Reflections on athletes and eating disorders

ObjectivesThe purposes of this paper were to offer reflections, thoughts, and observations on the burgeoning research regarding eating disorders in athletes over the past 25 years, to comment on the findings and clinical implications of the studies contained in this special issue, and to provide suggestions for future research.ResultsDisordered eating and eating disorders are complex, multidimensional, and multiply determined, and can affect the health and performance of athletes in both genders and most sports. Although coaches and teammates can be significant sources of weight and body image pressure, they can also play a positive role in identification and prevention.ConclusionsFurther research is needed in several areas. These include a broader focus that includes athletes believed to be at less risk, most notably males and non-lean sport athletes, and ironically younger athletes, who may be at greatest risk. We also need more research related to treatment of athletes with eating disorders and especially how we might better motivate them for recovery.     

Transitioning from sport: Life satisfaction,depressive symptomatology,and body satisfaction among retired female collegiate athletes

Retirement from sport has been associated with elevated levels of depression, anxiety and/or body dissatisfaction among athletes. Psychosocial dimensions, such as having reached sport goals and planned for life after sport, may affect how retired athletes’ respond psychologically. Thus, the primary aim of this study was to examine the association between psychosocial aspects of sports transition with body satisfaction, depressive symptoms and, life satisfaction among 217 female former NCAA athletes. Through hierarchical regression analyses, and after controlling for BMI and years since retirement, we determined that athletes who believed they had achieved their sport goals, developed a new life focus after their sport career, had focused on life areas other than just sport while competing, and remained involved in their sport in different ways after retirement reported being more highly satisfied with their lives and their bodies and experiencing fewer depressive symptoms; variance accounted for ranged from 24% to 28% across these outcomes. Athletes’ perceptions of what has occurred in their lives while transitioning from sport may have longstanding effects on their psychological well-being in retirement. Longitudinal methodologies are needed to determine the temporal influence of these psychosocial dimensions.     

Prevalence and correlates of disordered eating in female figure skaters

ObjectivesThe purposes of this study were to (a) examine the prevalence of disordered eating among female figure skaters, (b) compare levels of disordered eating between skaters and their same-age peers, (c) compare levels of disordered eating between elite skaters and their sub-elite counterparts, and (d) examine general and sport-related correlates of disordered eating (i.e., four sport-related weight pressures, general and sport-related body dissatisfaction, positive and negative perfectionism, self-esteem, and athletic identity).DesignThis study employed a cross-sectional design.MethodsParticipants completed paper–pencil surveys, including measures for disordered eating, four sport-related weight pressures, general and sport-related body dissatisfaction, positive and negative perfectionism, self-esteem, and athletic identity. Participants included 272 female figure skaters ages 12–25 (M = 15.63) across five US states.ResultsThirteen percent of participants scored within range of problematic eating attitudes and behaviors but were no more symptomatic than their same-age peers when compared to existing normative data. Levels of disordered eating did not significantly differ between those competing at the elite and sub-elite level. After controlling for body mass index and age, disordered eating was significantly predicted by self-consciousness of weight and appearance, general and sport-related body dissatisfaction, and positive perfectionism.ConclusionsDisordered eating occurs in female figure skaters across competitive levels. Concern over weight and appearance, dissatisfaction with one's body in general and in sport, and positive perfectionism may serve as important tools in the prevention and detection of disordered eating in female figure skaters.     

Weight on the bar vs. weight on the scale: A qualitative exploration of disordered eating in competitive female powerlifters

Disordered eating enquiry in sport psychology has arisen due to the need to investigate sub-clinical populations. Weight-class athletes have been found to be ‘at-risk’ of disordered eating. Therefore, interpretations of experiences can shed light on female weight-class athletes disordered eating accounts. In line with previous interpretive studies, athlete accounts can highlight unique social and cultural insights regarding disordered eating. The aim of the study was to explore disordered eating experiences of female powerlifters. One semi-structured interview was conducted with 17 participants. A thematic analysis resulted in four themes: fear of disclosing weight-cutting concerns; eating like a powerlifter; culture of regulation; and the female body vs. the powerlifter body. Findings highlighted a complex interaction between weight-cutting, the construction of disordered eating, and a female-athlete paradox within powerlifting. We anticipate findings will extend to other weight-class sports, and discuss applied implications for powerlifters' mental health and recommendations for future research.     

