How Anorexic-like Are the Symptom and Personality Profiles of Aesthetic Athletes?

Current trends and perspectives in the exploration of anorexia athletica-clinical challenges and therapeutic considerations

Elite athletes are exposed to a considerable amount of physical and psychological stress throughout their entire professional life, but the exploration of the consequences of this stressful regimen on mental health is still in its early stages. Eating disorders (EDs), substance use disorders, and behavioral addictions represent only several domains that are worth more investigation in this vulnerable population, in order to find preventative and therapeutic strategies. The exploration of EDs in athletes is important because this population is very vulnerable to the impact that weight and body shape may have on their professional performances, and epidemiological studies support this concern, i.e., the prevalence of EDs in athletes is significantly higher than in the general population. This article is dedicated to the synthesis of available data regarding a specific pathology reported in elite athletes, i.e., anorexia athletica (AA), based on a narrative reviewing methodology. The information about risk factors, pathophysiology, positive and differential diagnosis, epidemiology, structured evaluation, and treatment of AA have been summarized and future research directions have been highlighted. While tentative diagnostic criteria for AA and a self-administered questionnaire exist, its pathophysiology is still insufficiently explored, and the treatment is not based on good-quality trials. According to the retrieved data, more research targeting the physical and mental health of elite athletes, especially those practicing esthetic sports, is needed, in order to implement adequate screening and early intervention programs. Future studies targeting various sub-populations of elite athletes, i.e., esthetic vs. non-esthetic sports, individuals presenting a history of ED vs. those without such a history, and those practicing individual sports vs. team sports are needed to reach the objective of improving the quality of life in this population.

Anorexic Readiness Syndrome in Elite Female Acrobatic Gymnasts-International Study

Anorexic Readiness Syndrome (ARS) is a concept used in research for the early detection of disordered eating (DE). It is a set of indicators located primarily within the cognitive and behavioral sphere of an individual's functioning. The aim of this study was to examine whether among the elite acrobats there are girls showing a high level of anorexic tendency, and if so, what behaviors and attitudes are the most common. In addition, an attempt to determine what sport-related factors or other non-sport variables may increase the risk of ARS was conducted. The study group was made up of 133 acrobatic gymnasts aged 10-19, representing six countries that participated in the Acro World Cup competition held in Poland. The study procedures included surveys (personal questionnaire and the Eating Attitudes Questionnaire), anthropometric measurements such as weight, height, waist circumference (WC) and determination of the Body Mass Index (BMI), fat percentage (Fat%), and waist to height ratio (WHtR). A high level of ARS was found in 9.8% of acrobats. This group most often declared attitudes and behaviors indicative of anorexic tendencies. A strong relationship with the level of ARS was noted in the following: the use of fasting and diets (p ≤ 0.001; V = 0.54), limiting of fats and carbohydrates (p ≤ 0.001; V = 0.60), feeling angry after eating too much (p ≤ 0.001; V = 0.55), knowing the caloric value of many food products (p ≤ 0.001; V = 0.59), and the desire to improve the appearance of one's body (p ≤ 0.001; V = 0.52). The role played in the acrobatic partnership and the region of residence were considered as the sport-related risk factors. Among non-sport factors, the strongest predictor of ARS was the age of gymnasts (β = 0.516; p ≤ 0.001).

Eating disorder risks and awareness among female elite cyclists: an anonymous survey

Background

Eating disorders (EDs) are an increasingly recognized concern in professional sports. Previous studies suggests that both female gender and endurance sports put athletes at risk. Female elite cyclists are hence of specific interest. The present study aimed at evaluating the distribution of the individual risk of ED in this group. Further the association between individual risk and both the awareness for the topic ED and the deviation from “normal” weight was depicted.

Methods

Female cyclists registered with the Union Cycliste Internationale were contacted via email or facebook and asked to complete a survey comprising age, weight, the Eating-Attitude-Test (EAT-26), and questions regarding ED awareness. The observed distribution of the EAT-26 score was compared to results from previous studies in normal subjects and athletes. The distribution of the ED awareness was described and ED awareness was correlated with the EAT-26 score. Both the deviation from ideal weight and the body mass index (BMI) were correlated with the EAT-26 score.

