Eating Disorders
This content is for informative purposes only and is not intended to be used to diagnose a disorder. If you think you may have an eating disorder, please call or text Brittney Patera at (406) 551-0102 or Aaron Grusonik at 408-482-0323, or contact your team physician or MSU Counseling and Psychological Services at (406) 994-4531.
Overview
There is a widely held misconception that eating disorders are a choice of lifestyle. However, eating disorders are serious and often fatal illnesses. Eating disorders are associated with severe disturbances in people's eating behaviors and related thoughts and feelings. Preoccupation with food, body weight, and shape may indicate an eating disorder. Common eating disorders include anorexia nervosa, bulimia nervosa, and binge-eating disorder.5 Additionally, Orthorexia and Relative Energy Deficiency in Sports (RED-S) are related disorders affecting athletes in particular. Athletes need to fuel properly in order to achieve overall wellness and optimal performance in sport. Unhealthy eating habits and disordered eating impact psychological well-being, bone health, muscular strength, power, and endurance, and concentration abilities. Such effects limit the athlete's ability to be successful in academic and athletic performance.
Disordered Eating: Athletes
Athletes experience similar stressors that other students experience during college, with the added demands of sports and added visibility to others through social media. This visibility can influence eating behavior and body image.2 In the health domain, student-athletes are particularly vulnerable to eating disorders.1 Disturbance in eating behavior can occur across all sports, but sports that are judged in part on aesthetics where body size and shape can influence the score, and those that believe lower weight will increase athletic performance, are at increased risk.2 Developing and maintaining healthy eating habits and body image are important for athlete well-being and performance in academics and sport.Athletic injuries are a key risk factor for disordered eating. Injuries are a common occurrence among student-athletes at the collegiate level. Typical emotional responses to injury may include sadness, isolation, irritation, lack of motivation, anger, frustration, changes in appetite, sleep disturbances, and disengagement. However, problematic reactions can also happen. These are emotional responses that do not resolve, worsen over time, or seem excessive in severity. In the eating domain, alterations to appetite followed by disordered eating can occur. An example of how this may happen after an injury is in the event that an injured athlete restricts their caloric intake because they feel they 'do not deserve to eat' due to their injury. Restricting calories could trigger an eating disorder, especially if the athlete was already at risk for eating disorders.3 It is important to note that athletic injury can trigger several mental health concerns, and disordered eating is one of them.
Athlete experience with eating disorders:
- Jessie Diggins: https://www.espn.com/espnw/voices/story/_/id/26112613/olympic-gold-medalist-jessie-diggins-confronting-eating-disorder-recovery
- Mandy Dimarzo: https://www.youtube.com/watch?v=1-fU6ysqJFU
- Logan Davis: https://wamu.org/story/19/03/03/underdiagnosed-male-eating-disorders-are-becoming-increasingly-identified/
- Patrick Devenny, TEDx Talk: "When clean eating became an eating disorder" My journey from pursuing the NFL to being a recovery bulimic.
Signs and Symptoms of Eating Disorders
Anorexia Nervosa
People with anorexia nervosa may see themselves as overweight, even if they are dangerously underweight. People with anorexia nervosa typically weigh themselves repeatedly, severely restrict the amount of food they eat, often exercise excessively, and/or may attempt to lose weight by forcing themselves to vomit or using laxatives to lose weight. Anorexia nervosa has the highest mortality rate of any mental health disorder. While many people with this disorder die due to complications associated with starvation, others die of suicide.5Symptoms include:
- Extremely restricted eating
- Extreme thinness (emaciation)
- A relentless pursuit of thinness and unwillingness to maintain a normal or healthy weight
- Intense fear of gaining weight
- Distorted body image, a self-esteem that is heavily influenced by perceptions of body weight and shape, or a denial of the seriousness of low body weight
- Thinning of the bones (osteopenia or osteoporosis)
- Mild anemia and muscle wasting and weakness
- Brittle hair and nails
- Dry and yellowish skin
- Growth of fine hair all over the body (lanugo)
- Severe constipation
- Low blood pressure slowed breathing and pulse
- Damage to the structure and function of the heart
- Brain damage
- Multi-organ failure
- A drop in internal body temperature, causing a person to feel cold all the time
- Lethargy, sluggishness, or feeling tired all the time
- Infertility.5
Bulimia Nervosa
People with bulimia nervosa have recurrent and frequent episodes of eating unusually large amounts of food and feeling as though they lack control over the episodes. This binge-eating is followed by behavior that compensates for the overeating. This may include forced vomiting, excessive use of laxatives or diuretics, fasting, excessive exercise, or a combination. People with bulimia nervosa may be slightly underweight, normal weight, or over overweight.5Signs & Symptoms:
- Chronically inflamed and sore throat
- Swollen salivary glands in the neck and jaw area
- Worn tooth enamel and increasingly sensitive and decaying teeth as a result of exposure to stomach acid
- Acid reflux disorder and other gastrointestinal problems
