Citius, Altius, Fortius is the Olympic credo and many athletes are willing to go to great lengths to be ‘faster, higher and stronger’. Successful athletes need to be goal-oriented, strong-willed, disciplined and diligent, have the ability to withstand pain and be willing to push to improve—and win. Unfortunately, these same qualities may also make athletes more vulnerable to disordered eating (DE) and clinical eating disorders (EDs).
DE may be best understood to occur on a spectrum, from optimised nutrition and eating patterns, through to highly dysregulated patterns characteristic of an ED. In terms of nutrition and eating patterns, this may vary from meeting energy requirements sustained by regular, stable eating patterns through to irregular or highly restricted eating patterns that may also be accompanied by binge eating, purging, laxative or diuretic use (see Figure 9.1). Notably, DE may include a few, or even most, but not all of, the criteria required for a diagnosis of an ED, with these behaviours the most common indicators for developing an ED (NEDC 2015).
Spectrum of eating behaviour
Research suggests that the prevalence of DE across the general population increased by 3.5% from 2000–2013 then increased further by 7.8% from 2013–2018 (Galmiche et al. 2019). Athletes are particularly at risk of developing an ED, with rising incidence of both DE behaviours and diagnosed EDs in the past decade and a higher prevalence of DE reported among athletes than non-athlete controls (Bratland-Sanda & Sungot-Borgen 2013; Conviser et al. 2018). While current estimates indicate that 85–90% of clinical EDs occur in females, males are also vulnerable to body weight and shape pressures, particularly those imposed by sport—this includes transgender women and men (Brown et al. 2017). Myths abound about EDs in athletes, with dominant images being of young, thin female athletes. The reality is that DE and EDs can be experienced by any athlete, in any sport, at any time, crossing boundaries of gender, age, body size, culture, socioeconomic background, athletic calibre and ability (Wells et al. 2020). It is important that those who work with athletes have a clear understanding of the nature and scope of DE and EDs, including the aetiology, health consequences and strategies for prevention, intervention and treatment.
DISORDERED EATING AND EATING DISORDER CATEGORIES/CLASSIFICATIONS
Although frequently used interchangeably, the terms disordered eating and eating disorder are not one and the same. Disordered eating is a general term used to describe the spectrum of abnormal, dysregulated and harmful eating behaviours that are used to change or maintain one’s weight or body composition. Eating disorder refers to one of the six clinically diagnosable conditions recognised in the most recent, fifth edition of the Diagnostic and statistical manual of mental disorders (DSM-5) (APA 2013...