Results

Of the 409 registered athletes 386 could be contacted, 122 completed the questionnaire. Age ranged from 20-44yrs, BMI from 17.0 to 24.6 kg/m². In the EAT-26, 39 cyclists (32.0%) scored above 20 points indicating a potential benefit from clinical evaluation, 34 cyclists (27.9%) scored 10–19 points suggesting disordered eating. Sixteen athletes (13.2%) had been treated for an ED. About 70% of athletes had been pressured to lose weight. The mean EAT-26 score was above the average observed in normal female populations. It was also above the average observed in many female athlete populations, but lower than in other leanness focussed sports. More than 80%of athletes perceived elite cyclists at risk for developing ED. Increased ED awareness and deviation from the ideal weight were associated with higher EAT-26 scores, but not the body mass index.

Conclusion

Female cyclists are at risk of developing ED and they are aware of this risk. To improve their health and well-being, increased efforts to support elite cyclists and their teams in preventive activities and early detection are crucial.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13102-022-00563-6.

Eating-disorder psychopathology in female athletes and non-athletes: A meta-analysis

OBJECTIVE

There is ongoing discussion about whether sports participation is a risk or protective factor for eating disorders (EDs). Research is mixed, with some studies suggesting that athletes have higher mean levels of ED psychopathology compared to nonathletes, while other studies suggest the opposite effect or no differences. The purpose of the current meta-analysis was to identify whether female athletes reported higher mean levels of ED psychopathology compared to nonathletes.

METHOD

Following PRISMA guidelines, we identified 56 studies that reported ED psychopathology for female athletes and nonathletes. A three-level random-effects model of between- and within-study variance was completed for the following outcome variables: overall ED psychopathology, body dissatisfaction, drive for thinness, restricting, and loss-of-control eating.

RESULTS

Athletes reported lower levels of body dissatisfaction compared to nonathletes (g = -.21, p < .0001). Athletes and nonathletes reported similar levels of overall ED psychopathology, drive for thinness, restricting, and loss-of-control eating on average. Sport type significantly moderated standardized mean difference effect sizes of ED psychopathology in athletes versus nonathletes. Effect sizes comparing levels of drive for thinness, restricting, and loss-of-control eating in athletes versus nonathletes were larger for studies with athletes participating in aesthetic/lean sports compared to nonaesthetic/nonlean sports.

DISCUSSION

Findings from this meta-analysis could inform future ED prevention and treatment in female athletes by providing further evidence that athletes in aesthetic/lean sports may report higher levels of ED psychopathology. Participating in nonaesthetic/nonlean sports may be a protective factor for experiencing less body dissatisfaction.

PUBLIC SIGNIFICANCE STATEMENT

The current meta-analysis summarized findings from 56 studies that assessed levels of disordered eating, body dissatisfaction, dietary restricting, and loss-of-control eating in female athletes and nonathletes. Athletes reported lower levels of body dissatisfaction compared to nonathletes, highlighting that participation in sport could have some protective factors. Athletes participating in sports that require weight categories (e.g., judo) and sports that emphasize thinness/leanness (e.g., gymnastics and distance running) had higher levels of disordered eating relative to athletes participating in other types of sports that do not emphasize thinness/leanness (e.g., volleyball and basketball).

General and sport-specific weight pressures as risk factors for body dissatisfaction and disordered eating among female collegiate athletes

Female collegiate athletes are a high-risk group for disordered eating. Petrie and Greenleaf's (2007) sociocultural model proposes that both general and sport-related weight pressures lead athletes to internalize unrealistic body ideals, ultimately resulting in body dissatisfaction and disordered eating. In this study, we used structural equation modeling to assess general and sport-specific weight pressures in relation to thin- and muscular-ideal internalization, body dissatisfaction, and disordered eating among 212 female Division I college athletes. General weight pressures from parents, peers, and the media were associated with disordered eating indirectly via thin- and muscular-ideal internalization. In contrast, sport-specific weight pressures were not associated with disordered eating in the full model. After controlling for weight pressures and body ideal internalization, body dissatisfaction was also not associated with disordered eating. These findings suggest that female athletes are vulnerable to weight- and appearance-related pressures from outside the sport context and that the mechanisms underlying the development of disordered eating may differ between athletes and non-athletes.

