When the Symptoms Don’t Look Like You Expect: Navigating Atypical Eating Disorders in Athletes in Cherry Hill, NJ
To understand atypical eating disorders, we need to understand the criteria for each eating disorder. Eating disorders in athletes are a unique mental health illness by the DSM-V (Diagnostic and Statistic Manual of Mental Health). The DSM-V is a manual that guides mental health professionals to diagnosing and treating illnesses. Diagnosing an eating disorder, means you fit specific "criteria: that is unique to each type of eating disorder. Don't worry, we will go over those details.
The Different Types of Eating Disorders
Anorexia Nervosa when you are significantly underweight while restricting food. This in addition to an intense fear of gaining weight is the perfect storm of Anorexia. There are two sub categories of Anorexia, restrictive and binge-purge type. Restrictive means caloric restriction alone. Binge-purge type involves caloric restriction while also engaging in binge eating and purging.
Bulimia Nervosa
Bulimia Nervosa involves recurrent episodes of binge eating, followed by purging. This entails eating large amounts of food within a certain period of time while feeling out of control. Purging can entail self-induced vomiting, laxatives, diuretic, fasting or excessive exercise. The binge-purge cycle happens on average of at least once a week for three months.
Binge Eating Disorder
BED stands for Binge Eating Disorder. It consists of ongoing binge eating episodes. However, there is a lack of control and occurrs at least 2 days a week for 6 months or 1 day a week for 3 months.
Avoidant Restrictive Intake Disorder
ARFID is the avoidance of food due to sensory concerns or a fear of choking or vomiting. It can lead to nutritional deficiency and malnutrition. ARFID also results in significant weight loss and a interference with psychosocial functioning.
To learn more about eating disorders, check out our blog on the different types.
What are Atypical Eating Disorders?
Understanding each atypical eating disorder can be confusing. First we need to understand the diagnosis of OSFED. OSFED stands for Other Specified Feeding or Eating Disorder . It's the “catch all” eating disorder in the DSM-V. When an eating disorder does not fit into one category, it is OSFED. There are 5 different types of eating disorders for athletes under the OSFED.
Atypical Anorexia
Atypical Anorexia is similar to Anorexia. It is when someone meets the criteria for anorexia nervosa except the weight is not considered in a “normal” range. Atypical anorexia can have the same level of medical or psychological symptoms as anorexia nervosa.
OSFED
OSFED is also diagnosed when someone exhibits the behaviors of bulimia. There is a low frequency or duration of the binge/purge cycle. One may also experience the behaviors of BED with lower frequency or duration of the binges. Two other categories of OSFED consist of purging disorder and night eating syndrome. Purging disorder means purges occur through vomiting, laxatives, or exercise, but does not engage in binging. Night Eating Syndrome is when someone repeatedly eats at night.
Like any other eating disorder, OSFED has mental and physical implications. It can be extremely dangerous. Common myths hide the underlying problem. This leads to folks not feeling comfortable getting help, due to not feeling “sick enough”. Examples of this may be “If you’re not underweight, you’re fine.” or “Athletes need to eat differently, so it’s not disordered”. The dangerous reality is that health consequences can be as severe as “typical” eating disorders in athletes.
Why Athletes Are at Higher Risk
Performance culture leads to high pressures. This is due to trying to control every aspect of training, including body composition. Team culture, coaches, or judges make comments about body composition. Unrealistic expectations from athletes stem from myths like “leanness equals performance”. Restrictive eating and overtraining is disguised as "discipline”.
Specific sports have their own unique challenges. Endurance sports such as running, cycling or swimming have myths around body size. Aesthetic sports leaves athletes with high expectations around body shape and appearance. This includes sports like gymnastics, figure skating, dance, and cheerleading. Weight-class sports such as wrestling, rowing and martial arts puts pressure on athletes to fit in a specific category to compete.
Subtle Warning Signs of Eating Disorders in Athletes
Despite myths, the signs are often similar to other eating disorders in athletes. There are physical, behavioral, and emotional signs of atypical eating disorders.
Physical signs are fatigue, frequent injuries, irregular or absent menstrual cycles. It can even include prolonged recovery times. You may often notice a decrease in performance, despite an increase in training.
Behavioral signs may look like obsessive tracking of food, macros or calories or “clean eating” taken to the extreme. Athletes may avoid team meals or post game celebrations.
Emotional signs are anxiety around food choices and irritability. You may notice withdrawal from social activities and friends. It may also look like extreme distress when training is missed or a day of rest is needed.
Barriers to Recognition and Treatment
Internal barriers to treatment include athletes believing their habits are normal or dedication. There is also often a fear of losing playing time, athletic ability or athletic identity. External barriers include pressure from coaches, trainers and teammates. They may be praising the behavior, as well as misdiagnosis or dismissal from medical providers focused only on weight. Cultural barriers in sport can also be a factor. Athletes told to “tough it out” discourages vulnerability and help may be needed.
How Therapy Can Help Athletes with Atypical Eating Disorders
Finding a team of providers that has knowledge and experience working in eating disorder therapy for athletes is a priority. Once you find the right fit, there are many different therapeutic techniques that can work. Each individual is different in what techniques work for you.
CBT stands for Cognitive Behavioral Therapy. CBT helps you identify and challenge distorted beliefs about food, body image and performance.
Acceptance and Commitment Therapy (ACT) guides you towards shifting focus to values beyond sport.
RO-DBT stands for Radically Open Dialectical Behavioral Therapy. It is for athletes who struggle with overcontrol and perfectionism.
FBT is specific to eating disorders and stands for Family-Based Treatment. It is for young athletes with family involvement. FBT focuses on parents or guardians being the main support in the refeeding process.
Atypical eating disorders in athletes are as serious and deserving of treatment as any other eating disorder. If symptoms don’t look stereotypical, that does not mean you should not seek help and support. Recovery is possible without sacrificing an athlete’s passion for their sport.
Steps Towards Recovery of Eating Disorders in Athletes in the Cherry Hill, NJ Athletic Community
Early screening within sports programs is important. It catches disordered behaviors before they escalate. Creating a team culture that prioritizes mental health as much as physical conditioning is so valuable. It helps cultivate open dialogue, between athletes, parents, coaches and medical professionals. Serendipity Counseling supports individuals through eating disorder therapy for athletes in Cherry Hill, NJ. Here are the steps to get started:
Schedule a free consultation to see if we are a good fit!
Schedule the first session as we get to know each other and work towards food freedom.
Begin the journey to peak performance and self!
Other Services
Serendipity Counseling offers unique options for support outside of eating disorder therapy for athletes. Teams can receive mental health talks around disordered eating, body image in sport, and sports performance. Along with talks are featured podcasts and a support group for “Retired” Athletes.
About the Author: A Dedicated and Passionate Eating Disorder Therapist for Athletes
Kate Ringwood is an specialist in eating disorder therapy for athletes. She helps guide athletes towards food freedom and peak performance. Through her experience in eating disorder recovery as an athlete, she has a deep passion for guiding athletes. She knows the importance of going through this process without sacrificing an athlete’s passion for sport.
