Eating Disorders

EATING DISORDERS AND BODY DISSATISFACTION

Introduction

  • Victoria's Secret — Jax | LIVE Performance | SiriusXM: Song intended as a fun introduction to the topic of eating disorders and body dissatisfaction.

    • Story Behind the Song:

    • Songwriter Jax created it after witnessing a middle school girl upset over her body image due to peer comments while shopping.

PREVALENCE OF EATING DISORDERS (ED)

  • Over 9% of the population is affected by eating disorders.

  • Lifetime Statistics:

    • 21 million people will experience an eating disorder in their lifetime.

    • 7.8 million people will develop an eating disorder.

    • Of those, 1.9 million are likely to be adolescents younger than 20 years old.

  • Eating disorders are among the deadliest mental disorders, second only to opioid overdose.

  • Suicide Attempts:

    • 26% of those with eating disorders will attempt suicide.

  • Eating disorders (EDs) differ from disordered eating behaviors (DEBs).

  • Professional Help:

    • Once disordered behaviors commence, it is critical to seek professional help.

  • Higher prevalence of EDs in athletes compared to non-athletes due to excessive exercise.

  • EDs are more commonly diagnosed in females (6-45%) than in males (0-19%) due to a cultural focus on appearance and social media pressure.

NATIONAL GOVERNING BODIES/PROFESSIONAL ORGANIZATIONS

  • Definition of Eating Disorders:

    • "Disturbance of eating, altered consumption/absorption of food; impacts social functioning, mental and physical" (APA, 2013).

  • Key Organizations:

    • American Psychological Association (APA)

    • International Olympic Committee (IOC)

    • National Collegiate Athletic Association (NCAA)

    • National Eating Disorders Association (NEDA)

    • US Olympic and Paralympic Committee (USOPC)

  • Initiatives:

    • STRIPED (Strategic Training Initiative for the Prevention of Eating Disorders) by Harvard T.H. Chan School of Public Health.

BIOPSYCHOSOCIAL INTERVENTION AND OBSERVATION DISORDERED EATING (BIODE MODEL)

  • Examines the interplay of biological, psychological, and socio-cultural factors in disordered eating.

    • Biological Factors:

    • Eating disorders often have genetic components and may run in families.

    • Socio-Cultural Factors:

    • Increased pressures surrounding weight and body appearance.

    • Psychological Factors:

    • Traits such as perfectionism and traumatic experiences contribute to the risk of developing eating disorders.

BIOPSYCHOSOCIAL INFLUENCES

  • Nutritional Demands: Athletes often require specialized diets due to higher nutritional/energy demands.

  • Prevalence:

    • Increased occurrence of EDs in athletes as compared to the general population.

    • Adolescents are more likely to develop EDs due to societal pressures.

  • Media Influence:

    • Societal definitions of appearance impact food and exercise behaviors and perpetuate body dissatisfaction, self-objectification, and thin-ideal internalization.

    • Influences contributing to risk factors include low self-esteem and perfectionistic tendencies.

PERFORMANCE AND APPEARANCE PRESSURE

  • Psychosocial Triggers for Females:

    • Pressures surrounding training and competition performance.

    • Team weigh-ins and physical injuries can contribute to ED risk.

  • Psychosocial Triggers for Males:

    • Negative comments from coaches and peers about body appearance, dieting, injuries, and performance achievements influence self-worth and identity.

IMPORTANCE OF RECOGNIZING SIGNS AND SYMPTOMS

  • It is crucial for healthcare and sports professionals to be aware of warning signs and symptoms associated with eating disorders.

    • Consequences:

    • Negative physical and psychological outcomes if these signs are overlooked.

ASSESSMENT INVENTORY OF DISORDERED EATING DETERMINANTS (AIDED)

  • Determinants of Disordered Eating:

    • Biological and Physical:

    • Age, biological sex, growth stages, and family history of disordered eating behaviors.

    • Response:

    • Behaviors such as preoccupation with diets or body image indicate potential issues.

    • Cognitive and Psychological:

    • Body image dissatisfaction, low self-esteem, and perfectionism.

    • Social pressures and influences from media must also be considered.