Understanding risk factors for disordered eating symptomatology in athletes: A prospective study

Disordered eating and eating disorders have huge impact on athletic health and performance. Understanding risk factors for disordered eating development is paramount to protecting the health and performance of these athletes. This project tested a model longitudinally to test whether body dissatisfaction (mediated by negative affect) and societal pressures (mediated by internalisation) predicted bulimic symptomatology at 1 year. The study recruited 1017 male and female athletes in a range of sports at three time points over a year. Cross-lag meditation modelling in MPLUS was utilised to test the hypothesised model. Results indicated that societal pressures mediated by general internalisation led to bulimic symptomatology and that gender and sport type do moderate the relationships. However, measurement issues indicate that scales not originally created for athletes may not reliably measure athletes' experience. This research highlights how understanding how to better assess risk factors and disordered eating related concepts in athletes is a key next step. The study is unique in its longitudinal design and in its sampling of a wide range of sports in both male and female athletes.

Relative energy deficiency in sports (RED-S): elucidation of endocrine changes affecting the health of males and females

The purpose of this review is to present a different perspective of the relative energy deficiency syndrome, to improve understanding of associated endocrine alterations, and to highlight the need for further research in this area. The term "female athlete triad" was coined over 25 years ago to describe three interrelated components: disordered eating, menstrual dysfunction, and low bone mass. The syndrome's etiology is attributed to energy intake deficiency relative to energy expenditure required for health, function, and daily living. Recently, it became clear that there was a need to broaden the term, as the disorder is not an issue of only three interrelated problems but of a whole spectrum of insults resulting from low energy availability (LEA; i.e., insufficient energy availability to cover basic physiological demands) that can potentially affect any exerciser, irrespective of gender. The new model, termed relative energy deficiency in sport (RED-S), has received greater scrutiny in sports medicine due to its effects on both health and performance in athletes of both sexes. RED-S results from low-energy diets (intentional or unintentional) and/or excessive exercise. Energy deficiency reduces hypothalamic pulsatile release of gonadotropin-releasing hormone, this impairing anterior pituitary release of gonadotropins. In women, reduced FSH and LH pulsatility produces hypoestrogenism, causing functional hypothalamic amenorrhea and decreased bone mass. In men, it reduces testosterone and negatively affects bone health. Moreover, LEA alters other hormonal pathways, causing physiological consequences, such as alteration of the thyroid hormone signaling pathways, leptin levels, carbohydrate metabolism, the growth hormone/insulin-like growth factor-1 axis, and sympathetic/parasympathetic tone. This review explains and clarifies the effects of RED-S in both sexes.

Psychological risk indicators of disordered eating in athletes

Objectives

This project examined risk factors of disordered eating in athletes by adapting and applying a theoretical model. It tested a previously proposed theoretical model and explored the utility of a newly formed model within an athletic population across gender, age, and sport type to explain disordered eating.

Design

The design was cross-sectional and the first phase in a series of longitudinal studies.

Methods

1,017 athletes completed online questionnaires related to social pressures, internalisation, body dissatisfaction, negative affect, restriction, and bulimia. Structural equation modelling was employed to analyse the fit of the measurement and structural models and to do invariance testing.

Results

The original theoretical model failed to achieve acceptable goodness of fit (χ² [70, 1017] = 1043.07; p < .0001. CFI = .55; GFI = .88; NFI = .53; RMSEA = .12 [90% CI = .111-.123]). Removal of non-significant pathways and addition of social media resulted in the model achieving a parsimonious goodness of fit (χ² [19, 1017] = 77.58; p < .0001. CFI = .96; GFI = .98; NFI = .95; RMSEA = .055 [90% CI = .043-.068]). Invariance tests revealed that the newly revised model differed across gender, age, level, competition status, and length of sport participation.

