Self-Reported Restrictive Eating, Eating Disorders, Menstrual Dysfunction, and Injuries in Athletes Competing at Different Levels and Sports

The purpose of this study was to investigate the prevalence of self-reported restrictive eating, current or past eating disorder, and menstrual dysfunction and their relationships with injuries. Furthermore, we aimed to compare these prevalences and associations between younger (aged 15–24) and older (aged 25–45) athletes, between elite and non-elite athletes, and between athletes competing in lean and non-lean sports. Data were collected using a web-based questionnaire. Participants were 846 female athletes representing 67 different sports. Results showed that 25%, 18%, and 32% of the athletes reported restrictive eating, eating disorders, and menstrual dysfunction, respectively. Higher rates of lean sport athletes compared with non-lean sport athletes reported these symptoms, while no differences were found between elite and non-elite athletes. Younger athletes reported higher rates of menstrual dysfunction and lower lifetime prevalence of eating disorders. Both restrictive eating (OR 1.41, 95% CI 1.02–1.94) and eating disorders (OR 1.89, 95% CI 1.31–2.73) were associated with injuries, while menstrual dysfunction was associated with more missed participation days compared with a regular menstrual cycle (OR 1.79, 95% CI 1.05–3.07). Our findings indicate that eating disorder symptoms and menstrual dysfunction are common problems in athletes that should be managed properly as they are linked to injuries and missed training/competition days.

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Behavioral, Psychological, and Physical Characteristics of Female Athletes with Subclinical Eating Disorders

International Journal of Sport Nutrition and Exercise Metabolism ◽

10.1123/ijsnem.10.2.128 ◽

2000 ◽

Vol 10 (2) ◽

pp. 128-143 ◽

Cited By ~ 50

Author(s):

Katherine A. Beals ◽

Melinda M. Manore

Keyword(s):

Eating Disorders ◽

Body Weight ◽

Eating Disorder ◽

Energy Intake ◽

Female Athletes ◽

Physical Characteristics ◽

The Body ◽

Menstrual Dysfunction ◽

Subclinical Eating Disorders ◽

Disordered Eating Patterns

The purpose of this study was to delineate and further define the behavioral, psychological, and physical characteristics of female athletes with subclinical eating disorders. Subjects consisted of 24 athletes with subclinical eating disorders (SCED) and 24 control athletes. Group classification was determined by scores on the Eating Disorder Inventory (EDI), the Body Shape Questionnaire (BSQ), and a symptom checklist for eating disorders (EDI-SC). Characteristics representative of the female athletes with subclinical eating disorders were derived from an extensive health and dieting history questionnaire and an in-depth interview (the Eating Disorder Examination). Energy intake and expenditure (kcal/d) were estimated using 7-day weighed food records and activity logs. The characteristics most common in the female athletes with subclinical eating disorders included: (a) preoccupation with food, energy intake, and body weight; (b) distorted body image and body weight dissatisfaction; (c) undue influence of body weight on self-evaluation; (d) intense fear of gaining weight even though at or slightly below (-5%) normal weight; (e) attempts to lose weight using one or more pathogenic weight control methods; (g) food intake governed by strict dietary rules, accompanied by extreme feelings of guilt and self-hatred upon breaking a rule; (h) absence of medical disorder to explain energy restriction, weight loss, or maintenance of low body weight; and (i) menstrual dysfunction. Awareness of these characteristics may aid in more timely identification and treatment of female athletes with disordered eating patterns and, perhaps, prevent the development of more serious, clinical eating disorders.

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Validation of the Eating Disorder Examination Questionnaire in Danish Eating Disorder Patients and Athletes

Journal of Clinical Medicine ◽

10.3390/jcm10173976 ◽

2021 ◽

Vol 10 (17) ◽

pp. 3976

Author(s):

Mia Beck Lichtenstein ◽

Lauge Haastrup ◽

Karen Krogh Johansen ◽

Jacob B. Bindzus ◽

Pia Veldt Larsen ◽

...

