By Kaitlyn E. Finn, The University of Queensland
Introduction Eating disorders are extremely serious mental illnesses that manifest psychologically, physically, and emotionally and can lead to health complications or even death. Anorexia nervosa specifically has the highest mortality rate of any psychological disorder, due not only to medical issues but also to suicide (Bar, Cassin, & Dionne, 2015). Eating disorders affect roughly 16% of Australians at any given time, with percentages being comprised of binge eating disorder (BED), otherwise specified feeding and eating disorder (OSFED), anorexia nervosa, and bulimia nervosa. Eating disorders are non-discriminatory, and can affect individuals of any nationality, ethnicity, gender, income level, religion, or status (“What Are Eating Disorders?” 2018). However, eating disorders may not affect every group evenly, and may be more prominent in one group to the next, as is seen in the case in female athletes.
The rates of disordered eating among collegiate and elite athletes are higher than a group of non-athletes, even though physical activity has been linked to higher body satisfaction (Bar et al., 2015). The etiology of eating disorders is not solely based in any one factor. Rather, eating disorders are developed through a combination of biological, environmental, and psychological factors. However, it has been seen through research that a sport atmosphere heightens the risk factors for developing a possibly deadly eating disorder (Sundgot-Borgen, 1994). Eating disorder symptomology includes a severe and distressing preoccupation with weight and body size, distortions of perceived body shape, use of extreme weight loss methods (resulting in medical complications), and worsening or newly onset mental health issues (Kong & Harris, 2014). The combination of eating disorder symptoms, whether physical, mental, or emotional, extremely hinder athletes and affect their quality of performance as well as their quality of life.
Discussion Eating disorders are more prominent in female athletes than the general female population. Although eating disorders are caused by a wide variety of factors, it is seen that female athletes are a specifically vulnerable group. One National Collegiate Athletic Association study in the United States found that 34.75% of female athletes were at risk for developing anorexia nervosa and 38% of female athletes were at risk for developing bulimia nervosa (Johnson, Powers, & Dick, 1999). These percentages are much higher than those of the general population and are even higher (with 46.7%) for female athletes in leanness-focused sports (Kong & Harris, 2014). In leanness sports such as dance, ice-skating, and gymnastics, a pressure to perform in a perfect manner may also coincide with a pressure to look perfect as well. Thus, athletes in leanness sports see a higher percentage of clinical eating disorders than their non-leanness sport (i.e., soccer, baseball, and volleyball) counterparts (Torstveit, Rosenvinge, & Sundgot-Borgen, 2007). The higher rates of eating disorders among female athletes of every type might be due to the high stress of competition and pressure to perform, focus on weight and body, or a hypothesized concept called “attraction to sport,” in which female athletes with already present clinical eating disorders choose to engage in a sport where they can easily hide or be praised for their illness (Sundgot-Borgen, 1994). While true causes may be unknown from case to case, female athletes more easily can fall into an eating disorder than female non-athletes or male athletes, proving them to be in a group of risk.
Over the past forty years, and with the help of improvements like Title IX in the United States, female athletic participation has increased by over 1000%. Since it is seen that female athletes are more susceptible to eating disorders, this increase in the population of female athletes also poses the problem of possibly having more cases of eating disorders than ever before (Wagner, Erikson, Tierney, Houston, & Bacon, 2016). Because treatment outcomes for eating disorders are somewhat bleak, a majority of experts believe that the best way to help female athletes is through prevention. Prevention programs based on psycho-education show promise in outreach to competitive athletes in lowering risk factors for eating disorders such as body dissatisfaction, thin-ideals, disordered eating habits, or dieting (Bar et al., 2015). However, psycho-education for athletes alone is insufficient. Coaches, who in collegiate and elite atmospheres see their players day in and day out, have the potential to play a positive role in the lives of their athletes. In order to play a supportive role for at risk or suffering athletes, coaches should be versed in the factual knowledge of eating disorder causes, symptoms, and risks, as well as basic information about proper nutrition, weight management, and general impacts of malnourishment in athletic performance (Martinsen, Sherman, Thompson, & Sundgot-Borgen, 2015). Without specific education on eating disorders, coaches often unknowingly serve as a negative influence for their players, making comments on players’ body size or recommending weight loss, which can quickly spiral into an obsessive eating disorder in an uninformed or highly motivated athlete. Thus, early intervention, both on the coaching side and the athlete side, proves to be valuable in the health and wellness of female athletes, especially since eating disorders get harder to treat as time progresses (Sundgot-Borgen, 1994).
Although prevention methods have been outlaid, there are still other barriers to problem solving the issue of the prevalence of eating disorders in female athletes. For one, the data collection methods and screening tools that are used in a majority of studies have yet to be critically esteemed for their accuracy by other literature critiques (Wagner et al., 2016). Similarly, survey or interview methods of data collection might be erroneous due to the athletes’ desires to ensure the longevity of their sports career or due to the coaches’ desires to keep their sports programs looking outwardly good (Sundgot-Borgen, 1994; Johnson et al., 1999). A variation in findings in multiple studies also might be present due to changes in diagnostic criteria, such as the change from the DSM-IV to the DSM-V, which blurs the accuracy of the supposed eating disorder percentages if a study is replicated while using a newer DSM revision. This might lead readers to claim the data as untrustworthy and would be less likely to take seriously the issue of eating disorder rates among female athletes. Future studies should be conducted and replicated using the basis of the same DSM version, peer-reviewed data collection methods, and large sample sizes in order to further prove the prevalence of eating disorders in this sub-group. Future studies might also be conducted on the prevalence of eating disorders in male athletes. The National Collegiate Athletic Association study found that while 34.75% of female athletes were at risk for developing anorexia nervosa, 9.5% male athletes were at risk as well (Johnson et al., 1999). While the number is not as striking as the female athletes’, it raises a question into possible underreporting of eating disorders by men (and possibly some women) or a genuine lower percentage in cases. Many accurate and replicated studies will hopefully bring about a clearer consensus on the numbers of female (or male) athletes with eating disorders, which will allow sports programs and coaches to properly formulate an outreach plan to deal with affected or at-risk athletes.
Conclusion It has been shown through the aforementioned literature that eating disorders are more prevalent in the female athlete population than in the female non-athlete population. And within the female athlete population, those in leanness-focused sports face a higher percentage of eating disorders than those in non-leanness focused sports (Kong & Harris, 2014; Sundgot-Borgen, 1994). In response to this rising problem, experts in the field have suggested that prevention plans be put in place for athletes and that coaches go through their own prevention training as well to serve as a sturdy support for their players (Martinsen et al., 2015). However, due to the limited research replication, lack of evidence for prevention plans, and varying versions of the DSM, exact data regarding eating disorder sufferers, causes of eating disorders in athletes, and success of preventative measures is equivocal. Further research into the realm of eating disorders in regard to its prevalence in female athletes could save money on treatment costs, save athletes from serious mental anguish, and overall, save lives.