Conclusion

This study showed that the formation of disordered eating symptomology might not be associated with sport pressures experienced by athletes. It revealed that disordered eating development varies across gender, competition level, sport type, and age, which must be considered to prevent and treat disordered eating in athletes.

Systematic review of risk factors for eating psychopathology in athletes: A critique of an etiological model

OBJECTIVE

The theoretical model by Petrie and Greenleaf (2007, 2012) is an admirable attempt to collate the causal factors of disordered eating in athletes. The aims of this systematic review are (a) to provide an overview of the findings from the relevant literature, (b) to assess whether the model is supported by the existing research, (c) to evaluate the different designs, methods, and measures used to test the mediators in the model, and (d) to highlight areas for improvements and future research.

METHOD

A systematic review of four major online databases identified 37 relevant papers on risk factors of disordered eating in athletes, which were reviewed and critically compared with the theoretical model.

RESULTS

There is a lack of longitudinal research with the relevant mediators in athlete populations, which makes it difficult to determine whether the potential mediators described by Petrie and Greenleaf are causal risk factors rather than simply correlates of disordered eating for athletes. Findings for all the potential mediators are inconsistent, and the range of measures used makes it problematic to draw conclusions.

CONCLUSIONS

Future research needs to use gold standard measures and longitudinal designs in order to fully test and possibly update the model.

Mental Health Symptoms Related to Body Shape Idealization in Female Fitness Physique Athletes

Physical activity relates to optimal health, still the prevalence of mental health issues is high among athletes. Being young, female, and competing in aesthetic sports is a high-risk combination for mental health symptoms. Fitness physique athletes (FA) match this profile but are understudied. We aimed to study the intensity of mental health symptoms (i.e., body image, eating behaviour, relation to and routines for exercise, and perfectionism) in FA and in female references (FR), and to evaluate how preparing for fitness sport competitions affects these mental health symptoms. Before competition, FA had higher levels of drive for leanness (DFL) and eating restraint compared to FR. At the time of competition, eating restraint increased in FA only, concurrent with a reduction in symptoms of disordered eating. The levels of DFL, drive for muscularity, eating restraint, and exercising for figure toning were higher in FA compared to FR. At one-month post-competition, the differences between groups from competition time remained. Generally, perfectionism correlated with eating restrictions in FA and with disordered eating in FR. Overall, FA coped with the dieting, but self-control deteriorated post-competition with higher levels of disordered eating and an increased body shape concern. High DFL generally associated with more disordered eating behaviour, specifically in FR.

Body Dissatisfaction in Adolescents: Differences by Sex, BMI and Type and Organisation of Physical Activity

The aim of this study was to assess the differences in body dissatisfaction (BD) of male and female adolescents by body max index (BMI) and the quantity, type and organisation of physical activity (PA). To do so, 652 adolescents aged 12-17 years participated in a cross-sectional study. The cognitive-affective component of BD was assessed with the Body Shape Questionnaire (BSQ) and the perceptual component with Gardner's scale for the assessment of, body image (BI). PA was measured with the International Physical Activity Questionnaire (IPAQ-SF) and the item 1 from the Physical Activity Questionnaire for Adolescents (PAQ-A). The results show that sex and BMI are key variables when determining BD. Moderate-to-vigorous PA (MVPA) was moderately associated with a greater body satisfaction in males but no association was found between BD and the participation and organisation of PA. Moreover, the results suggest that participants in aesthetic/lean PA are at a higher risk of suffering from BD than participants in other PA types. These findings provide useful information for the design of programmes promoting healthy lifestyles, weight control and BI concern during the school period.

Anorexia nervosa and perfectionism: A meta-analysis

OBJECTIVE

Despite the multitude of research surrounding anorexia nervosa (AN) and perfectionism, there is yet to be a thorough investigation comparing perfectionism in those diagnosed with AN and other eating disorders, and other psychiatric diagnoses. The current meta-analysis aimed to explore these comparisons.

