In date. The interviews were between 60 and

the athletic world, there are a lot of outside factors that play into sport
performance. Society usually focuses on the positive impacts on sport
performance, however there is a darker side to the athletic world. Athletes are
so committed to their athletic career that they are willing to go to any
extreme to be successful. According to the National Association of Anorexia
Nervosa and Associated Disorders, about thirteen percent of athletes in judged
sports have eating disorders compared with a three percent in other sports. In
some cases, an eating disorder can arise unintentionally. The motives behind
the development of an eating disorder in an athlete can vary as every athlete
is different, however the impact on sport performance can all be similarly
negative. This review looks at how eating disorders can cause an impact on the
performance of an athlete.

            A study by (Papathomas, 2014) looked
to provide an alternative medical understanding of eating disordered eating in
sport through an emphasis on personal perspectives. He took in a subject,
Holly. The subject was a 20-year-old undergraduate student who was currently
competing to an elite level in basketball. The participant volunteered for
study because she held concerns that gaining weight was detrimentally
interfering with her sport performance. Although her behaviors were never formally
clinically diagnosed as an eating disorder, the study labels he behaviors as
disordered eating. The study was constructed over an 8-month period, Papathomas
conducted a series of 6 interviews with Holly yielding a total of over 7 hours
of date. The interviews were between 60 and 90 minutes. Holly was asked to
recall her earliest memories.

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            The study led the researcher to
believe that the notion behind Holly’s disordered eating was that she was
striving to meet the expectations of others. Through the research it was found
that the background for this belief was the pressures a childhood coach put on
her while she was playing basketball. The study showed that Holly’s disordered
eating began soon after she had an unsuccessful England trial. As a result of
her failure, she began really enforce her diet and restrict her food intake.
Holly called it “cutting down” on what she ate a month prior to a trial to
become fitter. She noticed that her motives of self-starvation as working to
improve herself later became a form a self-punishment. The researcher concluded
that in Holly’s case and other athletes, when the demands of performance
narrative render achievement opportunities scarce, self-starvation may be
constructed as the only means of achievement possible.

            In a study (Arthur-Cameselle, Quatromoni,
2010) used to identify factors related to the onset of eating disorders in
female athletes, 17 collegiate female athletes (mean age 20.7) who experienced
eating disorders participated. There were 15 Caucasian participants, one Asian-
American and one African- American. Fifteen of the participants were competitive
Division I athletes, two competed at Division III level. Participants
experienced a variety of eating disorder diagnoses, including: Anorexia Nervosa
(n=8), Bulimia Nervosa (n=2), Binge Eating Disorder (n=2), Anorexia followed by
Bulimia (n=4), and Anorexia followed by Bing Eating Disorder (n=1).  interviewed individually and responses were
coded.  Each participant was interviewed
by a single interviewer (the primary researcher). The interviewer asked each
participant four questions, once the questions were answered he asked open
ended questions and asked the participant to tell him about their experiences
and what lead them to develop an eating disorder.

            During the study, two main factors
arose from the participant’s responses; factors that were internal and those
who were external. Participants did not mention one specific factor but instead
told stories of their external environment and internal conflicts or emotional
states that triggered the development of eating disorders for them. The
negative internal factors included; negative mood, low self-esteem, perfectionism/
achievement, and desire for control. The external factors include; negative
influence on self-esteem, hurtful relationships, hurtful role models, and sport
performance. The researchers found that pressure to perform in sport, other
athletes who model maladaptive eating behaviors, and harmful comments from
coaches are unique factors that influence the onset of eating disorders in
female athletes. They concluded that more education is needed for coaches and
parent of female athletes on the topic of predisposing factors for eating

            In a study (Krentz, Warschburger,
2011) sports-related risk factors for disordered eating were examined in a one
year longitudinal study with two assessment points The purpose was to examine
potential risk factors for disordered eating in aesthetic sports. The
participants were 65 adolescent athletes from aesthetic sports, mean age 14,
who completed measures of disordered eating, social pressure from sports
environment, sport-related body dissatisfaction, desire to be leaner to improve
sports performance, and emotional stress resulting from missed exercise
sessions. The sports included in the study were; gymnastics (12 male and 8
female athletes), ice figure skating (4 male and 15 female athletes), diving (7
male and 3 female athletes), ballet (3 male and 4 female athletes),
roller-skate figure skating (1 male and 5 female athletes), rhythmic gymnastics
(3 male athletes). The participants completed a questionnaire that required
personal information such as; weight, height, and exercise habits, along with;
Eating Attitudes Test (EAT), Obligatory Exercise Questionnaire, Contour Drawing
Rating Scale (CDRS), and German Questionnaire on Appearance- Related Social

