Athletes with Eating Disorders

How the Demands in Athletic Competition Fuel Disordered Eating

Athletes with Eating Disorders

It’s easy to grasp how an athlete may develop an eating disorder.  Competition among athletes is fierce, and the pressure to meet the perceived physical appearance standards or weight requirements of a sport can be unrelenting.  In fact, according to a 2004 study from Norway, athletes are far more likely to develop an ED than the general public.  The study found that 14% of the 1,620 athletes evaluated had an active ED, versus 5% of the general population.  In addition, the study showed a higher incident of ED in female athletes, with a prevalence among athletes in leanness-dependent and weight-dependent sports.

Although eating disorders do occur in every sport, athletes who participate in what are referred to as “lean sports” tend to be more susceptible to acquiring an eating disorder.  Those sports include gymnastics, wrestling, cycling, running, ballet, diving, rowing, jockeying, and martial arts.  These particular sports tend to have a weight-class requirement, such as wrestling, or a standard that promotes low body weight for peak performance, such as cycling.

Why do Athletes Develop Eating Disorders?

Along with the stringent demands involved in being a competitive athlete that may drive some toward disordered eating habits to accommodate the physical standard for the sport, personality traits also factor in.  “The traits found in those with anorexia are also often found in high-performing athletes,” states Dr. James Greenblatt, chief medical officer at Walden Behavioral Care in Waltham, Massachusetts.  Greenblatt continues, “These traits include high self-expectations, perfectionism, competitiveness, hyperactivity, preoccupation with weight and dieting, and a tendency toward depression.”

Disordered eating among athletes, as in the general population, is caused by complex factors, including psychological, behavioral, environmental, and genetics.  In sports, some participants may go to unhealthy lengths to control their weight, influenced by such factors as:

  • Demands for peak performance, including speed and agility
  • Aesthetic demands, such as grace and beauty in dance or gymnastics
  • Pressure from coaches, judges, peers, and teammates to have a certain body size and shape and who emphasize only performance and success
  • Form-fitting athletic attire
  • Training for a sport from a young age
  • Public weigh ins
  • Media images of top athletes that present a stereotypical body image for a sport

The Consequences of ED among Athletes

These pressures can cause an athlete to go to any means necessary to shed pounds in a short period of time.  Binging and purging or starving oneself of important calories and nutrients becomes a de facto method to achieving the weight or physical appearance required by their sport. By engaging in such unhealthy dietary practices, the athlete may become more prone to injury, having the net result of a shortened career.

In female athletes, the lack of appropriate nutrition can cause detrimental health effects, referred to as the Female Athlete Triad.  This includes disordered eating, amenorrhea, and osteoporosis.  The process begins with the disordered eating, which can result in a female athlete ceasing to menstruate (amenorrhea), which in turn may cause calcium and bone loss that can lead to stress fractures of the bones (osteoporosis).  Male athletes battling an ED may have an increased incidence of co-morbid depression and substance abuse.

How Can Eating Disorders be prevented in the Sports Community?

Those with key roles in the athletic community have a responsibility to be proactive about addressing the dangers and prevalence of eating disorders.  Many turn a blind eye, considering disordered eating as part and parcel of participation in competitive sports.  In some instances, the coaches themselves are to blame for triggering an ED by belittling comments toward their athletes about body size and shape, or by public weigh-ins where peers can humiliate a fellow athlete.

Those in power positions, like a coach, have the opportunity to address the ED and to influence the athlete back to healthy eating habits.  Effective coaches exhibit responsible eating habits themselves, and emphasize health and wellbeing over the destructive success-at-all-costs mantra.  In doing so they provide positive examples to their young athletes that promote healthy lifestyles in addition to athletic performance.

We Can Help

At Casa Serena our expert treatment specialists are available to treat athletes who are battling an eating disorder.  These compassionate professionals are trained in treating the specific issues related to participating in competitive sports, helping the athlete to reclaim a balanced and healthy approach toward the demands of their sport.  Call today for a discreet consultation at (925) 682-8252.