Keyword(s):

Eating Disorders ◽

Eating Disorder ◽

Binge Eating ◽

Factor Structure ◽

Elite Athletes ◽

Weight Concerns ◽

Eating Disorder Examination Questionnaire ◽

Eating Disorder Examination ◽

Recreational Athletes ◽

Eating Disorder Symptoms

The Eating Disorder Examination Questionnaire (EDE-Q) is a gold standard questionnaire to identify eating disorder symptoms but has not yet been validated in Danish. The scale consists of four theoretical constructs of disordered eating: Restraint eating, Eating concerns, Shape concerns and Weight concerns. However, the four-factor structure has been difficult to replicate across cultures. This study aimed to examine the factor structure and psychometric properties of the EDE-Q in Danish. The study consisted of four samples (aged 15–70): Patients with anorexia, bulimia and unspecified eating disorders (n = 101), patients with symptoms of binge-eating disorder (n = 300), recreational athletes (n = 404), and elite athletes (n = 526). Depending on the analysis performed, participants had to complete the EDE-Q, the SCOFF questionnaire for eating disorders or the Binge Eating Disorders Questionnaire. In accordance with international research, we found no evidence for a four-factor structure in the EDE-Q among patients or among athletes. But our results showed significant, positive associations between EDE-Q and SCOFF, BED-Q and MDI in all samples. We conclude that the internal structure of EDE-Q is low, while construct validity is high, making EDE-Q useful as an instrument to identify individuals with eating disorder symptoms, including recreational, and elite athletes.

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Targeting maladaptive overcontrol with radically open dialectical behaviour therapy in a day programme for adolescents with restrictive eating disorders: an uncontrolled case series

Journal of Eating Disorders ◽

10.1186/s40337-020-00338-9 ◽

2020 ◽

Vol 8 (1) ◽

Author(s):

Julian Baudinet ◽

Mima Simic ◽

Helena Griffiths ◽

Cecily Donnelly ◽

Catherine Stewart ◽

...

Keyword(s):

Eating Disorders ◽

Eating Disorder ◽

Social Connectedness ◽

Case Series ◽

Self Report ◽

Behaviour Therapy ◽

Treatment Needs ◽

Dialectical Behaviour Therapy ◽

Restrictive Eating ◽

Eating Disorder Symptoms

Abstract Background Radically Open Dialectical Behaviour Therapy (RO-DBT) was developed to target maladaptive overcontrol, a proposed core difficulty of restrictive eating disorders. RO-DBT is now the main group treatment model at the Intensive day Treatment Programme (ITP), Maudsley Hospital. This ITP case series aimed to investigate whether overcontrol is associated with restrictive eating disorder symptoms in adolescents and to evaluate ITP outcomes since RO-DBT skills classes were introduced. Method Self-report measures of eating disorder symptoms and temperament, personality and social characteristics linked to overcontrol were collected at assessment and discharge from ITP for all consecutive adolescents who attended between February 2015 and January 2019 (N = 131). Weight change, global outcomes and treatment needs post-ITP were also recorded. Results Eating disorder symptoms at assessment were significantly correlated with overcontrol factors, including social connectedness (r = −.67), reward responsivity (r = −.54), and cognitive inflexibility (r = .52). Adolescents stayed in ITP on average 13.40 weeks. 70.8% had a Good-Intermediate outcome on Morgan-Russell scale. 4.6% did not respond and were referred to inpatient treatment from ITP. Significant improvements in drive for thinness (d = .33), depressive mood (d = .41), social connectedness (d = .48), and emotional expressiveness (d = .97) were reported at discharge. No changes were observed in perfectionism or negative temperament. Conclusions This study offers preliminary evidence that eating disorder symptoms are associated with overcontrol factors in adolescence and that they can improve with RO-DBT informed day programme treatment. RO-DBT is a promising treatment that offers a new way of conceptualising treatment targets and recovery for adolescent restrictive eating disorders.

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The Prevalence and Consequences of Subclinical Eating Disorders in Female Athletes

International Journal of Sport Nutrition ◽

10.1123/ijsn.4.2.175 ◽

1994 ◽

Vol 4 (2) ◽

pp. 175-195 ◽

Cited By ~ 85

Author(s):

Katherine A. Beals ◽

Melinda M. Manore

Keyword(s):

Eating Disorders ◽

Body Weight ◽

Eating Disorder ◽

Female Athletes ◽

Psychological Consequences ◽

Restrictive Eating ◽

Growing Body ◽

Chronic Dieting ◽

Subclinical Eating Disorders ◽

Anorexia Athletica

A growing body of evidence suggests that the prevalence of eating disorders and excessive concerns regarding body weight in certain subpopulations of female athletes are increasing. The pressure on female athletes to improve their performances and physiques, coupled with the general sociocultural demand placed on all women to be thin, often results in attempts to achieve unrealistic body size and body weight goals. For some female athletes the pressure to achieve and maintain a low body weight leads to potentially harmful patterns of restrictive eating or chronic dieting. This paper seeks to further delineate the characteristics of a recently identified subclinical eating disorder in female athletes:anorexia athletica. Research studies that support the existence of subclinical eating disorders will be reviewed. In addition, the possible physiological and psychological consequences of subclinical eating disorders will be explored.

