Disordered Eating Attitudes, Anxiety, Self-Esteem and Perfectionism in Young Athletes and Non-Athletes

Are you how you eat? Aspects of self-awareness in eating disorders

Eating disorders (ED) are severe psychiatric disorders characterized by dysfunctional behaviors related to eating or weight control, with profound impacts on health, quality of life, and the financial burden of affected individuals and society at large. Given that these disorders involve disturbances in self-perception, it is crucial to comprehend the role of self-awareness in their prevalence and maintenance. This literature review presents different self-awareness processes, discussing their functioning across different levels of complexity. By deconstructing this concept, we can gain a better understanding of how each facet of self and personality relates to the symptoms of these disorders. Understanding the absence or impairment of self-awareness in ED holds significant implications for diagnosis, treatment, and overall management. By recognizing and comprehending the characteristics of self-awareness, clinicians can develop tailored interventions and evidence-based treatments for individuals with ED. Furthermore, this narrative review underscores the importance of considering temperament and personality factors in the context of ED, as temperament traits and personality characteristics may interact with self-awareness processes, influencing the development and maintenance of ED. Ultimately, the results highlight the pressing need for further research on the development of effective interventions and support strategies grounded in the aspects of self-awareness mechanisms for individuals affected by these disorders.

The use and misuse of the SCOFF screening measure over two decades: a systematic literature review

PURPOSE

The SCOFF questionnaire was designed as a simple, memorable screening tool to raise suspicion that a person might have an eating disorder. It is over 20 years since the creation of the SCOFF, during which time it has been widely used. Considering this, we wish to review the use of the SCOFF in peer-reviewed scientific journals, and to assess whether it is being used appropriately in the manner in which it was originally devised and tested.

METHODS

The Preferred Reporting Items for a Systematic Review and Meta-analysis (PRISMA) guidelines were followed, and all search strategies and methods were determined before the onset of the study. PubMed and Wiley Online Library were searched using the terms SCOFF and eating. Two reviewers were involved in the reviewing process. Criteria for appropriate use of the SCOFF were formalised with the tool's original authors.

RESULTS

180 articles were included in the final review. 48 articles had used the SCOFF appropriately, 117 articles inappropriately and 15 articles had been mixed in the appropriateness of their use.

CONCLUSION

This systematic review highlights the inappropriate use of the SCOFF in diverse languages and settings. When used correctly the SCOFF has made a significant contribution to the understanding of eating disorders and its simplicity has been applauded and led to widespread use. However in over two-thirds of studies, the use of the SCOFF was inappropriate and the paper highlights how and in what way it was misused, Guidelines for the appropriate use of the SCOFF are stated. Future validation and avenues of research are suggested.

LEVEL OF EVIDENCE

Level I.

The relationship among positive body image, body esteem, and eating attitude in Iranian population

Background and aim

The correlation between eating attitudes, positive body image, and body esteem is a pivotal area of research that has garnered substantial attention in recent years, given its implications for both mental and physical well-being. The objective of this study was to examine the interplay between positive body image, body esteem, and eating attitudes within an Iranian population.

Materials and methods

This study employed a cross-sectional study design and was conducted in the year 2022. A convenience sample of 752 participants residing in Tehran, Iran, was included in the study. The data collection tools were comprised of a demographic registration form, the Adolescence/Adults Scale (PBIAS), the Eating Attitudes Test (EAT), and the Body Esteem Scale (BES) as measurement instruments.

Results

Mean age of participants was 26.36 (SD = 8.49). Significant relationships were found among positive body image (B = - 0.095, β = -0.150, p < 0.001), and body esteem (B = 0.175, β = 0.149, p < 0.001) with eating attitudes.

Conclusion

These findings suggest that individuals with positive body image and high body esteem may have healthier eating attitudes, while those with negative body image and low body esteem may be more likely to have unhealthy eating attitudes.

