Trigger Warning: Discussion of Eating Disorders and Suicide
Eating disorders (ED) destroy everything in their path more often than not. Out of any mental illness they have the highest mortality rate, without treatment 20% of ED sufferers die, with treatment that mortality rate decreases to about 2%-3% (source). People ages 14-25 are most at risk for eating disorders (source). Anyone can develop an eating disorder, but they’re especially common in sports that put a lot of emphasis on body composition, including size, structure, weight, and physique. Sports like this include (but are not limited to) dancing, cheerleading, wrestling, figure skating, bodybuilding, and gymnastics. There are so many factors that contribute to an individual’s struggle with EDs, but some of the biggest things is anxiety surrounding perfectionism.
Perfectionism is something that plays a huge role in any serious athlete’s life. I was a competitive cheerleader for 11 years, 4 of them being during college, and sports like cheerleading are so focused on perfectionism that it seeps into every aspect of the athletes’ lives oftentimes. When preparing to write this blog I consulted one of our clinicians, Jade Autumn, to get some more information about EDs. She said perfectionism and control were huge factors in these disorders, and that sports like this put a lot of emphasis on perfectionism. Perfectionism doesn’t necessarily sound like the worst thing in the world from the outside looking in, it just seems like someone who wants to do their best at everything, but it can be crippling. Jade also said that perfectionism can be a pattern of the internal perception of self and always feeling like they're falling short. Brené Brown, a social work researcher, has a quote about perfectionism that says “When perfectionism is driving, shame is riding shotgun, and fear is the annoying backseat driver.” This quote is a really good example of how if someone is a perfectionist, it’s never actually about being proud of the work they do, rather they’re terrified of being anything other than perfect. Jade also made me aware of another example of perfectionism, which is the “All or Nothing” thinking (which is one example of many different unhelpful thinking styles also known as cognitive distortions) that feeds into perfectionist behaviors and mentality. If an athlete is going to do something, they’re going to do it as intensely as they can, because that’s just the norm in their life. When they work out, they push themselves to their limits, when they practice, they’re expected to push through the pain that comes with intense athletics. So, as a result, if an athlete develops an ED, they’re going to be the “best” they can be at it, meaning their ED could or is likely to very serious very quickly.
These sports are also commonly associated with ED’s because of their focus on body composition. In cheerleading, flyers especially, have pressure to stay as small as possible so they’re easier to lift and throw. In dance they’re pressured to stay small so their body looks a certain way when they dance, and the same with gymnastics and ice skating. These predominantly women’s sports are associated mostly with anorexia nervosa (source). Anorexia nervosa is very dangerous, and people with anorexia nervosa are 32 times more likely to commit suicide (source). For a list of statistics on eating disorders, click here. With wrestling these athletes are expected to meet certain weight requirements, so they’ll work out in trash bags and 4 sweatshirts so they will sweat a bunch and drop weight to meet a weigh in. Bulimia nervosa is also very common with wrestlers, where they binge and purge. There are many dangers of bulimia nervosa, for a list of them click here. Another thing that’s important to recognize about eating disorders is that it’s not always about appearances, it can also be about performance. In athletes like bodybuilders, a lot of their obsession with food is focused on being able to perform in the gym better. A big factor in how common these disorders are in sports like this is body dysmorphia. Body dysmorphia is when someone can’t stop thinking about their perceived flaws of their body. When talking to Jade she said that this plays a huge role specifically in the female dominated sports, because the uniforms/costumes for these sports are usually tight, short, and small. These uniforms and costumes put people’s bodies on display at all times when they’re performing or practicing.
I had a teammate when I was cheering in college who is now in recovery for her ED, and I interviewed her to get some insight on what it was like to be an athlete while struggling with an eating disorder. We never really realized how bad it was because she would eat around us when we went out to dinner or if we were eating at someone’s house, but when I interviewed her she said it was all about keeping up the image of being healthy. She said she didn’t care if people thought she had a problem as long as they thought it wasn’t that bad. When I asked her what a typical day looked like for her with food, she said she would plan around if she was going out to eat with friends or not, and if not she would usually eat one meal a day. When I asked her how big of a role control played in her ED she told me it was all about control and perfectionism. She said she had to be “good” at her eating disorder, and that she would make games out of it. She would go out to eat with friends and if she had food left on her plate she was doing a good job. When I asked her what to avoid when talking to someone you love that’s in recovery, she told me to avoid comments about anything to do with size. Even comments like “you look so healthy” could be damaging to someone’s recovery. She said the best thing you can do is to treat them the way you’ve always treated them, but put a little more emphasis on reminding them you’re there for them. Another thing you can do for your loved one is ask them to eat with you, but don’t comment on what or how much they’re eating. The most important takeaway from interviewing her is that it’s not always obvious, and you can’t always help someone. She said there was nothing anyone could have done for her until she decided to help herself, but that doesn’t mean you shouldn’t try.
So what is there to do? I asked Jade for advice on what to look for and what you can do if someone you love is displaying these signs. She gave me some signs you can look for whether you're a coach, a parent, a friend, a teammate, a sibling, etc.
Lethargy, lack of stamina
Bloodshot eyes
Smell of vomit
Avoiding social situations where food is involved
Diuretics/laxatives use/abuse
Frequent disappearances to the bathroom after meals
Consistent restrictive eating
Excessive exercise
Other things Jade told me to look for is the language someone uses around food and/or exercise. Someone struggling with an ED may say things like “oh after eating this I’m going to have to work out for so long” or “I didn’t exercise enough to deserve this.” There are misconceptions surrounding ED’s that it’s all just only eating celery and lettuce, but eating disorders can look very different in different people. It could be someone taking a diet too seriously. Someone with an eating disorder can eat things that are considered unhealthy, it’s not just people eating small amounts of healthy food.
A coach can make a huge difference in whether or not an athlete develops an ED, but there are times when a coach has done everything they can and an athlete still develops an ED. When discussing this with my old teammate and Jade, a few things were pointed out as options. Jade said as a coach there are precautions you can take to keep your athletes as healthy as possible. When talking about things like nutrition, it should be focused on fueling your body and brain, not just what the food will do to your body in regards to physique or weight. Conversations regarding food should be focused on balance, wellness, and well-being, not on weight. The teammate of mine said one thing you can do as a coach is to not comment on changes in athletes bodies, even if it's not weight related. This is especially important when coaching children and teenagers, since their bodies are still growing. Commenting on changes during these years of puberty and growth can be very damaging and stick with an athlete for the rest of their life.
There are steps you can take if you think you are struggling with your relationship with food, and the first of those steps is to confide in an adult that you feel comfortable with, whether that's a parent, a coach, a religious leader, just someone you trust. From there, that person can help you find resources to help with your disorder. They can lead you to an inpatient clinic or talk therapy, and from there you can get referred to a dietician who can help you get a new plan for how to healthily fuel your body. When talking with my teammate, she said to expect relapses and to be kind to yourself when they happen. She explained it like getting the flu, you just have to treat yourself like you're sick so you can get back to recovery. Another thing my teammate discussed with me was refeeding syndrome. She said it made it hard to want to keep eating at first, but you have to push through that part of it to get healthy again. Once you're in recovery, talk therapy is one of the most effective ways to improve your body image and your relationship with food.
If you’re struggling with an eating disorder, consider talk therapy with one of our clinicians. To schedule an appointment, click here.