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.     

On Targeting Emotion Regulation Deficits in Eating Disorders through Defense Analysis

ABSTRACT

Psychodynamic approaches to the treatment of individuals with eating disorders are underrepresented in research and in academia. This will increasingly deprive patients of a viable therapeutic alternate to the dominant behavioral family-based models. As psychodynamic approaches may have unique benefits, there is value in resolving this loss. Recent models of dynamic therapies for eating disorders within modern, empirically derived theory show promise for future psychodynamic viability. An attachment-focused approach targeting disordered attachment patterns that are common in individuals with eating disorders has recently been introduced. To complement this model, this article proposes an approach for individuals with eating disorders that is hypothesized to target emotion regulation deficits that are also commonly found in individuals with eating disorders. Observed parallels between the implicit branch of the emotion regulation system and that of contemporary constructs of defense mechanisms guide this proposal. Developmental considerations reveal important connections between this biologically based model and a two-person model based in attachment theory. In this way, this proposal offers a flexible psychodynamic approach that integrates with the existing literature. Further development of this approach could one day help patients to have a greater range of therapeutic options for recovery from eating disorders.     

Phyloanalysis: Theoretical and Practical Considerations on Burrow's Group Analytic and Socio-Therapeutic Method by W. Riese and H. Syz

Abstract

Women in an eating disorders partial hospital program and a psychiatric partial hospital program were compared on a self-report measure of group climate following a psychodynamic-interpersonal therapy group. Those with eating disorders experienced their groups as more engaged and as more avoiding than those in the psychiatric partial hospital group. Therapists may be able to use initial heightened engagement in eating disorder groups to counteract the tendency to avoid content.     

Connecting Eating Pathology with Risk for Engaging in Suicidal Behavior: The Mediating Role of Experiential Avoidance

Individuals with eating pathology, particularly those with diagnosed eating disorders, are at high risk for suicide. It is less clear whether undiagnosed eating pathology and subsyndromal eating disorders carry the same risk and, if so, what mechanisms may explain why higher levels of eating pathology yield greater risk for engaging in suicidal behaviors. The indirect relationship between disordered eating and risk for suicidal behaviors via facets of experiential avoidance was tested using a multiple‐mediator model. The model was tested using bootstrapping estimates of indirect effects in a sample of 218 noncollege student adults (Mage = 32.33, 66.1% women) with a history of suicidal attempt and/or history of nonsuicidal self‐injury (NSSI). Results revealed that disordered eating indirectly predicted risk for suicidal behaviors, distress aversion (i.e., negative attitudes or dislike of distress), and procrastination (i.e., delaying engagement with distressing activities). Results suggest that targeting experiential avoidance and helping those who have a history of engaging in suicidal behaviors and/or NSSI develop regulation strategies to use during times of distress may be of utmost importance for treatment and prevention of eating pathology.     

To Know Another Inside and Out: Linking Psychic and Somatic Experience in Eating Disorders

ABSTRACT

This article explores the role of the body in the psychoanalytic treatment of eating disorders from a relational and developmental perspective. Many who struggle with eating disorders and related issues have had early experiences that adversely affected the development of flexible, adaptive self-regulation, including the ability to experience affects as psychic states that can be safely shared in the context of a relationship. Because of their difficulty symbolizing and expressing feelings, patients with eating disorders often experience affects as somatic problems, for which they seek somatic solutions. Tuning in to patients’ bodily experience can open up pathways for accessing and, eventually, verbalizing and reflecting on internal states in the therapeutic relationship. As shown through a detailed case illustration, the therapist can discover and engage aspects of the intersubjective matrix that may not meet the eye by attending to his or her own bodily experiences and associations in and out of sessions.     

Perceived Weight of Other Persons

Abstract

On the basis of photographs, students (N = 258) evaluated the weights of 77 male executives or 50 businesswomen. Women students were expected to be less likely than men, and non-American students (mostly ethnic Chinese) to be less likely than Americans, to assign thin ratings to the people in the photographs. No differences in ratings were found between the responses of male and female students, but some significant differences in ratings were found between the American and non-American students. The results suggest that studies of other persons' body images may yield limited insights into the eating disorders that can accompany body self-image distortions.     