Prognostic significance of two sub-categorization methods for the treatment of binge eating disorder: negative affect and overvaluation predict, but do not moderate, specific outcomes

Given the absence of known predictors and moderators for binge eating disorder (BED) treatment outcome and recent findings regarding meaningful sub-categorizations of BED patients, we tested the predictive validity of two subtyping methods. Seventy-five overweight patients with BED who participated in a randomized clinical trial of guided self-help treatments (cognitive-behavioral therapy (CBTgsh) and behavioral weight loss (BWLgsh)) were categorized in two ways. First, a cluster analytic approach yielded dietary-negative affect (29%) and pure dietary (71%) subtypes. Second, research conventions for categorizing patients based upon shape or weight self-evaluation yielded clinical overvaluation (51%) and subclinical overvaluation (49%) subtypes. At the end of treatment, participants subtyped as dietary-negative affect reported more frequent binge episodes compared to the pure dietary subtype, and those with clinical overvaluation reported greater eating disorder psychopathology compared to the subclinical overvaluation group. Neither method predicted binge remission, depressive symptoms, or weight loss. Neither sub-categorization moderated the effects of guided self-help CBT and BWL treatments on any BED outcomes, suggesting that these two specific treatments perform comparably across BED subtypes. In conclusion, dietary-negative affect subtyping and overvaluation subtyping each predicted, but did not moderate, specific and important dimensions of BED treatment outcome.     

Effects of achievement goals on self-regulation of eating attitudes among elite female athletes: An experimental study

Introduction

The influence of achievement goals on eating attitudes has mainly been examined through correlational studies (e.g., [De Bruin et?al., 2009] and [Duda and Kim, 1997]), and none of the studies to date has focused on the self-regulation of eating attitudes in athletes. The present study experimentally tested the effects of achievement goals on both self-reported (Study 1) and behavioral indices (Study 2) of the self-regulation of eating attitudes in female figure skaters.

Method

Elite female figure skaters (Study 1: n = 44; Study 2: n = 54) were randomly assigned to one of four conditions designed to induce specific goal involvement (performance-approach, mastery-approach, performance-avoidance, and mastery-avoidance) or a control condition (no goal induction). The participants in Study 1 completed the Self-Regulation of Eating Attitudes in Sport Scale (SREASS, Scoffier, Corrion, Paquet, & Arripe-Longueville, 2010) and those in Study 2 completed a virtual behavioral measure of self-regulation of eating attitudes (VSSR; Scoffier, 2009).

Results

Variance analyses indicated that induced mastery-approach goals and performance-avoidance goals resulted in higher scores for self-regulation of eating attitudes than induced performance-approach goals and mastery-avoidance goals. The relationships were the same at both self-reported and behavioral levels.

Discussion

This experimental study confirms the findings of previous correlational works and shows that achievement goals contribute to the causal processes of self-regulation of eating attitudes. These findings might help to prevent eating disorders in female athletes by providing guidance for the development of adapted motivational strategies.     

Defining features of unhealthy exercise associated with disordered eating and eating disorder diagnoses

ObjectivesThe current study sought to compare different features of unhealthy exercise on associations with disordered eating and their ability to identify individuals with eating disorders. A secondary aim of the study was to compare prevalence and overlap of different aspects of unhealthy exercise and potential differences in their gender distribution.DesignCross-sectional epidemiological study.MethodsA community-based sample of men (n = 592) and women (n = 1468) completed surveys of health and eating patterns, including questions regarding exercise habits and eating disorder symptoms.ResultsCompulsive and compensatory features of exercise were the best predictors of disordered eating and eating disorder diagnoses compared to exercise that was excessive in quantity. Further, compulsive and compensatory aspects of unhealthy exercise represented overlapping, yet distinct qualities in both men and women.ConclusionsIncluding the compulsive quality among the defining features of unhealthy exercise may improve identification of eating disorders, particularly in men. Results suggest that the compensatory aspect of unhealthy exercise is not adequately captured by the compulsive aspect of unhealthy exercise. Thus, interventions that target unhealthy exercise behaviors among high-risk individuals, such as athletes, may benefit from addressing both the compulsive and compensatory aspects of unhealthy exercise. Future prospective longitudinal studies will aid in determining the direction of the association between these features of unhealthy exercise and the onset of eating pathology.     

