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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.
... Current research indicates that female athletes are at greater risk for developing ED and DE than the general population, and are 5-10 times more likely to suffer from an eating disorder than men 19 . Reported prevalence of EDs in female athletes ranges from 6-59% 17,20,21,22,23 . A higher prevalence of ED has been reported in sports that emphasise leanness for improved performance, and/or that require body-revealing clothing in comparison to sports where leanness is not a performance requirement 3,17,24 . ...
... Furthermore, athletes participating at a competitive versus recreational level are considered at higher risk of DE or ED 18,24 . However, research is limited, and reported prevalence rates are equivocal due to the varied methodologies used and wide range of sporting populations tested 17,20,21,22,23 . ...
Article
Eating disorders (ED), disordered eating (DE) and low energy availability (LEA) can be detrimental to health and performance. Previous studies have independently investigated prevalence of ED, DE or LEA, however limited studies have combined methods identifying risk within female runners. The aim of this study was to identify prevalence of ED, DE and LEA in United Kingdom-based female runners and associations between age, competition level and running distance. The Female Athlete Screening Tool (FAST) and Low Energy Availability in Females Questionnaire (LEAF-Q) were used in a cross-sectional study design. A total of n = 524 responses eligible for analysis were received. A total of n = 248 (47.3%), n = 209 (40%) and n = 49 (9.4%) athletes were at risk of LEA, DE and ED, respectively. LEAF-Q scores differed based upon age (Age: H(3) = 23.998, p≤0.05) and competitive level (Comp: H(1) = 7.682, p≤0.05) whereas FAST scores differed based on age (Age: F(3,523) = 4.753, p≤0.05). Tukey’s post-hoc tests showed significantly higher FAST scores in 18–24 years compared to all other age categories (p≤0.05). Stepwise multiple regression demonstrated age and competitive level modestly predicted LEAF-Q scores (R2adj = 0.047, F(2,523) = 13.993, p≤0.05, VIF = 1.0) whereas age modestly predicted FAST scores (R2adj = 0.022, F(1,523) = 12.711, p≤0.05, VIF = 1.0). These findings suggest early identification, suitable screening methods and educational intervention programmes should be aimed at all levels of female endurance runners.
... Based on previous studies investigating disordered eating behavior in female athletes (Sundgot-Borgen and Torstveit, 2004), the EDE-Q was followed by two self-constructed questions regarding eating disorder history: "Have you ever been diagnosed with an eating disorder?" If the participants answered "yes," the following question was "What eating disorder(s) have you been diagnosed with?" with the answer options "Anorexia Nervosa," Bulimia Nervosa" "Binge Eating Disorder," or "Eating Disorder Not Otherwise Specified/Other Specified Feeding or Eating Disorders (e.g., atypical Anorexia or Bulimia Nervosa)" (multiple answers allowed). ...
... Our results suggests that for the majority of the athletes, LEA is due to unintentional origins such as suppression of appetite post exercise (Larson-Meyer et al., 2012;Howe et al., 2016), low energy-dense diets (Melin et al., 2015), lack of knowledge regarding optimal sports nutrition (Benardot, 2013;Trakman et al., 2016;Heikkilä et al., 2018;Sim and Burns, 2021), lack of knowledge about the consequences of LEA (Folscher et al., 2015;Condo et al., 2019;Tosi et al., 2019;Logue et al., 2020) or a busy lifestyle with frequent traveling where lack of time and access to food become important barriers to adequately fueling (Benardot, 2013;Burke et al., 2018;Logue et al., 2021). Nevertheless, disordered eating behavior was common among this group of female endurance athletes with a risk rate of 21.3% using a EDE-Q global score 2.5 as cut-off compared to 24-25% earlier reported in elite female endurance athletes (Sundgot-Borgen and Torstveit, 2004;Melin et al., 2015) using the gold standard EDE Interview (Fairburn and Beglin, 1994). Collectively, these results suggest a concerning and persistently high prevalence of disordered eating among female endurance athletes. ...
