Advances in Management of the Female Athlete Triad and Eating Disorders

This study examined the prevalence of and relationship between the disorders of the female athlete triad in collegiate athletes participating in aesthetic, endurance, or team/anaerobic sports. Participants were 425 female collegiate athletes from 7 universities across the United States. Disordered eating, menstrual dysfunction, and musculoskeletal injuries were assessed by a health/medical, dieting and menstrual history questionnaire, the Eating Attitudes Test (EAT-26), and the Eating Disorder Inventory Body Dissatisfaction Subscale (EDI-BD). The percentage of athletes reporting a clinical diagnosis of anorexia and bulimia nervosa was 3.3% and 2.3%, respectively; mean (±SD) EAT and EDI-BD scores were 10.6 ± 9.6 and 9.8 ± 7.6, respectively. The percentage of athletes with scores indicating “at-risk” behavior for an eating disorder were 15.2% using the EAT-26 and 32.4% using the EDI-BD. A similar percentage of athletes in aesthetic, endurance, and team/anaerobic sports reported a clinical diagnosis of anorexia or bulimia. However, athletes in aesthetic sports scored higher on the EAT-26 (13.5 ± 10.9) than athletes in endurance (10.0 ± 9.3) or team/anaerobic sports (9.9 ± 9.0, p < .02); and more athletes in aesthetic versus endurance or team/anaerobic sports scored above the EAT-26 cut-off score of 20 (p < .01). Menstrual irregularity was reported by 31% of the athletes not using oral contraceptives, and there were no group differences in the prevalence of self-reported menstrual irregularity. Muscle and bone injuries sustained during the collegiate career were reported by 65.9% and 34.3% of athletes, respectively, and more athletes in aesthetic versus endurance and team/anaerobic sports reported muscle (p = .005) and/or bone injuries (p < .001). Athletes “at risk” for eating disorders more frequently reported menstrual irregularity (p = .004) and sustained more bone injuries (p = .003) during their collegiate career. These data indicate that while the prevalence of clinical eating disorders is low in female collegiate athletes, many are “at risk” for an eating disorder, which places them at increased risk for menstrual irregularity and bone injuries.

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Eating Disorders and the Female Athlete Triad

Sex- and Gender-Based Women's Health ◽

10.1007/978-3-030-50695-7_34 ◽

2020 ◽

pp. 523-533

Author(s):

Brianna Rossiter ◽

Anna K. Donovan

Keyword(s):

Eating Disorders ◽

Female Athlete ◽

Female Athlete Triad

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The Female Athlete Triad: Is the Triad a Problem Among Division I Female Athletes?

Journal of Clinical Sport Psychology ◽

10.1123/jcsp.1.4.358 ◽

2007 ◽

Vol 1 (4) ◽

pp. 358-370 ◽

Cited By ~ 6

Author(s):

Justine J. Reel ◽

Sonya SooHoo ◽

Holly Doetsch ◽

Jennifer E. Carter ◽

Trent A. Petrie

Keyword(s):

Eating Disorders ◽

Disordered Eating ◽

Female Athlete ◽

Female Athletes ◽

Division I ◽

Female Athlete Triad ◽

Muscle Injuries ◽

Menstrual Dysfunction ◽

Eating Disordered ◽

Menstrual History

The purpose of the study was to determine prevalence rates of the female athlete triad (Triad), differences by sport category (aesthetic, endurance, and team/anaerobic), and the relationship between each of the components of the Triad. Female athletes (N= 451) from three Division I universities with an average age of 20 years completed the Menstrual History Questionnaire, Injury Assessment Questionnaire, and the Questionnaire for Eating Disorder Diagnoses (Q-EDD; Mintz, O’Halloran, Mulholland, & Schneider, 1997). Almost 7% of female athletes reported clinical eating disorders, and 19.2% reported subclinical disordered eating. Disordered eating was prevalent in all three sport categories with no significant differences between groups. Muscle injuries were more prevalent in team/anaerobic sports (77.4%) than the aesthetic (68.1%) and endurance groups (58.1%). Furthermore, those athletes with menstrual dysfunction more frequently reported clinical eating disorders (1.4%) and sustained more skeletal injuries (51%) during their athletic career than athletes with regular menstrual function. Clinical implications and further research directions are addressed.

