Specialized Treatment for Athletes with Eating Disorders

by Travis Stewart, LPC, NCC, McCallum Place

Roberta Trattner Sherman, Ph.D. and Ron Thompson, Ph.D. were pioneers when it came to treating athletes with eating disorders. They had a vision to provide residential treatment for athletes that was supportive both of recovery AND the option to return to competition. This was realized when they, along with Dr. Kimberli McCallum, opened The Victory Program at McCallum Place. This approach recognizes several factors that are needed when helping athletes recover from anorexia, bulimia, binge-eating and other disordered behaviors.

Nutritional needs of athletes with eating disorders

Athletes have different nutritional needs than the general population. Athletes need to “fuel” before, during and after practices and competition in a way that helps the body prepare, perform and recover from high intensity activity. Athletes who perform at the elite, high school, college or professional levels approach food differently—and can abuse food differently as well.

When working with athletes who have eating disorders, a dietitian who has  obtained a Certified Sports Specialist in Sports Dietetics (CSSD) is recommended. This is a registered dietitian with additional training in the area of providing nutritional guidance to athletes. Not only can they understand the goals of athletes and support them nutritionally, they can be on the look-out for how an athlete with an eating disorder might abuse or avoid nutrition in the context of sport.

Psychological needs of athletes with eating disorders

A sport psychologist is a critical part of treatment for an athlete and provides support and encouragement while challenging the eating disorder thoughts and behaviors. With specialized training for the psychological aspects of sport, a sport psychologist understands the pressures of competition, will explore multifaceted issues that can influence athletic performance, and encourage a balanced approach to training and competition.

At The Victory Program athletes have several separate groups from the general population. These groups get to the core of the athletic experience and equip athletes with the skills, knowledge and group interaction needed to pursue recovery. Victory groups include topics such as:  body image, mental preparation for sport, challenges related to being injured, returning to competition and reintegrating training, all from the perspective of an athlete. This unique setting helps athletes feel understood and allows them to address issues that would otherwise be overlooked in typical eating disorder therapy groups.

For example, in addition to having the typical struggles of body image which exist in our culture, athletes often have two “body images.” One body image relates to their social and relational experiences of living in Western society which places so much emphasis on a thin build. The other body image they carry internally is connected to their sport. For example, a runner who is told, “I’m surprised you are a runner. You don’t look like a runner” may perceive their body to not “fit” their sport and use eating disorder behaviors to attempt and change their body shape in life-threatening ways. Or a gymnast may value her strong thigh muscles when tumbling during the floor routine but be highly uncomfortable wearing a pair of jeans to class. Groups specific to athletes allow individuals to explore these issues and feel understood by other athletes and treatment providers.

Fitness needs of athletes with eating disorders

A unique aspect of treating athletes with eating disorders is the inclusion of a strength and conditioning coach on the treatment team. Many athletes may push themselves far beyond optimal training in time, intensity and frequency. In doing so the athlete may lose touch with both physical and emotional cues and experience injuries and emotional exhaustion. A strength and conditioning coach who is trained to work with eating disorders can assist the athlete in better understanding what proper training feels like and correct the tendency to over train.

When an athlete is medically stable, is nutritionally compliant, reaching treatment targets, and is mentally prepared, a strength and conditioning coach can assist in returning to a balanced training regimen. This includes preparing workouts and exposure to the sport in an incremental way along with processing of triggers and body cues. Amanda Tierney with The Victory Program describes her role with athletes this way,

“My role is to help bridge the gap between research and clinical practice, as well as communicate and collaborate with all of the key players involved in the care and development of our patient-athletes. It’s important for me to meet each individual where they are at and cultivate trust and transparency; to provide supervision, guidance and support during the, challenging yet important, work of (re)-establishing a balanced and sustainable relationship to training and sport.

During the healing process, my hope is to create a compassionate and non-judgmental space to restore confidence and rediscover passion, in sport and life. I truly believe that with the right mix of supervision, support, clear guidance and intentional practice, an unbalanced familiarity with fitness, can develop into a joyful experience that is both safe and sacred”.

Relational needs of athletes with eating disorders

Addressing family and relational dynamics in the context of treatment is a common and important part of treating an eating disorder. When an athlete is performing at a high level and the sport contributes significantly to their identity and community, treatment providers need to work with sport personnel by listening, educating, and communicating with them. This group of sport personnel, which can include coaches, strength and conditioning coaches, team doctors, athletic trainers and teammates is sometimes referred to as the “sport family.”  It is important for treatment providers to gather information from this group as they prepare a treatment plan and incorporate them into discharge planning and relapse prevention if the athlete intends on returning to sport.