A systematic review, meta-analysis, and meta-regression of the prevalence of self-reported disordered eating and associated factors among athletes worldwide

BACKGROUND

The purpose of this meta-analysis was to provide a pooled prevalence estimate of self-reported disordered eating (SRDE) in athletes based on the available literature, and to identify risk factors for their occurrence.

METHODS

Across ten academic databases, an electronic search was conducted from inception to 7th January 2024. The proportion of athletes scoring at or above predetermined cutoffs on validated self-reporting screening measures was used to identify disordered eating (DE). Subgroup analysis per country, per culture, and per research measure were also conducted. Age, body mass index (BMI), and sex were considered as associated/correlated factors.

RESULTS

The mean prevalence of SRDE among 70,957 athletes in 177 studies (132 publications) was 19.23% (17.04%; 21.62%), I2 = 97.4%, τ2 = 0.8990, Cochran's Q p value = 0. Australia had the highest percentage of SRDE athletes with a mean of 57.1% (36.0%-75.8%), while Iceland had the lowest, with a mean of 4.9% (1.2%-17.7%). The SRDE prevalence in Eastern countries was higher than in Western countries with 29.1% versus 18.5%. Anaerobic sports had almost double the prevalence of SRDE 37.9% (27.0%-50.2%) compared to aerobic sports 19.6% (15.2%-25%). Gymnastics sports had the highest SRDE prevalence rate, with 41.5% (30.4%-53.6%) while outdoor sports showed the lowest at 15.4% (11.6%-20.2%). Among various tools used to assess SRDE, the three-factor eating questionnaire yielded the highest SRDE rate 73.0% (60.1%-82.8%). Meta-regression analyses showed that female sex, older age, and higher BMI (all p < 0.01) are associated with higher prevalence rates of SRDE.

CONCLUSION

The outcome of this review suggests that factors specific to the sport affect eating behaviors throughout an athlete's life. As a result, one in five athletes run the risk of developing an eating disorder. Culture-specific and sport-specific diagnostic tools need to be developed and increased attention paid to nutritional deficiencies in athletes.

Sporting Mind: The Interplay of Physical Activity and Psychological Health

The symbiotic relationship between sports practice and psychological well-being has, in recent times, surged to the forefront of academic and public attention. The aim of this narrative review is to comprehensively explore the intricate pathways linking physical engagement in sports to its subsequent impacts on mental health and synthesize the multifarious effects of sports on psychological health, offering insights for integrating physical and psychological strategies to enhance well-being. From neurobiological underpinnings to therapeutic applications, this comprehensive manuscript provides an in-depth dive into the multifaceted world of sports and psychology. Highlighting evidence-based interventions, this review aspires to offer actionable insights for practitioners, athletes, and individuals alike, advocating for a holistic approach to mental well-being. This manuscript highlights the profound impact of sports on mental health, emphasizing its role in emotional regulation, resilience, cognitive function, and treating psychological conditions. It details how sports induce neurochemical changes, enhance brain functions like memory and learning, and aid against cognitive decline. This review also notes the benefits of regular exercise in mood improvement, stress management, and social skill enhancement, particularly when combined with mindfulness practices. It underscores the importance of considering cultural and gender perspectives in sports psychology, advocating for an integrated physical-psychological approach to promote overall well-being.

Attention-deficit hyperactivity disorder is associated with disordered eating in adolescents

AIM

Attention-deficit hyperactivity disorder (ADHD) and disordered eating (DE) are both highly prevalent among adolescents, but their relationship is understudied. This study examines their possible association in a nationally representative sample of adolescents.

METHODS

Participants in the Israeli Youth Health and Nutrition Survey (2015-2016), a cross-sectional, school-based study, completed self-administered questionnaires, including the SCOFF questionnaire, and underwent anthropometric measurements. An affirmative reply to at least two SCOFF items was considered a DE case. Multivariable logistic regression evaluated the ADHD-DE association and the associations between ADHD and individual SCOFF items, controlling for age, sex, socioeconomic status, and body mass index.