Sources for this page:

Calling Binge Eating what it is…a Real Disorder

Understanding the Very Real Dangers of BED

When people hear the terms ‘anorexia’ or ‘bulimia,’ most understand these words to represent complex mental health disorders that result in disordered eating.  For decades now, public awareness of the serious emotional issues that underlie anorexia and bulimia have helped people understand the validity of these dangerous psychiatric conditions.  However, upon hearing the term ‘binge eating disorder,’ many may wrongly associate it with simply a lack of self-control or a character flaw rather than as a bona fide disorder.

On the contrary, binge eating disorder, or BED, was recently added to the revised Diagnostic and Statistical Manual (DSM 5), recognizing it as a valid, diagnosable illness.  By adding BED to the DSM it gives health professionals specific diagnostic criteria that will aid clinicians in identifying and assessing the disorder, leading to effective treatment decisions for those struggling with BED.

What is Binge Eating Disorder?

Because the word “binge” has been used loosely to describe compulsive behaviors such as binge-watching a TV series, or “binging out” on ice cream after a break-up, there is a tendency to dismiss a binge eating disorder as just a reckless overindulgence in food that has resulted in weight gain; just as binge-watching on Netflix results in lost productivity.  It is a misnomer though, as BED usually has co-occurring mental health conditions that drive the disordered eating, which can result in dire health and psychological outcomes.  These comorbid mental health conditions include:

  • Anxiety
  • Bi-polar disorder
  • Depression
  • Substance abuse

Binge eating disorders affect about 2.8 million adults, according to a 2007 national survey by Biological Psychiatry.  Of those who suffer from BED, 5.2% will die from health complications that resulted from the disorder.  Shockingly, BED is more prevalent in adults in the U.S. than both anorexia and bulimia combined.

Those who suffer from BED use food to manage emotions they do not want to experience.  These unwanted emotions include anger, boredom, guilt, stress, sadness, or a sense of being out of control.  Someone with a BED will attempt to offset these emotions with the pleasure they anticipate they’ll feel by consuming vast quantities of comfort food on a recurrent basis.

BED is also accompanied by a fixation on body image, leading to compensatory behaviors after over-indulging in the food, such as vomiting (although purging is not a common trait in BED), using diuretics or laxatives, or over-exercise.  Despite the serious psychological and sociological issues that underlie BED, the disorder is often misdiagnosed as simply an issue with weight.

Diagnostic Criteria for BED

The DSM-5, published in 2013, lists the diagnostic criteria for binge eating disorder as such:

 Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:

  • Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than what most people would eat in a similar period of time under similar circumstances
  • Eating much more rapidly than normal
  • The binge eating episodes are associated with three (or more) of the following:
  • A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating)
  • Eating until feeling uncomfortably full
  • Eating large amounts of food when not feeling physically hungry
  • Eating alone because of feeling embarrassed by how much one is eating
  • Feeling disgusted with oneself, depressed, or very guilty afterward
  • Marked distress regarding binge eating is present
  • The binge eating occurs, on average, at least once a week for 3 months
  • The binge eating is not associated with the recurrent use of inappropriate compensatory behaviors (e.g., purging) as in bulimia nervosa and does not occur exclusively during the course of bulimia nervosa or anorexia nervosa

 Signs and Symptoms of BED

Although there are a multitude of variations of BED, there are certain signs and symptoms that someone may be suffering from this serious disorder.   By being aware of these signs, the chance for successful treatment of the disorder is made possible.  Some behaviors are displayed that may be predispositions for developing an eventual BED, but not necessarily.  Regardless, awareness is key in helping a loved one with a mental health condition such as BED.

Emotional characteristics of BED

  • Depression, social isolation, and moodiness
  • Feelings of anger, shame, anxiety and worthlessness preceding the binge
  • Negative or distorted body image
  • Rigid thinking
  • Perfectionist tendencies
  • Need to be in control
  • Conflict avoidance

Behavioral characteristics of BED

  • Eating secretly, hiding, stealing, or hoarding food
  • Disappearance of large amounts of food, empty wrappers or containers indicating large quantities of food consumed
  • Periods of impulsive or continuous eating beyond the point of feeling full, but does not purge. Eating fast, or eating large amounts of food when not hungry
  • Creating rituals allowing for binge sessions
  • Extreme rigidity with food, with periodic dieting/fasting

Effects of BED

A binge eating disorder can put someone at risk for developing several serious health conditions, including heart disease, type 2 diabetes, or high blood pressure, mostly due to obesity or radical weight fluctuations.  Because of the comorbid psychiatric conditions, a BED can also lead to a substance abuse disorder, which in itself can lead to death.

