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Prevalence of Eating Disorders in Elite Athletes Is Higher Than in the General Population
Abstract
The objectives of the study were to examine the prevalence of anorexia nervosa (AN), bulimia nervosa (BN), anorexia athletica (AA), and eating disorders not otherwise specified (ED-NOS) in both male and female Norwegian elite athletes and a representative sample from the general Norwegian population.
A 2-step study including self-reported questionnaire and clinical interview.
The entire population of Norwegian male and female elite athletes (n=1620) and controls (n=1696) was evaluated for the presence of eating disorders (EDs).
Based on the results of the questionnaire, all athletes and controls classified as at risk for EDs, and a representative sample of athletes and controls classified as healthy participated in the clinical part of the study to determine the number of subjects meeting the Diagnostic and Statistical Manual of Mental Disorders-IV criteria for EDs.
More athletes (13.5%) than controls (4.6%; P<0.001) had subclinical or clinical EDs. The prevalence of EDs among male athletes was greater in antigravitation sports (22%) than in ball game (5%) and endurance sports (9%; P<0.05). The prevalence of EDs among female athletes competing in aesthetic sports (42%) was higher than that observed in endurance (24%), technical (17%), and ball game sports (16%).
The prevalence of EDs is higher in athletes than in controls, higher in female athletes than in male athletes, and more common among those competing in leanness-dependent and weight-dependent sports than in other sports. A collaborative effort among coaches, athletic trainers, parents, physicians, and athletes is optimal for recognizing, preventing, and treating EDs in athletes.
... This is because in contrast to recreational settings where sport is generally considered beneficial to mental health, EYAs face a combination of age-related developmental risks, in combination with high performance sport-specific risk factors [5,10]. As described in depth elsewhere [9], EYA's face increasing pressure to perform and intensive training regimes, potentially leading to an increased desire to manipulate body weight or shape [10][11][12]. Thus, enhancing our understanding of how EDs and DE exist within elite youth sport is critical for advancing clinical care and creating healthy sports environments. ...
... Perhaps most reliably however, prevalence of athletes with an ED meeting DSM-IV criteria ranged from 5.6% to 7% [30,34]. This is comparatively lower than studies in adult elite athletes (e.g., 13.5% [11] and 28% [42]). Similarly, these rates are considerably lower than the recently reported prevalence ranging from 13.6% to 22.2% of adolescents meeting DSM-5 criteria for an ED among the general population [43]. ...
... Similarly, these rates are considerably lower than the recently reported prevalence ranging from 13.6% to 22.2% of adolescents meeting DSM-5 criteria for an ED among the general population [43]. Previous studies among adult elite athletes have often identified higher rates of EDs than the general population [11,42]. There were mixed findings within the current review, however the only study that used clinical interview for assessment found higher rates among EYAs than non-athletes [34]. ...
... Several studies demonstrate that athletes in lean sports have an increased risk for the development of eating disorders [11][12][13][14], probably due to the dissemination of practices aimed at reducing body weight such as fasting, laxative use, and exercise, which can act as triggering factors, however, it has also been observed that sports defi ned as "non-lean" are not immune to the risk of eating disorders [5,15,16]. Furthermore, inconsistencies in the prevalence rates of disordered eating in athletes may also depend on whether the interviewed athletes were male or female [17][18][19][20]. ...
... Another important fact to dwell on is the prevalence of the risk of developing eating disorders among the population practicing physical activity, whether at a competitive level or not. In fact, numerous studies have consistently shown a higher prevalence of eating disorders among athletes than controls [15,20,39,40]. Surprisingly, the low prevalence rate of risk is represented in sports such as aerobic gymnastics and ice skating (0.7% and 0% respectively out of 13%). ...
... Surprisingly, the low prevalence rate of risk is represented in sports such as aerobic gymnastics and ice skating (0.7% and 0% respectively out of 13%). These "lean sports," in which a low body weight is thought to favor athletic performance, have a higher risk of developing eating disorders than the general population [20]. Therefore, some authors believe that greater attention to nutritional aspects in sports such as gymnastics, considered particularly at high risk in previous studies, may have led to the reform of this sport and thus reduced the percentage of athletes at risk of developing eating disorders [5]. ...
Eating Disorders represent one of the fastest-growing mental health problems in the world. While a diagnosis of an eating disorder can only be made after careful psychiatric evaluation, the detection of “at-risk” individuals can be conducted through screening programs that use tools such as the Eating Attitude Test (EAT-26), a test used to measure the symptoms and concerns characteristic of eating disorders. This observational study was designed to evaluate the presence of at-risk individuals, using the EAT-26, among young athletes in “lean sports”, young athletes in non-”lean sports”, young non-athlete sportspeople, and young people who did not practice any sports. In addition, the presence of a correlation between the risk of developing eating disorders, gender, and age was also investigated. The results identified a prevalence of risk of 13% among study participants. None of the subjects who did not engage in any physical activity obtained a test score that could be considered at risk. Furthermore, no correlation was found between gender and the scores obtained. These results should be taken into consideration to emphasize the importance of nutritional intervention by expert and qualified personnel within various sports societies, in order to prevent the development of these pathologies and at the same time increase and improve performance.