RESULTS

Of 4616 participants (12-18 years, 50.2% male), 654 reported an ADHD diagnosis. DE prevalence among ADHD adolescents was significantly higher than the non-ADHD group (50.2% vs. 43.9%, p = 0.003). Controlling for potential covariates, the association between ADHD and DE remained significant (OR = 1.409; 95% CI: 1.170-1.697), as did associations between ADHD and three SCOFF items. No difference in DE prevalence was found between stimulant-treated (n = 287) and untreated (n = 326) adolescents with ADHD.

CONCLUSION

Adolescents with ADHD are more likely to experience DE. As DE can herald an imminent eating disorder, early identification is crucial. Further studies are needed to determine the ADHD-DE relationship's causality.

IMPACT

Disordered eating (DE) and attention-deficit hyperactivity disorder (ADHD) are common among adolescents, and significantly affect health and well-being. This study examined the association between ADHD and DE in adolescents using the SCOFF questionnaire. Following adjustment for sociodemographic variables and BMI z-score, ADHD was associated with a 41% increased odds for DE. This study established the association between ADHD and DE, using a well-known questionnaire, in a large, nationally representative sample of adolescents. Monitoring eating behaviors and attitudes among adolescents with ADHD should be a priority, to minimize the risk of developing an eating disorder and its harmful consequences.

Maternal Bonding as a Protective Factor for Orthorexia Nervosa Risk in Dietetics Students

This study aimed to determine the prevalence of the risk of orthorexia nervosa (ON) in dietetics students in Greece, and its relationship with diet, risk of eating disorder (ED), body mass index (BMI), body image flexibility, and parental attachment. The participants were 132 dietetics students, with a mean age of 22.94 ± 3.5 years, who completed a series of questionnaires that recorded sociodemographic, clinical, and anthropometric characteristics; adherence to the Mediterranean diet (MedDiet); ON indicators as determined by the ORTO-15 questionnaire; body image flexibility, with the Body Image-Acceptance and Action Questionnaire (BI-AAQ-5); the risk for ED as assessed using the EAT-26; anxiety level according to the STAIT 6 instrument; and recollection of their parents' attitudes towards them during the first 16 years of life, with the Parental Bonding Instrument (PBI). ON risk appeared to be significantly associated with BMI (p = 0.002), exercise frequency (p = 0.023), anxiety level (p = 0.002), risk of ED (p < 0.001), body image inflexibility (p < 0.001), and inversely with the affectionate constraint of maternal bonding (p = 0.036). In conclusion, disordered eating behaviors and body shape concerns are prevalent among dietetics students, with parental attachment to the mother influencing their occurrence. Identification of potential ON and development of prevention mechanisms during childhood could help eliminate these concerns and improve the lives of dietetics students.

Link Between the Female Athlete Triad and Gymnastics-Related Injury in Retired Collegiate Gymnasts

OBJECTIVES

To compare gymnastics-related injuries between former collegiate gymnasts who did and did not report components of the female athlete triad (Triad) during college, including disordered eating or menstrual irregularity. We hypothesized that athletes reporting these 2 triad symptoms would have higher rates of time loss injury and injuries requiring surgery.

DESIGN

Retrospective case-control.

SETTING

Online survey.

PATIENTS

Four hundred seventy former collegiate gymnasts.

INTERVENTIONS

Athletes completed online survey distributed through social media.

MAIN OUTCOME MEASURES

Participants were grouped based on self-reported menstrual irregularity and disordered eating during college. We compared time loss injuries, injuries resulting in surgery, and injury locations between the groups using χ2 analyses.

RESULTS

Seventy percent (n = 328) of participants in this study reported a time loss college injury without surgery, and 42% (n = 199) reported an injury during college that required surgical treatment. A significantly greater proportion of gymnasts with only disordered eating reported a time loss gymnastics injury (without surgery) compared with those who reported only menstrual irregularity during college (79% vs 64%; P =0 .03). A significantly greater proportion of the disordered eating-only group reported a spine injury compared with the menstrual irregularity-only group (P = 0.007) and the group who reported neither menstrual irregularity nor disordered eating (P = 0.006).

