eating disorders Flashcards
(11 cards)
What are common eating disorders in sport?
Anorexia nervosa (AN): focus on self-starvation and excessive weight loss, extreme restriction of food intake leading to weight loss or failure to gain weight
Bulimia nervosa (BN): cycle of bingeing and compensatory behaviours to undo/ compensate for the effects of binge eating. Require recurrent episodes of binge eating, recurrent inappropriate compensatory behaviour in order to prevent weight gain. Involves a binge purge cycle linked to emotional factors.
Binge eating disorder (BED): recurrent binge eating without regular use of compensatory measure. Shame and often a solitary behaviour.
Discuss prevalence rates of eating disorders and disordered eating?
There is a higher prevalence of eating disorders in athletes compared to non-athelts across lifetimes. 4.6% in non-athletes vs 13.5% in athletes.
Sundgot-Borgen & Torstveit (2004)
- assessed all elite athletes in Norway vis questionnaire for risk of ED and then interviewed for who met diagnostic criteria
- found elite athletes have significantly higher prevalence compared to controls
- Female athletes have a higher prevalence than male athletes
- Sports that focus on leanness and weight had a higher prevalence than other sports and controls
This could be in relation to eating patterns and extreme diets e.g. early training session and weight requirements.
Disordered eating: common for athletes to be in disordered eating, 6-45% of female athletes and 0-19% of male athlets in DE + ED spectrum
Discuss diagnostic criteria for eating disorders
AN: Restriction of food intake leading to weight loss or a failure to gain weight. Involves “significantly low body weight” for person, age, sex and height. Also takes into account energy related intake. Involves a fear of becoming fat or gaining weight. Will have a distorted view of self and condition.
In contrast
BN: Recurrent episodes of binge eating. Recurrent inappropriate compensatory behaviour in order to prevent weight gain e.g. exercise, vomiting, laxatives. Binge eating and inappropriate compensatory behaviours both occur on average at least once a week for three months. Self-evaluation is unduly influenced by body shape and weight. Binge-purge cycle often linked to emotional factors.
Whereas
BED: recurrent binge eating at frequency of at least once per week over past 3 months (when averaged). Presence of at least 3 of the following
- eating more quickly than usual
- eating until uncomfortably full
- eating a lot when not physically hungry
- eating alone because of embarrassment
- feeling very bad or guilty after eating
Discuss co-morbidities of eating disorders
eating psychopathology predicted depressive symptoms 6 months later in British athletes (Shanmugam et al., 2014)
Male athletes who were symptomatic of ED experience more stress than asymptomatic (Petrie et al., 2007)
Higher scores on exercise dependence was associated with ED symptoms + RED-S biomarkers in trained male cyclists (Torstveit et al., 2019)
Higher scores on exercise addiction was associated with more depressive symptoms and abnormal eating attitudes in Israeli athletes (Levit et al., 2018).
Discuss health concerns in relation to eating disorders
The female athlete triad was presented by the IOC which involves a combination of disordered eating with impaired menstrual cycles link to bone health - since updated to energy deficiency
Approximately only 50% of people that should have been aware were.
- however, female athletes weren’t required to have severely low body fat to suffer from Female Athlete Triad which can be another issue.
Male athletes also can show increased risk of fractures, hormonal disruptions, decreases in performance, and higher long-term risk of poor skeletal health which the triad does not allow for
Relative Energy Deficiency in Sports (RED-S)
Results in impaired physiological functioning caused by relative energy deficiency and includes but is not limited to impaired:
- metabolic rate
- menstrual function
- bone health
- immunity
- protein synthesis
- cardiovascular health
Health consequences include:
- slowed metabolism
- menstrual dysfunction / testosterone reduction
- compromised bone density
- decreased immunity
- decreased protein production
- compromised cardiovascular system
RED-S covers many more factors including psychological factors and the female athlete traid is included in it (Mountjoy et al., 2014; 2018)
Discuss performance concerns in relation to eating disorders
Can lead to low energy availability
- due to electrolyte imbalance, reduced fat and lean body mass and dehydration
Physical fitness can also be impaired
- decreased cardiovascular response to exs
- decreased muscular strength
Increased risk of injury
- MSK - e.g. tendon issues
- Increased risk of fractures
Discuss treatment approaches for eating disorders
Early intervention has been found to increase chances of recovery and had greater sense of control in life (Berkman et al., 2007)
CBT-E and ACT are both possible treatments for eating disorders
CBT-E
- evidence-based and NICE approved
- transdiagnostic
- understand interaction between thoughts, feelings, and behaviours
- develop strategies to challenge maladaptive/distorted thoughts and behaviours
Goals are to engage person in treatment & actively involve them in process of change, remove ED psychopathology, disrupt mechanisms maintaining ED psychopathology and ensure lasting change.
