turn may elicit biological and social reinforce-
ments leading to the development of eating
disorders (Sundgot-Borgen 1994a). Thus, longi-
tudinal studies with close monitoring of a
number of sport-specific factors such as volume,
type and intensity of the training in athletes rep-
resenting different sports are needed before the
question regarding the role played by different
sports in the development of eating disorders can
be answered.
Also, starting sport-specific training at prepu-
bertal age may prevent athletes from choosing
the sport most suitable for their adult body type.
Athletes with eating disorders have been shown
to start sport-specific training at an earlier age
than athletes who do not meet the criteria for
eating disorders (Sundgot-Borgen 1994a).
In addition to the pressure to reduce weight,
athletes are often pressed for time, and they may
have to lose weight rapidly to make or stay on
the team. As a result, they often experience fre-
quent periods of restrictive dieting or weight
cycling (Sundgot-Borgen 1994a). Such periods
have been suggested as important risk or trigger
factors for the development of eating disorders
in athletes (Brownell et al.1987; Sundgot-Borgen
1994a).
Pressure to reduce weight has been the general
explanation for the increased prevalence of
eating-related problems among athletes. It is not
necessarily dieting per se, but the situation in
which the athlete is told to lose weight, the words
used, and whether the athlete receives guidance
or not, that are important.
The characteristics of a sport (e.g. emphasis on
leanness or individual competition) may interact
with the personality traits of the athlete to start
or perpetuate an eating disorder (Wilson &
Eldredge 1992). Finally, athletes have reported
that they developed eating disorders as a result
of an injury or illness that left them temporarily
unable to continue their normal level of exercise
(Katz 1985; Sundgot-Borgen 1994a). An injury
can curtail the athlete’s exercise and training
habits. As a result, the athlete may gain weight
due to the reduced energy expenditure, or the
athlete may develop an irrational fear of weight
gain. In either case, the athlete may begin to diet
as a means of compensating (Thompson &
Trattner-Sherman 1993). Thus, the loss of a coach
or unexpected illness or injury can probably be
regarded as traumatic events similar to those
described as trigger mechanisms for eating dis-
orders in non-athletes (Bassoe 1990).
Most researchers agree that coaches do not
cause eating disorders in athletes, although inap-
propriate coaching may trigger the problem
or exacerbate it in vulnerable individuals
(Wilmore 1991). Therefore, in most cases the role
of coaches in the development of eating disor-
ders in athletes should be seen as a part of a
complex interplay of factors.
Figure 39.2 illustrates an aetiological model for
the development of eating disorders in athletes.Medical issues
Whereas most complications of anorexia nervosa
occur as a direct or indirect result of starvation,
complications of bulimia nervosa occur as a
result of binge eating and purging (Thompson &
Trattner-Sherman 1993). Hsu (1990), Johnson and
Connor (1987) and Michell (1990) provide infor-
mation on the medical problems encountered in
eating-disordered patients.
Studies have reported mortality rates from
less than 1% to as high as 18% in patients
with anorexia nervosa in the general population
(Thompson & Trattner-Sherman 1993).
Death is usually attributable to fluid and elec-
trolyte abnormalities or to suicide (Brownell
& Rodin 1992). Mortality in bulimia nervosa is
less well studied, but deaths do occur, usually
secondary to the complications of the binge–
purging cycle or to suicide. Mortality rates
from eating disorders among athletes are not
known.
For years, athletes have used and abused
drugs to control weight. Some athletes use
dieting, bingeing, vomiting, sweating and fluid
restriction for weight control. It is clear that many
of these behaviours exist on a continuum, and
may present health hazards for the athlete. Laxa-
tives, diet pills and diuretics are probably the