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Relative energy deficiency in sport (RED-S) is a complex syndrome describing health and performance consequences of low energy availability (LEA) and is common among female endurance athletes. Various underlying causes of LEA have been reported, including disordered eating behavior (DE), but studies investigating the association with exercise addiction and food intolerances are lacking. Therefore, the aim of this cross-sectional study was to investigate the association between DE, exercise addiction and food intolerances in athletes at risk of LEA compared to those with low risk. Female endurance athletes, 18-35 years, training ≥5 times/week were recruited in Norway, Sweden, Ireland, and Germany. Participants completed an online-survey comprising the LEA in Females Questionnaire (LEAF-Q), Exercise Addiction Inventory (EAI), Eating Disorder Examination Questionnaire (EDE-Q), and questions regarding food intolerances. Of the 202 participants who met the inclusion criteria and completed the online survey, 65% were at risk of LEA, 23% were at risk of exercise addiction, and 21% had DE. Athletes at risk of LEA had higher EDE-Q and EAI scores compared to athletes with low risk. EAI score remained higher in athletes with risk of LEA after excluding athletes with DE. Athletes at risk of LEA did not report more food intolerances (17 vs. 10%, P = 0.198), but were more frequently reported by athletes with DE (28 vs. 11%, P = 0.004). In conclusion, these athletes had a high risk of LEA, exercise addiction, and DE. Exercise addiction should be considered as an additional risk factor in the prevention, early detection, and targeted treatment of REDS among female endurance athletes.
... Los Trastornos de la Conducta Alimentaria (TCA) son una enfermedad mental seria, causante de morbilidad física y psicosocial (1), tienen una mayor prevalencia entre adolescentes y adultos jóvenes, incidiendo en la población femenina y entre deportistas (2). Se desconoce la causa exacta de los TCA (1,2), siendo problemas psicológicos relacionados con la alteración de los patrones de alimentación y autopercepción. ...
... Los Trastornos de la Conducta Alimentaria (TCA) son una enfermedad mental seria, causante de morbilidad física y psicosocial (1), tienen una mayor prevalencia entre adolescentes y adultos jóvenes, incidiendo en la población femenina y entre deportistas (2). Se desconoce la causa exacta de los TCA (1,2), siendo problemas psicológicos relacionados con la alteración de los patrones de alimentación y autopercepción. Los TCA conllevan la aparición de comportamientos como la restricción excesiva de alimento, conductas de purga, realización desmesurada de actividad física (AF) e ingestión de grandes cantidades de comida de manera descontrolada (3). ...
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Eating Disorders (ED) are a severe mental illness that causes physical and psychosocial problems. This illness has a higher prevalence among young women, and between athletes. cognitive behavioural therapy (CBT) is the current treatment for this type of disorder. However, more and more programs are including physical exercise (PE) and nutritional therapy (TN) for eating disorders treatment. Objective. To carry out an exploratory systematic review of the literature that allows us to know the current state of intervention programs through physical exercise and nutritional therapy for the treatment of eating disorders. Materials and methods. For the reference search thesame search phrase was used. The terms were entered in English in the following computerized databases: SCOPUS, Web of Science, and PubMed. To limit the search, four inclusion criteria were introduced. Results. The review included five scientific articles related to the study topic, which met the inclusion criteria. Conclusion. Intervention programs for the treatment of eating disorders that include physical exercise and nutritional therapy are shown as an alternative or complementary tool to conventional therapy. These programs involve a reduction in the severity of ED symptoms and an improvement in anthropometric parameters and physical condition. More studies that combine PE and TN programs for people with ED are required.
... Some student-athletes feel a loss of personal identity outside of their sport which can create feelings of isolation in addition to elevating their depression and anxiety (Etzel, 2006). Student-athletes often feel pressure to maintain peak physical condition, and at times adhere to bodyweight expectations that can lead to depression and anxiety (Smith et al., 1990;Sundgot-Borgen & Torstveit, 2004). Additionally, studentathletes must manage interpersonal conflicts with teammates and/or coaches (Sudano et al., 2017), cope with the emotions of athletic success and failure (Reardon et al., 2019) and, some in what are considered high-profile sports, deal with pressure from the commercialization of college athletics (Brown et al., 2014). ...