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Adapting a neuroscience-informed intervention to alter reward mechanisms of anorexia nervosa: a novel direction for future research

Journal of Eating Disorders ◽

10.1186/s40337-021-00417-5 ◽

2021 ◽

Vol 9 (1) ◽

Author(s):

Ann F. Haynos ◽

Lisa M. Anderson ◽

Autumn J. Askew ◽

Michelle G. Craske ◽

Carol B. Peterson

Keyword(s):

Anorexia Nervosa ◽

Eating Disorder ◽

Anxiety Disorders ◽

Reward Processing ◽

Future Research ◽

Restrictive Eating ◽

Eating Disorder Symptoms ◽

Mood And Anxiety Disorders ◽

Reward Responsivity ◽

Eating Disorder Behaviors

AbstractAccumulating psychobiological data implicate reward disturbances in the persistence of anorexia nervosa (AN). Evidence suggests that individuals with AN demonstrate decision-making deficits similar to those with mood and anxiety disorders that cause them to under-respond to many conventionally rewarding experiences (e.g., eating, interacting socially). In contrast, unlike individuals with other psychiatric disorders, individuals with AN simultaneously over-respond to rewards associated with eating-disorder behaviors (e.g., restrictive eating, exercising). This pattern of reward processing likely perpetuates eating-disorder symptoms, as the rewards derived from eating-disorder behaviors provide temporary relief from the anhedonia associated with limited responsivity to other rewards. Positive Affect Treatment (PAT) is a cognitive-behavioral intervention designed to target reward deficits that contribute to anhedonia in mood and anxiety disorders, including problems with reward anticipation, experiencing, and learning. PAT has been found to promote reward responsivity and clinical improvement in mood and anxiety disorders. This manuscript will: (1) present empirical evidence supporting the promise of PAT as an intervention for AN; (2) highlight nuances in the maintaining processes of AN that necessitate adaptations of PAT for this population; and (3) suggest future directions in research on PAT and other reward-based treatments that aim to enhance clinical outcomes for AN.

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Adolescents newly diagnosed with eating disorders have structural differences in brain regions linked with eating disorder symptoms

Nordic Journal of Psychiatry ◽

10.1080/08039488.2016.1250948 ◽

2016 ◽

Vol 71 (3) ◽

pp. 188-196 ◽

Cited By ~ 5

Author(s):

Linda Solstrand Dahlberg ◽

Lyle Wiemerslage ◽

Ingemar Swenne ◽

Anna Larsen ◽

Julia Stark ◽

...

Keyword(s):

Eating Disorders ◽

Eating Disorder ◽

Brain Regions ◽

Newly Diagnosed ◽

Eating Disorder Symptoms ◽

Structural Differences

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Exploring the experience of being viewed as “not sick enough”: a qualitative study of women recovered from anorexia nervosa or atypical anorexia nervosa

Journal of Eating Disorders ◽

10.1186/s40337-021-00495-5 ◽

2021 ◽

Vol 9 (1) ◽

Author(s):

Kari Eiring ◽

Trine Wiig Hage ◽

Deborah Lynn Reas

Keyword(s):

Anorexia Nervosa ◽

Eating Disorder ◽

Qualitative Study ◽

Help Seeking ◽

Severity Of Illness ◽

Physical Sign ◽

Structured Interviews ◽

Restrictive Eating ◽

Eating Disorder Symptoms ◽

Atypical Anorexia Nervosa

Abstract Background Despite common misconceptions, an individual may be seriously ill with a restrictive eating disorder without an outwardly recognizable physical sign of the illness. The aim of this qualitative study was to investigate the perspectives of individuals who have previously battled a restrictive eating disorder who were considered “not sick enough” by others (e.g., peers, families, healthcare professionals) at some point during their illness, and to understand the perceived impact on the illness and recovery. Such misconceptions are potentially damaging, and have been previously linked with delayed help-seeking and poorer clinical outcomes. Methods Seven women who had recovered from anorexia nervosa or atypical anorexia nervosa participated in semi-structured interviews. Interviews were transcribed and interpretive phenomenological analysis was used. Results Three main themes emerged: (1) dealing with the focus upon one’s physical appearance while battling a mental illness, (2) “project perfect”: feeling pressure to prove oneself, and (3) the importance of being seen and understood. Participants reported that their symptoms were occasionally met with trivialization or disbelief, leading to shame, confusion, despair, and for some, deterioration in eating disorder symptoms which drove further weight loss. In contrast, social support and being understood were viewed as essential for recovery. Conclusion To facilitate treatment seeking and engagement, and to optimize chances of recovery, greater awareness of diverse, non-stereotypical presentations of restrictive eating disorders is needed which challenge the myth that weight is the sole indicator of the presence or severity of illness.

