As a treatment provider, working with female athletes can present an additional set of unique factors that need to be considered. Oliver-Pyatt Centers Clinical Director Jamie Morris, MS, LMHC dives into the treatment of female athletes, particularly those participating in the collegiate level, in this week’s blog post.
In all instances of eating disorders, an individual’s relationship with exercise is one of many facets that call for assessment and consideration in developing a treatment plan. When working with female athletes, particularly those participating in collegiate level sports, there are an additional set of vulnerabilities to consider. It is important that as treatment providers, we are aware of the demands that often exist at this level of competition to help discern when a client is simply working to meet the competitive demands of her sport versus when she is acting on behalf of her eating disorder.
The special considerations for athletes may be more relevant than one may think. Athletes are at higher risk for developing an eating disorder than individuals not participating in sports; that, combined with the increased risk of eating disorders among college students places NCAA/collegiate athletes at the highest risk of eating disorders than any other group. Additionally, student-athletes may experience more stress than non-athletes because they deal not only with the transition away from home and stressors related to academic and social demands of college, but also the pressures associated with sport participation and sport performance. Focus on eating, exercise, and/or body often become a way for individuals to cope with such stressors.
While the complex nature of disordered eating in female athletes is not different than in the non-athlete population, the specifics of genetic, psychological, environmental, and behavioral factors differ between the two populations. Environmental factors, for example, may include family or peer pressure about athletic performance or coaching that encourages sole focus on excellence in sport.. Additionally, an individual identified as an athlete often gains self-esteem through praise offered from sport performance. Psychological factors may include the sole focus on success and performance without the ability to assess how fatigue/overtraining influences performance, or the belief that body modification will influence enhanced performance. Athletes tend to face pressures to lose, maintain, gain, or otherwise manipulate their body weight, shape or size on some level due to the technical or aesthetic demands of the sport, rules or conventions, media portrayal of athletes in their sport, or societal demands. Though this pressure is higher in some sports, such as dance, than others, it is likely that all athletes grapple with weight and body size/shape pressures in the athletic environment on some level.
Despite the numerous additional risk factors, female athletes do have some protective factors on their side. For instance, they tend to show more self-efficacy and have less negative views on life than their non-athletic counterparts. They also show a greater use of approach coping- a “take the bull by the horns approach” to dealing with life’s stressors. Some athletes with eating disorders even show less psychopathology compared to non-athletes. This may be observed in the clinical setting to have better/more effective emotion regulation, fewer negative arousals, more consistent reports of happiness, and higher self-esteem compared to non-athletes.
With a better understanding of athletic demands and the particular protective/risk factors that high performing athletes bring the table as eating disorder clients, there are a few treatment considerations that are important for us to keep in mind throughout evaluation and treatment. Try to assess how much pressure is placed on the client to return to their sport; it is possible that parents and coaches have turned a “blind eye” to the athlete’s issues in order to preserve competitive placement within a team. This information can guide focus in individual and family therapy. Another thing worth exploring with a client might be how she describes herself outside of being an athlete. Is she able to identify other talents, strengths or interests? Medically, it is particularly important with female athletes to assess risk for injury through DEXA scan and bone mass density evaluation. Many athletes can buy into the myth that amenorrhea is an expected part of rigorous training or that birth control/hormone replacement therapy will maintain bone mass. It is important that we work to debunk these myths and instead focus on educating our clients about what is needed from a caloric and nutritional standpoint to fuel and sustain training expectations when they return to sport. When medically indicated, allow for engagement in some training activities they would do if they return to sport to further evaluate psychological and medical readiness to return to sport. It is so important that we are able to process sensations that come up around training and work with them so that their approach to training involves ample self-awareness and self-care.
Working with athletes and eating disorders may be an intimidating task, these women are entrusting their recovery and a very strong part of their identity with us when they come through our doors. No matter the outcome of their athletic career, whether they choose to return to their sport or not, we will be able to guide them with careful assessment and consideration, ultimately empowering them to make decisions from a place of health and ease rather than force.