Eating Disorders in Sport

Ron A. Thompson, Roberta Trattner Sherman

• Publisher: Routledge
• Year: 2011
• ISBN:
  9781135839666
• Edition: 1
• Topic: Psychology
• Subtopic: Abnormal Psychology
• Index: Psychology

Over the past fifteen years, there has been a great increase in the knowledge of eating disorders in sport and effective means of treatment.In this book, the authors draw on their extensive clinical experience to discuss how to identify, manage, treat, and prevent eating disorders in sport participants. They begin by examining the clinical conditions related to eating problems, including descriptions of specific disorders and a review of the relevant literature. Special attention is given to the specific gender and sport-related factors that can negatively influence the eating habits of athletes.

The second half of the book discusses identification of participants with disordered eating by reviewing symptoms and how they manifest in sport; management issues for sport personnel, coaches, athletic trainers, and healthcare professionals; treatment; and medical considerations, such as the use of psychotropic medications.A list of useful resources is included in an appendix, as well as a glossary of important terms.

1
Introduction

When our book Helping Athletes With Eating Disorders was published in 1993, little was known about eating problems in sport. Much of the book contained a review of the available literature, as well as anecdotal information we provided based on our clinical experience. In the succeeding 15 years, much has changed. Most important, the general literature on eating disorders has burgeoned, and the literature specific to sport in this area has grown significantly. Our clinical and consulting experience has broadened and deepened, and we have been involved with educational and preventive endeavors with the National Collegiate Athletic Association (NCAA) and the Medical Commission of the International Olympic Committee (IOCMC). As a consequence, we believe that Eating Disorders in Sport is a better documented, more in-depth, and more scholarly edition, while hopefully still serving as a practically useful resource for healthcare professionals and sport personnel.

One aspect of eating disorders in sport that has not changed in recent years is the seriousness and extent of the problem. Most recent prevalence data (Torstveit, Rosenvinge, & Sundgot-Borgen, 2008) indicate that clinical eating disorders continue to be significant problems for more than 46% of elite females in lean sports and almost 20% in nonlean sports. Because sport participants face the same general risk factors as the general population, as well as risks unique to the sport environment, we contend that they are more at risk. As a consequence, we believe that those in sport comprise a very special subpopulation of eating disorder patients in need of specialized approaches to identification, management, treatment, and prevention.

Our primary objectives for this book include providing the reader with practical recommendations regarding the following:

• Special issues that complicate identification

• Techniques to facilitate managing the competitor–patient

• Components of effective treatment

• Educational strategies for enhancing primary and secondary prevention

TWO WORLDS

How to identify, manage, treat, and prevent eating disorders in sport requires an understanding of, and appreciation for, two worlds—the world of sport and the world of eating disorder treatment. Although we are psychologists who specialize in the treatment of eating disorders (with more than 50 years of combined experience), we have also spent a considerable amount of time in the sport world. We are not, however, typical sport psychologists in that we do not usually work with sport participants regarding enhancement of sport performance. Rather, we are psychologists who typically work clinically with those in sport.

Specifically, we have worked as consulting psychologists to the Department of Intercollegiate Athletics at Indiana University– Bloomington for the past 20 years. In that capacity, we have worked clinically with sport participants and as consultants to the medical, coaching, and training staffs. Additionally, in recent years we have been fortunate to have worked with the National Collegiate Athletic Association (NCAA), as well as with the Medical Commission of the International Olympic Committee (IOCMC). Our work with the NCAA has included conducting research related to eating disorders in sport, providing education and training on eating disorders at NCAA member institutions, and the development and writing of two NCAA manuals—Managing the Female Athlete Triad (NCAA, 2005) and Managing Student-Athletes’ Mental Health Issues (NCAA, 2007). Our work with the IOCMC primarily involved coauthoring (with Jorunn Sundgot-Borgen, PhD) the “Disordered Eating” section of the IOCMC Position Stand on the Female Athlete Triad (IOCMC, 2005). We feel that our work in both worlds provides us with the knowledge, experience, and objectivity to provide the information and practical guidance necessary to work effectively with this very special subpopulation of patients with eating problems.

