORTS AND EATING DISORDERS 267
FRANCISCO, ALARCÃO, AND NARCISO
268
reference to the theme by participants at focus groups or in
the literature reviewed.
2) Sources of Influence, which indicate the source of
the influence factors. We have found three main sources of
influence—dance school/gymnastics club (72%), classical
dance world/elite gymnastics world (13%), and parents (9%).
We will present a detailed analysis of each source of
influence upon dancers’ and gymnasts’ attitudes and
behaviors, to try to understand which factors appear to be
most related to each source. To provide insight into the
experiences of the participants, some of their quotations
are included within the explanation of each factor of
influence (names given to respondents are pseudonyms to
guarantee anonymity).
Results for Dancers
Dance School: Five essential categories emerged within
the dance school: teachers (31%), peers (13%), system
(culture and rules of dance school; 19%), training (15%),
and schedules (4%).
Teachers.Teachers appear to be the major source of
influence upon ballet students. The category most frequently
referred to was the negative relationship between teacher
and students (41.5%), which includes features such as
feeling that teachers are not accessible, fear of them, or
expressions of partiality (“showing preferences”) and
hostility toward students, which is likely to contribute to
lower self-esteem, poor perception of social support, and
so on.
Some teachers aren’t approachable (...) we can hardly
say Teacher, I’m in pain, what can I do? (Ana, 16-year-
old girl)
(...) in my first year, I had a teacher who acted like this
was the military (...) because when we did something wrong
she’d scream at us! (Carolina, 12-year-old girl)
This category is strongly related to some risk factors
for ED, such as pressure for thinness; emotional distress
(including anxiety, sadness, and frustration); and negative
comments about eating, weight, and body image (which
sometimes involve the indication of food restriction as a
weight control method). This appears to happen with both
female and male students but seems to be more frequent
and cause more emotional distress in girls.
They suffer a lot (...) sometimes they have to hear things
like you’re really fat! You’d better start losing weight! or
You’ll never fit into a tutu! (Henrique, 17-year-old boy)
On the other hand, dancers also talk about, although
less frequently, a positive relationship between teacher and
students (23.1%), which we considered a protective factor
for problems in general. This factor includes themes such
as the impartiality and professionalism of teachers, and
empathy and trust between teachers and students.
I think he’s a great teacher, and he works hard for his
students! (José, 12-year-old boy)
We can trust him and talk to him... (Ana, 16-year-old
girl)
Another relevant category was the undervaluing of
health (10%), especially related to ED symptoms.
There was that thing with Teresa, who was obviously
anorexic, and the teacher kept saying you look nice! (...) If
teachers encourage that, how are we supposed to care about
health? (Ana, 16-year-old girl)
Peers. The most frequently mentioned factors associated
to peers are all risk factors for ED, especially negative
comments about weight and body image (36.2%), which
seem to be a trigger of emotional distress and many
different weight control behaviors. Interestingly, negative
comments are not mentioned by older dancers (aged 15 to
18) at all.
There was talk about what I ate (...) I don’t know if it’s
on purpose, it probably isn’t on purpose, but they should
realize they’re tearing other people down. (...) sometimes
we have really nice colleagues [ironic tone] who say we’re
fat and that day I decided to stop eating. That day I didn’t
have lunch or dinner... (Madalena, 13-year-old girl)
We also have to underline the frequency of comparisons
between dancers who are exposed to a high level of
competition (competitive comparisons, 27.6%), although
these are more referred to by younger dancers. However,
older dancers also recognize the classical dance environment
as extremely competitive, which is considered a strong risk
factor for ED.
I think there are people who worry too much about
other people instead of worrying about themselves.
(Carolina, 12-year-old girl)
You have to be better than other people. (Paulo, 17-
year-old boy)
System.Pressure for thinness (23.3%) and food
restriction (24.4%) as a method of weight control are,
undoubtedly, the risk factors for ED most related to this
source of influence. These two themes are widespread in
the classical dance subculture (e.g., Gvion, 2008), and are
no exception at this Portuguese dance school.