... Consequently, even short-and long-term health hazards, including exhaustion and hormonal disturbances, have been associated with DE, which can lead to menstrual irregularities and reduced bone mineral density (Rock et al., 1996). According to Sundgot-Borgen and Torstveit (2004), the prevalence of athletes with eating disorders is 13.5% of that are subclinical or clinical. Among the athletes, the prevalence of DE is especially higher in female athletes than in male athletes, and more popular than in other sports for those participating in leanness-dependent and weight-dependent sports. ...
... Also, the global score of EDE-Q subscales was 1.71 (60 to 65 percentile rank) in all the participants. According to Sundgot-Borgen & Torstveit (2004) the prevalence amongst eating disorders was 13.5 % among athletes that are subclinical or clinical. The prevalence of disordered eating was higher among athletes compared to sedentary individuals and higher in female athletes compared to male athletes especially for those who participate in leannessdependent and weight-dependent sports. ...
... In previous study, 18% of athletes were diagnosed with an eating disorder in a survey of 522 elite female athletes compared with just 5 % of non-athletes control (Loucks et al., 2003). Eating disorder was more prevalent among athletes than non-athletes, highlighting the relative importance of this topic in the athlete population (Sundgot-Borgen & Torstveit, 2004). In comparison, relative to the control group, athletes appeared to under-report disordered eating symptoms on questionnaires. ...
This study investigated sports activity involvement, menstrual history, and prevalence of eating disorders among Malaysian elite female athletes. A total of 50 female national and state level athletes with a mean age of 21.16 ± 2.31 years old participated in this study. They were 6 gymnasts, 17 swimmers, 5 cyclists, 7 long distance runners, and 15 silat athletes. The participants were required to answer the sports activity involvement questionnaire, menstrual history questionnaire, and Eating Disorder Examination Questionnaire (EDE-Q). The present study found that 44 (88%) of the total participants had regular menstruation, while 6 (12%) participants had irregular menstruation. The global score of EDE-Q subscales was 1.71 (60 to 65 percentile rank) in all the participants. Comparisons of measured variables between participants with regular menstruation and irregular menstruation showed that age in years at the beginning of training was younger in participants with irregular menstruation (9.83 ± 4.07) than participants with regular menstruation (11.84 ± 3.52). The global score of EDE-Q subscales was higher in participants with irregular menstruation (2.32; 75 to 80 percentile rank) than participants with regular menstruation (1.63; 60 to 65 percentile rank). In conclusion, the results of the present study show that participants with irregular menstruation seem to have higher global score of EDE-Q subscales, i.e., restrain, eating concern, shape concern, and weight concern. Irregular menstruation may be related to the young starting age of the athletes involved in training and the long total training period in years.
... In the last two decades, EDs within sporting populations have received increasing attention (Bratland-Sanda & Sundgot-Borgen, 2013), and whilst study designs are not consistent, the consensus is that EDs are more prevalent among athletes compared to the general population (Augestad & Flanders, 2002;Martinsen & Sundgot-Borgen, 2013;Sundgot-Borgen & Torstveit, 2004). Additionally, it has been previously reported that as an athlete's competitive level increases, the risk of developing ED symptoms also increases (Picard, 1999;Sundgot-Borgen & Torstveit, 2004). ...
... In the last two decades, EDs within sporting populations have received increasing attention (Bratland-Sanda & Sundgot-Borgen, 2013), and whilst study designs are not consistent, the consensus is that EDs are more prevalent among athletes compared to the general population (Augestad & Flanders, 2002;Martinsen & Sundgot-Borgen, 2013;Sundgot-Borgen & Torstveit, 2004). Additionally, it has been previously reported that as an athlete's competitive level increases, the risk of developing ED symptoms also increases (Picard, 1999;Sundgot-Borgen & Torstveit, 2004). Considering that nutrition plays a pivotal role for optimising performance, it is common practice for athletes to exert control over their diet to improve recovery, enhance training adaptations and to achieve a desired body weight and composition, which may lead to the presence of ON (Thomas, Erdman & Burke, 2016). ...
... As result, it was found that 9.5% of male athletes were at risk of developing AN [42]. This prevalence of ED risk is slightly higher than that reported in other studies: 15.47% of positive cases in women and 2.66% in men [38]; 19% in women [43]; and 17.3% in women [44]. It must be noted that some of these authors applied the EAT-40 instead of the EAT-26 used in this study. ...