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Understanding the Female Athlete Triad: Eating Disorders, Amenorrhea, and Osteoporosis

Journal of School Health ◽

10.1111/j.1746-1561.1999.tb06425.x ◽

1999 ◽

Vol 69 (8) ◽

pp. 337-340 ◽

Cited By ~ 16

Author(s):

Katherine A. Beals ◽

Rebecca A. Brey ◽

Julianna B. Gonyou

Keyword(s):

Eating Disorders ◽

Female Athlete ◽

Female Athlete Triad

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Stress Fractures And The Reproductive System In The Female Athlete

10.2310/fm.1513 ◽

2018 ◽

Author(s):

Irfan M Asif ◽

Kimberly Harmon ◽

Mallory Shasteen

Keyword(s):

Femoral Neck ◽

Disordered Eating ◽

Reproductive System ◽

Female Athlete ◽

Female Athletes ◽

Stress Fractures ◽

Female Athlete Triad ◽

Low Back ◽

Mineral Density ◽

Pubic Ramus

Stress fractures are more common in the female athlete. Stress fractures of the pubic ramus and femoral neck are particularly more common in females than in males. Rib stress fractures are an important injury to consider in the female rower, whereas spondylolysis is a common cause of low back pain in female athletes who hyperextend their spines. The higher incidence of stress fractures in females is mainly due to the higher prevalence of disordered eating and subsequent energy imbalance, which leads to detrimental effects on bone. This review discusses stress fractures and unique issues related to exercise and the female reproductive system. This review contains 6 figures, 5 tables and 49 references Key words: amenorrhea, bone mineral density, disordered eating, female athlete triad, femoral neck, pregnancy, pubic ramus, rib, spondylolysis, stress fracture

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Female Athlete Triad

Primary Care Clinics in Office Practice ◽

10.1016/j.pop.2018.07.004 ◽

2018 ◽

Vol 45 (4) ◽

pp. 615-624 ◽

Cited By ~ 3

Author(s):

Jennifer P. Daily ◽

Jessica R. Stumbo

Keyword(s):

Female Athlete ◽

Female Athlete Triad

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Bone-Mineral Density and Other Features of the Female Athlete Triad in Elite Endurance Runners: A Longitudinal and Cross-Sectional Observational Study

International Journal of Sport Nutrition and Exercise Metabolism ◽

10.1123/ijsnem.20.5.418 ◽

2010 ◽

Vol 20 (5) ◽

pp. 418-426 ◽

Cited By ~ 32

Author(s):

Noel Pollock ◽

Claire Grogan ◽

Mark Perry ◽

Charles Pedlar ◽

Karl Cooke ◽

...

Keyword(s):

Female Athlete ◽

Negative Energy ◽

Endurance Athletes ◽

Female Athlete Triad ◽

Training Volume ◽

Mineral Density ◽

Cross Sectional ◽

Menstrual Dysfunction ◽

Endurance Runners ◽

And Training

Low bone-mineral density (BMD) is associated with menstrual dysfunction and negative energy balance in the female athlete triad. This study determines BMD in elite female endurance runners and the associations between BMD, menstrual status, disordered eating, and training volume. Forty-four elite endurance runners participated in the cross-sectional study, and 7 provided longitudinal data. Low BMD was noted in 34.2% of the athletes at the lumbar spine, and osteoporosis in 33% at the radius. In cross-sectional analysis, there were no significant relationships between BMD and the possible associations. Menstrual dysfunction, disordered eating, and low BMD were coexistent in 15.9% of athletes. Longitudinal analysis identified a positive association between the BMD reduction at the lumbar spine and training volume (p = .026). This study confirms the presence of aspects of the female athlete triad in elite female endurance athletes and notes a substantial prevalence of low BMD and osteoporosis. Normal menstrual status was not significantly associated with normal BMD, and it is the authors’ practice that all elite female endurance athletes undergo dual-X-ray absorptiometry screening. The association between increased training volume, trend for menstrual dysfunction, and increased loss of lumbar BMD may support the concept that negative energy balance contributes to bone loss in athletes.

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