When we’re a little bigger (...) I always think will this
mean I can’t be in this school, can they ask me to leave
because of that? (Carolina, 12-year-old girl)
(...) if people tell me I’m skinny or even anorexic,
because I know it’s not true, it’s actually a compliment to
me! (...) It’s almost my goal! (Ana, 16-year-old girl)
Two other categories are only mentioned by students
from higher artistic degrees: early demand for maturity
(which we considered a risk factor for problems in general)
and great maturity that students feel they attain, truly, and
view as an advantage of studying at this dance school
(which can work as a protective factor for ED).
I’ve seen teachers talk to 1st year girls and boys and be
very hard on them: You have to grow up, you have to learn!
Do you want to be a dancer or what are you here for?
Don’t be an idiot! (Paulo, 17-year-old boy)
One thing I think a dancer gets out of this is... knowing
how to deal with life (...) thinking about everything that
surrounds each person and other people much more easily
and much earlier than normal people who go to other
schools. (Henrique, 17-year-old boy)
However, they are frequently related to some forms of
emotional distress.
We’re more mature, but we make up for it in nerves
and stress! (Ana, 16-year-old girl)
We have to devote ourselves to dance! Which is very
hard! (Sérgio, 15-year-old boy)
Training. The factors with the greatest number of
references related to this source of influence are intensive
training (20.6%) and overtraining (20.6%). Just as some
characteristics of athletes are similar to the characteristics
of patients with Anorexia Nervosa (Thompson & Sherman,
1993), the boundaries between these two themes are unclear.
Thus, we considered intensive training as a characteristic
of the work developed at the dance school, within
reasonable limits, and overtraining (Sundgot-Borgen, 1994)
as the situation where dancers consider they work their
bodies besides what is reasonable or acceptable, which
sometimes is related to injuries.
You have to work hard, but not by hurting your body.
(Paulo, 17-year-old boy)
Absolutely. We push our bodies... (Henrique, 17-year-
old boy)
I have classmates who got injured, and said I can’t stop
because I have goals to achieve!, but then there were
consequences! (Diana, 13-year-old girl)
Injuries are considered risk factors for ED in the
literature because of their influence on rhythm and training
habits. Athletes who stop training for some time frequently
gain weight. As a consequence, they may adopt restrictive
behaviors to compensate for the lack of exercise or over-
exercise when they get back to training, as referred to by
our participants.
When we have to stop, we sometimes don’t burn as
many calories every day (...) and then when we get back
to work we have to give 110, 120% to lose it. (Carolina,
12-year-old girl)
Schedules. Dance school schedules are considered too
excessive by older ballet students. These are associated to
a great time demand (65%) for dancing and, consequently,
to social isolation (60%), because of a withdrawal from
social contacts or task-centered social contacts.
I don’t have time for myself. (...) I miss something else!
(...) having fun! Of hanging out with other people too,
because we’re in this school 12 hours a day around the
same people! (Henrique, 17-year-old boy)
Classical Dance World: This source is particularly
related to the pressure for thinness (44.3%; risk factor for
ED), as well as to dependence on public approval (8.5%;
risk factor for problems in general).
We work for the audience (...) We can look in the mirror
and not like what we’re doing, but if the audience likes it,
we’ll keep up that work. (Paulo, 17-year-old boy)
At the same time, social support (10.4%), as a
consequence of appreciation of dancers’ performances by
those who watch their auditions is cited as an important
encouragement.
If we get a compliment from the teachers or even from
the audience, it’s an incentive! (Ana, 16-year-old girl)
Parents: Our participants cited social support from
parents (25.5%; protective factor for ED) as a good way
to deal with emotional distress caused by auditions or by
important episodes at school.
(...) my parents have been suffering a lot because of
school, because when we suffer they suffer too and they
always try to help us as best they can. (Henrique, 17-year-
old boy)
However, the category most frequently mentioned
regarding parents is the pressure to pursue a dancing career
(38.3%), often reflecting their parents’ ambitions rather than
their own.
[my mother] tried [to be a dancer] when she was little,
but it didn’t work out...! So she put me in this school, I
didn’t want to come here! (Leonor, 15-year-old girl)
Results for Gymnasts
Gymnastics Club: Four principal categories emerged
within the gymnastics club: coaches (56%), peers (2%),
training (13%), and schedules (7%).