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Perfectionism is associated with higher eating disorder symptoms and lower remission in children and adolescents diagnosed with eating disorders

Eating Behaviors ◽

10.1016/j.eatbeh.2018.05.008 ◽

2018 ◽

Vol 30 ◽

pp. 55-60 ◽

Cited By ~ 16

Author(s):

Jack Johnston ◽

Chloe Y. Shu ◽

Kimberley J. Hoiles ◽

Patrick J.F. Clarke ◽

Hunna J. Watson ◽

...

Keyword(s):

Eating Disorders ◽

Eating Disorder ◽

Children And Adolescents ◽

Eating Disorder Symptoms

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Association Between Paranoia And Anorexia Nervosa In Adolescents: What Factors Are Involved?

10.21203/rs.2.24625/v1 ◽

2020 ◽

Author(s):

Gennaro Catone ◽

Filomena Salerno ◽

Giulia Muzzo ◽

Valentina Lanzara ◽

Antonella Gritti

Keyword(s):

Eating Disorders ◽

Body Image ◽

Anorexia Nervosa ◽

Eating Disorder ◽

Social Anxiety ◽

Associated Factors ◽

Anxiety Symptoms ◽

Pediatric Care ◽

Eating Disorder Symptoms ◽

Body Image Concerns

Abstract Background: psychiatric comorbidities are of particular interest in Eating disorders. The association between anorexia nervosa and psychotic disorders is less studied than that with affective disorders (anxiety/depression). The aim of this study is to describe a psychotic symptom (paranoia) in adolescents with Eating Disorders looking at several potential explicative associated factors: eating disorder symptoms, body image concerns, depression and social anxiety. Our hypothesis is that paranoia in AN patients is more explained by the concomitant depression and social anxiety symptoms than core symptoms of the disease (eating disorder symptoms or body image concerns). Methods: this is a retrospective cross sectional study and consecutive, help-seeking adolescents admitted to the Eating Disorder service of the Integrated Pediatric Care Department, Luigi Vanvitelli University Hospital constituted the sample. Data was obtained trough retrospective collection of clinical interviews and self – report questionnaires administered by trained and expert child and adolescent psychiatrists. Results: We obtained data from 92 adolescents with Eating Disorders. Paranoia was dimensionally distributed in the sample (mean: 22,17 SD: 17,7; median 18 IQR: 7/36; range: 0-62). Our regression model explained that paranoia in this population was better explained by depression (coefficient= 0,415 SD: 0,210, p=0,052) and social anxiety symptoms (coefficient= 0,253 SD: 0,060; p<0,001) than eating disorder symptoms (coefficient= 0,092 SD: 0,107; p=0,398) and body image concerns (coefficient= 1,916 SD: 2,079; p=0,359) that did not retain their significance when all our predictive factors entered in the model. Conclusion: This study has some theoretical, clinical and treatment implications. It is important to carrying out screening for the presence of psychotic symptoms in patients with Eating Disorders. These symptoms and associated factors (depression and social anxiety) may complicate the clinical picture of the disease with the need, in certain cases, of psychopharmacological drugs and, among these, anti-psychotics. Finally in the psychotherapy context, paranoid idea may be subject of treatment for patient with EDs.

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What Kinds of Psychotherapy Help Eating Disorder Symptoms The Most?

Eating Disorders ◽

10.1093/wentk/9780190926595.003.0012 ◽

2020 ◽

Author(s):

B. Timothy Walsh ◽

Evelyn Attia ◽

Deborah R. Glasofer

Keyword(s):

Eating Disorders ◽

Eating Disorder ◽

Theory And Practice ◽

Eating Disorder Symptoms

Although the landscape of helpful psychotherapies for eating disorders continues to evolve, several promising interventions are already available. They differ somewhat in theory and practice but share several features. First, these talk therapies focus on the present—on the here and now. They are more...

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