In addition to the physical effects, a BED can cause the sufferer to become disengaged from their normal responsibilities, eventually becoming unable to keep up with their obligations.  A BED can also affect relationships, due to the secretive behaviors and shame that may cause the sufferer to withdraw from loved ones.

Because BED is often a misunderstood condition, it is important to seek help from a provider who is an expert in the field of treating eating disorders.  At Casa Serena, our specialized professionals use evidence-based treatment methods in a caring and supportive environment to effectively treat BED.   Allow our compassionate staff to restore you or your loved one to good health and renewed quality of life.  Call us today (925) 682-8252!

Sources for this page:


Coping with a Loved One’s Eating Disorder

Heartbreak Often Accompanies the Battle

The emotional impact of witnessing your child or significant other battle a dangerous eating disorder is much the same as if it were any other debilitating physical disease.  The pain, guilt, anger, sorrow, confusion, frustration, and a myriad of other emotions experienced as one watches their loved one suffer a potentially life threatening disease are the very similar.  The heart hurts the same, regardless of the affliction, as it beholds the suffering of anyone we hold dear.

The truth is, just like any other deadly disease, an eating disorders can become a battle waged against a wily foe.  Just as cancer cells dodge valiant efforts to arrest the progression of that disease, widely unseen and powerful psychological mechanisms embedded in disordered eating can also prove formidable adversaries that inhibit recovery.

Just as a person battling a drug or alcohol addiction becomes fixated on their next hit or drink, someone battling an eating disorder is also expending much of their energy on obsessive thoughts and behaviors.  In both cases, significant relationships suffer as a result of neglect.

Built in to the behaviors of a person who suffers from an ED is a tendency to keep people at an emotional distance, usually in an effort to avoid judgment for their affliction.  Because at the root of their disorder lies shame and self-loathing, your loved one may believe that they are unlovable or undeserving of your love.  In addition, with their central focus on continuing on the path of disordered eating, your loved one may even see you as an adversary—someone who wants to block his or her efforts.

Sometimes an eating disorder is the result of a subconscious desire to avoid intimacy and authentic relationships.  In order to avoid the perceived messiness of a close emotional connection, some develop eating disorders to sidestep the difficult aspects of relationships, such as experiencing uncomfortable emotions like sorrow, disappointment, insecurity, or anger.  All close relationships include difficult moments and challenges, but someone with disordered thinking looks for ways to avoid possible undesirable emotions, and to exercise some control over the relationships.

Common Emotions Experienced by Loved Ones

Loving someone with an eating disorder can be difficult and trying.  Strong emotions rise up in response to the stress that accompanies the disorder, which may include:

  • Feelings of guilt are usually associated with the parent of a child or young adult suffering from an eating disorder.  It is common for parents to wonder if their parenting itself was to blame for the resulting ED.  They may wonder why they did not recognize the symptoms earlier, or have doubts that they can provide the right support for their child’s recovery.
  • An eating disorder is a serious disease.  Suicide rates among those with all forms of eating disorders are the highest among all mental health disorders, and premature mortality due to organ failure, heart failure, or malnutrition is a daunting reality.  Those who love someone with an eating disorder live with constant fear of losing them.
  • It is difficult to witness a loved one’s decline mental and physical health.  As the disease progresses, there is a pervading sense of loss felt by family and friends who sense their loved one drifting away.  Loved ones feel sad about the life changes an ED imposes on the person they love, while they witness hopes and dreams fade away with the progression of the disease.
  • Loved ones may feel exasperated as they watch an ED take over the victim’s life, and wonder why they seem to make no effort to get help to stop the destructive behaviors.  When a loved one’s attempts to help are shunned, they may become frustrated and angry.  Also, people with an ED may resort to deceptive behaviors to hide their disordered eating habits, leading to angry feelings and a loss of trust among friends and family.

 As with other mental health or addiction disorders, loved ones may not know how to help.  The disordered thoughts and habits confuse them because they seem irrational, so they don’t know how to act or what to say, or even how to support the person with the eating disorder.