Despite being concerned with the welfare of those in sport, the two worlds of sport and eating disorder treatment are quite different in their focus, their concern, and their management of eating problems. Even from a research or scientific standpoint, the two worlds often are reading different professional literature. We hope to help bridge the gap between the two with this book and an integration of the literature, such that it could be more helpful to both worlds.

Unfortunately, there has sometimes been a misunderstanding or lack of trust of one world by the other. In our work, we have often heard healthcare professionals and colleagues attribute eating problems to sport or to coaches, or even suggesting that they are the problem and that the participant should leave the sport. On the other hand, individuals in the sport world have suggested that many healthcare professionals do not appreciate the importance of sport in the life of serious competitors and may tell them to leave their sport without appreciating the consequences. Additionally, many coaches have told us that they cannot get any information from mental health practitioners about their sport participants when they go into treatment, making them feel as if the practitioner does not trust them. Thus, they may become reticent about making referrals. We feel that this problem can be alleviated with relationship building and improved communication.

Because we view relationship building and communication as being more under the purview of mental health and psychology than sport, we believe the onus for bridging the gap between the two worlds falls on practitioners such as ourselves. Therefore, when and where appropriate, we will try to provide practical recommendations for avoiding or resolving these issues, as well as others that can sometimes interfere with the identification and treatment of eating disorders in this special population.

This focus on worlds should also remind us that eating disorders in sport are not simply a problem in the United States. Eating disorders are nondiscriminatory; they can, and do, occur virtually anywhere and everywhere. Thus, our focus will be an international one. When taking an international approach, one must try not to be too ethnocentric, and remember to use a common language. A prime example is the term athlete, which in the United States could refer to a competitor in any sport, whereas in the UK and other parts of Europe, it refers to a competitor in track and field. Conversely, sport participants other than those in track and field are referred to as sportsmen in the UK and other parts of Europe, whereas the term sportsmen in the United States could be taken to mean hunters and fishermen. In this book, we will try to use ethnicity-neutral terms such as competitors or sport participants when appropriate, or refer to the specific individual(s) in a particular sport, such as gymnasts, runners, or wrestlers.

Related to the issue of communication is how different sports are grouped or labeled throughout this book. Unfortunately, it is sometimes difficult to evaluate some studies in the literature because of a lack of consistency of labeling between studies. In an effort to facilitate communication in this regard, we have chosen to use two sets of labels. The first involves the general terms lean and nonlean sports. Lean sports include those for which there is a weight-class requirement, or in which a low body weight or lean body is believed to confer a competitive advantage either from a biomechanical standpoint (i.e., moving the body through space) or from a judging standpoint based on appearance. In essence, all other sports that do not have such an emphasis or focus on a small or lean body shape or have a weight-class requirement will be considered nonlean. At the same time, this should not be construed to mean that leanness is unimportant in nonlean sports. In fact, during the past 15 to 20 years, most sports—even most power sports—have been emphasizing body leanness as performance enhancing. For classifying specific sports within these two major categories, we have chosen to use a classification system suggested by Sundgot-Borgen and Larsen (1993) that includes the following sport or event categories: technical (e.g., fencing, golf), endurance (e.g., cycling, distance running), aesthetic (e.g., gymnastics, figure skating), weight class (e.g., judo, wrestling), ball game (e.g., volleyball, basketball), power (e.g., shot put, speed skating), and antigravitation (e.g., high jump, pole vault). Endurance, aesthetic, and weight-class sports will comprise the lean sports, and technical, ball game, power, and antigravitation sports will comprise the nonlean sports. For a variety of reasons, however, not all entities fit neatly into specified categories, whether these are individuals into diagnostic categories, or sports into what appear to be logical sport categories. We will explain our rationale on the few occasions when we feel a need to depart from this classification system, from either a logical or illustrative standpoint. The classification of sports will be discussed in more depth in Chapter 3.

HOW THIS BOOK IS ORGANIZED

In Chapter 2, we discuss the clinical conditions related to eating problems. This discussion, of course, includes the eating disorders—anorexia nervosa, bulimia nervosa, and eating disorder not otherwise specified. Additionally, we discuss what have been termed partial or subthreshold syndromes that do not meet diagnostic criteria for an eating disorder but compromise physical or psychological health or interfere with work, school, sport, or relationships. Specifically, we discuss disordered eating, low energy availability, anorexia athletica, and the female athlete triad. In Chapter 3, we review the literature related to sport and eating problems, as well the factors such as gender and type of sport that may moderate the risk. We continue with risk factors in Chapter 4 by discussing general and sport-specific factors that increase the risk of eating problems.

