Introduction
Athletes seem to be at increased risk of develop-
ing eating disorders, and studies indicate that
specific risk factors for the development of eating
disorders occur in some sport settings.
The diagnosis of an eating disorder in athletes
can easily be missed unless specifically searched
for. Counselling on wise food choices and eating
habits will be helpful for most athletes and the
role of the sport nutritionist in working with ath-
letes with eating disorders is crucial. Therefore,
nutritionists should have good knowledge of
the symptomatology of eating disorders, how to
approach the athlete and how to establish trust
that can lead to effective treatment.
If untreated, eating disorders can have long-
lasting physiological and psychological effects
and may even be fatal. For a number of reasons,
there is a strong pattern of denial, and a stan-
dardized scale or a diagnostic interview specific
for athletes must be obtained.
This chapter reviews the characteristics of
eating disorders, their prevalence, and risk
factors for the development of eating disorders in
sport. Practical implications for the identification
and treatment of eating-disordered athletes and
the need for future research are also discussed.
Characteristics of eating disorders
As described in the Diagnostic and Statistical
Manual of Mental Disorders(DSM), eating disor-
ders are characterized by gross disturbances
in eating behaviour. They include anorexia
nervosa, bulimia nervosa and eating disorder not
otherwise specified (American Psychiatric Asso-
ciation 1987).
Anorexia nervosa is characterized in individ-
uals by a refusal to maintain body weight over a
minimal level considered normal for age and
height, a distorted body image, an intense fear of
fatness or weight gain while being underweight,
and amenorrhoea (the absence of at least three
consecutive menstrual cycles). Individuals with
anorexia ‘feel fat’ while they are underweight
(American Psychiatric Association 1987).
Bulimia nervosa is characterized by binge
eating (rapid consumption of a large amount of
food in a discrete period of time) and purging.
This typically involves consumption of calorie-
dense food, usually eaten inconspicuously or
secretly. By relieving abdominal discomfort
through vomiting, the individual can continue to
binge (American Psychiatric Association 1987).
The eating disorder not otherwise specified
category is for disorders of eating that do not
meet the criteria for any specific eating disorder
(American Psychiatric Association 1994).
Athletes constitute a unique population and
special diagnostic considerations should be
applied when working with this group (Szmuck-
leret al. 1985; Sundgot-Borgen 1993; Thompson
& Trattner-Sherman 1993). An attempt has been
made to identify athletes who show significant
symptoms of eating disorders, but who do not
meet the DSM criteria for anorexia nervosa
or bulimia nervosa. These athletes have been