            The results of the study were in
favor of the belief that athletes were at higher risk of developing eating
disorders. The correlation in their study was very high over a year. In more
detail, the study showed that there was a significant decrease in disordered
eating and social pressures among males than females. The results supported the
idea that increase in the desire to be leaner to improve sport performance,
strongly correlated with an increase in disordered eating. The cross-lagged partial
correlation analysis showed that the desire to be leaner for sport improvement
was predictive of disordered eating, but not the other way around. This was
very important to the study because it confirmed that athletes are at greater
risk for eating disorders since they have the mentality that “thin is going to
win” and are willing to develop unhealthy eating habits to enhance their performance.

            A study by the same researchers
(Krentz, Warschburger, 2011) focused on how eating disorders correlated to
aesthetic sports and how it is more prevalent within these sports. The pupose
of the study was to focus on sport-specific variables in aesthetic sports and
to exame the relation to disordered eating. The cross-sectional study consisted
of 96 elite athletes from aesthetic sports (61girls, 35 boys) who were compared
to a control group of the same number of athletes. The mean age was 14 years
old. The athletes were from German sports institutions with high performance
levels such as elite sport schools or Olympic training centers. The control
group was made up of adolescents from three different German high schools, and
were part of a larger study on eating disorders. The students/ athletes were
given a questionnaire to fill out.

            The results of the study showed that
athletes revealed significantly higher values for disordered eating as compared
with the control group. The study indicated that there are higher rates for
disordered eating in aesthetic sports, especially for high-performance levels.
They came to this conclusion by studying the results of eating habits between
the German elite athletes from aesthetic sports to the non-athletic control
group. Thought the size difference between these athletes was small, they were
still able to conclude that disordered eating is higher in athletes performing
in aesthetic sports. Overall, the researchers concluded that aesthetic athletes
have a higher prevalence for disordered eating, while the main risk factor,
body dissatisfaction, is not elevated.

            A study (Goldfield, 2009) was done
to compare competitive female bodybuilders (CFBBs) and recreational female
weight training controls (RFWTs) on a broad scope of eating related and general
psychological characteristics. There were 45 participants made up of 20 CFBB
and 25 RFWT. The bodybuilders were chosen from flyers posted in a gym in

subjects completed a questionnaire about brief demographics and the Eating
Disorder Inventory (EDI) to assess eating related attitudes and psychological
factors associated with eating disorders.

            The results showed that due to the
high standards to be lean and muscular for CFBBs that currently stand, CFBBs
exhibit greater body dissatisfaction and extreme eating and weight control
practices compared to women who lift on a recreational level. There was a 15%
and 12% prevalence of bulimia nervosa in CFBBs and RFWTs respectively. The
researchers also found that there are high rates of eating disorders among
competitive female bodybuilders in the form of anorexia nervosa. There was a
high prevalence of body dissatisfaction, weight and shape preoccupation, strict
dieting and vigorous exercise, binge eating, anabolic steroid use and a history
of bulimia nervosa in CFBB. The motive behind this was found to be the pursuit
of a lean and tone ideal body that cannot be attributed solely through a normal

            In another study (Wyon, Hutchings,
Wells, Nevill, 2013), researchers examined the association between BMI, eating
attitudes, and nutritional knowledge or elite students and professional ballet
dancers. There were 189 participants from an elite full-time dance school and from
and elite ballet company. Of these participants, 69 were male and 111 were
female. The age range was 11-18. The participants engaged in a 4-6 hour ballet
training six days a week while the professional dancers spent 38 hours a week
dancing. Body mass, weight, and height were taken before the study. The
participants were also asked to participate in the EAT.

            The results showed a difference in
BMI between professional dancers and students however the difference could be a
result from muscles mass from high level training. The researchers were also
able to conclude that esthetic sports and dance, where leanness or specific
weight category is important, are prone to disordered eating. It is also
important to note that professional dancer had a lower EAT-26 score compared to
students. This could have been, according to the researchers, due to
professional not being as pressured to maintain a body figure in their career
compared to the student dancer. In the conclusion, the researchers mention that
female dancers with a lower BMI were found to display higher levels of
disordered eating and have less knowledge of nutrition.