Coaches. The majority of references to risk factors for
ED related to coaches are pressure for thinness (27.7%),
associated to weight control (30.4%), especially through
advice on food restriction, monitoring athletes’ weight, and
negative comments (22.3%), particularly about eating and,
with fewer references, about weight and body image.
We’ve had our last training session, we’re going on
holiday [4 days], and she weighed everybody—as if she
meant to say I’m weighing you so you won’t be heavier
when you come back! (Susana, 17-year-old girl)
While dancers have made many more references to the
negative relationship between teacher and students than to
the positive relationship, the number of references among
gymnasts was very similar (17.6% and 18.9%, respectively).
It is important to underline that the negative relationship
between coach and gymnasts is more related to female
gymnasts and also seems to provoke higher emotional
distress in female gymnasts, especially related to negative
comments about eating and control of eating by coaches.
Sometimes, the girls are afraid of coaches (...) we
respect them... the girls mind what the coaches say a lot
more. (Mário, 16-year-old boy)
(...) once I went with a friend of mine to McDonald’s
after an event, and... I think I’m so used to it I was eating
and keeping a look to see if any coach was coming! And
AESTHETIC SPORTS AND EATING DISORDERS 269
then, to make fun of me, she said There’s the coach!, and
I started looking and I got very nervous! (Catarina, 13–year-
old girl)
On the other hand, almost all male gymnasts made
references to an absence of eating control by coaches
(12.2%). This factor was considered an ambiguous factor
of influence because of the deficiency of this aspect in the
reviewed literature, as well as of possible effects on athletes’
health from a total lack of eating control.
We simply, I mean, eat a lot at breakfast and at lunch
and nobody says anything! We eat chocolates in front of
the coaches and it’s okay. (Mário, 16-year-old boy)
Despite showing little expression in terms of number
of references, the fact that gymnasts talked about knowledge
of ED cases among their female coaches, even specifying
some symptomatic behaviors, is indeed alarming.
I’ve noticed she keeps weighing herself (...) I think I
see her weighing herself at every practice! (Miguel, 16-
year-old boy)
Peers. The more relevant category is related to a
protective factor, the low competitiveness (58.3%) that
gymnasts feel among peers inside their own club, between
different clubs, and at competitions.
There was a group where there was more compe-
titiveness and more pressure, but otherwise... basically it
was if everything goes right they win. (Susana, 17-year-
old girl)
Training. There were two ambiguous factors related to
this source of influence—intensive training (38.5%) and
physique and body composition changes (35.9%)—
associated to each other because daily intensive training
has some effects on physique and body composition.
I think we know from the start we’re never going to be
like that [like models] (...) we have a different life. (Susana,
17-year-old girl)
We look fuller. (Rute, 15-year-old girl)
Despite the fact that regular training could result in
different body shapes compared to their nonathlete peers
(e.g., muscular hypertrophy of thoracic and arm musculature
in male gymnasts), this factor does not appear excessively
related to emotional distress.
Sometimes they make fun of me and call me ‘shorty’,
‘pygmy’ (...) It’s good for a gymnast, but... sometimes I
don’t like being like this. (Carlos, 14-year-old boy)
Schedules. To this source of influence are associated,
essentially, time demands (79.2%)—3 to 4 hours of training
a day, after school—but not so much social isolation, as is
the case with dancers. This probably has to do with the fact
that their social contacts are not too centered on gymnastics,
contrary to that of ballet students (who attend dance classes,
in addition to completing a high school curriculum, at the
same place, and with the same colleagues). Nevertheless,
gymnasts also feel some limitations, when comparing
themselves to their school peers, specifically concerning
the common activities of adolescents.
If our friends want to do something in the afternoon,
we can’t because we have practice. And at night we
shouldn’t go either because we have practice the next day.
But I usually go out at night anyway! (Miguel, 16-year-old
boy)
Elite Gymnastics World: Pressure for thinness is
associated to the elite gymnastics world, with the same
frequency of references as weight control (19.4%)—
specifically food restriction. These behaviors are seen as
“normal”, especially to female gymnasts, and are considered
important risk factors for ED.