Article
Objective: Collegiate-athletes are vulnerable to mental health disorders, such as anxiety and depression, yet very little is known about what variables might predict the use of on-campus mental health services among them. The purpose of this study was to investigate the utility of Andersen’s Behavioral Model (ABM) in predicting the use of on-campus mental health services by student-athletes using data from the Spring 2019 American College Health Association’s National College Health Assessment IIc (ACHA-NCHA IIc). Participants: The sample consisted of college student participants in the Spring 2019 administration of the ACHA-NCHA IIc survey (n= 67,973) with 3,536 students who reported participating in “varsity” level college athletics in the previous 12 months. Methods: The ABM enabled selection of predisposing, enabling, and need predictor variables utilizing the Spring 2019 ACHA-NCHA IIc survey. Analyses were conducted individually and collectively using descriptive statistics, Chi-squares, and logistic regressions to test for differences in use of on-campus mental health services. Results: Use of on-campus mental health services was similar between college student athletes and their non-athlete peers. Results indicate that the Andersen Model is a useful model for framing the relationship between use of on-campus mental health services among college student-athletes and the ABM variables. Need factors were more likely to predict use of mental health counseling services while Enabling variables were the least likely to predict these impacts. Comparisons pointed to heightened risks for the subgroups of Latinx, Native American/Native Hawaiians, males, heterosexuals, those attending public colleges and universities, and first year student-athletes for being the least likely to utilize on-campus mental health services. Conclusions: Findings in this investigation have implications for prevention, practice, and future research and warrant increased attention and targeted outreach to those student-athletes recognized for being most at-risk for not accessing on-campus mental health services. A multifaceted approach that decreases stigma and improves attitudes towards utilizing on campus mental health services could have the most meaningful effect on encouraging service use and bolstering student-athlete mental wellness. Results make the case for adopting an inclusive lens across demographic and organizational culture variables when conceptualizing mental health risk and resilience among student-athletes.
... Disordered eating (DE) refers to irregular eating behavior, which occurs less frequently or less severe than a diagnosable eating disorder [1]. Among athletes, DE occurs often in sports where weight is a significant factor, for instance in sports that depend on leanness or are weight-dependent [2]. ...
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Purpose Disordered eating (DE) has been associated with elevated anxiety, high stress, and low self-esteem and occurs often in sports where weight is a limiting factor. Sport climbing in general provides a combination in these aspects but the relevance of a low body weight differs in the different climbing types (e.g., weight supported top rope climbing vs non-supported bouldering). To date, these differences have yet been investigated, while they might provide useful insight into the mechanisms of disordered eating and potential preventative strategies. This study aimed to assess the influence of different types of climbing (bouldering vs top rope) on the relation between anxiety and DE. Methods 59 rock climbers (male, n = 38; female, n = 21; mean age = 28.33 ± 7.4 years) completed a survey (including the Dutch Eating Behavior Questionnaire, Mental toughness Questionnaire, Cattell's Anxiety Scale Questionnaire) investigating preferred climbing style, trait anxiety, mental toughness, and eating behavior. Results Boulderers showed a higher anxiety score compared to top rope climbers. Among boulderers, higher anxiety levels were associated with lower mental toughness. Among top rope climbers, anxiety was associated with emotional and external eating behavior. Conclusion Findings showed a higher anxiety in boulderers but no greater measures of DE. It is possible that, through their experience in a high anxiety environment, boulderers have been able to develop effective coping strategies that have a protective effect against DE.
... Another study in male dancers described a 14% lifetime incidence of an eating disorder among male dancers [9]. The prevalence of eating disorders in female aesthetic sport athletes (from sports such as gymnastics, figure skating and diving) has been reported at 42% [40], and a recent study in male and female circus artists revealed that 36% were at risk of disordered eating [41]. Such findings highlight the frequency of unhealthy weight control practices in aesthetically judged athletic disciplines, such as dance. ...
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Dancers are an athlete population at high risk of developing iron deficiency (ID). The aesthetic nature of the discipline means dancers potentially utilise dietary restriction to meet physique goals. In combination with high training demands, this means dancers are susceptible to problems related to low energy availability (LEA), which impacts nutrient intake. In the presence of LEA, ID is common because of a reduced mineral content within the low energy diet. Left untreated, ID becomes an issue that results in fatigue, reduced aerobic work capacity, and ultimately, iron deficient anaemia (IDA). Such progression can be detrimental to a dancer’s capacity given the physically demanding nature of training, rehearsal, and performances. Previous literature has focused on the manifestation and treatment of ID primarily in the context of endurance athletes; however, a dance-specific context addressing the interplay between dance training and performance, LEA and ID is essential for practitioners working in this space. By consolidating findings from identified studies of dancers and other relevant athlete groups, this review explores causal factors of ID and potential treatment strategies for dancers to optimise absorption from an oral iron supplementation regime to adequately support health and performance.
... Female figure skating also typically emphasizes slenderness (13), and elite female skaters often begin competing before puberty and practice for more than 30 h/week (13)(14)(15). The prevalence of ED is higher among female participants in artistic sports and weightcategorized sports than that in other sports (16). The reported EA in ballet dancers averages 39.5 kcal/kg FFM/day, and 45% of professional ballet dancers reach menarche after 15 years of age, with 65% previously experiencing menstrual dysfunctions (17,18). ...