Eating disorders (EDs) refer to a group of diseases characterized by a strong tendency toward chronicity, often involving distortions in body image distortion and other related symptoms The prevalence of EDs has increased in recent years, specifically in athletic populations. Therefore, the purpose of this study was to analyse risky eating attitudes in a sample of 1102 subjects from Se-ville (Spain): 142 women and 960 men aged between 15-25 years old. An online survey, designed using Google Forms, consisted of three questionnaires (EAT-26, SCOFF, and BITE), were com-pleted individually and anonymously. With regards to the cut-off points, the percentage of posi-tive cases with significant scores was 11.43% for EAT-26, 31.22% for SCOFF and 4.36% for BITE. The study found that the probability of testing positive for EDs is significantly higher in women than in men (p < 0.001). Specifically, the risk attitude for EDs in female athletes measured by the EAT-26 test is three times higher than in male athletes, while the risk attitude measured by the SCOFF test is twice as high in females. Risk attitude for EDs in athletes measured by the BITE test is 8 times higher in females than in males. This study’s findings confirm several important as-sumptions made at the outset of the research. There is indeed a higher risk of EDs in athlete populations. Moreover, all three tests therefore show a higher frequency of possible events of EDs in women, with very similar percentages of difference between sexes. The tests also confirm the role played by the coaches in the prevention of EDs in sports and their capacity to reduce ab-normal food-related behaviours. Thus, the future inclusion of these tests in the screening of athletes is highly recommended.
... Sport subcultures may encourage unhealthy measures to look, weigh, or a belief that weight influences performance that may then lead to onset of food restricting, calorie counting, binging and purging that may ultimately lead to eating disorders (Defaciani, 2016; Thompson & Sherman, 2014). The prevalence of eating disorders has been documented to be higher in elite athletes than that of the general population (Martinsen & Sundgot-Borgen, 2013;Sundgot-Borgen & Torstveit, 2004). An overview of eating disorder prevalence amongst athletes reported female athletes as more likely to struggle with an eating disorder than male athletes, as the prevalence rate of an eating disorder for male athletes ranges from 0-19% whereas female athletes range from 6-45% (Bratland-Sanda & Sundgot-Borgen, 2013). ...
Collegiate and professional athletes are at higher risk of developing anxiety disorders, depressive disorders, and substance abuse disorders. These competitive athletes often struggle with unique stressors such as balancing social life with sport and mental health stigma due to expectation of mental toughness. Research suggests these vulnerabilities amongst competitive athletes may make them hesitant to seek mental health resources. Cognitive-Behavioral Therapy (CBT) is an evidence-based approach that promotes skill development that reduces symptoms of anxiety, depression, substance use and other mental health struggles. CBT strategies may also enhance athletic performance. Combined, CBT skills for athletes may have promise as a primary prevention strategy for mental health symptoms, a secondary prevention strategy by offering referral for more serious symptoms and may earn buy in from coaches and athletes due to the potential for enhancing athletic performance. This paper provides empirical and theoretical rationale and framework for such an approach.
Exposure to critical body weight comments in youth athletes could lead to decreased self-esteem, affect body image, and increase the risk of eating disorders and cause depressive symptoms. The aim was to explore differences between sex, body mass index, sports type, with regards to body weight satisfaction, exposure to critical body weight comments from their coach and nutrition status in adolescent elite athletes. A questionnaire about body weight, critical body weight comments and nutrition was distributed to 489 adolescent elite athletes and injury prevalence was monitored across 20 weeks. The results showed that almost one in four athletes (n=116, 24%) was not satisfied with their weight and 12% (n=59) had received critical body weight comments from their coach. Of the athletes who were unsatisfied with their body weight (n=116), 47% wanted to lose weight (n=55). A significant (p<0.05) higher proportion of ice hockey players and swimmers used nutritional supplements, were unsatisfied with their body weight, and were more exposed to critical body weight comments compared to athletes from other sports. Adolescent elite athletes as young as 15–16 years old are exposed to critical body weight comments from their coach and experience challenges with body weight satisfaction that is partly dependent on the sport-specific context.