They don’t eat, that’s it. But with girls it’s different!
(Mário, 16-year-old boy)
Parents: When asked about the way parents deal with
the demands of elite gymnastics, gymnasts’ answers seemed
to indicate a dismissive relation family pattern (47.8%),
showing poor involvement of parents in gymnastics issues.
It’s convenient for them, because we’re here every day
(...) (Daniel, 15-year-old boy)
I sometimes tell what my parents when I disagree with
my coach. And my parents pretend they’re kind of not
listening. (Carlos, 14-year-old boy)
However, our data also reflect a protective factor for
ED—parental support (30.4%)—, although very different
from the almost “unconditional” support that dancers talk
about.
She [mother] supports us [me and my sister] (...) my
dad isn’t like that, but because we only live with our mom,
she lets us do what we want. (Susana, 17-year-old girl)
Discussion
Our data show that risk factors (58%), for ED or
problems in general, are twice as referred to as protective
factors (29%). This fact underlines dance and gymnastics
as risk contexts and suggests a need to investigate them,
even besides ED issues. Using the dance school and the
gymnastics club as sources of influence, there emerged the
same essential categories, except the sub-category related
to the system, which is only mentioned by dancers. The
gymnastics club is not referred to by gymnasts as having
a specific culture or rules which influence them, probably
because they spend much less time inside this system,
compared to dancers and their dance school (about 3-4
hours vs. 10-12 hours a day, respectively). So, for gymnasts
the coaches are seen as the principal source of influence
(56% of gymnasts’ references vs. 31% of dancers’
references) and even peers seems to have much less
influence among gymnasts than among dancers (2% vs.
13%, respectively).
Specifically related to ED, the main risk factor is,
undoubtedly, the pressure for thinness, which is similar to
what happens in these contexts in other countries (e.g.
Neumärker, Bettle, Dudeck, & Neumärker, 1998; Sundgot-
FRANCISCO, ALARCÃO, AND NARCISO
270
Borgen, 1994; Toro et al., 2005). Among gymnasts, this
pressure comes essentially from coaches, who often make
negative comments about eating, monitoring of athletes’
weight, and advice on food restriction. For ballet students,
thinness is experienced as an implicit rule of the world of
classical dance and the system itself (Dance School), but it
is viewed also as an explicit rule because of critical
comments from teachers and peers about eating, weight,
and food. Since this pressure comes from different sources,
the demand to maintain their bodies as thin as possible seems
to be more internalized among dancers, reflecting a centenary
institutional habitus of the Balletic world (Gvion, 2008).
Different studies have demonstrated a strong association
between the pressure from coaches of elite athletes to lose
weight (Donohue, Miller, Crammer, Cross, & Covassin,
2007; Kerr, Berman, & De Souza, 2006), dieting behaviors,
and the clinical and subclinical syndromes of ED (Toro et
al., 2005). We believe the same could happen with dancers
and their teachers. Sundgot-Borgen, Skårderud, and Rodgers
(2003, p. 390) support the idea that “the important factor
may not be dieting per se, but rather the situation in which
the performer is told to lose weight, the words used and
whether the athlete receives guidance.” Our sound data about
the impact of the negative/positive relationship with their
tutors (teachers or coaches) on well-being, attitudes, and
behaviors, reinforce this idea. The positive relationship
referred to by our participants can, eventually, be considered
to be a protective factor for ED, especially if teachers can
encompass health and overall well-being and not just
performance. Therefore, preventive actions should promote
and improve positive relationships among athletes and their
respective tutors, particularly based on empathy, trust, an
open dialogue, and more attention to the individual
differences and idiosyncrasies of each athlete. It is also
important that coaches and teachers learn about the effect
of their comments on athletes’ self-esteem and body image
(Kerr et al., 2006). Besides that, the dancers’ idea that extra-
thinness (and even Anorexia Nervosa) is sometimes
interpreted by the professional community as a way to
achieve success and perfection (Sundgot-Borgen et al., 2003),
reinforces the hypothesis that, in these contexts, there is a
normalization of some ED symptoms, and bodies are seen
as “machines” independent of physical needs (Gvion, 2008).