Table 7.1: Assessment Inventory Summary

  • Commonly Observed Behaviors in Eating Disorders:

    • Preoccupation with food and body shape.

    • Polarized thinking about eating behaviors (restrictive vs. excessive).

    • Avoidance of food-related social activities.

    • Evidence of harmful physical effects (e.g., dental issues, hormone dysfunction).

ANOREXIA NERVOSA (AN)

  • DSM-5 Criteria:

    • Restrictive energy intake leading to significantly low body weight.

    • Intense fear of weight gain coupled with behaviors that prevent weight gain.

    • Body image disturbance or inability to recognize the severity of low weight.

  • Severity Classification:

    • Mild ( BMI ≥ 17 kg/m²)

    • Moderate (BMI 16-16.99 kg/m²)

    • Severe (BMI 15-15.99 kg/m²)

    • Extreme (BMI < 15 kg/m²)

  • Types of AN:

    • Restricting type: Weight loss through dieting, fasting, or exercise.

    • Binge-eating/purging type: Self-induced vomiting and misuse of laxatives or diuretics.

BULIMIA NERVOSA (BN)

  • Behavioural Criteria:

    • Binge eating and purging or non-purging behaviors occurring at least once a week for 3 months is required for diagnosis.

    • Feelings of loss of control over eating are significant.

  • Signs and Symptoms:

    • Individuals do not always present as underweight; normal weight or overweight is common.

    • Intense feelings of shame and attempts to conceal the behavior.

    • Frequent consequences include constant sore throat, dental issues, and dehydration due to vomiting.

BINGE EATING DISORDER (BED)

  • Criteria for Diagnosis:

    • Binge eating occurring at least once weekly over a period of 6 months.

    • Marked distress is a key component; differs from non-purging BN as no compensatory behaviors are used.

  • Prevalence:

    • Most common eating disorder, affecting an estimated 3% of the US population (approximately 10 million) which is three times the prevalence of AN and BN combined.

BODY DYSMORPHIC DISORDER (BDD)

  • Definition:

    • An obsessive concern with perceived body imperfections, often minimal or imperceptible to others, emphasizing muscle and fat perceptions.

  • Relevance in Athletes:

    • Athletes may develop distorted self-perceptions when compared to societal ideals and through compulsive mirror-checking.

    • Bodybuilders or athletes using steroids are significantly at risk due to obsession with muscle building correlated with BDD.

ORTHOREXIA NERVOSA (ON)

  • Definition:

    • An unhealthy obsession with eating foods deemed "healthy."

    • Focuses on food quality rather than quantity and often leads to malnutrition and restricted food variety.

  • Consequences:

    • Symptoms and problems mirror those found in anorexia nervosa; compulsive calorie counting and adherence to rigid eating guidelines.

OTHER SPECIFIED FEEDING OR EATING DISORDER (OSFED) AND UNSPECIFIED FEEDING AND EATING DISORDER (UFED)

  • OSFED:

    • A diagnosis when individuals exhibit ED symptoms that do not meet the stringent DSM-5 criteria yet still cause significant distress.

  • UFED:

    • Conditions that lack specific categorization under current eating disorder definitions but still result in similar psychological and physical struggles.

WIN AT ALL COSTS FILM

  • Overview:

    • PBS segment discussing mental health pressures faced by athletes and the impact of diet culture in sports.

    • Features recovery stories and insights from medical professionals to foster a positive relationship with food and sport.

  • Length:

    • 26 minutes.

CASE STUDY: Nori

  • Background:

    • High school All-American soccer player experienced an avulsion fracture leading to surgery and prolonged recovery.

    • Pressuring circumstances included fear of missing scholarship opportunities leading to compensatory behaviors.

  • Symptoms Observed:

    • Withdrawal, increased irritability, and secretive purging behaviors.

  • Diagnosis:

    • Initially does not meet criteria for a specific disorder but demonstrates significant distress, resembling OSFED.

  • Treatment Steps:

    • Informed family about OSFED, sought appropriate treatment, and engaged in mindfulness to rebuild self-esteem and confidence.

EATING DISORDERS, BODY IMAGE, AND WEIGHT CONTROL ACTIONS

  • Importance of recognizing even subclinical symptoms of ED.