Identifying and preventing disordered eating among athletes: Perceptions of track and field coaches

ObjectiveThis study aimed to identify the strategies employed by coaches when identifying disordered eating (DE) among track and field athletes.DesignThis was a qualitative study and an inductive thematic analysis was conducted.MethodSemi structured interviews were conducted with eleven track and field coaches, with experience of coaching at national and international level. The interviews were recorded, transcribed verbatim and analysis was conducted.ResultsTrack and field coaches reported using physical, social and performance indicators to identify disordered eating in their athletes. Coaches also monitored their athletes' eating attitudes and behaviors. Weight loss (both observed and objectively monitored) was considered to be a key indicator of disordered eating. Coaches placed a high level of importance on weight for performance, and an “ideal” female athlete body. Previous experiences of detecting disordered eating and a close relationship with the athlete facilitated the identification of disordered eating. Athlete secrecy and masking behaviors, difficulties in communication and coaches' stereotypical beliefs were found to complicate the identification process.ConclusionsThis study highlights the need for additional information, advice and guidance for track and field coaches to improve their knowledge and confidence in identifying disordered eating among their athletes.     

Parenting to prevent body dissatisfaction and unhealthy eating patterns in preschool children: A Delphi consensus study

Interventions to prevent body dissatisfaction and unhealthy eating patterns are needed in early childhood. Identifying effective parenting strategies would be useful for parents and prevention researchers. To develop expert consensus, an online Delphi study was conducted with experts (N = 28, M_age = 44.34) who rated statements describing potential parenting strategies gleaned from a systematic literature search. If 90–100% rated a statement as either Essential or Important, it was endorsed as a guideline. From a total of 335 statements 153 were endorsed. Despite some areas of disagreement, including whether parents should weigh their child or discourage weighing, experts were able to reach consensus on a wide range of issues, such as how to discuss healthy eating with children. The developed guidelines provide a novel and required resource for parents, and a framework for researchers developing interventions to prevent the onset of body dissatisfaction and unhealthy eating patterns in early childhood.     

Group cohesion and relatedness as predictors of self-determined motivation and burnout in adolescent female athletes

ObjectivesAthlete burnout is the result of a maladaptive sport experience that is influenced by the social context. A salient social contextual feature of youth sport is group cohesion. Cohesion may link with burnout through its association with relatedness and self-determined motivation. The current study was designed to test a model in which cohesion associates with burnout by way of relatedness and self-determined motivation.DesignCross-sectional survey-based study.MethodFemale youth soccer athletes (N = 276; M age = 14.9 years, SD = 1.3) completed measures of task and social cohesion, relatedness, self-determined motivation, and burnout.ResultsTask (β = 0.26) and social (β = 0.59) cohesion associated with perceptions of relatedness. In turn, relatedness positively linked with self-determined motivation (β = 0.38), which in turn negatively associated with global burnout (β = −0.79). The indirect effects from task cohesion to burnout (β = −0.08) and from social cohesion to burnout (β = −0.18) by way of relatedness and self-determined motivation were significant.ConclusionsResults support the proposed model whereby greater cohesion associates with an athlete’s feelings of relatedness, which links to more self-determined motivation and, consequently, lower burnout perceptions. Future research is needed to assess support for causality of these links and explore how contextual factors such as the teammate-created motivational climate contributes to group cohesion and relatedness perceptions within this burnout model.     

Confirmatory factor analysis of eating disorder symptoms in college women

Recent studies have found that the eating disorders can best be conceptualized as multidimensional. Four factors have consistently emerged from factor analytic studies of eating disorder symptoms: dietary restraint, bulimic behaviors, neurotic personality characteristics, and body image/body dysphoria. Confirmatory factor analysis was utilized to determine if this four-factor structure of eating disorder symptoms would be found in a sample of college women. Principal components analysis extracted four factors which were supported with a confirmatory factor analysis procedure. These four factors were negative affect and body dysphoria, bulimic behaviors, restrictive eating, and body image. The negative affect and body dysphoria factor was positively correlated with the other factors (i.e., bulimic behaviors, restrictive eating, and body image). This factor structure was similar to the factor structure found in samples of patients with bulimia and anorexia nervosa, except that the factors were more highly intercorrelated in the nonclinical sample. Results suggest that the measures of eating disorder symptoms used in this investigation are measuring the same multidimensional constructs in clinical and nonclinical subjects.This paper is partially based upon the master's thesis of the first author.     