            In another study (McArdie, Meade,
Moore, 2016), researchers conducted a study to explore the area of mental
health that results in eating disorders. The study was done by employing an
attribution model of stigma as a conceptual lens. Fourteen service providers
working in high performance sport in Ireland were interviewed. Of the 14
service providers, seven were male and seven were female. The participants were
interviewed on their mental health and their relation to sports, along with
eating disorders.

            The results showed different results
from other studies. Finding revealed in the general population that sport-based
personnel did not hold individuals responsible for the development of their
eating disorder. Instead, it was concluded that most athletes that developed an
eating disorder had already been facing anxiety and worry so those could have
led to the eating disorder. It was also found that confidentiality played a big
role in the disclosure of eating disorders within athletes. The researchers
expressed how this study highlighted the importance of greater education toward
this mental health.

            Another study (Shanmugan, Jowett,
Meyer, 2011) was done with two motives. The motives were to explore the utility
of components related to the trans diagnostics cognitive model of eating
disorders within an athletic population and to investigate the extent to which
the model can be applied across gender, sport type, and performance standard.
There were 588 British male and female athlete participants. The participants
completed a battery of self-report instruments related to eating
psychopathology, interpersonal difficulties, perfectionism, self-esteem, and

            The results showed that eating
psychopathology can develop from an interaction of interpersonal difficulties,
low self-esteem, high levels of self-critical perfectionism, and depressive
symptoms. In short, there was a correlation between eating disorders and mental
health. The study also showed that the way eating disorders develop in athletes
isn’t very different or unique among the athletes and their performance.
However, there is variety among genders. The researchers concluded that the
correlation between athletes and eating disorders is significant, however there
is also an impact that results from the mental health of the individual.

            A study (Mukherjee, Chand, Choong,
Lau, Wang, Tou, Ng, 2016) focused more on females and the results of the female
athlete triad. The objective of the study was to investigate the awareness,
knowledge, and perceptions of Singaporean coaches on the Female Athlete Triad.
It was a cross-sectional survey. The study consisted of 106 coaches from the
Singapore National Registry of Coaches. From the 106 participants, 81 were male
and 25 were female. The questionnaire was made of 31 questions made to determine
the perceptions, awareness, and knowledge on the Female Athlete Triad. The
research team was present during the surveying of the coaches.  The questionnaire included demographics and
coaching practice information, awareness and knowledge levels, gender
differences in participants with different levels of coaching and

            The results showed a 100% response
rate. The knowledge levels were at 85% of coaches not having heard of the triad
while 89% of coaches not being able to identify any of the symptoms of the
triad, and only two coaches being able to correctly identify the three
components of the triad. There was a significant amount of coaches that had a
very strong misconception of low body fat, leanness, menstrual irregularity,
and bone health in female athletes. The researchers concluded that coaches have
low levels of awareness in the Female Athlete Triad, which has resulted in the
development of disordered eating among female athletes.

            In a study by researchers previously
mentioned (Papathomas, lavallee, 2006) a participant, Mike, who had developed
an eating disorder at a young age. Mike went through a series of interviews
with the researchers through a four-week period, with each interview ranging
from 60 minutes to 105 minutes. In the end, 11 hours of his life history had
been collected. First Mike was asked to look back over his entire life course,
he was asked to go into very deep detail so that the research could understand
where and why the eating disorder developed. Mike was asked to talk about his
family and childhood experiences.

            The results of the study showed Mike
developed an eating disorder when he joined the basketball team at age 16. He
mentioned there was suddenly a big pressure on being lean and what being “fit”
meant. Mike then became onset to eating disorders as he started picking up
dangerous eating habits, like intense dieting periods. The researchers mention
how his eating disorder could have also been a result of being a perfectionist.
The researchers used Mike’s experiences to relate the risk factors of eating
disorders to real life experiences. For example, in Mike’s case, he had a very
strong idea that to be perfect, he had to had the perfect diet.

            Throughout most of the studies, it
was shown that there was a correlation between sport performance and eating
disorders. Although, every situation was unique, it was shown that there was
always a result in eating disorders when the pressures of sport competition and
influence of outside forces played into action. The studies showed examples of
a variety of sports being tested for the prevalence of eating disorders. There
were not studies that resulted in an insignificant correlation of sport performance
and eating disorders.

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