- Intestinal distress and irritation from laxative abuse
- Severe dehydration from purging of fluids
- Electrolyte imbalance (too low or too high levels of sodium, calcium, potassium, and other minerals) which can lead to stroke or heart attack.5
Binge-eating disorder
People with binge-eating disorder have recurrent and frequent episodes of eating unusually large amounts of food, with a lack control over the episodes. Unlike bulimia nervosa however, periods of binge-eating are not followed by purging, excessive exercise, or fasting. Thus, people with binge-eating disorder often are overweight or obese. Binge-eating disorder is the most common eating disorder in the U.S.5Signs & Symptoms:
- Eating unusually large amounts of food in a specific amount of time, such as a 2-hour period
- Eating even when you're full or not hungry
- Eating fast during binge episodes
- Eating until you're uncomfortably full
- Eating alone or in secret to avoid embarrassment
- Feeling distressed, ashamed, or guilty about your eating
- Frequently dieting, possibly without weight loss.5
Orthorexia
NCAA Orthorexia Fact Sheet (PDF)Orthorexia is defined as an obsession with healthful or proper eating.6 It is not formally recognized in the Diagnostic and Statistical Manual (DSM-5) but has been on the rise in recognition since the term was coined in 1998. It is not harmful to be health-conscious or to be aware of the nutritional quality of the food you eat. This can be very helpful for wellness and performance. However, becoming excessively fixated on eating properly or healthfully can be harmful to an athlete's overall wellbeing. Because Orthorexia is not a formal diagnosis in the DSM-5, it is up for debate whether Orthorexia is a stand-alone diagnosis, a subtype of other eating disorders such as anorexia, or an obsessive-compulsive disorder.6 Orthorexia is a serious health and wellness concern for affected athletes.
Signs and Symptoms of Orthorexia:
- Compulsive checking of ingredient lists and nutritional labels,
- An increase in concern about the health of ingredients,
- Cutting out an increasing number of food groups (all sugar, all carbs, all dairy, all meat, all animal products),
- An inability to eat anything but a narrow group of foods that are deemed 'healthy' or 'pure,'
- Unusual interest in the health of what others are eating,
- Spending hours per day thinking about what food might be served at upcoming events,
- Showing high levels of distress when 'safe' or 'healthy' foods aren't available,
- Obsessive following of food and 'healthy lifestyle' blogs on Twitter and Instagram,
- Body image concerns may or may not be present.6
Relative Energy Deficiency in Sports (RED-S)
NCAA Energy Availability Fact Sheet (PDF)
RED-S is an often unrecognized disorder that can include low energy availability (inadequate caloric intake); with or without disordered eating; amenorrhea (lack of menstrual periods); and low bone mineral density.7 Inadequate caloric intake can occur as a result of poor eating habits and too intense exercise. This under-consumption of calories can happen intentionally or unintentionally, and negatively impacts wellness and athletic performance. RED-S is typically found among physically active persons, especially among athletes with a competitive nature and strong sense of discipline. Competitive athletes (such as those competing at a collegiate level) may be at an increased risk compared to more casual athletes due to the rigorous training schedule and the "play-to-win" nature of elite sports. Athletes who compete in endurance sports (such as cross-country running and nordic ski), aesthetic sports (such as cheer and spirit squad), and sports which require formfitting uniforms are at an increased risk for RED-S. Further, an emphasis on a certain athletic "look" and the belief that carrying less weight will universally improve performance in sport increases the risk for RED-S.7
Impact on Performance
RED-S can negatively impact sport performance and overall wellness among athletes.7 The lowered energy availability impairs performance because the muscles are not fueled properly. This is universal across sports. If under-fueling continues after initial signs of fatigue, the skeletal muscle will actually reduce in size because the body begins to break it down. It is also important to note that every organ in the body requires energy to keep operating properly. This includes the brain, which means that under-fueling also impacts the athlete's ability to concentrate on academic work and athletics. This low concentration can increase the athlete's risk for injury and then prolong the injury recovery time. Next, amenorrhea (loss of menstrual period) among female athletes signals a change in the body's intricate and complicated hormone system. Under-fueling can trigger lower estrogen production. The most recognizable health effect of low estrogen is bone loss, which can result in bone stress fractures. Please note that amenorrhea is NOT a normal part of athletic training, no matter what sport the athlete competes in. It is a sign of improper fueling. Finally, low bone mineral density is a trademark sign of RED-S and can place the athlete at high risk for injuries. Athletes with repeated stress fractures should be evaluated further because this is a red flag for RED-S.7Signs & Symptoms
1. Physical/Medical Signs and Symptoms7- Amenorrhea
- Dehydration
- Gastrointestinal problems
- Hypothermia (cold intolerance)
- Cardiac abnormalities: bradycardia (low heart rate), orthostasis (abnormal changes in heart rate and/or blood pressure during positional changes)
- Stress fractures (and overuse injuries)
- Significant weight loss
- Muscle cramps, weakness, or fatigue
- Dental and gum problems.
