Eating disorders

Eating disorders (ED) include anorexia nervosa (AN) and bulimia nervosa (BN). The former is characterized by a refusal to maintain a minimally normal bodyweight, while the latter involves repeated episodes of binge eating followed by inappropriate compensatory behaviours, such as food restriction, self-induced vomiting or excessive exercise. Eating disorders among athletes have been relatively well studied, and these conditions might well represent psychiatric disorders that are perpetuated by participation in sport itself.

Calhoun et al. published a 1998 review on eating disorders in sport. They found that the incidence of eating disorders in women athletes has been reported to be as high as 60% and is mostly associated with long distance running, gymnastics and figure skating (so-called ‘leanness sports’). Rosen et al (…) found that at the college level, 32% of women varsity respondents to an anonymous survey had engaged in at least one weight-control behaviour (self-induced vomiting or use of laxatives, diuretics or diet pills) on a daily basis for at least 1 month. Also, at the college level, Burckes-Miller and Black  (…) found that greater than one-third of 695 men and women athletes from intercollegiate teams reported significant weight fluctuation associated with binging and fasting. At the elite level, Byrne and McLean  (…) showed that, of Australian women elite athletes representing many different’ sports, anorexia nervosa or bulimia nervosa was present in 15% of those in leanness sports and 2% in non-leanness sports, compared with 1% of non-athlete controls.

Among Australian men elite athletes, anorexia nervosa or buhmia nervosa was present in 5% of those in leanness sports; no eating disorders were identified in men in non-leanness sports or in male controls. More recently, Torstveit et al. (…) and Sundgot-Borgen and Torstveit (…) confirmed a higher percentage of eating disorders in elite athletes in leanness sports than in both athletes competing in non-leanness sports and in controls. Research performed exclusively on men rowers and wrestlers suggested that the prevalence of eating disorders in some populations of men athletes is as high as in high-risk groups of women athletes.”’^’ Moreover, men athletes are more at risk of developing eating disorders compared with the general population of men than women athletes are when compared with the general population of women (…). However, Glazer  (…) reported that men may return more rapidly to their normal weights and eating behaviours than do women after ending their competitive athletic careers, although this is variable, with some retired athletes continuing to rely on eating disordered behaviours for stress reduction.

It is important to consider the diagnosis of ‘anorexia athletica’ even if an athlete’s weight is not <85% of ideal bodyweight, since intense training can result in increased muscle mass  Despite ‘normal’ weight in these athletes, they may exhibit many of the other signs and symptoms of anorexia nervosa, such that this would be considered ‘Eating Disorder Not Otherwise Specified’ in Diagnostic and Statistical Manual of Mental Disorders (4th Edition) Text Revision nomenclature.’•”‘