METHOD

Following the Preferred Reporting Items or Systematic Reviews Meta Analyses (PRISMA) guidelines, we identified empirical studies that compared maladaptive and/or adaptive perfectionism scores in those diagnosed with AN and either a non-clinical comparison group, people diagnosed with a non-AN ED, or people diagnosed with another psychological disorder (i.e., other DSM diagnoses). In total, we identified 23 studies, comprising 3,561 participants who were all female. Comparison groups extracted from the studies were a non-clinical group, bulimia nervosa (BN) diagnosis group, and another psychological diagnostic group.

RESULTS

When AN maladaptive perfectionism levels were compared against the comparison groups, the results showed that those diagnosed with AN were more perfectionistic compared to the non-clinical group (g = 1.00), and the other psychiatric diagnosis group (g = 0.41). People diagnosed with AN also had higher levels of adaptive perfectionism levels compared to the non-clinical group (g = 1.24). Comparisons between those diagnosed with AN and BN were statistically non-significant for maladaptive perfectionism.

DISCUSSION

Although publication bias potentially affected the psychological diagnosis group comparisons, findings suggest that maladaptive perfectionism is a factor associated with both AN and BN.

The role of self-esteem in the treatment of patients with anorexia nervosa - A systematic review and meta-analysis

OBJECTIVE

We aimed to provide a comprehensive overview of the role of self-esteem in the treatment of patients with anorexia nervosa (AN). Specifically, our objectives were to investigate the differences in self-esteem between individuals with AN and healthy controls, or individuals with other eating disorders, and to examine self-esteem as an outcome, predictor, moderator, and mediator in AN treatment.

METHOD

The databases PsycINFO, PSYNDEXplus, Ovid MEDLINE®, and ProQuest were searched for studies published from 1990 to 2018. To estimate aggregated effect sizes, we performed random-effects meta-analyses.

RESULTS

A screening of 1,596 abstracts and 203 full-texts identified 68 relevant publications. Results suggest a significantly lower global self-esteem in individuals with AN than in healthy controls (d = -1.90, p < .001). In contrast, global self-esteem of AN and bulimia nervosa (BN) patients was found to be comparable (d = 0.05, p = .529). It might be specific to AN patients that negative self-evaluations may not affect scholastic and professional abilities. Significantly moderate self-esteem increases were observed in treated AN patients at the end of treatment (d = 0.56, p < .001), short-term (d = 0.50, p < .001), and long-term (d = 0.75, p < .001) follow-up. Self-esteem did not predict end of treatment remission-or weight-related outcome and treatment dropout. However, small to moderate predictive effects were detected on short-term (r = .15, p = .007) and long-term remission or weight (r = .33, p = .017). Finally, first indications point to self-esteem as a mediator in adult AN inpatient treatment.

DISCUSSION

The review provides insights relevant for theory, research, and practice. Implications concern the overall support for transdiagnostic approaches and the recommendation to consider low initial self-esteem for decisions on after-care.

Lives on the Line: The Online Lives of Girls and Women With and Without a Lifetime Eating Disorder Diagnosis

This study aimed to compare the scope, internet use patterns, and degree of online need satisfaction of girls and women with and without a lifetime eating disorder (ED) diagnosis. Participants were 122 females aged 12-30, 53 with a lifetime ED diagnosis recruited via a hospital-based treatment program, and 69 age-matched controls recruited via normative social media sites. Participants completed questionnaires assessing disordered eating, body image, positive and negative affect, general distress, and life satisfaction, and completed an online survey about the scope of their internet use, the frequency of watching and posting pictures and videos, online friendships and social comparison, fulfillment of needs online, and mood after internet use. All questionnaire scores differed significantly between groups in the expected directions. Whereas overall, ED and control groups spent similar amounts of time online (6.21, SD = 5.13), they spent this time differently. ED participants reported devoting 56.7% of their online time to eating, weight and body image, versus 29.1% for controls, and spent significantly more time than controls on forums and blogs (t = -5.3, p < 0.0001, Cohen's d = 0.87). They also engaged more often in social comparison (t = 3.6, p < 0.005, Cohen's d = 0.65), had a higher online-offline friend ratio (t = 3.7, p < 0.0001, Cohen's d = 0.65), and more online friends with ED (t = 5.4, p < 0.0001, Cohen's d = 0.89). In comparison to controls, ED participants reported that their use of forums and blogs gave them more eating- and weight-related advice, and a greater sense of belonging, social support, and safety resulting from anonymity, with effect sizes of 0.63-0.96. However, they also reported more negative affect after posting online. Most online behaviors and patterns correlated positively with measures of symptomatology and negatively with measures of psychological health, in both groups. Internet use was rarely addressed in therapy. Professionals, families and friends should help people with disordered eating and EDs to broaden the scope of their internet use. They should invest less in food- and weight-related forums/blogs, expand their "real life" social lives and develop their interpersonal skills, so that their legitimate needs can be satisfied face-to-face, rather than virtually. Clinicians should address the online lives of their ED clients in therapy.

