9 restlessness—relaxing is difficult or
impossible;
10 social withdrawal from teammates and sport
support staff, as well as from people outside
sports;
11 depression;
12 insomnia.
bulimia nervosa
Most athletes suffering from bulimia nervosa
are at or near normal weight. Bulimic athletes
usually try to hide their disorder until they feel
that they are out of control, or when they realize
that the disorder negatively affects sport perfor-
mance. Therefore, the team staff must be able to
recognize the following physical symptoms and
psychological characteristics.
The physical symptoms of athletes with
bulimia nervosa (Thompson & Trattner-Sherman
1993) include:
1 callus or abrasion on back of hand from
inducing vomiting;
2 dehydration, especially in the absence of
training or competition;
3 dental and gum problems;
4 Oedema, complaints of bloating, or both;
5 electrolyte abnormalities;
6 frequent and often extreme weight fluctua-
tions (i.e. mood worsens as weight goes up);
7 gastrointestinal problems;
8 low weight despite eating large volumes;
9 menstrual irregularity;
10 muscle cramps, weakness, or both;
11 swollen parotid glands.
The psychological and behavioural charac-
teristics of athletes with bulimia nervosa
(Thompson & Trattner-Sherman 1993) include:
1 binge eating;
2 agitation when bingeing is interrupted;
3 depression;
4 dieting that is unnecessary for appearance,
health or sport performance;
5 evidence of vomiting unrelated to illness;
6 excessive exercise beyond that required for
the athlete’s sport;
7 excessive use of the restroom;
8 going to the restroom or ‘disappearing’ after
eating;
9 self-critical, especially concerning body,
weight and sport performance
10 secretive eating;
11 substance abuse—whether legal, illegal, pre-
scribed, or over-the-counter drugs, medications
or other substances;
12 use of laxatives, diuretics (or both) that is
unsanctioned by medical or training staff.
Laboratory investigations recommended for
all eating-disordered patients, those indicated
for particular patients and those of academic
interest with expected finding are discussed by
Beumontet al. (1993).Eating pattern and dietary intake in
elite eating-disordered athletes
The eating-disordered athlete’s attitude to eating
and nutrition is often based on myths and mis-
conceptions. Most eating-disordered athletes
report that the onset of their eating disorder
was preceded by a period of dieting or weight
cycling. Apart from the binge eating, most bulim-
ics, as well as the anorexia athletica and anorexia
nervosa patients, show restrictive eating pattern.
In a study of female elite athletes, as many as
29% of the anorexia nervosa, 14% of the anorexia
athletica and 60% of the bulimia nervosa, and
13% of the healthy athletes reported having two
or fewer meals a day (Sundgot-Borgen & Larsen
1993a). Bulimic athletes have fewer meals per
day than athletes with anorectic symptoms. For a
number of eating-disordered athletes, the dura-
tion between meals is 7–11 h. Thus, it is not diffi-
cult to understand why such a high number of
eating-disordered athletes binge and purge on
a regular basis. In the same study, eating-
disordered athletes reported that they had irreg-
ular eating pattern even before the eating disor-
der developed. Therefore, this may be an
adapted and ‘normal’ eating pattern for these
young female athletes, and as such, a possible
risk factor for the development of eating dis-
orders. These results indicate the need for teach-
ing young athletes and their parents about