Anorexia in Exercise and Sport

Abstract

Introduction: Mental disorders that are associated with severe disturbances in eating behavior are called “eating disorders.” According to the American Psychiatric Association1, a mental disorder consists of “a clinically significant behavioral or psychological syndrome or pattern that occurs in an individual and that is associated with present distress (e.g., a painful symptom) or disability (i.e., impairment in one or more important areas of functioning) or with a significantly increased risk of suffering death, pain, disability, or an important loss of freedom.” Of particular attention here is the eating disorder of anorexia nervosa. This disorder amounts to a refusal to maintain a normal body weight. In the fourth edition of the Diagnostic and Statistical Manual of the American Psychiatric Association (DSM-IV, pp. 544–545), the diagnostic criteria for anorexia nervosa (See Table 1) are associated with physical symptoms (abnormal body weight, amenorrhea) and psychological symptoms (fear in gaining weight and body image disturbances).Table 1: A. Diagnostic Criteria for Anorexia NervosaDiscussion: Although the incidence of clinically diagnosed anorexia nervosa is only about 1% in the U.S. population, its prevalence among athletes in sports that emphasize leanness has been estimated to be much higher. Part of this confusion comes from misinterpreting scores on questionnaires such as the Eating Disorders Inventory (EDI) or the Eating Attitudes Test (EAT). These standardized instruments are not designed to determine psychopathology since it takes a clinical interview to determine if the DSM-IV diagnostic criteria are met. Instead, the EDI and EAT are useful in determining who might be at risk for meeting the diagnostic criteria of anorexia nervosa. Athletes in sports that emphasize leanness will often have elevated scores on the drive for thinness scale of the EDI2. However, when athletes are subjected to a clinical interview, most of those classified as “at risk,” are not found to have a true clinical relevant “eating disorder.” Higher scores on the EDI, for instance, may be only be a rationale response on the part of the athlete and may not represent a clinical eating disorder. As O'Connor and Smith3 have pointed out, a higher drive for thinness score may merely represent a desire to perform well, especially in light of the time the athlete has devoted to the sport. Evidence from several sources suggests that athletes are more apt to have “subclinical or disordered eating patterns,” particularly when their sports are in-season. However, the disordered eating patterns seen in most athletes are not of the severity that would qualify as a clinically diagnosed eating disorder.