Understanding Eating Disorders in Elite Gymnastics: Ethical and Conceptual Challenges

Eating disorders and disordered eating are more common in high performance sports than the general population, and particularly so in high performance aesthetic sports. This paper presents some of the conceptual difficulties in understanding and diagnosing eating disorders in high performance gymnasts. It presents qualitative and quantitative data from a study designed to ascertain the pattern of eating disorder symptoms, depressive symptoms and levels of self-esteem among national and international level gymnasts from the UK in the gymnastic disciplines of sport acrobatics, tumbling, and rhythmic gymnastics.

Body dissatisfaction in women's artistic gymnastics: A longitudinal study of psychosocial indicators

Body dissatisfaction is prevalent in women's artistic gymnastics (WAG). Cross-sectional research points to social and individual risk factors, however it does not account for potential changes in body dissatisfaction during an athletic season. This study aimed to determine how gymnasts' body dissatisfaction, risk factors for eating disorders, media internalisation, perfectionism and mood state change during pre-competition, competition and post-competition seasons and to identify how these psychosocial indicators impact on body dissatisfaction during the athletic year. The sample consisted of 20 Brazilian elite women's artistic gymnasts aged 10-16 years. Data were obtained from a 9-month study using: Body Shape Questionnaire (BSQ); Eating Attitude Test-26; Sociocultural Attitudes Towards Appearance Questionnaire-3 (SATAQ-3); Multidimensional Perfectionism Scale (MPS); Brunel Mood Scale (BRUMS) and triceps and subscapular skinfolds. Body dissatisfaction was higher during the competition season and disordered eating, perfectionism and vigour values were higher in the pre-competition season. Disordered eating has been found as the strongest predictor of body dissatisfaction during all seasons, and mood state partly contributed to body dissatisfaction in the competitive season. Stakeholders should understand that body dissatisfaction and the prevalence of disordered eating may change over time.

Sport type and interpersonal and intrapersonal predictors of body dissatisfaction in high school female sport participants

Through multiple group structural equation modeling analyses, path models were used to test the predictive effects of sport type and both interpersonal (i.e., mothers' body dissatisfaction, family dynamics) and intrapersonal factors (i.e., athletic self-efficacy, body mass index [BMI]) on high school female sport participants' (N=627) body dissatisfaction. Sport types were classified as esthetic/lean (i.e., gymnastics), non-esthetic/lean (i.e., cross-country), or non-esthetic/non-lean (i.e., softball). Most participants reported low body dissatisfaction, and body dissatisfaction did not differ across sport types. Nevertheless, mothers' body dissatisfaction was positively associated with daughters' body dissatisfaction for non-esthetic/lean and non-esthetic/non-lean sport participants, and high family cohesion was predictive of body dissatisfaction among non-esthetic/lean sport participants. Across sport types, higher BMI was associated with greater body dissatisfaction, whereas greater athletic self-efficacy was associated with lower body dissatisfaction. These findings highlight the complex relationship between interpersonal and intrapersonal factors and body dissatisfaction in adolescent female sport participants.

