1987; Burckes-Miller & Black 1988; Rosen &
Hough 1988; Rucinski 1989).
Only one study on male athletes has used the
DSM criteria to diagnose eating disturbances.
The prevalence of clinically diagnosed eating
disorders in Norwegian male elite athletes is 8%
compared to 0.5% in matched controls (Torstveit
et al. 1998).
In a study by Blouin and Goldfield (1995),
bodybuilders reported significantly greater body
dissatisfaction, a high drive for bulk, a high drive
for thinness, increased bulimic tendencies and
more liberal attitudes towards using steroids
than runners and martial artists.
Sykoraet al. (1993) compared eating, weight
and dieting disturbances in male and female
lightweight and heavyweight rowers. Females
displayed more disturbed eating and weight
control methods than did males. Male rowers
were more affected by weight restriction than
were female rowers, probably because they
gained more during the off-season. Lightweight
males showed greater weight fluctuation during
the season and gained more weight during the
off season than did lightweight females and
heavyweight males and females. Despite the
methodological weaknesses, existing studies
are consistent in showing that symptoms of
eating disorders and pathogenic weight-control
methods are more prevalent in athletes than
non-athletes, and more prevalent in sports in
which leanness or a specific weight are consid-
ered important, than among athletes competing
in sports where these factors are considered less
important (Hamilton et al. 1985, 1988; Rosen et al.
1986; Dummer et al. 1987; Sundgot-Borgen &
Corbin 1987; Rosen & Hough 1988; Wilmore
1991; Sundgot-Borgen 1994b; O’Connor et al.
1996).
Furthermore, the frequency of eating disorder
problems determined by questionnaire only is
much higher than the frequency reported when
athletes have been clinically evaluated (Rosen
& Hough 1988; Rucinski 1989; Sundgot-Borgen
1994b).
512 practical issues
Self reports vs. clinical interview
Elite athletes underreport the use of purging
methods such as laxatives, diuretics and vomit-
ing and the presence of an eating disorder, and
overreport the use of binge eating when data are
obtained in the questionnaire (Sundgot-Borgen
1994a). Therefore, it is the author’s opinion that
to determine whether an athlete actually suffers
from any of the eating disorders described, an
interview with a clinician is necessary to assess
an athlete’s physical and emotional condition,
and whether this interferes with everyday
functioning.
Firm conclusions about the optimum methods
of assessment and the prevalence of disordered
eating at different competitive level cannot be
drawn without longitudinal studies with a
careful classification and description of the com-
petitive level of the athletes investigated.Risk factors
Psychological, biological and social factors are
implicated in the development of eating disor-
ders (Katz 1985; Garner et al. 1987). Athletes
appear to be more vulnerable to eating disorders
than the general population, because of addi-
tional stresses associated with the athletic
environment (Hamilton et al. 1985; Szmuckler
et al. 1985). It is assumed that some risk factors
(e.g. intense pressure to be lean, increased
training volume and perfectionism) are more
pronounced in elite athletes.
Hamiltonet al. (1988) found that less skilled
dancers in the United States reported signifi-
cantly more eating problems than the more
skilled dancers. On the other hand, Garner et al.
(1987) found that dancers at the highest competi-
tive level had a higher prevalence of eating disor-
ders than dancers at lower competitive levels.
A biobehavioural model of activity-based
anorexia nervosa was proposed in a series of
studies by Epling and Pierce (1988) and Eplinget
al.(1983) and there are some studies indicating
that the increased training load may induce an
energy deficit in endurance athletes, which in