Heavenly Bodies: Religious Issues in Cognitive Behavioral Treatment of Eating Disorders

Minimal attention has been given to the role that religion may play in the development, maintenance, and treatment of eating disorders. Many religions espouse specific doctrines about the nature and purpose of the body as well as prescribe particular body grooming and eating practices. These doctrines and practices influence individuals' schemas and experiences of the body and eating, which can either contribute to or provide protection from eating disorders. This paper describes pathways through which religious beliefs and practices may impact risk for and maintenance of eating disorders. Methods for integrating religious concepts, practices, and resources into standard cognitive-behavioral treatment for eating disorders are discussed, including interventions that address purported religiously oriented contributory and protective factors. Treatment of a religious client with an eating disorder is described to illustrate the incorporation of religiously oriented interventions in practice.     

‘I didn’t realise I was such a sausage’: men’s accounts of whole-body scanning,body image,and expected changes in health-related behaviours

Objective: Whole-body scanning is now available in stores to assist buyers in choosing well-fitting clothes. This study was designed to investigate men’s accounts of scanning, body image and expectations of behaviour change. Design: Ten men aged 18–39 years without histories of eating disorders or previous experience of whole-body scanning, took part in semi-structured interviews before and after scanning. Data were analysed using inductive thematic analysis. Results: Pre-scan, men’s body ideals were tall, slender and relatively muscular. Post-scan, seven reported looking shorter, fatter, thinner and/or less symmetrical than they hoped; three were pleasantly surprised by the images. Men were interested in scans as an objective view of their bodies and as a ‘wake-up call’ to motivate healthy behaviours. Five men intended to change their behaviour as a result of scanning, and repeat scanning was seen as a good way to monitor behavioural changes. Participants suggested that scanning may raise body concerns in other men, though downplayed impacts on their own body image. Conclusion: Whole-body scanning may encourage men to exercise and eat more healthily. However, men became more negative about their bodies as a result of seeing their body scans, so scanning needs to be carried out with supervision and support.     

Body Image: Gender,Ethnic, and Age Differences

Abstract

Using figure drawings (E. Fallon & P. Rozin, 1985), 120 male and female U.S. college students–African American, Hispanic, and Caucasian–indicated their current and ideal figures, the figures that they considered most attractive to the opposite sex, and the opposite-sex figures most attractive to themselves. Dissatisfaction with body shape was greater among the women regardless of ethnicity. Both the men and the women misjudged which shapes the opposite sex would rate as most attractive: The women guessed that the men preferred shapes thinner than those that they actually reported. The African American women had the most accurate perceptions of what the men found attractive, whereas the Caucasian women had the most distorted views. The men guessed that the women preferred shapes bulkier than those that they actually indicated. These findings may be relevant to the lower incidence of eating disorders among African American women and the higher incidence of such disorders among Caucasian women.     

Weight-based discrimination,body dissatisfaction and emotional eating: The role of perceived social consensus

Objective: Discrimination can have a negative impact on psychological well-being, attitudes and behaviour. This research evaluates the impact of experiences of weight-based discrimination upon emotional eating and body dissatisfaction, and also explores whether people's beliefs about an ingroup's social consensus concerning how favourably overweight people are regarded can moderate the relationship between experiences of discrimination and negative eating and weight-related cognitions and behaviours.

Research methods and procedures: 197 undergraduate students completed measures about their experiences of weight-based discrimination, emotional eating and body dissatisfaction. Participants also reported their beliefs concerning an ingroup's attitude towards overweight people.

Results: Recollections of weight-based discrimination significantly contributed to emotional eating and body dissatisfaction. However, the relationships between experiencing discrimination and body dissatisfaction and emotional eating were weakest amongst participants who believed that the ingroup held a positive attitude towards overweight people.