Although pressure for thinness and weight control are also
associated to the elite gymnastics world—indicating that
these factors are grounded at this elite gymnastics subculture-
—they do not emerge as such an undervaluing of health as
with dancers. Moreover, because of the crucial role coaches
play in athletes’ lives (Dosil & González-Oya, 2008; Kerr
et al., 2006; Lopiano & Zotos, 1992), the fact that coaches
present ED symptomatic behaviors in front of their athletes
is alarming and should be carefully evaluated in future
research.
Are there any differences related to the age of
participants? Older dancers and gymnasts (ages 15 to 17
years) felt under more pressure to reduce weight and to be
thin. However, it was the younger dancers and gymnasts
who made more references to negative comments highly
related to emotional distress. This could be a sign of such
an acceptance of the thinness “rule” that the pressure to
attain it is no longer felt as such by older athletes. It is
something totally accepted, respected, and unquestionable.
On the other hand, it also could be a sign that they have
found different ways to deal with this kind of pressure that
do not translate into emotional distress. The fact that older
dancers do not make references to negative comments from
peers could be a sign of a stronger relationship between
them (perhaps because of the rapport they have been building
for at least four years) and could protect them more
effectively against this influence. Thus, promoting emotional
and social skills since their entry into dance school and
gymnastics clubs would help to prevent ED among elite
athletes. Another theme was only referred to by the ballet
students from higher artistic degrees—maturity—which is
something new in research in this field, as we know.
Although somewhat expected, it is the first time we hear
adolescents talking about it and referring to implications for
their lives. An early demand of maturity is felt from the
beginning of their “career” at ballet school, although this is
only realized when they get older, when comparing
themselves with other adolescents, and in some way, feeling
they are best prepared to go through the real professional
world. However, because of the relationship they establish
between maturity and emotional distress, they do not seem
to be “emotionally mature”, which can be a risk factor for
ED and other problems in their future lives. Future studies
should focus on this, as well as preventive actions.
The major differences between female and male athletes
are related to the pressure for thinness and other factors
related to that, like negative comments from teachers and
coaches (independent of tutors’ gender) or the rules
“imposed” by the subculture of the classical dance and
gymnastics worlds. In fact, female athletes appear to be
more at risk for ED, which is in accordance to other
empirical studies. As happens in society in general, female
dancers and gymnasts are also the most frequent targets of
critical comments and rigid rules related to low weight and
a thin body image. Interestingly, these gender differences
are also clearly mentioned by male athletes, even if this
pressure to be thin is not directed through them. However
among male athletes, the dancers seem to be more pressured
to be thin than gymnasts (who often cited an absence of
control about their weight or eating, contrary to the dancers),
showing differences related to the ballet and gymnastics
male aesthetic ideal.
Different levels of competitiveness were found among
dancers and gymnasts. Ballet students feel a lot of
competition between peers and also during their professional
careers, as was expected according to the literature. Indeed,
high levels of competitiveness at ballet schools (especially
AESTHETIC SPORTS AND EATING DISORDERS 271
in national schools, such as the one we are studying) are
associated with an increased risk of disordered eating (e.g.
Garner & Garfinkel, 1980; Levine & Smolak, 2002; Thomas
et al., 2005). With regards gymnasts, it was interesting to
find that, despite them being from a club with some of the
best Portuguese athletes, they revealed low level of
competitiveness (justified by the prestigious and excellent
results from their club), which has been considered a strong
protective factor for ED among them. We think that these
differences could be related to the fact that high school also
has a central role in their lives, contrary to the ballet
students, for whom dance is “everything” in their lives. In
fact, their references to time demands and social isolation
are related to that, as it may influence the development of
problems such as lack of identity in other roles besides
being an “athlete” or “dancer” (Lopiano & Zotos, 1992).
Thus, we consider these two aspects as important risk
factors for ED, which should be taken into account in
specific research and psychotherapeutic interventions with
ballet students from professional schools.
