Increased Prevalence of Eating Disorders in Athletes- a Controlled Study

Abstract

Introduction: Only a handful of studies on athletes and eating disorder (ED) have gone beyond the administration of ED questionnaires. Several researchers have pointed out the limitations of ED questionnaires and the need to use clinical interviews to determine more accurate prevalence data. Furthermore, it has been stated that since athletes constitute a unique population special diagnostic considerations should be made when working with this group. Previous investigations suggest ED to be of clinical concern mainly in female athletes but it is as yet not clear whether clinical ED is a problem among male athletes, or whether gender differences observed in the general population also exist among athletes. Therefore, the aim of the present study was to examine the prevalence of male and female elite athletes and control meeting the DSM-IV criteria for ED or the criteria for anorexia athletica (AA). Methods: This two-stage study comprised initial screening by a questionnaire to detect athletes and controls “at risk” for ED, and thereafter a detailed standardized clinical interview of all “at risk” individuals. The prevalence of eating disorders (ED) was studied in the total population of Norwegian male (n = 960) and female (n = 660) elite athletes and a matched group of controls (916 males and 780 females). First all participants were sent a questionnaire for screening. The response rate was 83% in athletes and 74% in controls. Thereafter, based on the questionnaire 182 athletes (12%) and 80 controls (5%) were classified as “at-risk” for ED. Participation rate in athletes and controls was 98% and 89% respectively. Athletes and controls meeting the DSM-IV criteria for ED or the criteria listed for AA were classified as eating disordered athletes and controls. Results: The diagnostic criteria for ED were met by more female (20%) than male athletes (9%), (p < 0.05). Corresponding values for controls were lower in both genders, females (9%) vs. female athletes (p < 0.051) and males 0.5% vs. male athletes (p < 0.01). A significantly higher prevalence of ED was observed among female athletes competing in aesthetic (42%), weight class (30%) and endurance sports (24%), as compared to the prevalence in the other sports (all significance levels being, p < 0,05). For the male athletes, ED were significantly more common in anti-gravitation sports (22%) and weight class sports (18%), as compared to other sports (all significance levels being, p < 0,05). Based on international ranking classification, no significant difference was observed in prevalence of ED among athletes. Discussion: ED is more prevalent in female than in male athletes. Furthermore the prevalence of ED is higher in elite athletes of both genders as compared to controls. A higher prevalence was also diagnosed in “leanness-” and/or weight-class sports as compared to the other sports. Thus, sport specific demands seem to be related to the development of ED. Therefore prevention- and treatment programs targeting elite athletes have to be developed and initiated. Acknowledgements: This study was supported by grants from the Norwegian Olympic Committee and Confederation of Sports.