CONCLUSIONS

College gymnasts who experienced disordered eating were more likely to experience a nonsurgical time loss injury while in college, as well as spine injury compared with those with menstrual irregularity. Sports medicine providers should be aware of the association between injuries and individual components of Triad in gymnasts beyond bone stress injuries.

Influence of Mindfulness on Levels of Impulsiveness, Moods and Pre-Competition Anxiety in Athletes of Different Sports

Training in emotional regulation skills is one of the most important resources for the adaptation of athletes to contexts of sports pressure, especially during competitions. This study explored the effects of a mindfulness programme (Flow Meditation) on levels of impulsivity, mood and pre-competition anxiety-state in a sample of athletes (N = 41, 22.83 ± 5.62 years). Participants were randomly assigned to an intervention group (N = 21; 14 males and 7 females) which received the intervention over 10 weeks (a weekly session) and a control group (wait-list; N = 20; 13 males and 7 females). The variables under study were assessed through different questionnaires at pre- and post-test (T1-T2) in both groups. The mindfulness intervention was effective in reducing impulsivity (cognitive (t = -4.48, p ≤ 0.001, Cohen's d = 1.40), both motor (t = -4.03, p ≤ 0.001, Cohen's d = 1.20) and unplanned (t = -5.32, p ≤ 0.001, Cohen's d = 1.66)), mood (tension (t = -4.40, p ≤ 0.001, Cohen's d = 1.37), depression (t = -4.56, p ≤ 0.001, Cohen's d = 1.42), anger (t = -7.80, p ≤ 0.001, Cohen's d = 2.47), somatic anxiety (t = -5.28, p ≤ 0.001, Cohen's d = 1.65), and cognitive anxiety (t = -6.62, p ≤ 0.001, Cohen's d = 2.07) in the intervention group compared to the control group and with large to very large effect sizes. Mindfulness is a factor that enhances athletes' ability to cope with high sport pressure and the healthy management of competition (e.g., fear of failure), or with their daily life.

A Scoping Review of the Influence of Mindfulness on Men's Sexual Activity

Mindfulness practice and mindfulness-based interventions are widely known, especially for women's sexuality. However, it is currently unknown how this practice affects the experience of male sexuality, possibly due to the existence of pharmacological treatments that are usually the first choice of treatment for men. The objectives of this study are to explore the influence of mindfulness on different components of men's sexuality from a scoping review of relevant scientific articles existing in the literature. A literature search from 2010 to 2022 was carried out in the electronic databases MEDLINE, Embase, PsycINFO, Web of Science, Scopus, PubMed, Dialnet, SciELO Citation Index, and Redalyc. Out of the 238 studies, 12 that met the defined selection criteria were selected. The analysis of these studies seems to indicate that the practice of mindfulness favours different variables of male sexuality, such as satisfaction and sexual functioning or genital self-image. Mindfulness-based interventions represent a valuable and promising contribution. No adverse effects were detected from the review of scientific articles considered in this work. Nevertheless, more randomized studies with active control groups are necessary to establish the benefits of mindfulness-based interventions in sex therapy for men.

Self-esteem and socialisation in social networks as determinants in adolescents' eating disorders

Eating disorders are mental health illnesses that are influenced by various individual, family and social factors. The present study aimed to examine the influence of self-esteem and socialisation through social networks on eating disorder behaviours in adolescence. The sample was made up of 721 secondary school students (49.1% girls). The sample age ranged between 12 and 18 years (M = 13.89, SD = 1.37). Participants completed the Eating Attitudes Test-26 (EAT-26) to measure disordered eating attitudes and behaviours, the Rosenberg Self-Esteem Scale and the ESOC-39 scale, which measures socialisation through social networks, in addition to a brief initial sociodemographic survey. Descriptive and multivariate analyses were carried out with MANOVA. Low self-esteem was shown to increase behaviours linked to eating disorders globally. Likewise, high socialisation through social networks was also associated with a general increase in eating disorders during adolescence. The findings of the study provide empirical support for the need to develop prevention strategies that address the improvement in self-esteem and adequate socialisation through social networks during adolescence. The development of effective interventions along these lines could be helpful to treat the behaviours and attitudes that are observed in eating disorders.