As referred to by Gvion (2008, p. 79) regarding Israeli
dancers who are “trained to communicate through
performance, disregard pain and aim toward extra-thinness,
reinforcement from either an audience or significant others
compensates for the difficulties dancers encounter.” Among
significant others, parents are particularly important to help
ballet students in coping with emotional distress. As in the
general population (Crago, Shisslak, & Ruble, 2001),
parental support can also be an important protective factor
of ED to dancers. As girls who feel closer to their parents
and spend more time with them report fewer weight and
eating concerns (Swarr & Richards, 1996), the role of
parents in supporting their athletic children should be further
explored, especially among gymnasts, who revealed poor
involvement of their parents in gymnastics issues. A final
factor related to parental influence which we have
considered in our study to be an important risk factor for
ED is the pressure to pursue a dancing career. In fact, a
study with adolescent girls (ED patients, psychiatric patients,
and healthy adolescents) demonstrated that the only
experience that distinguished ED patients from other girls
was inappropriate parental pressures, such as being forced
to engage in activities that reflect parents’ ambitions
(Horesh, Apter, Ishai, & Danziger, 1996).
Bronfenbrenner ecological model (1979) is useful to
understand and systematize the diverse levels of influence
among elite athletes (see Figure 1). We have focused on the
microsystem settings where these adolescents live—mainly
the dance school or gymnastics club (we described the
complex activities, roles, and relations established there)
and also their families and high school, especially in the
case of gymnasts because dancers only attend one school,
which integrates both curricula—where we identified specific
risk and protective factors for ED. The interrelations among
family, high school, and dance school or gymnastics club
(mesosystems) are considered very relevant to the
development of adolescents, namely because the social
support received is an important protective factor for ED.
The world of classical dance or elite gymnastics is
considered a specific area among the macrosystem (society),
where the values and beauty ideals shared by an
industrialized culture roughly have the same influence among
adolescents. As said by Striegel-Moore and colleagues
(1986), this specific world is a subculture where the influence
of environmental and sociocultural factors is amplified, with
additional characteristics that we have identified here. Finally,
the dimension time (Bronfenbrenner & Morris, 1998) seems
to have an extremely important role, as highlighted by the
age differences found in our data.
There were a number of limitations in this study. Firstly,
the methods of analysis did not allow direct causality to
be established. Secondly, we had a restricted participation
of gymnasts at focus groups, only from one gymnastics’
club. Also, ballet students were all from one professional
classical dance school, the only one in Portugal that prepares
young dancers for professional dance careers. Nevertheless,
purposive sampling was adequate for a first qualitative
approach to these Portuguese contexts, and the study
presents some practical implications for family and
teachers/coaches in charge of athletes.
Conclusion
Ballet students see their school environment as a system
of specific rules and culture, more so than gymnasts.
However, the pressure to be thin and food restriction as a
way to attain the ideal body are important ED risk factors
that are shared by dancers and gymnasts alike, and are
characteristics that they themselves associate with classical
dance and elite gymnastics worlds in general.
FRANCISCO, ALARCÃO, AND NARCISO
272
Figure 1. Levels of influence among elite athletes (adapted from
Bronfenbrenner, 1979, 1998).
Teachers and coaches are clearly essential sources of
influence on young dancers and gymnasts, especially
regarding their body and eating attitudes and behaviors.
The pressure to be thin exerted by them, essentially through
negative critical comments, advice on food restriction and
monitoring of athletes’ weight, is the risk factor most
referred to by both dancers and gymnasts. Among dancers,
specifically, this pressure appears to be framed in a negative
relationship between teachers and students (low supportive
relationship, frequently associated with negative emotions).
On the other hand, more positive relationships (based on
empathy and trust) seem to be more frequent among
gymnasts, particularly male ones.
It seems essential to us that all participants in these
contexts value athletes’ health more, respect the body’s
limits and needs, and become aware of the need to eat
adequately, especially with regard to female dancers and
gymnasts. Because some characteristics of the classical
dance and elite gymnastics worlds cannot be easily changed,
factors such as social support or positive relationships
between athletes and tutors could be vital to prevent the
development of ED in these contexts and contribute to the
well-being of dancers and gymnasts. Based on this work,
further research should focus on a wide range of gymnastics
clubs and dance schools, both in elite/competitive and
recreational environments, and evaluate the risk for
disordered eating among these athletes.
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Received March 20, 2010
Revision received January 25, 2011
Accepted April 10, 2011
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