Athletes and Eating Disorders: A Time of High Pressure and Performance
With the Summer Olympics right around the corner, many elite athletes are striving to get into peak shape. One things that I believe is not talked about enough among athletes is they are actually at more risk of struggling from mental health illnesses, including eating disorders. So let’s break this down and get into why eating disorders are so prevalent in athletes and what to do about it.
How do sports and eating disorders correlate?
Characteristics and personality traits among athletes tend to also be common among those with eating disorders. This includes being achievement-oriented (or as most of us know it, perfectionism), sensitive to consequences, high attention to detail, and high pain tolerance. Now let’s take a look further into each.
Achievement-Oriented
Being achievement-oriented means we want those big rewards. We want to get it perfect. This creates a high drive for success, pushing athletes to achieve their ultimate goals (like the Olympics)!
Sensitive to Consequences
Sensitive to consequences can look like fear of disappointing coaches or fear of not following your training plan to a T. It may be difficult to take criticism or constructive feedback.
High Attention to Detail
High attention to detail means you are paying close attention to every exact split you run, basket you shoot, or spin you take. You are paying attention to everything down to the seconds on the clock and the form of your stride.
High Pain Tolerance
How many of you do not feel an injury until the bone is totally broken, or the ligament is completely torn and you are out for months or maybe even years? As athletes, we are really good at pushing the pain out of our mind. In fact this helps us in so many ways to push past our limits and improve!
These characteristics can lead someone to be an amazing athlete, while also leading them down an unhealthy path of an eating disorder. Here are a few examples of what I mean:
- Being achievement-oriented can mean searching for results. If you have a certain weight in your mind or a certain muscle mass you want to achieve, you may push yourself into unhealthy places in order to accomplish these goals.
- High pain tolerance leads folks to be able to ignore the signs their body is giving them that tells them they are hungry and depleting of energy.
- High attention to detail can look like counting every calorie or constantly stepping on the scale.
- Sensitive to consequences may be emotionally beating yourself up if the number goes up, or you ate something that you were not planning on eating.
If some of those behaviors or warning signs sound familiar to you, then I am glad you are here.
The Pressures of Athletes around Disordered Eating
Our society promotes the concept of thinness as a healthy form of one’s body. Likewise, each sport has their own pressures as an athlete to fit the “ideal” body in that specific sport. This starts getting extra confusing and conflicting as an athlete is then pulled in two different directions.
For example, if your sport’s culture emphasizes stronger and more muscle mass as a way to increase performance, this may become conflicting when also met with the “thin ideal” within diet culture outside of the sport. This is only one factor in the pressures of an athlete.
Athletes may also feel pressure to fit into the team culture or revealing uniforms. Other forms of pressure may include the coach/athlete relationship, and the lack of knowledge around disordered eating.
Health Consequences of Restrictive Eating in Athletes
Striving for thinness can negatively impact the ability to perform at any level. Athletes are at risk of relative energy deficiencies in sport (RED-S). RED-S is when there is not enough energy required for the amount exerted, leaving the body depleted, making it difficult to function properly. Low energy can affect performance and increase the risk of injury.
A few examples of performance consequences from RED-S include:
- Hormone imbalances which could lead to compromised bone density (potentially stress fractures)
- Lower VO2 max and running speed
- Decreased concentration and ability to manage emotions in sport (think about that performance anxiety)
- Dehydration
RED-S and eating disorders in athletes not only negatively impact performance, but can also result in very serious health risks. According to Renfrew, the mortality rate of those with anorexia nervosa are more than 12 times higher than the death rate of all causes of death for female identifying folks ages 15 to 24 years old.
Signs for an Eating Disorder in Athletes
The signs and symptoms for someone struggling with an eating disorder may be different for many. They are often undetectable if you don’t know what to look out for because you cannot tell if someone has an eating disorder based on how they look (unlike many myth suggests). So, here are a few common signs to look for:
Shifts in Mood
This may look like irritability, increase in anxiety or depression. Shifts in personality like becoming more introverted, isolated, or angry can also be signs.
