Understanding Eating Understanding Eating Disorders and AthletesDisorders and Athletes

Stephanie Chervinko, Ph.D.Stephanie Chervinko, Ph.D.

University of West FloridaUniversity of West Florida

Counseling CenterCounseling Center

OverviewOverview

Definitions, diagnostic criteriaDefinitions, diagnostic criteria

PrevalencePrevalence

Factors unique to athletesFactors unique to athletes

Warning signsWarning signs

InterventionIntervention

Diagnostic CriteriaDiagnostic Criteria

Anorexia NervosaAnorexia Nervosa

– Refusal to maintain minimally healthy Refusal to maintain minimally healthy body weight for age and heightbody weight for age and height

– Intense fear of gaining weight, even Intense fear of gaining weight, even though underweightthough underweight

– Disordered body imageDisordered body image– Amenorrhea (absence of 3 consecutive Amenorrhea (absence of 3 consecutive

menstrual cycles)menstrual cycles)

Diagnostic CriteriaDiagnostic CriteriaBulimia NervosaBulimia Nervosa

– Recurrent episodes of binge eatingRecurrent episodes of binge eating– Recurrent inappropriate compensatory Recurrent inappropriate compensatory

behavior in order to prevent weight gainbehavior in order to prevent weight gain– Binge eating and compensatory Binge eating and compensatory

behaviors occur on average twice a behaviors occur on average twice a week for 3 monthsweek for 3 months

– Self-evaluation unduly influenced by Self-evaluation unduly influenced by body shape and weightbody shape and weight

Diagnostic CriteriaDiagnostic Criteria

Eating Disorders Not Otherwise Eating Disorders Not Otherwise Specified (EDNOS)Specified (EDNOS)

– Atypical or subclinical eating disorderAtypical or subclinical eating disorderCriteria for anorexia met except amenorrhea Criteria for anorexia met except amenorrhea or weightor weight

Binge eating disorderBinge eating disorder

Anorexia AthleticaAnorexia AthleticaSubclinical eating disorder frequently Subclinical eating disorder frequently found in athletesfound in athletes

Individuals <5% of expected body weightIndividuals <5% of expected body weight

Fear of becoming fatFear of becoming fat

Restriction of food to <1200 kcalRestriction of food to <1200 kcal

Compulsive exerciseCompulsive exercise

AmenorrheaAmenorrhea

Occasional binge/purgeOccasional binge/purge

Female Athlete TriadFemale Athlete Triad

Disordered eating (AN, BN, EDNOS)Disordered eating (AN, BN, EDNOS)

AmenorrheaAmenorrhea

Osteoporosis – loss of bone densityOsteoporosis – loss of bone density

PrevalencePrevalenceNormative for young women to experience Normative for young women to experience body dissatisfaction and desire weight lossbody dissatisfaction and desire weight loss

Sociocultural demands placed on women Sociocultural demands placed on women to be thin along with pressure from sport to be thin along with pressure from sport to meet weight standards or body size to meet weight standards or body size expectations of sportexpectations of sport

~33% of female college athletes report ~33% of female college athletes report disordered eatingdisordered eating

Prevalence and MenPrevalence and MenSociocultural demands placed on men to achieve Sociocultural demands placed on men to achieve a particular physique along with pressure from a particular physique along with pressure from sport to meet weight standards or body size sport to meet weight standards or body size expectations of sportexpectations of sport

~16% of individuals with eating disorders are ~16% of individuals with eating disorders are male (increasing)male (increasing)

~25% of individuals with binge eating disorder ~25% of individuals with binge eating disorder are maleare male

Gay men particularly at riskGay men particularly at risk

NCAA Study on Athletes and NCAA Study on Athletes and Eating DisordersEating Disorders

1,145 student athletes from 11 1,145 student athletes from 11 Division 1 schoolsDivision 1 schoolsFemales-mean desired body fat 13% Females-mean desired body fat 13% & mean actual body fat 15.4% & mean actual body fat 15.4% (healthy = 17% - 25%)(healthy = 17% - 25%)Females-173 had BMI 15-20Females-173 had BMI 15-20Males-mean desired body fat 8.6% & Males-mean desired body fat 8.6% & mean actual body fat 10.5% mean actual body fat 10.5% (healthy = 10% - 15%)(healthy = 10% - 15%)

Factors Unique to AthletesFactors Unique to Athletes

No single cause for eating disordersNo single cause for eating disorders

Sport body stereotype – “thin-build Sport body stereotype – “thin-build sports”sports”– Expectation for athletes in certain sports Expectation for athletes in certain sports

to display a characteristic body size and to display a characteristic body size and shapeshape

