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Are Athletes More Susceptible to Eating Disorders?

Athletes face a lot of pressure to stay fit, stay winning and stay in school. The pressure to be invincible can make it harder to get help for the anxiety and associated eating disorders that often result from this perfectionism.

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By Dana Byerly

06/10/14

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High school and college athletes cope with pressure every day: pressure from their parents to make them proud, pressure from teammates and coaches to win and academic pressure to retain passing grades.  

Most athletes manage these pressures responsibly, and many even thrive, but others struggle to balance the stress of organized sports with healthy eating and exercise behaviors. These athletes commonly have underlying mental conditions such as anxiety, depression or obsessive-compulsive disorder that put them at higher risk of developing an eating disorder.  

Ron Thompson – a practicing psychologist and co-founder of The Victory Program in St. Louis – works mainly with athletes and has counseled patients with eating disorders for 26 years. He has advised the National Collegiate Athletic Association and the International Olympic Committee on mental health and eating disorders specific to athletes.     

Thompson said athletes and non-athletes share similar risk factors for developing mental and eating disorders, but “society often views athletes as being so strong, they can’t have anything wrong with them. Sometimes it’s made worse by participating in a sport itself, maybe by an emphasis on being thin, or it might be the pressures associated with big-time athletics.”

Denver psychotherapist and licensed professional counselor Suzie Jordan believes athletes with eating disorders are extremely competitive in almost every aspect of their lives.  

“Plus, I think coaches put on a lot of pressure because they want to win,” she said. “When you have that internal, built-in competitiveness, and it’s fueled by someone on the outside, it’s a double whammy.”  

With female athletes in particular, Thompson acknowledges coaches do contribute a lot of pressure, but he also said current research suggests there is even more pressure from teammates.  

“They’re girls and young women, and they do what’s called ‘fat talk.’ They talk about their bodies. ‘I don’t like this’ or ‘I need to diet,’ or ‘My thighs are too big,’” he said. “Athletes do that both within the unit and outside, so they double up.”

Female athletes – particularly those in aesthetic sports that are judged on appearance and performance – have the highest risk of developing eating disorders, he said. Of the 30 million people with eating disorders, two-thirds are women, and with Thompson's estimate of 10 to 15 percent of young women in college engaging in disordered eating, athletes gauge slightly higher.    

“Not only do they focus on weight and a particular look, which puts them at risk, but they wear revealing uniforms. The problem there is the upper-body comparisons. They are constantly comparing theirs to someone else’s, usually someone they think looks better – which means thinner – than they do,” Thompson said. “In aesthetic sports, there are risk factors in just what they wear. They have uniforms that facilitate all that, and now they have a rationalization why they need to look a particular way.”

Another problem area is weight-classified sports such as wrestling and boxing, in which athletes often binge-eat and purge to make a specific weight class. They are also particularly prone to excessive exercising, a classic symptom many coaches overlook or don’t recognize.

“Coaches love athletes who are willing to train hard. It makes them look like a good athlete, and sometimes they are,” Thompson said. “Wrestlers, for years, are purported to be the guys who throw up on a regular basis, do excessive training, ride exercise bikes and saunas and rubber suits, all for the purpose of making weight. It’s all part of that culture that sometimes it’s viewed as being normal.”

That doesn’t mean athletes who work out a lot are at risk for eating disorders, though. Jennifer Gaudiani, an associate professor of medicine and assistant medical director for the Acute Center for Eating Disorders at Denver Health, said the problem comes into play when athleticism and strong work ethic turn malignant and dangerous.  

“It’s when you see people start to overtrain and become rigid in what’s acceptable for a day of training, and continue to pursue a high level of training, even when they’re out of training,” Gaudiani said. “Anybody who goes into a competitive season is going to be hyper-focused, training their ass off, and maybe doing different things with nutrition in order to optimize their body function for a season. If, when they’re out of season, they insist on the same mileage – same amount of weights or more, same rigid eating pattern, same low body fat – that starts to get a little extreme.”  

Jordan said athletes frequently use their sport to justify their disordered eating or exercise behaviors.  

“A slippery slope of eating disorders is when someone says, ‘If I lose a little weight, I will gain some muscle and be faster, and I will cut out my eating,’” Jordan said. “What they learn is the minute you start restricting diet, you start losing weight and losing muscle. You’re not faster; you’re slower. But the perception of ‘I’ll be faster if I’m lighter’ fuels a lot of eating disorders.”

What complicates the problem is that athletes’ identities are often tied up with their sport, and they fear losing it.  

“They’ve got a team. They have a good relationship with their coach. They get to go on trips. Then, all of a sudden, they can’t do this anymore. That’s been robbed. So here you are, developing your own persona, balancing school and social life, preparing for your sport, and all of a sudden, it’s gone,” Jordan said.  

It’s a theme echoed by Dawn Theodore, clinical director of the Monte Nido Eating Disorder Center in the Los Angeles suburb of Woodland Hills.

“Their identity is tied to themselves as a runner, gymnast or whatever. And if they don’t have that, who will they be?” Theodore said. “I don’t think it’s a subconscious thought, but they think what if they don’t make it or don’t become a professional dancer or gymnast. Many times, they’ve been so focused on winning that they’ve lost all sense of what it’s like to be in a relationship with people.”  

Instead, the team environment often substitutes for family. Coaches often take on the role of parent, and teammates assume the role of siblings. But sometimes these relationships are so intertwined, people fail to see the warning signs, Thompson said. It’s not helped by the fact that athletes suffering from eating disorders are trying to hide the symptoms out of fear of losing the sport they’ve dedicated their young adult life to. 

Ironically, the fear of losing the sport may be part of the key to helping them, Thompson said. 

“If it’s that important to them, let’s use that to treat them to get well. Some people say that’s the problem – that they need another aspect to their life – which they absolutely do. And that’s something we do in treatment, as well,” he said.  

“Try selling help to a 19-year-old. They’re not buying it. They don’t care. They think they’re invincible. So you have to have something that’s more important to them than being fit, or whatever their issue happens to be. What we found for our athletes in college and at the elite level is they will work to get back their sport. It’s also a way for them to stay connected to their identity as an athlete.”  

Theodore, a former dancer and recovered anorexic, said she’s tried using a dance studio to gauge her patients’ reactions to their body image and exercise during treatment. 

“It was great because there were clients who’d never danced before, then you had clients who had danced and had to stop because they were obsessed with themselves in the mirror. So much came out when we saw how they were in the dance studio, it was such good information,” she said. “I had people who had to leave because they couldn’t stop looking at themselves in the mirror. Then I had people so engrossed in what they were doing, they forgot the mirror was even there because they were having so much fun. Introducing things back to people and seeing how they react is such an important part of treatment.”

Also charting new ground are Thompson and his colleagues at The Victory Program. After 16 months, it’s still a work in progress, Thompson said, because every time staff members think they’ve uncovered all the risk factors for a sport, a new one comes along. 

“I think being a special subpopulation, you have to have special approaches to identify,” he said.

For example, The Victory Program is developing a new standard of tools and assessments designed specifically for athletes with eating disorders – tools intended to keep athletes on track even when they’re no longer athletes.

“Sport is not life, but when you’re in college, it’s a big part of your life. Most of them aren’t going to be professional athletes. It’ll last a few years at most,” Thompson said. “Most of the ones we work with are college athletes with eating disorders, and seldom is the eating disorder related directly to their sport.  Sport often plays a role, but many would’ve had the disorder even without the sport.”

Dana Byerly is on staff at The Fix, and has written for the San Antonio Express-News and The Oklahoman among others. She last wrote about federal classification of marijuana.

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