Article
Eating disorders are more prevalent in athletes than in the general population and may have severe consequences for sports performance and health. Identifying symptoms can be difficult in athletes because restrictive eating and slim body images are often idealised in a sports setting. The Eating Disorders Examination Questionnaire (EDE-Q) and the SCOFF (Sick, Control, One stone, Fat and Food) questionnaire (SCOFF) are widely used generic instruments to identify symptoms of eating disorders. This study aimed to investigate the instruments’ validity and explore eating disorder symptoms in a sample of athletes. A sample of 28 athletes (25 females) competing at a national level was interviewed based on the diagnostic criteria for eating disorders. We interviewed 18 athletes with a high score on EDE-Q and 10 with a low score. All interviews were transcribed and analysed from a general inductive approach. We identified 20 athletes with an eating disorder diagnosis, while 8 had no diagnosis. EDE-Q found 90% of the cases, while SCOFF found 94%. EDE-Q found no false-positive cases, while SCOFF found one. The qualitative results showed that most athletes reported eating concerns, restrictive eating, eating control (counting calories), weight concerns, body dissatisfaction (feeling fat and non-athletic), excessive exercise and health problems (eg, pain, fatigue). In conclusion, EDE-Q and SCOFF seem valid instruments to screen athletes’ samples but may fail to find 6%–10% cases with eating disorders. Despite athletic bodies and normal body mass index, many athletes report severe eating problems and dissatisfaction with weight and body appearance. Implementation of regular screening may identify these symptoms at an early stage.
Article
Objective: There is ongoing discussion about whether sports participation is a risk or protective factor for eating disorders (EDs). Research is mixed, with some studies suggesting that athletes have higher mean levels of ED psychopathology compared to nonathletes, while other studies suggest the opposite effect or no differences. The purpose of the current meta-analysis was to identify whether female athletes reported higher mean levels of ED psychopathology compared to nonathletes. Method: Following PRISMA guidelines, we identified 56 studies that reported ED psychopathology for female athletes and nonathletes. A three-level random-effects model of between- and within-study variance was completed for the following outcome variables: overall ED psychopathology, body dissatisfaction, drive for thinness, restricting, and loss-of-control eating. Results: Athletes reported lower levels of body dissatisfaction compared to nonathletes (g = -.21, p < .0001). Athletes and nonathletes reported similar levels of overall ED psychopathology, drive for thinness, restricting, and loss-of-control eating on average. Sport type significantly moderated standardized mean difference effect sizes of ED psychopathology in athletes versus nonathletes. Effect sizes comparing levels of drive for thinness, restricting, and loss-of-control eating in athletes versus nonathletes were larger for studies with athletes participating in aesthetic/lean sports compared to nonaesthetic/nonlean sports. Discussion: Findings from this meta-analysis could inform future ED prevention and treatment in female athletes by providing further evidence that athletes in aesthetic/lean sports may report higher levels of ED psychopathology. Participating in nonaesthetic/nonlean sports may be a protective factor for experiencing less body dissatisfaction. Public significance statement: The current meta-analysis summarized findings from 56 studies that assessed levels of disordered eating, body dissatisfaction, dietary restricting, and loss-of-control eating in female athletes and nonathletes. Athletes reported lower levels of body dissatisfaction compared to nonathletes, highlighting that participation in sport could have some protective factors. Athletes participating in sports that require weight categories (e.g., judo) and sports that emphasize thinness/leanness (e.g., gymnastics and distance running) had higher levels of disordered eating relative to athletes participating in other types of sports that do not emphasize thinness/leanness (e.g., volleyball and basketball).
Article
There has been scarcity of research regarding the unique mental health risk factors that adolescent athletes face. The recently proposed Rational Emotive Self Determination Scale of Adolescents (RESD-A) has been suggested to understand the antecedent and associative factors of adolescent athlete mental health. The principal aim of this study is to examine the structural and criterion validity of the RESD-A in an athlete sample for the first time. To achieve this aim, two hundred and forty-two club level soccer athletes participated in the study. Confirmatory factor analysis (CFA) was conducted to test the validity of the RESD-A’s factor structure. Partial correlation analyses with the subscales of RESD-A, Emotional Intelligence, and mental health scores were used to examine criterion validity. Initial results for the structural and criterion validity of the RESD-A with an athlete population are promising. The potential importance, limitations and the direction of future research are discussed.
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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
Article
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.
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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.
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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.
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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.
Article
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.