The EDI-2 manual is currently out of print but the attached file provides the table of contents for the EDI-3 which includes all of the EDI-2 items as well as the updated scale structure and scoring system for the EDI-3
This article reviews current eating disorder self-report and interview measures and makes recommendations for choosing assessment devices for practice and research. The authors also incorporate overviews of related measures, such as body satisfaction and restrained eating. The presentation of women with eating disorders on measures of gen-eral psychological functioning (such as the Minnesota Multiphasic Personality Inven-tory) is also discussed. Implications and recommendations for practice are presented, as are recommendations for future research. The lack of validation of, and urgent need for, eating disorder assessment measures with ethnic minority women is discussed throughout. Our goal is to provide information about useful assessment methods for counseling psychologists doing research or practice in the area of eating dis-orders (EDs). As Crowther and Sherwood (1997) noted, the multifaceted nature of EDs requires multidimensional, comprehensive assessment. The ED assessment literature is burgeoning with increasing attention focused on evaluating the psychometric qualities of both new measures and revisions of more established instruments (Crouther & Sherwood, 1997). In this article, we cover two major types of assessment procedures specific to eating disor-ders: self-report inventories and structured interview measures. In addition, we provide brief information regarding related measures of potential interest to researchers and practitioners (e.g., body image assessment) and briefly cover material concerning how women with EDs typically score on standard assessment inventories such as the Minnesota Multiphasic Personality Inven-tory (MMPI) and the Millon Clinical Multiaxial Inventory (MCMI). Finally, we conclude with implications for practice and research. Throughout the arti-cle, we attend to issues of assessment with ethnic minority women. A great 662
A growing body of evidence suggests that the prevalence of eating disorders and excessive concerns regarding body weight in certain subpopulations of female athletes are increasing. The pressure on female athletes to improve their performances and physiques, coupled with the general sociocultural demand placed on all women to be thin, often results in attempts to achieve unrealistic body size and body weight goals. For some female athletes the pressure to achieve and maintain a low body weight leads to potentially harmful patterns of restrictive eating or chronic dieting. This paper seeks to further delineate the characteristics of a recently identified subclinical eating disorder in female athletes: anorexia athletica . Research studies that support the existence of subclinical eating disorders will be reviewed. In addition, the possible physiological and psychological consequences of subclinical eating disorders will be explored.
Research shows inconclusive results pertaining to the comparison of eating disorder indices between athletes and nonathletes and among different subgroups of athletes. The purpose of this study was to meta-analytically review the literature on (a) bulimia nervosa indices, (b) anorexia nervosa indices, and (c) drive for thinness (a cardinal feature of both anorexia and bulimia) in male and female athletes. Results of 92 studies with 560 effect sizes (ES) revealed small ESs (range: -.01 to .30) in relation to group membership characteristics. Results for female athletes revealed small ESs for bulimia and anorexia indices, suggesting that female athletes self-reported more bulimic and anorexic symptomatology than control groups; nonsignificant group differences were evidenced for drive for thinness. Results for male athletes revealed small ESs on all three indices, suggesting that male athletes self-reported more eating disorder symptomatology than control groups. Moderator variables that might contribute to understanding the results are examined, and future research directions are presented.
This study investigated the possibility that male athletes who, owing to the rules of their sport, are pressured to maintain a low weight show an elevated prevalence of subclinical eating disorders. Twenty-five wrestlers and 59 rowers in the lower weight categories were investigated using the Eating Disorder Inventory (EDI). Fifty-two percent of the athletes reported the occurrence of binging. The EDI profiles of 11% of the athletes suggested the presence of a subclinical eating disorder. These figures are clearly elevated compared with the normal male population. Low-weight wrestlers and rowers should be considered a high-risk male population for subclinical eating disorders. These findings are comparable to high-risk groups consisting mainly of women (such as ballet and modelling students). The causal relationship between the specific sport and the development of a psychogenic eating disorder is discussed.
Objective
This study compares males and females with DSM-IV-defined eating disorders who were admitted to the inpatient eating disorders service at The New York Hospital, Cornell between 1984 and 1987.Methods
During this period, 51 males and 693 females presented for their first admission. Demographic information, questionnaires, and SCID interviews were used to compare the male and female samples.ResultsMales were significantly more likely than females to have a later onset of their eating disorder (20.56 vs. 17.15 years), and to be involved in an occupation or sport in which weight control influences performance. There were no significant gender differences in other characteristics or comorbid diagnoses. Males constituted an increasing percentage of total admissions between 1984 and 1997 (r = .692, p = .009).DiscussionThe similarities of core eating disorder psychopathology and comorbid illness in male and female patients encourage the continued use of similar detection and treatment strategies with both groups. © 1999 by John Wiley & Sons, Inc. Int J Eat Disord 25: 415–424, 1999.
The article reports on two studies investigating the frequency of eating disorders among swimmers. The first study was a screening based on self-report only and the second was a controlled study with a clinical interview of alle subjects. In the screening study, 28% of men and 3.5% of women had suspected eating disorder symptoms. No significant relationship was found between risk levels and competitive levels. In the controlled study, no indications of anorexia nervosa were found. Among Swimmers, 3.2% satisfied the DSM-III-R criteria for bulimia nervosa, and 9.7% had partial bulimic conditions. The results did not support the hypothesis of an increased frequency of clinical or partial eating disorders in elite athletes. The presence of symptoms was more related to being a woman rather than being a swimmer. Suggestions for further research are outlined to determine the causal relationship between sports and eating disorders.