- Anxiety or depression
- Claims of "feeling fat" despite being thin
- Exercising beyond what's expected/required
- Excessive use of the restroom
- Unfocused, difficulty concentrating
- Preoccupation with weight and eating
- Avoidance of eating and eating situations
- Use of laxatives, diet pills, etc.
Female Athlete Triad
The female athlete triad is part of RED-S under another name, and refers to a combination of 3 clinical entities found in young athletes who have a menstrual cycle:- Menstrual dysfunction: Loss or irregularity of menstrual cycle,
- Low energy availability (with or without an eating disorder): lacking the energy to complete daily tasks,
- Decreased bone mineral density (osteopenia): weak/brittle bones resulting from loss of bone mass.4
For more information: female athlete triad
Do I have an eating disorder?
Complete a screening: CPS Disordered Eating ScreeningResources
- Athletic Nutrition Department: https://msubobcats.com/sports/2020/5/13/nutrition-appointment-booking.aspx
- MSU On-Campus Resources: https://msubobcats.com/sports/2021/1/20/on-campus-resources.aspx
- Off-Campus Resources: https://msubobcats.com/sports/2021/1/21/off-campus-resources.aspx
- MSU Counseling & Psychological Services: Eating Disorders and Body Image Self-Help
- Emily Program: https://www.emilyprogram.com/
- The Emily Program offers individualized care leading to recovery from eating disorders. They hope to foster peaceful relationships with food, weight, and body image, where everyone with an eating disorder can experience recovery. On their website, they have videos, podcasts, a blog, and more information about eating disorders.
- The National Eating Disorders Association (NEDA): https://www.nationaleatingdisorders.org/identity-eating-disorders
- A nonprofit organization dedicated to supporting individuals and families affected by eating disorders. NEDA provides education materials, screening tools, treatment options, blogs, forums, and connections.
- National Association of Anorexia Nervosa and Associated Disorders (ANAD): https://anad.org/about/history/
- ANAD is the oldest organization aimed at fighting eating disorders in the United States. ANAD assists people struggling with eating disorders and also provides resources for families, schools, and the eating disorder community.
More information
- "Mind, Body and Sport: Eating disorders" An excerpt from the Sport Science Institute's guide to understanding and supporting student-athlete mental wellness
- Podcasts: Food Psych, Body Kindness, Peace Meal
- NCAA Nutritional, Sleep, and Educational Resources
References
1. Barnard, J., D. (2016). Student-athletes' perceptions of mental illness and attitudes toward help-seeking. Journal of College Student Psychotherapy, 30(3), 161-175, doi: 10.1080/87568225.2016.11774212. Egan, K. (2019). Supporting mental health and well-being among student-athletes. Clinical Sports Medicine, 38, 537-544. doi: 10.1016/j.csm.2019.05.003
3. Putukian, M. (2016). The psychological response to injury in student athletes: a narrative review with a focus on mental health. British Journal of Sports Medicine, 50(3), 145-148. doi: 10.1136/bjsports-2015-095586
4. Nazem, T. G., & Ackerman, K. E. (2012). The female athlete triad. Sports health, 4(4), 302–311. https://doi.org/10.1177/1941738112439685
5. U.S. Department of Health and Human Services, National Institute of Mental Health. (2016). Eating Disorders. Retrieved from: https://www.nimh.nih.gov/health/topics/eating-disorders/index.shtml#part_145414
6. National Eating Disorders Association. (2018). Orthorexia. Retrieved from: https://www.nationaleatingdisorders.org/learn/by-eating-disorder/other/orthorexia
7. Brown University Sports Nutrition Department. (2015). Relative Energy Deficiency in Sport (RED-S). Retrieved from: https://www.brown.edu/campus-life/health/services/promotion/nutrition-eating-concerns-sports-nutrition/relative-energy-deficiency-sport-red-s
Developed 2021 by Quinn DeStefano, OTD Student
Reviewed 2021 by Aaron Grusonik, MA, Psy.D
