Bulimia In Female Athletes

Kate had everything going for her. She was a cheerleader on the university cheer squad, had a boyfriend on the top-ranked football team, was excelling in school, and had the respect of those around her. But Kate felt miserable, as though she was juggling the many aspects of her life and that, at any moment, she’d drop a ball and everything would come crashing down around her.

What people didn’t see was Kate’s obsessiveness with food, exercise, and body image concerns. Kate was hard on herself and pushed herself to the limits, whether it be with academic achievement, success in sport, or an unrelenting social calendar.

A Vicious Cycle of Highs and Lows

Kate was trapped in the cycle of an eating disorder. Specifically, she struggled with bulimia and would swing between periods of dietary restriction, wherein she would cut out “bad” foods, eat “clean,” and try to be the picture of the perfect athlete, and periods of feeling out of control emotionally and behaviorally, including binge eating, self-induced vomiting, and lack of self-care.

Kate felt great shame about the extremes she experienced, and yet she felt caught in a trap of disordered eating, fear about changes in her body, and pressure to perform as an athlete.

Athletes Are At Higher Risk of Having an Eating Disorder

Some athletes struggle with disordered eating. Research supports that athletes, especially female athletes, have more eating concerns than non-athletes (Thompson & Sherman, 2010). Athletes face many pressures related to sports performance, team interaction, coaching concerns, and risk for injury.

Expected: Long Exercise Sessions

It can often be difficult to spot eating concerns among athletes as a sport environment can mask some of the signs of eating concerns. For instance, in the world of sport it is the norm to engage in challenging, intensive, and long training sessions. For someone who uses exercise as a form of purging, emotional control, and weight loss, the behavior is accepted as what is required to be an excellent athlete and athletes are praised for their commitment to training.

Expected: Strict Dietary Intake

Likewise, when it comes to dietary intake, eating concerns can often be hidden under the guises of eating “clean,” eliminating “junk” food, and fueling for performance. Behind this front what may actually be happening is that athletes are developing chaotic eating patterns and destructive behaviors to compensate.

While athletes who struggle with anorexia may come to the attention of coaching and training staff due to low weight and injuries secondary to low weight, often those with bulimia and binge eating disorder may go undetected for longer periods of time due to being of normal weight. It is important to remember, however, that even at a “normal” weight, there are considerable health concerns that must be addressed.

Sometimes even the athletes themselves don’t understand the significance of their concerns because they are in a “normal” weight range.

Signs & Symptoms of Bulimia In Athletes

Despite being difficult to identify, there are signs and symptoms of bulimia in athletes.

Physical and/or medical symptoms include:

• Callus on back of hand from inducing vomiting
• Dehydration
• Dental problems
• Edema
• Electrolyte abnormalities
• Frequent weight fluctuations
• Gastrointestinal problems
• Low weight despite eating large volumes of food
• Menstrual irregularity
• Muscle cramps
• Weakness
• Swollen parotid glands (Thompson & Sherman, 2010)

Psychological and/or behavioral symptoms of bulimia include:

• Binge eating
• Agitation if bingeing is interrupted
• Depression
• Dieting that is unnecessary for health or sport performance
• Evidence of vomiting unrelated to illness
• Excessive exercise beyond what is needed for sport
• Excessive use of bathroom
• Going to bathroom directly after eating
• History of sexual abuse
• Self-critical, especially concerning body
• Secretive eating; stealing, especially food or laxatives
• Substance abuse
• Use of laxatives or diuretics (Thompson & Sherman, 2010)

As mentioned, it is typically the norm for athletes to participate in rigorous training sessions as part of their sport.

However, even in competitive athletes, there are signs and symptoms of unbalanced or unhealthy exercise, such as:

• Exercise as the individual’s primary means of coping
• Exercise despite injury
• Withdrawal effects (i.e., sleep and appetite disturbance, negative shifts in mood, decreased concentration, etc.) when exercise is withheld
• Overuse injuries
• Stress fractures
• Menstrual irregularity
• Loss of bone density
• Decreased immunity
• Frequent colds or upper respiratory tract infections
• Rigidity of exercise schedule
• Decrease in sport performance; overtraining syndrome (Thompson & Sherman, 2010)

The Female Athlete Triad is an additional concern among athletes with eating concerns. The Triad, which consists of disordered eating, amenorrhea or menstrual changes, and osteoporosis or loss of bone density, is a significant health concern among female athletes.

It is important that athletes who may be experiencing eating concerns consult with their medical provider, coaches, and training staff in order to address the very real concerns that accompany eating concerns among athletes.

Blurred Lines

Kate, like many athletes, felt confused by her experience. On the one hand, she was a competitive athlete who focused on a healthy lifestyle, and yet many of her behaviors did not support health. Even though she was embarrassed and ashamed, Kate sought out the support of her coach and training staff.

They encouraged her to seek professional help for the eating disorder by working with a therapist, dietitian, and medical providers with eating disorder expertise. As Kate reached out for support, she learned that there was no need for her to juggle all the balls in her life on her own, and she found meaningful help for her concerns.

She also found a way to continue participating in her sport in a healthy, balanced way, and discovered that in addition to her sport team, she had a strong support team to help her in recovery.

How to Help an Athlete with Bulimia

Early identification and intervention result in fewer and less severe complications, less resistance to treatment, and faster, easier, and more positive treatment outcomes. Here are steps you can take to help an athlete with bulimia:

1. 1. Prepare. Gather resources and have them available when you approach the athlete. Any literature about bulimia and athletes or where to go for help may help the athlete identify that they are struggling with bulimia. Also, in the case that they may have some awareness of their struggles, you are providing them with resources they may not know were available to them.
   2. Talk. Find a good time to talk to the athlete. Speak to the athlete privately and allow for adequate time to talk openly and honestly. Ask how the athlete feels, both physically and psychologically. Communicate to them that you are very concerned about him or her. Calmly tell the athlete the specific observations that you have noticed and that is a cause of your concern. Focus on eating or exercise behaviors that you have noticed or other problems (e.g., withdrawing or isolating from others).
   3. Listen. Allow the athlete time to respond to your concerns. Listen carefully and in a non-judgmental and open manner. Listening is very important in this process. Face the athlete; maintain eye contact and an open posture.
   4. Respond. If the athlete refuses to acknowledge that there is a problem, or any reason for you to be concerned, restate your feelings and the reasons for them and leave yourself open and available as a supportive listener. If the athlete acknowledges there is a problem, you can summarize what you have heard, and explain that you think these things may indicate that there could be a problem that needs professional attention. Ask the athlete to explore these concerns with a counselor, doctor, nutritionist, or another health professional who is knowledgeable about eating disorders. If you feel comfortable doing so, offer to help the athlete make an appointment or accompany them on their first visit.
   5. Get help. After talking with the person, if you are still concerned with their health and safety, find a trusted adult or professional to talk with (e.g., an eating disorder specialist, doctor, school counselor or nurse, coach, or minister). Problems that are particularly troubling and warrant seeking medical attention immediately include: if the athlete is binging and purging several times throughout the day, passes out or complains of chest pains, complains of severe stomachaches or vomiting blood, or has thoughts of harming themselves or suicide.

Article Contributed By: Melissa H. Smith, PhD, Licensed Psychologist & Clinical Director, Center for Change

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