20-40 sessions in a multistage approach
Would use case formulation
Acceptance and commitment therapy (ACT)
- part of CBT
- stress, anxiety, depression, chronic pain, OCD, BPD, substance abuse, physical illnesses and ED all appropriate for
- shifts attention to what is under person’s control
- becoming more psychologically flexible
- learning to be present and accept experiences
ACT increases psychological flexibility through
- self as context
-present moment
- cognitive defusion
- experiencing acceptance
- values
- committed action
Put in terms of a matrix rather than 5 Ps
What are unique factors that influence ED onset in sport
Onset of bulimia can be influenced by performance pressure, achievement related perfectionism and rigid dieting in elite male footballers (Papathomas and Lavellee, 2006)
Increased ED symptoms can relate to sport performance pressures and reinforcement of weight loss by coaches in high school athletes (Reindl, 2001, Woods, 2004)
What are unique factors that support recovery in sport?
Attending professional treatment and leaving sport due to injury aided elite male footballers (Papathomas and Lavellee, 2006)
Unconditional support from parents and coaches, and from friends and partners
Antidepressants in some cases - high school athletes (Reindl (2001), Woods (2004))
Desire to regain strength and energy (Arthur-Cameselle & Quatromoni, 2014)
What are similarities and differences between disturbed eating and eating disorders?
Disordered eating = a range of irregular eating behaviours that may or may not warrant a diagnosis of a specific ED
Well et al., 2020 British Journal of Sports Medicine:
Similarities include pathogenic behaviours like restricting, diet pills, bingeing, purging and saunas/ sweat runs. However in DE not occurring regularly, in ED occur multiple times a week.
Involve preoccupation with healthy eating or significant attention to caloric or nutritional parameters of food eaten. However in DE intake remains acceptable whereas in ED there is significant dietary restriction.
In DE may be a cognitive focus on burning calories when exercising, however not aiming to use as method of purging and in ED experience excessive exercise beyond that recommended by coaches.
DE thoughts of food and eating do not occupy most of day whereas in ED do.
Functioning remains intact in DE whereas in ED functioning in life activities is precluded by eating patterns and obsessions.
What are common signs and symptoms of disturbed eating and eating disorders in sports?
Behavioural changes:
- preoccupation with food, calories, body shape and weight
- polarised dichotomous thinking
- avoidance of food-related social activities
- Restrictive eating e.g. cutting down or cutting out food groups
- Bathroom visits after meals
- Evidence of binge eating
- Restriction followed by binge eating
- Secretive behaviour regarding food intake and / or exercise behaviour
- Increasing rigidity or inflexibility in situations
Physical changes:
- Wearing baggy or layered clothing hiding body shape
- relentless excessive exercise
- exercise through injury / illness
- bone stress injury
- hormone dysfunction
- frequent illness
- low body fat
- dehydration
- bad breath, sore gums or signs of enamel loss
- swelling around jaw
- skin effects, including dry skin, fine hairs growing around face or signs of calluses on knuckles
- Unexpected weight gain beyond that expected from growth / development
- dramatic or rapid weight loss or gain or fluctuation
Psychological changes
- persistently poor and / or declining mental health
- increased attention to and/or criticism of one’s own body
- Feeling out of control with regard to food
- Body image dissatisfaction and distortion