The contributions of oxytocin and vasopressin pathway genes to human behavior

Arginine vasopressin (AVP) and oxytocin (OXT) are social hormones and mediate affiliative behaviors in mammals and as recently demonstrated, also in humans. There is intense interest in how these simple nonapeptides mediate normal and abnormal behavior, especially regarding disorders of the social brain such as autism that are characterized by deficits in social communication and social skills. The current review examines in detail the behavioral genetics of the first level of human AVP-OXT pathway genes including arginine vasopressin 1a receptor (AVPR1a), oxytocin receptor (OXTR), AVP (AVP-neurophysin II [NPII]) and OXT (OXT neurophysin I [NPI]), oxytocinase/vasopressinase (LNPEP), ADP-ribosyl cyclase (CD38) and arginine vasopressin 1b receptor (AVPR1b). Wherever possible we discuss evidence from a variety of research tracks including molecular genetics, imaging genomics, pharmacology and endocrinology that support the conclusions drawn from association studies of social phenotypes and detail how common polymorphisms in AVP-OXT pathway genes contribute to the behavioral hard wiring that enables individual Homo sapiens to interact successfully with conspecifics. This article is part of a Special Issue entitled Oxytocin, Vasopressin, and Social Behavior.

Disordered eating and injuries among adolescent ballet dancers

BACKGROUND

Ballet dancers are at elevated risk for eating disorders, but the extent to which disordered eating attitudes and behaviors represent a relatively benign adaptation to an environment that values extreme thinness, or a functionally impairing form of psychopathology, has sparked considerable debate.

METHOD

To determine whether disordered eating is associated with role impairment in dancers, we evaluated its association with musculoskeletal injuries among 239 adolescent female ballet students.

RESULTS

Dance students reported a variety of lifetime disordered eating behaviors to control weight including fasting (29.3%), vomiting (9.6%), and laxative use (4.2%). More than half (52.3%) reported a lifetime history of injury (stress fracture, broken bone, and/or medically treated tendonitis). A greater number of lifetime disordered eating behaviors was associated with a greater number of lifetime injuries (p=0.01). Moreover, vomiting history was associated with greater likelihood of injury (p=0.004) and increased time to recover from injury (median difference=22.8 days, p=0.006).

CONCLUSION

Although the direction of causality cannot be determined from this retrospective design, these results suggest that disordered eating is associated with role-relevant functional impairment, even among members of a subculture that values extreme thinness.

Influence of personality on pre-menstrual syndrome in athletes

The purpose of this study was to investigate the influence of personality on Premenstrual Syndrome (PMS) in athletes. The sample included 25 Brazilian athletes, between 18 and 49 years of age. A diary of PMS symptoms was used (based on the criteria from the American College of Obstetricians and Gynecologist, ACOG, 2000) and the Factorial Personality Inventory (Pasquali, Azevedo, & Ghesti, 1997). The Fisher exact test was used for data analysis, with p < .05. The athletes with PMS showed a strong need for performance, low need for assistance and introversión and very low need for change, while athletes without PMS demonstrated a very strong need for denial and strong needs for assistance, dominance, and persistence. There was a significant association between low denial (not submitting passively to external forces) and PMS (p < .05). It was concluded that certain personality traits may predispose athletes to react more intensely to needs and pressures produced by changes caused by the menstrual cycle, contributing to the onset of PMS.

Psychopathology in elite rhythmic gymnasts and anorexia nervosa patients

This study investigates current psychopathology and psychological distress in elite rhythmic gymnasts. Due to a strong emphasis on leanness in aesthetic sports and the controversial findings in literature regarding the role of anorexia nervosa (AN) in such sports, we compared elite rhythmic gymnasts (n=51) to inpatients with AN (n=55) as a disease control group and to high school students (n=53) as a "normal" control group. We assessed psychopathology using the Symptom Checklist (SCL-90-R). Moreover, body height, weight, Body Mass Index (BMI) and the presence of amenorrhea were assessed. Regarding physical aspects, the rhythmic gymnasts showed an intermediate position between the two other groups. In terms of psychopathology, significant differences were found between the gymnasts and the AN patients, while no differences were detected between the gymnasts and the "normal" control group. Depression discriminated best between the three groups. Elite rhythmic gymnasts may show a lean, almost anorexic-like physique. Nevertheless, no psychological distress comparable to that of AN patients was found. Therefore, even though analogies to AN might seem obvious in elite rhythmic gymnasts, this study is putting emphasis on the importance of a careful consideration of psychological distress and psychopathology.