By Joan Zhang

Clinically Reviewed by Sehrish Ali, PhD, LPC, CEDS

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Participating in sports has many notable benefits to physical and emotional well-being. However, restrictive eating habits or excessive exercise can be glorified in the context of competition which can make it difficult for athletes to distinguish problem behaviors from performance expectations and sports traditions.

Because of this, athletes can struggle with hidden disordered eating patterns that contribute to added stress and anxiety. Because a strict emphasis is often placed on weight, muscle mass, and performance, athletes across sports are often introduced to behaviors that can lead to eating disorders by coaches, teammates, and other well-meaning supporters in their lives.

What are athletes' unique risk factors for eating disorders? 

There are several reasons why athletes may face a higher risk of eating disorders than the general population; these can occur at all skill levels and may intersect with other underlying risk factors prevalent among patients with EDs. 

Performance Standards

Athletic performance is often linked to food intake and exercise level. This also creates stress and anxiety around performance, and it can emphasize or reward how athletes look while performing. When athletes begin to see a certain body type as “ideal,” they are more likely to take restrictive or extreme measures to achieve or maintain it. 

Internal Pressure

Competing is exhilarating, but it’s also stressful. Many athletes experience competition anxiety, and the nature of competitive sports can foster a perfectionist mindset. Seeking control over the outcome, athletes may begin engaging in disordered eating and extreme exercise to boost their chances of winning. 

A History of Success

High-performing athletes who have repeatedly done well in their sport often develop a perfectionist mindset. They want to be better than their opponents but also their previous selves. Top-performing athletes also have high achievement orientation and a high attention to detail — traits that naturally overlap with folks who have eating disorders. 

External Pressure

Pressure from coaches, peers, or parents to perform can further fuel eating disorders and unhealthy exercise behaviors. The desire to please others and avoid disappointing them can make it easy for someone to become anxious and obsessive about their weight and physical physique. 

The external pressure can be overt or more subtle; someone may tell an athlete they need to lose weight to reach a certain performance goal. Other times, they may just encourage them to keep training. In either case, the internalized need to meet others’ expectations can have serious effects on someone’s mental health. 

Anxiety Relief 

Anxiety from competing and performing can be triggering for many athletes. Eating disorder behaviors can offer a false sense of security through control. By restricting what you eat, controlling how much you work out, and doing as much as possible to achieve a certain standard, you can temporarily ease anxiety. In reality, these actions only go on to worsen anxiety and perpetuate an unhealthy cycle. 

Predisposing Factors

Many other factors can contribute to an eating disorder, such as low self-esteem, social isolation, body dysmorphia, anxiety or mood disorders, a family history of ED, or a history of abuse or trauma. These factors affect many other people with eating disorders, and they can lay the groundwork for disordered eating behaviors in athletes, too. 

Are some eating disorders in athletes more common than others? 

Any type of eating disorder can affect an athlete. Generally, athletes have disordered eating patterns that develop due to their sport. For example, monitoring caloric intake, restricting calories, and creating a deficiency through physical exercise can lead to an eating disorder.

Athletes are also prone to over-exercising and becoming fixated on things like protein and carbohydrate intake. This can lead to an unhealthy relationship with food that leads to more restrictive eating, on-and-off dieting, fasting, and under-fueling. 

The type of eating disorders you see among athletes are often connected to an external goal — the desire to win and be the best at their sport. While non-athletes may have more internalized fears about food, athletes often develop eating disorders in reverse. Their outstanding desire to win and do well ultimately causes them to pick up unhealthy behaviors.

When they do perform well, this only reinforces their actions and can lead to more disordered behavior in the future. It can eventually become difficult for someone to understand the difference between training and fueling like an athlete and having an eating disorder. 

What sports tend to see more athletes with an ED? 

Any sport can lead to an eating disorder, but risks increase more when there is a subjective element to how the athlete is evaluated or judged based on how lean, slender, or thin they look. Athletes are more likely to struggle when weight or physique is emphasized as a key part of performance. Examples of sports that may have this effect include: 

• Gymnastics
• Dance
• Wrestling
• Running
• Cycling
• Swimming & Diving
• Figure Skating
• Bodybuilding 
• Rowing (Crew)
• Equestrianism

What are some of the physical and performance impacts of eating disorders on athletes?

Athletes can suffer from all the effects of eating disorders as anyone else. This includes anxiety, depression, insomnia, reduced brain function, dehydration, malnutrition, and slowed digestion. There is also a unique condition athletes with eating disorders can develop called Relative Energy Deficiency in Sports (RED-S). 

RED-S

The International Olympic Committee defined RED-S. It describes a set of symptoms that can affect athletes who under-fuel or don’t get the right nutrition for their needs. These symptoms can have negative effects on not only their performance but also their daily lives. They include:

• Fatigue
• Disrupted menstruation
• Early onset osteoporosis 
• Frequent illness (decreased immunity to infections/disease)
• Low heart rate causing dizziness
• Hair loss
• Trouble staying warm
• Trouble focusing

What are some of the mental and emotional health impacts of eating disorders on athletes?