– Fitted uniforms, body on displayFitted uniforms, body on display– Belief that thinness enhances Belief that thinness enhances

performanceperformance

Factors Unique to AthletesFactors Unique to Athletes

Symptoms vs desired characteristics Symptoms vs desired characteristics of athletesof athletes– Driven personalityDriven personality– PerfectionistsPerfectionists– People pleasersPeople pleasers– Obsessive-compulsive tendenciesObsessive-compulsive tendencies– High pain toleranceHigh pain tolerance– Size increase due to weight trainingSize increase due to weight training

Factors Unique to AthletesFactors Unique to Athletes

Stress of being in the spotlightStress of being in the spotlight

Balancing multiple role demandsBalancing multiple role demands

Warning SignsWarning SignsPhysicalPhysical– Intolerance to coldIntolerance to cold– Dizziness, fainting spellsDizziness, fainting spells– ConstipationConstipation– Loss of muscle toneLoss of muscle tone– Frequent weight fluctuationsFrequent weight fluctuations– Impaired concentrationImpaired concentration– Swollen salivary glands, puffiness in cheeksSwollen salivary glands, puffiness in cheeks– Broken blood vessels in eyesBroken blood vessels in eyes– Complains of sore throat, fatigue, & muscle Complains of sore throat, fatigue, & muscle

achesaches– Tooth decay, receding gumsTooth decay, receding gums

Warning SignsWarning SignsBehavioralBehavioral– Restricted food intake Restricted food intake – Eliminating specific foods or whole food groupsEliminating specific foods or whole food groups– Fear of food, avoiding situations where food is presentFear of food, avoiding situations where food is present– Excuse of “picky” eater, despite previous flexible eatingExcuse of “picky” eater, despite previous flexible eating– Excessive exerciseExcessive exercise– Regular weighingRegular weighing– Frequent comments about own weight, calories, food fat Frequent comments about own weight, calories, food fat

contentcontent– Frequent bathroom visits following mealsFrequent bathroom visits following meals– MoodinessMoodiness– Withdrawal from othersWithdrawal from others

Warning SignsWarning Signs

AttitudinalAttitudinal– Dichotomous thinkingDichotomous thinking– Denial of eating problemsDenial of eating problems– Perfectionistic standardsPerfectionistic standards– Harsh self-criticismHarsh self-criticism– Self-worth determined by weightSelf-worth determined by weight

Intervention: What to DoIntervention: What to DoSet aside time for a private, respectful meeting to Set aside time for a private, respectful meeting to discuss your concerns openly and honestly in a discuss your concerns openly and honestly in a caring and supportive way.caring and supportive way.

Describe what you have seen and heard that has Describe what you have seen and heard that has lead to your concerns.lead to your concerns.

Ask the person to explore these concerns with a Ask the person to explore these concerns with a counselor, doctor, or any health professional s/he counselor, doctor, or any health professional s/he feels comfortable enough to see.feels comfortable enough to see.

Expect denial, rationalization, & anger.Expect denial, rationalization, & anger.

Intervention: What to DoIntervention: What to DoOffer to accompany athlete to first medical or Offer to accompany athlete to first medical or therapy appointment for support.therapy appointment for support.

Emphasize place on team will not be endangered Emphasize place on team will not be endangered by admitting an eating disorder (coaches).by admitting an eating disorder (coaches).

Add that participation will only be curtailed if Add that participation will only be curtailed if eating disorder has compromised athlete’s health eating disorder has compromised athlete’s health or put athlete at risk for injury (coaches).or put athlete at risk for injury (coaches).

Remember most athletes with eating disorders Remember most athletes with eating disorders have tried and failed to solve the problem on have tried and failed to solve the problem on their own.their own.

Intervention: What to DoIntervention: What to DoArrange for regular, private follow-up meetings Arrange for regular, private follow-up meetings apart from practice times.apart from practice times.

Remember that many athletes who develop Remember that many athletes who develop eating disorders have been told to lose weight. eating disorders have been told to lose weight. Past or present coaches may have contributed to Past or present coaches may have contributed to eating disorder.eating disorder.

Let the athlete know that the demands of the Let the athlete know that the demands of the sport may have played a role in the development sport may have played a role in the development of the problem.of the problem.

When in doubt about how to intervene, consult, When in doubt about how to intervene, consult, consult, consultconsult, consult

Intervention: What Not to DoIntervention: What Not to DoDon’t question teammates or talk to them Don’t question teammates or talk to them about the athlete. Talk directly to athlete.about the athlete. Talk directly to athlete.

Don’t ignore the problem. InterveneDon’t ignore the problem. Intervene

Never conclude that an athlete just isn’t Never conclude that an athlete just isn’t trying hard enough to overcome an eating trying hard enough to overcome an eating disorder.disorder.

Don’t try to keep the problem hidden or Don’t try to keep the problem hidden or try to deal with it yourself.try to deal with it yourself.

Intervention: What Not to DoIntervention: What Not to Do

Don’t get into a power struggle about Don’t get into a power struggle about whether there is a problem.whether there is a problem.

Don’t be deceived by excuses.Don’t be deceived by excuses.

Questions?Questions?