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).

The Athlete’s Paradox: Adaptable Depression

We proposed that an athlete’s depressive symptoms may be different from the general population in etiology if considered from the context of a depressive disorder. By shifting focus from a limited notion of symptoms onto a comprehensive model of depression, the full scope of the phenomenon becomes clearer. This paper investigated the relationship between neurotransmitters and allostatic load to explain the incidence of depression among elite athletes. This literature review extensively analyzed exercise-induced neurohormonal imbalance resulting in depressive states among athletes. The research revealed that 5-HTTLPR polymorphism, brain-derived neurotrophic factor (BDNF), extensive psychological demands, social stigma, and overtraining syndrome (OTS) may all contribute to a unique version of depression. The research revealed that the biological standards of athletes differ from those of non-athletes, to the point that the new model may be useful, thereby introducing the new term “Adaptable Depression (AD)” to the literature. This framework suggests a new direction for future research to precisely measure the neurotransmitter-related brain changes that result in “Adaptable Depression” in athletes and to establish a better understanding of the depressive tipping point.

Relationships between Risk Events, Personality Traits, and Risk Perception of Adolescent Athletes in Sports Training

Personality traits have close relationships with risky behaviors in various domains, including physical education, competition, and athletic training. It is yet little known about how trait personality dimensions associate with risk events and how vital factors, such as risk perception, could affect the happening of risk events in adolescent athletes. The primary purpose of this study is to investigate the prediction of risk events by regression analysis with dimensions of personality, risk perception and sports, relations between risk events, risk perception, and the facets of the personality dimensions via data collecting from 664 adolescent athletes aged 13–18 years (male 364, female 300). Secondary intent is to assess school-specific levels of training risks among sports schools, regular schools, and sports and education integrated schools. The results show that psychology events are the strongest predicted by personality traits, risk perception, and sports, followed by injury and nutrition. Emotionality has the most significant positive correlation with risk events, while other traits have a significant negative correlation with risk events, except agreeableness. The integration schools are more conducive to the healthy development of adolescent athletes’ personalities. Moreover, the research indicates that sports training can strengthen the development directions of different personality characteristics.

Inhabiting the Body(ies) in Female Soccer Players: The Protective Role of Positive Body Image

In a social and sports world dominated by weight-centred beliefs and highly exigent and gendered athletic and beauty body standards, the vulnerability for eating pathology, i.e., disordered eating and eating disorders (EDs), is elevated among women athletes. The aim of this study was to explore body image facets and ED risk among female athletes in masculinised sports such as soccer. Forty-five federated amateur female soccer players from Spain participated in this study, voluntarily complying with an extensive evaluation protocol on attitudes towards body and appearance and eating practises. The participants overall reported self-representations of their bodies that corresponded to their reality as athletes, but their body ideals were also more demanding in terms of low fat and muscularity, in association with the functionality of their body and the physical demands of their athletic activity. Despite having a fairly high positive body image and body satisfaction, they also expressed negative attitudes towards their bodies. Around 2 out of 10 players were at risk of suffering from an ED. Players with negative attitudes towards their bodies had an odd 12 times likely to develop an ED compared to those with lower self-devaluation, after adjusting for BMI and body perceptions (OR = 12.3, p < 0.01). On the contrary, players who appreciate their bodies and hold a positive body image had an odd 83% lower to suffer from eating pathology, after adjusting for BMI and body satisfaction (OR = 0.17, p < 0.05). Our findings support the healthy and protective role of positive body image in sports contexts. Body attitudes should be addressed in preventive and therapeutic efforts for reducing the prevalence of EDs in women's sports, within both a "negative" and a "positive" paradigm of body image.