Discussion: Beliefs about ingroup social consensus concerning overweight people can influence the relationships between weight-based discrimination and emotional eating and body dissatisfaction. Changing group perceptions to perceive it to be unacceptable to discriminate against overweight people may help to protect victims of discrimination against the negative consequences of weight-based stigma.     

"I feel fat": an experimental induction of body displacement in disordered eating

Body displacement, the theory that predicts that individuals with eating disorders will displace negative feelings about themselves onto their body, was tested experimentally in this study. Unrestrained eaters (n = 61), restrained eaters (n = 33), and individuals with eating disorders (n = 26) were randomly assigned to a control condition or an ineffectiveness induction. In the ineffectiveness condition participants were asked to recall and reflect on a past experience when they felt useless or incapable (i.e., ineffective). Results showed that individuals with eating disorders who were made to feel ineffective reported more implicit appearance/body concern than those in the control condition. Unrestrained and restrained eaters did not show this effect. This is the first experimental study to support body displacement theory. These data can be used clinically to educate and encourage patients with eating disorders to address thoughts and feelings related to ineffectiveness directly, instead of displacing this distress onto their body and potentially perpetuating their eating disorder.     

A structural equation model of intuitive eating with adolescents

IntroductionThe tendency to eat by paying attention and respecting the body's hunger and satiety cues is called intuitive eating. This eating behavior has been linked to positive health and well-being outcomes.ObjectiveThe purpose of this study was to test a global model linking intuitive eating with self-esteem, body esteem, media influence and including fear of negative appearance evaluation in adolescents’ boys and girls.MethodIn total, 740 adolescent high school students (51.5% girls; M age = 14, SD = 1.5) completed self-report questionnaires with measures of intuitive eating, body esteem, self-esteem, media influence and fear of negative appearance evaluation.ResultsStructural equation modeling revealed an overall excellent fit for the final four-variable model excluding the fear of negative appearance evaluation variable. Mediation analyses showed an indirect relationship between intuitive eating and body esteem via media influence, for girls but not for boys. Body esteem mediated the relationship between intuitive eating and self-esteem, for girls and boys.ConclusionA new model is proposed where intuitive eating is associated with self-esteem through body esteem and media influence. These findings suggest that regulating attitudes and behaviors toward food may be related to higher psychological well-being.     

Treatment hurts: Lay theories of graded exposure in the treatment of four anxiety disorders

Objective: This paper concerned the perceived suffering/side effects caused by various well-known treatments for personal problems. It looked at whether people understood whether potentially painful treatments that confront negative aversive affect were effective or not.

Method: In total, 106 participants completed a long questionnaire assessing the ‘psychological pain’ ratings of 30 psychotherapy treatments, varying in fear exposure, for four relatively common anxiety disorders: social phobia, agoraphobia, post-traumatic stress disorder, and obsessive compulsive disorder.

Results: Factor analytic results revealed four clear factors underlying lay efficacy beliefs of psychotherapy interventions, varying in fear exposure: talking therapies, fear confrontation, fear avoidance, and alternative therapies. Talking therapies were rated the most effective across all disorders, but also the most painful. Fear avoidance therapies were rated the least effective and, along with alternative medicine, the least painful. Treatments involving fear exposure were rated the most painful. Regression analysis revealed talking therapies to be rated more efficacious by younger subjects than older subjects.

Conclusion: Most people seem able to differentiate between the efficacies of interventions for different anxiety disorders and hold consensually held optimistic conceptions about the usefulness of psychotherapy treatments and counseling that involve fear exposure, despite knowledge of the psychophysical side effects that these therapies often entail. They favored talking cures over others, but that may have been due to misleading items in the questionnaire.     

