Eating disorders among athletes. Research and recommendations.

Research indicates that certain athletes, particularly those in sports that emphasize leanness to enhance performance or appearance (e.g., gymnastics, wrestling, figure skating, diving, and ballet), are at risk for eating disorders. Little is known about the risk for eating disorder symptoms in weight and strength training. It is concluded that, even when mild variants of eating disorders are observed in athletes, they should be given immediate attention because they may severely compromise health and performance. Practical recommendations are made for coaches and trainers to identify the physical, psychological, and behavioral symptoms of eating disorders. Finally, suggestions are made for addressing eating disorders in athletes.

Self-control program in the treatment of obesity.

In a pilot study utilizing self-control techniques for the purpose of modifying the cue-reactive eating habits of obese patients, three subjects maintained a continuous weight loss throughout the first year of treatment. Techniques included goal setting, self-monitoring, brief delay and self-confrontation prior to eating unauthorized food and direct observation of oneself in a mirror when eating unauthorized food. All patients are expected to remain in treatment for the foreseeable future with no termination of the program despite apparent success with regard to control of their feeding disturbance. The rationale for this approach is discussed.

Treatment technique for chronic wrist cutters.

A treatment technique is presented which has been developed to eliminate chronic self-induced wrist cutting behavior. The technique substitutes painful but non-injurious exercises for self-cutting behavior when the urge to self-cut emerges. The rationale for initiating this approach is described.

Seasonal mood disturbances in collegiate hockey players.

OBJECTIVE: THE PURPOSE OF THIS PAPER IS TO: 1) describe the seasonal affective disorder syndrome using a case illustration, 2) provide a simple and reliable method for identifying seasonal affective disorder, and 3) provide data as to the prevalence of the syndrome in a subset of collegiate hockey players. DESIGN AND SETTING: Collegiate hockey players were selected, because their practices begin in the fall and play is completed in the spring. The teams selected for participation were from the far Northwest and the upper Midwest regions. SUBJECTS: Sixty-eight Division I hockey players volunteered for the study. The three teams from which the subjects were chosen were located above latitude 42 degrees /45' north. Subjects were from the northern latitudes. MEASUREMENTS: The Seasonal Pattern Assessment Questionnaire was used to screen for seasonality. A sample of the athletes was also examined using the Hamilton Rating Scale for Depression together with the Diagnostic and Statistical Manual of Mental Disorders (4th ed) criteria for Seasonal Pattern Specifier. RESULTS: Thirty-three (51%) were asymptomatic, 7 (11%) met the criteria for seasonal affective disorder, and 25 (39%) hockey players scored in the range that could classify them as candidates for subsyndromal seasonal affective disorder. CONCLUSIONS: The prevalence of seasonal affective disorder among our sample approximated the national norm for the northern latitudes. However, the prevalence of subsyndromal seasonal affective disorder in our population was 25% compared to 13% reported nationally. Light therapy has been shown to reverse the effects of the disorders; however, further research needs to be conducted to determine its acceptance and effectiveness by the athletic population.

Pathogenic Weight-Control Behaviors of Female College Gymnasts.

In brief: To study the methods and extent to which iemale college gymnasts diet, data were collected from 42 gymnasts aged 17 to 22 years, who represented five teams in a major athletic conference. The survey showed that (1) all the participants were dieting; (2) 26 were using at least one form of pathogenic weight-control behavior; and (3) 21 of the 28 competitors who were told by their coaches that they were too heavy resorted to using pathogenic weight-control behaviors. The authors discuss the implications of the demands of gymnastics and the additional social pressure to maintain exceptional thinness.

Pathogenic Weight-Control Behavior in Female Athletes.

In brief: Athletes have gone to extraordinary lengths to reduce their body fat stores in an effort to improve performance. To identify athletes who need help, a questionnaire was administered to 182 female collegiate athletes. Results showed that 32% practiced at least one of the weight-control behaviors defined as pathogenic, which include self-induced vomiting; binges more than twice weekly; and the use of laxatives, diet pills, and/or diuretics. A number of steps are suggested to alert coaches, trainers, and team physicians to the high-risk athlete who requires special attention or treatment to correct this disorder.

Pathogenic Weight-Control Behaviors of Young Competitive Swimmers.

In brief: To study the use of weight-modification techniques by young swimmers, data were collected from 487 girls and 468 boys, aged 9 to 18, at a competitive swimming camp. The survey revealed that (1) many young swimmers had misperceptions about their body weights, with girls particularly likely to misperceive themselves as overweight; (2) swimmers' decisions to lose or gain weight were based on their perceptions more than on their actual weights; (3) opinions of others strongly influenced swimmers' opinions of their own weights; and (4) 15.4% of the girls (24.8% of postmenarcheal girls) and 3.6% of the boys used pathogenic weight-loss techniques. The swimmers' concerns about weight seemed to be more related to societal influences than to the demands of their sport.

Psychosocial functioning of two groups of morbidly obese patients.

Fourteen morbidly obese women who were candidates for intestinal bypass surgery were compared in terms of psychosocial functioning and dietary behavior to 14 morbidly obese women who elected not to undergo the bypass procedure. Each patient underwent a psychiatric evaluation which included a developmental and dietary history, a mental status exam, and the administration of the MMPI. Diagnoses were based on the DSM-III multi-axial system. There was no difference between the bypass group and the non-bypass group on the Axis I diagnoses, however the bypass group did have a significantly higher frequency of Axis II diagnoses. The bypass group demonstrated significantly higher levels of psychosocial stressors (Axis IV) and lower levels of adaptive functioning (Axis V) when compared to the non-bypass group. The bypass patients also had a significantly higher frequency of past suicide attempts. On the MMPI, the bypass group had significantly higher elevations on scales 2 (depression), 4 (psychopathic deviate), 6 (paranoia), and 0 (social introversion). There were no significant differences between the groups in terms of dietary history and behavior, except that significantly fewer bypass patients could place a numerical estimate on their daily energy intake. These results were discussed in terms of their implications for the assessment and treatment of morbidly obese patients.

Anorexia nervosa "restricters" who purge: implications for subtyping anorexia nervosa.

It has not been clear from earlier studies whether it is binge eating per se or the compensatory behaviors frequently associated with binge eating (i.e., self-induced vomiting and/or laxative abuse) that provide the most relevant marker for subclassifying anorexia nervosa. The current study addressed this question by comparing the clinical and psychological features of three groups of anorexia nervosa patients: "pure restricting" patients who do not binge (by definition) and who also do not purge (AN-R, N = 116); "restricting-purging" patients who engage in purging behavior (AN-RP, N = 74); and anorexia nervosa "bulimics" who binge eat as defined in earlier studies (AN-B, N = 190). While all three groups displayed similar levels of psychological disturbance on many variables, the overall pattern of findings indicates that the AN-RP group displays significantly more psychopathology than the AN-R group and their profile of disturbance is very similar to that observed with the AN-B group. Thus, anorexia nervosa patients who purge, regardless of whether or not they report objective binge episodes, may be meaningfully distinguished from nonpurging patients. These results, combined with the medical risks associated with purging behaviors and the formidable problems associated with the definition of binge eating, support a sub-typing system for anorexia nervosa based on the presence or absence of purging rather than binge eating.