The differential depiction of female athletes in judged and non-judged sport magazines

Sports magazines portrayal of female athletes over the past ten years, in terms of body size, age, and race was examined. Using the Contour Drawing Rating Scale (CDRS), estimated body size was obtained for cover models on a set of judged and non-judged sport magazines. The frequency with which the full bodies of models were depicted on the covers of these magazines was also investigated. Cover models on judged sport magazines were rated as significantly thinner than cover models on non-judged sport magazines. Judged sport magazines also displayed a higher number of full-body images than non-judged sport magazines. These findings suggest that individuals who read judged sport magazines are more likely to be exposed to thin media images than those reading non-judged sport magazines.     

Emotional eating and cognitive conflicts as predictors of binge eating disorder in patients with obesity

Background/Objectives: Binge Eating Disorder (BED) is often associated with obesity. In order to identify the variables that allow to better detect the presence of BED, people with overnutrition were compared with and without BED in the presence of cognitive conflicts, eating symptoms and anxious-depressive symptoms. The inclusion of cognitive conflicts had been relevant in bulimia studies but had not been investigated with respect to BED. Method: Two groups with obesity were evaluated, one without BED (OB, n = 54) and the other with BED (OB-BED, n = 48), using a social-demographic questionnaire as well as a semi-structured interview to assess BED, questionnaires (DASS-21, EDE-Q, EEQ) and the Repertory Grid Technique. Results: Overall, the OB-BED group presented more conflicts and more symptoms. The model that best differentiated between the groups included emotional eating and level of cognitive conflicts, correctly classifying 91.4% of the sample. Conclusion: These results highlight the role played by cognitive conflicts and emotional eating as differentiating elements between OB and OB-BED, with a high level of predictive accuracy.     

The influence of peer groups in organized sport on female adolescents' identity development

IntroductionEngagement in the process of identity development has been identified as the most significant milestone of adolescence (Erikson, 1968) and peer groups serve as a key facilitator in this process (Kroger, 2007). Peer groups are particularly significant in the lives of female adolescents, as females derive a substantial part of their identity through these relationships (Josselson, 1987). Despite the significance of personal identity development in adolescence and the importance of peer groups in this process, this area has not been explored in the extant sport psychology literature.PurposeTo investigate the potential influence of peer groups in organized sport on female adolescent identity development.MethodsData were collected through photo-elicitation and semistructured interviews of eight female athletes between the ages of 13 and 17 years. Participants in the study played a variety of sports and competed at various levels. Data were analysed using a thematic narrative approach.ResultsParticipant stories suggest that interactions with peers in sport assist female adolescent athletes in developing their psychological (including emotional and intellectual), social, and physical selves.ConclusionStories shared by the female athletes suggest that a relationship exists between peer influence and identity development in sport. Findings are interpreted through Erikson's (1968) Theory of Psychosocial Development and the nature of the relationships in which peer influence on identity development occurs are discussed. Recommendations for future research are proposed.     

Effects of parental comments on body dissatisfaction and eating disturbance in young adults: A sociocultural model

This study examined a sociocultural model of the influence of parental comments on body shape and eating concerns among males and females. Questionnaires were completed by 338 undergraduates. Participants reported levels of perceived parental comments, internalization of media ideals, appearance comparison, body dissatisfaction, drive for thinness and bulimia. Results revealed that, regardless of gender, internalization and appearance comparison only partially mediated the relationship between parental comments and the outcome variables. The final model for females explained a larger proportion of the variability in body shape and eating concerns than in males, with positive and negative parental comments directly related to body dissatisfaction and through it to eating outcomes. In males, only negative comments were directly related to body dissatisfaction. These findings highlight the role of parental influences in sociocultural models of the development of body dissatisfaction and eating concerns, and the gender-specific patterns of sociocultural influence.     

A receiver operator characteristics analysis of treatment outcome in binge eating disorder to identify patterns of rapid response

The purpose of this study was to perform a receiver operator characteristics (ROC) analysis on a treatment sample from a randomized controlled treatment trial of participants with binge eating disorder (BED). An ROC analysis was completed with 179 adults in a 20-week treatment trial for BED to predict abstinence from binge eating at end of treatment. Percent reductions in binge eating episodes were examined following weeks 1 through 10 of treatment. The rate of percent decrease in binge eating episodes during treatment for BED was a significant predictor of clinical outcome at end of treatment. Participants who demonstrated a 15% reduction in binge eating episodes at week one were more likely to respond positively to treatment and achieve clinical remission. Findings from the current study suggest that a significant reduction in binge eating during the first week of treatment may be predictive of end of treatment remission in those with BED.     