  • Risk Factors:

    • Body dissatisfaction prevalent in elite athletes involved in weight-sensitive sports.

  • Weight Control Behaviors:

    • Include dehydration, excessive exercise, fasting, self-induced vomiting, and usage of performance-enhancing drugs.

  • Negative Outcomes:

    • Risks include susceptibility to injury, muscle deficiencies, and heightened social and emotional distress.

GENDER CONSIDERATIONS

  • Female Body Ideal:

    • Emphasis on thinness with curvy attributes.

  • Male Body Ideal:

    • Focus remains on thinness but also muscularity.

  • Sport-Specific Ideals:

    • Female power sports may resemble male body ideals; adult male elite athletes report eating disorder prevalence up to 32.5%.

WEIGHT CONTROL IN ATHLETES

  • Factors Leading to Weight Control Behaviors:

    • Pressure exerted by coaches and perceived maltreatment are critical indicators of extreme weight control behaviors.

    • Normalization of unhealthy eating behaviors within sport culture can lead to athlete's belief in their necessity.

BODY IMAGE

  • Definition:

    • Body image is the mental perception of one’s body and the associated emotional reaction.

  • Female Dissatisfaction:

    • Studies show that women with eating disorders exhibit heightened body dissatisfaction, perceiving themselves as "fat" regardless of their actual body composition.

SOCIAL INFLUENCES

  • Coaching Impact:

    • Coaches play a vital role, influencing athletes' perceptions of ideal body shapes and weights through comments and weigh-ins.

    • Considerable pressure arises when societal stereotypes clash with athletic expectations.

HEALTH RISKS, WELL BEING, QUALITY OF LIFE

  • Comorbidities with EDs:

    • Common mental health conditions include anxiety, depression, and obsessive-compulsive disorders.

  • Mortality Rate:

    • Eating disorders carry one of the highest mortality rates among mental disorders due to complications like suicide and cardiac arrhythmias.

  • Female Athlete Triad:

    • Characterized by low energy availability, menstrual dysfunction, and reduced bone mineral density.

  • Redefinition:

    • RED-S (Relative Energy Deficiency in Sport) introduced in 2014 to encompass similar risks in males as well.

SPORT RETIREMENT

  • Transition Challenges:

    • Retirement from sport may exacerbate EDs due to difficulties in adjusting to standard nutrition and exercise practices post-career.

    • Heightened dissatisfaction and changes can exacerbate the risk of developing ED behaviors in retired athletes.

ASSESSMENT AND TREATMENT OF EDS

  • Evaluation Tools:

    • EDE (Eating Disorder Examination) is recognized as the gold standard, though self-report formats may yield less comprehensive results.

  • Early Intervention:

    • Prompt treatment is associated with better recovery outcomes; stigma remains a barrier for many athletes in seeking help.

  • Team Approach:

    • A multidisciplinary team is crucial for effective treatment planning and delivery.

TREATMENT OF EDS

  • Care Levels:

    • The severity of symptoms dictates treatment approaches ranging from educational interventions to intensive therapy programs.

COGNITIVE BEHAVIORAL THERAPY (CBT)

  • Utility in ED Treatment:

    • CBT helps individuals recognize and challenge their cognitive distortions related to eating behaviors.

  • Application in Athletes:

    • Often met with resistance due to societal views on weakness; utilizes mental skills to increase the willingness to engage in therapy.

MINDFULNESS

  • Practice:

    • Engaging in non-judgmental awareness of thoughts and feelings concerning eating and body image.

  • Complementary Activity:

    • Often combined with mental skills training such as goal setting and stress management to enhance quality of life.

PREVENTION OF EDS

  • Educational Programs:

    • Programs designed to reduce stigmas surrounding disordered eating and identify at-risk populations are vital.

  • Key Components:

    • Provide signs and symptoms of EDs, explore their effects, treatment approaches, and available resources for athletes, coaches, and parents to maintain healthy mind/body relationships in sports.

EDUCATION

  • Athlete Health First:

    • Emphasize that athlete health should take priority over performance.

  • Encouraging Ideal Awareness:

    • Clarify the differences between healthy ideals and societal expectations while promoting positive self-image and nutrition literacy.