Physical Symptoms
Physical symptoms are not always noticeable. For example, some females may develop menstrual irregularity or irregular lab work. For others, there may be more obvious symptoms such as weight loss, weight gain, brittle or loss of hair, difficulty regulating body temperature, or compromised immune system.
Behavioral Changes
This can look like anything from isolation, not eating in front of others, frequent bathroom use, ritualistic eating, avoidance of water or excessive water intake, restriction of certain food groups, or preoccupation with food.
Shift in Performance
Sometimes in the beginning stages of an eating disorder, an athlete can see an increase in performance. However, this does not last due to the body’s inability to sustain a deficit in energy. Soon you will see a decrease in performance, such as the issues stated above.
What percentage of athletes struggle with eating disorders?
Athletes are more susceptible to eating disorders than non-athletes. About 1 in 4 student athletes are said to have eating disorders. However, about 80% believe they are overweight and have a desire to lose weight.
Some sports are even more vulnerable to disordered eating and eating disorders such as, gymnastics, dance, running, or swimming. Athletes participating in endurance sports have a higher risk of an eating disorder. Actually, cross country and track are two of the top three sports for bone injuries. Female athletes in older age are now showing higher rates of osteoporosis and bone fractures than non-athletes.
Helping Athletes with Eating Disorders
As you can see above, discomfort with your body is so high among athletes. I believe the first step to prevention is talking about it. So many folks feel isolated in their discomfort with their body and the pressure around their sport to look a certain way, yet we are not talking about it. Increasing communication among team members and coaches has been seen to actually reduce the risk.
When an eating disorder presents itself, it can be hard to balance treatment and training. For athletes, treatment is complicated, especially for those running at elite levels. Treatment may look like taking a break from sport, getting a scholarship taken away or even not getting paid. For others, it may look like limited time on the field or cross-training. Every athlete is different and so is their recovery process. When working with athletes, I do my best to keep them engaged in their sport, as long as medically stable.
The most important element of assisting an athlete with a disorder related eating habits is to give priority to the individual athlete. Treatment requires time and commitment to be effective, and players cannot often commit to their sport and recover simultaneously. The athlete may need time to concentrate exclusively upon treatment and recovery.
For most athletes, this feels terrifying. The thought of putting your life in sport on hold is a very difficult concept. There are however a few programs specific to athletes with eating disorders that specialize in guiding clients through aspects like fueling for sport, eating competence, body esteem, recovery skills, and resiliency. A few of these programs are:
Finding the Balance of Eating Disorder Recovery while Pursuing Athletic Goals
Finding the balance between sport performance and eating disorder recovery is not an easy task. It is critical to prioritize your health and well-being over performance. Finding a treatment team that provides you the ability to engage with peers and teammates, can also provide a positive outlook on recovery. Preventing isolation and promoting openness, support, and encouragement are key factors in cultivating a positive recovery environment.
Achieving balance between treatment and training can look like adjusting workouts to accommodate fluctuations in energy and health, allowing you to prioritize flexibility and trust with your body’s signals. Taking regular days off can help support mental and physical recovery and again, teach flexibility and balance.
Expectations and goals may need to be adjusted while recovery is going on. Learning to build an identity outside of your sport can help you establish who you are in and outside of sports, instead of connecting your self worth to your performance.
Seeking Help
If some of this resonates with you, please know that you are not alone. Despite the complexity of seeking help as an athlete, there are resources to help support you. You do not need to do this alone.
ANAD’s free peer support services are available to anyone struggling with an eating disorder. Visit our Get Help page now to learn more or our Treatment Directory to find treatment providers in your area.
Kate Ringwood, LCPC
(she/her)
Kate is a psychotherapist, eating disorder specialist, and founder of Serendipity Counseling Services. Make sure to check out her recent episode on the Lane 9 Podcast!