A comparison of body size ideals, body dissatisfaction, and media influence between female track athletes, martial artists, and non-athletes

ObjectivesIn assessments of body image among athletes, there remains an important discrepancy between studies reporting, on one hand, increased body dissatisfaction among athletes and, on the other, lower body image concerns. In order to help resolve this contradiction, the present study examined body size ideals, body dissatisfaction, and media influence among female recreational athletes and non-athletes.MethodForty-one track athletes (a judged sport in which leanness is actively promoted), 47 women involved in Taek Won Do (a martial art with little or no emphasis on leanness), and 44 non-athletes completed self-report measures of ideal body size, body dissatisfaction, and media influence, and provided their demographic details.ResultsResults showed that, after controlling for participants' body mass index (BMI), there were no significant between-group differences in ideal body size. By contrast, track athletes reported the highest body dissatisfaction scores and the highest internalisation of athletic media messages. Results of a regression analysis showed that, for the total sample, participants' BMI and internalisation of athletic media messages predicted body dissatisfaction over-and-above involvement in the different sports.ConclusionThese results support the suggestion that women participating in leanness-promoting sports experience greater body dissatisfaction than women in other sports or non-athletes.     

Team weigh-ins and self-weighing: Relations to body-related perceptions and disordered eating in collegiate male athletes

ObjectivesIn this study we examined the relation of team weigh-ins and self-weighing frequency on collegiate male athletes' internalization of body ideals, social pressures about weight/body, body satisfaction, dietary intent, negative affect, drive for muscularity, and bulimic symptomatology.Design and methodsWe used a cross-sectional survey design, and collected data electronically from 738 male intercollegiate athletes in the U.S.ResultsAthletes who self-weighed 7 + times per week reported the most pressure to lose weight and be lean and muscular, engaged in muscle-building behaviors most frequently, dieted most often, and had the highest level of bulimic symptomatology. Further, athletes on teams that conducted mandatory weigh-ins (vs. not) engaged in more muscularity behaviors and dietary restriction.ConclusionWeighing, but in particularly that conducted voluntarily, may contribute to an overconcern with appearance, body size/shape, and weight, which in turn can lead to a variety of behaviors related to eating and body change.     

Habit reversal versus supportive psychotherapy in Tourette's disorder: a randomized controlled trial and predictors of treatment response

Tourette syndrome (TS) is characterized by chronic motor and vocal tics. Habit reversal therapy (HR) is a behavioral treatment for tics which has received recent empirical support. The present study compared the efficacy of HRT in reducing tics, improving life-satisfaction and psychosocial functioning in comparison with supportive psychotherapy (SP) in outpatients with TS. In addition, we investigated whether impairments in response inhibition in patients with TS predict response to HR treatment which specifically aims to inhibit tics. Thirty adult outpatients with DSM-IV TS were randomized to 14 individual sessions of HR (n = 15); or SP (n = 15). HR but not SP reduced tic severity over the course of the treatment. Both groups improved in life-satisfaction and psychosocial functioning during active treatment. Reductions in tic severity (HR) and improvements in life-satisfaction and psychosocial functioning (HR and SP) remained stable at the 6-month follow-up. The extent of pre-treatment response inhibition impairment in the HR group predicted reductions in tic-severity from pre- to post-treatment. Our results suggest that HR has specific tic-reducing effects although SP is effective in improving life-satisfaction and psychosocial functioning. Assessments of response inhibition may be of value for predicting treatment response to HR.     

Internalization of the thin and muscular body ideal and disordered eating in adolescence: the mediation effects of body esteem

This study investigates body esteem factors (weight-esteem and appearance-esteem) as mediators of the relationship between ‘internalization of the ideal body figure’ and disordered eating behaviors (restrained, emotional and external eating) in a community sample of adolescent males (n = 810) and females (n = 1137) from the Ontario Research on Eating and Adolescent Lifestyles (REAL) study. Mediation models were examined using a bootstrapping approach to test indirect effects and indirect contrasts. In males, weight-esteem partially mediated the relationship between muscular ideal and restrained eating; appearance-esteem partially mediated effects in the emotional and external eating regressions. In females, both weight-esteem and appearance-esteem partially mediated the relationship between thin ideal and all three forms of disordered eating; weight-esteem was a stronger mediator for restrained eating, and appearance-esteem a stronger mediator for emotional and external eating. Body esteem is important to consider for prevention and treatment of disordered eating in both genders.