 We Can Help

 At Casa Serena our caring and supportive professionals understand the difficult emotions that family and friends experience when their loved one is afflicted with an eating disorder.  Our individualized treatment plans include weekly multi-family groups that help loved ones address issues related to the eating disorder dynamics in the family and within significant relationships.  Individual family counseling is also available when needed.  Casa Serena provides education to the family as a tool to support their loved one’s path to a full recovery.  Call us today (925) 682-8252!



Treating Eating Disorders with Psych Meds

Treatment for an eating disorder commonly includes a multi-disciplinary approach with the psychotherapist and psychiatrist as the primary treatment providers. In addition, a licensed dietician and a primary care physician make up the rest of the team involved in the care of the patient.   Depending on the type of eating disorder diagnosed, use of specific pharmacotherapy can also be effective.

To date, there has not been much success in treating anorexia nervosa with psychotropic drugs to cure the physical aspects of the disease. Indeed, food is still the best medicine for regaining physical wellbeing for anorectics. However, some SSRIs have shown promise in treating the underlying mental health conditions that accompany the eating disorder, once a healthy weight has been attained.

There has been much more success treating patients with psych meds who present with bulimia nervosa or a binge eating disorder. It has been found that bulimics respond well to antidepressants, even if they are not suffering from depression.

 Drug Treatment for Anorexia Nervosa

The most challenging eating disorder to treat is anorexia. Psychotherapy remains the primary tool used to stabilize and treat this eating disorder, as there are typically serious mental health issues that accompany the disordered eating. To date, there has been little evidence that medication is effective in treating anorexia, but when mood disorders such as depression or obsessive-compulsive disorder accompany the disorder, Fluoxetine (Prozac) has helped the anorectic patient manage these.

Side effects of these selective serotonin uptake inhibitors (SSRIs) are generally mild and tolerated well for most patients. Side effects can include:

  • Drowsiness
  • Decreased interest in sex
  • Nausea
  • Diarrhea
  • Weight gain
  • Agitation

If the patient does not tolerate the SSRI, then their psychiatrist may prescribe olanzapine (Zyprexa), a psychotropic drug used primarily to treat schizophrenia. In a patient who has anorexia nervosa, olanzapine can help them gain weight and modify their obsessive thinking. Side effects of olanzapine include:

  • Dizziness
  • Weakness
  • Drowsiness
  • Lightheadedness
  • Dyskinesia (movement disorder)

In addition, anti-anxiety medications can be effective in reducing the anxiety the patient may experience before eating.

Drug Treatment for Bulimia Nervosa

 Patients diagnosed with bulimia nervosa tend to respond well to fluoxetine in reducing the binge eating and purging. This is the only antidepressant that is approved by the U.S. Food and Drug Administration to treat bulimia nervosa.

In addition to fluoxetine, another group of antidepressant drugs called tricyclics (Norpramin, Tofranil, and Elavil) have been prescribed with some success. They have similar side effects as the antidepressants, but also have more risk of overdose and drug interactions.

Several placebo-controlled trials have shown topiramate (Topamax) to be effective in controlling binge and purge behaviors. Side effects include taste perversion, difficulty concentrating, and a sensation of pins and needles or skin crawling.

Studies with lithium demonstrated it is ineffective in treating bulimia.

Drug Treatment for Binge Eating Disorder

In treating binge eating disorders, the most effective drug has been topiramate , a medication usually associated with treating epileptic seizures and migraine headaches, as well as bipolar disorder. Side effects are listed above.

SSRIs (Prozac and Zoloft) and appetite suppressants (such as Meridia) have also been effective in treating the binge-eating behaviors. Appetite suppressants can help suppress hunger, which helps in weight loss, but they can have serious side effects. Common side effects of Meridia include dangerous changes in blood pressure, headache, dry mouth, and sleep disturbance.

Get Help Now

Casa Serena offers a safe and supportive environment to treat Anorexia Nervosa, Bulimia Nervosa, and Binge Eating Disorders. Casa Serena incorporates yoga and mindfulness, expressive arts therapy, family education, body image support group, and many more effective program components. Our caring, professional staff can help you reclaim your power and gently guide your or your loved one to a full, healthy recovery. Call (925) 682-8252