Living with an eating disorder is emotionally, mentally, and physically difficult. You may not even recognize the symptoms at first and mistake them for something else. Common emotional and mental health impacts of eating disorders include:

Moodiness, Depression, and Anxiety

Not eating properly disrupts your body’s hormones, leading to dysregulated emotions and a higher risk of mental health issues. The psychological side of eating disorders is also closely linked to conditions like depression and anxiety. 
Struggling with an eating disorder can make you more prone to mood swings because of the constant stress cycle you undergo. It can become difficult to cope with the constant loop of frustration, anxiety, relief, shame, guilt, and fear. Part of eating disorder treatment involves learning how to recognize and cope with difficult emotions and separate them from unhealthy behaviors.

No Longer Enjoying Their Sport

Because the stress and anxiety of having an eating disorder can be so extreme, it’s not uncommon for a struggling athlete to lose interest in a sport they once loved. This can be devastating in and of itself as they feel a sense of grief and possibly guilt over not being able to rekindle old feelings of passion and enthusiasm. 

Difficulty Focusing and Concentrating 

When your body is under-fueled, your cognition is affected. Your brain needs nutrients to perform, so when it’s not receiving enough, it can lead to difficulty thinking clearly, a sense of fogginess, and increased distractibility. 

Decreased Coordination and Impaired Judgement

Because the brain and body are intrinsically linked through your central nervous system, widespread impairments are common when you have an eating disorder. Athletes with disordered eating or exercise behaviors may find themselves struggling to play sports like they used to, noting reduced balance, stability, stamina, and perception.

What signs can you look for in yourself? 

There are some warning signs you may have an eating disorder, including: 

Frequently Purging, Restricting, and/or Over-Training 

If you heavily control your food intake, purge, or exercise to control your weight or appearance, you may have an eating disorder. This can be fueled by a feeling you need to exercise even when you’re hurt or ill. You might be the type of person who has to work out no matter what, and if you don't, you feel overwhelming anxiety, stress, or guilt. 

Some people may praise your dedication, but the truth could be that you simply don’t know how to not exercise at this point. 

Constantly Dissatisfied With Your Body

It’s normal to have training goals, but if you always feel like your body isn’t up to standards, then you could be struggling with a condition called body dysmorphic disorder (BDD). BDD causes you to constantly focus on a perceived flaw and go out of your way to hide it or fix it. You could obsess over not looking a certain way, always compare yourself to your teammates or opponents, and belittle your appearance whenever you look in the mirror or see other people.

Misusing Supplements or Stimulants for Weight Control or Weight Loss

There are many supplements or stimulants available that can affect how full you feel after eating or even eliminate your appetite. You may also take things that make you more energized, so you can work out more in hopes of burning more calories. 

Using substances to control your weight is risky, and it can lead to serious health complications. 

Another major sign you might have an eating disorder is the inability to stop behaviors you recognize as unhealthy or dangerous. You might know that what you’re doing isn’t best for you, but the overwhelming desire to achieve your ideal body type is just too strong for you to quit. 

You don’t have to feel ashamed, but you should consider reaching out for help. You don’t have to suffer alone.

Persistent Belief That Losing Weight Will Make You Stronger, Faster, or Improve Your Performance 

Do you believe that if you could lose more weight, you’d increase your strength or stamina? Do you believe that continued fat loss could enhance your performance and help you reach your athletic goals? These beliefs may be fueling disordered eating, and you can tell they’re rigid if they often motivate you to control or restrict your eating or work out/train as often as possible. 

What signs should you look for in an athlete you’re concerned about? 

The same symptoms you’d look for in yourself as the same others will experience. In addition, you may also notice:

• Decreased concentration
• Reduced energy, muscle function, coordination, and speed
• Increased fatigue and perceived exertion 
• More frequent muscle strains, sprains, and/or bone fractures 
• Additional training than what is required for the sport, e.g. always running extra miles, doing more push-ups, extra laps, etc. 
• Reduced interaction with coaches and teammates 
• Increased moodiness and irritability

What kinds of treatments are appropriate for athletes with eating disorders? 

Eating disorder therapies that work for other folks can be just as effective for athletes. These include cognitive behavioral therapy (CBT) and dialectical behavioral therapy (DBT). It’s important to work with a licensed provider who understands the unique challenges and factors affecting eating disorders in athletes, so they can integrate this knowledge with an effective treatment plan.

At Arise, we’re here to help with eating disorders with care and compassion. Our affordable, flexible treatment plans are built to work around your life, so you can tackle your symptoms wherever works best for you. By building treatment into your routine, we make it accessible for you to make and keep positive changes in your life.

If you’d like to learn more about how we approach eating disorder treatment, book a free consultation. We’d love to speak with you. (And if you’re unsure if your feelings or behaviors could indicate an eating disorder, you’re not alone. You can start with our screener here.)

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