Chapters 5 to 8 are clinical chapters. In Chapter 5 we discuss identification of participants with disordered eating. Although there are many challenges in identification because it is easier for them to hide their disorder than for those in the general population, we discuss specific symptoms and how they manifest themselves in sport. Chapter 6 focuses on management issues for sport personnel, coaches, athletic trainers, and healthcare professionals. Additionally, advice on how to approach the individual believed to be at risk is included. Chapter 7 focuses on treatment. The types of treatment and treatment professionals that comprise the treatment team are explained. Issues of confidentiality and decisions regarding training and competing while in treatment are addressed. Finally, issues regarding motivation in treatment as well as handling patient resistance are addressed. In Chapter 8, Pauline Powers, MD, discusses specific medical issues, including the use of psychotropic medications. We conclude with a discussion of prevention in Chapter 9. Finally, we have an appendix with useful resources. Additionally, there is a glossary to assist the reader with terms that may be unfamiliar.

A FINAL THOUGHT

A final thought regarding Eating Disorders in Sport involves the issue of the risk factors for eating disturbances associated with specific sports or sport participation. Some have suggested that sports are a big part of the problem, and thus sport participation should not be encouraged, especially for girls and young women. We would heartily disagree with this conclusion. We view sport participation as providing a variety of opportunities for physical and psychological growth and development. From a physical standpoint, sport participation can increase strength, speed, coordination, endurance, and overall health. Psychologically, sports can increase self-esteem and self-efficacy, promote identity development, and foster a sense of teamwork, not to mention providing opportunities for healthy competition. As we will discuss in this book, sport participation per se is not the problem, and thus does not need to be avoided. Rather, it is the risks to sport participants that need to be eliminated or avoided—a topic that will be thoroughly discussed in this volume.

Other individuals have sometimes suggested that even writing about the issues and problems contained in this book can discourage young people from participating in sport. Obviously, our goal is not to discourage sport participation. Rather, our goal is to make others more aware of the potential risks associated with sport, as well as how to decrease, eliminate, or avoid them in an effort to provide a healthier and an even more satisfying sport experience.

2
Eating Disorders

Clinical and Subclinical Conditions

In this chapter, we discuss clinical eating disorders, but we have also included descriptions and discussions of other eating-related attitudes and behaviors that can affect an athlete’s health and performance. These have sometimes been described as subclinical, subthreshold, and subsyndromal, and have been given names such as anorexia athletica, disordered eating, muscle dysmorphia, and the female athlete triad. These conditions are of importance not only because of their deleterious effects on health and performance in their own right, but also because they can progress to clinical eating disorders if left untreated. The conditions discussed in this chapter are described in large part as if they were discrete and separate conditions primarily for purposes of illustration. In actuality, they tend to occur on a continuum or spectrum of eating-related difficulties, and individuals who experience them cross over from one condition to another (Tozzi et al., 2005).

EATING DISORDERS

Eating disorders are not simply disorders of eating. Also, they are not simply a misguided attempt to be thin; nor are they simply a sport participant’s means to reduce body weight or body fat in an effort to enhance sport performance. They are mental disorders that manifest themselves in a variety of eating and weight-related signs and symptoms. They are not caused by sports or coaches, although sports and coaches can increase the risk of developing such a disorder or exacerbate an existing disorder. Rather, they are potentially life-threatening d...

Table of contents

• ADVANCED PRAISE FOR EATING DISORDERS IN SPORT
• CONTENTS
• ACKNOWLEDGMENTS
• AUTHORS AND CONTRIBUTOR
• DISCLAIMERS
• 1 Introduction
• 2 Eating Disorders
• 3 Eating Disorders and Disordered Eating in Sport
• 4 Risk Factors for the Development of Problem Eating
• 5 Identification of Eating Disorders and Related Conditions
• 6 Management of Eating Problems in the Sport Environment
• 7 Treatment Issues
• 8 Medical Considerations
• 9 Prevention and Education
• EPILOGUE
• GLOSSARY
• RESOURCES
• REFERENCES
• INDEX