Supervision for Counselors Working With Eating Disorders Groups: Countertransference Issues Related to Body Image,Food, and Weight

Because of similarities in age, education, and background, group counselors and members of eating disorders groups may easily identify and connect with each other. Although it can be positive, such overidentification may also create countertransference issues and demand attention in supervision. A model of supervision based on parallel process is presented to address these issues. The article describes (a) societal values related to eating disorders and countertransference; (b) specific themes in eating disorder groups and their impact on group process; (c) examples of countertransference related to body image, food, and weight; and (d) guidelines for supervision of female counselors working with eating disorders groups.     

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.     

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.     

Pinning down the problems and influences: Disordered eating and body satisfaction in male wrestlers

ObjectivesDisordered eating and body dissatisfaction are common concerns among athletes. However, these variables have been minimally explored in male wrestlers. Sociocultural influences can impact drive for muscularity, body satisfaction, and disordered eating, but it is unclear which influences are most prominent in this population. The present study had two aims: 1) examine the nature of drive for muscularity, body satisfaction, and disordered eating in collegiate wrestlers, and 2) investigate which sociocultural influence (general, coach/teammate, sport appearance pressures) most strongly predicts drive for muscularity, body satisfaction, and disordered eating.Methods and designThis study was cross-sectional. Participants included 103 National Collegiate Athletic Association Division I male collegiate wrestlers in the U.S. who completed surveys in season on sociocultural influences, drive for muscularity, body satisfaction, and disordered eating.ResultsWrestlers had a high drive for muscularity and engaged in many unhealthy behaviors to lose weight; however, they had relatively high body satisfaction. Relative weight analyses showed that sport appearance pressures were the strongest predictor of drive for muscularity while general pressures were the strongest predictor of body satisfaction and restricting eating behaviors.ConclusionsFindings suggests that disordered eating needs to be addressed among wrestlers and potential influences to target.     

Understanding the Role of Gender and Ethnic Oppression when Treating Mexican American Women for Eating Disorders

Gender, ethnicity, and weight issues are often the basis for internalized oppression. Mexican American women with eating disorders are subject to such internalization, complicated by cultural and family factors. Mexican American women (n = 136) were assessed. The resulting culturally discrepant gender identity theory describes the complicated set of relationships between weight, cultural weightism, gender identity, assimilation to U.S. culture, family factors, and eating disorder symptoms. Therapists treating eating disorders should consider ethnic and gender identity in addressing the conflicts between family, culture, and gender expectations; and demonstrate sensitivity to the complex inter-generational relationships in Mexican American families.     

Rumination, experiential avoidance, and dysfunctional thinking in eating disorders

The majority of research in eating disorders (ED) has investigated the content of disorder-specific thoughts, while few studies have addressed underlying cognitive-affective processes. A better understanding of processes underpinning ED may have important implications for treatment development. Two studies were conducted that investigated levels of rumination, beliefs about rumination, experiential avoidance, and aspects of schematic thinking in individuals with eating pathology. The latter was assessed with a newly designed ED-Sentence Completion Task (ED-SCT). Study 1 (N = 177) examined relations between ED psychopathology and these variables in a student population. Extending this, Study 2 (N = 26) assessed differences between patients with anorexia nervosa and healthy control participants. The results showed that ED psychopathology was related to disorder-specific cognitions, experiential avoidance as well as ruminative brooding but not reflection. A follow-up of anorexia nervosa patients indicated that changes in ED psychopathology were associated with changes in dysfunctional attitudes and maladaptive cognitive-affective processes. These findings highlight cognitive processes that may play an important role in the maintenance of eating pathology.     

A Review of Eating Disorders in Athletes

SUMMARY

The current review aims to evaluate the literature on eating disorders and athletes with the purpose of making recommendations for sport psychologists and other relevant personnel on how to proceed in identifying, managing, and preventing eating disorders in school settings. Whereas the intention of this review is to make recommendations for secondary educational settings, research on other populations such as collegiate and young adult athletes was also reviewed where helpful or where information on adolescent athletes was not available. Recommendations for prevention and intervention include ongoing education of athletes and coaches regarding nutrition, body composition, and performance, using appropriate screening to detect eating disorders, and use of a sport management team to aid in athlete recovery.