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Eating disorders affect children and young adults more than the general population, for a multitude of reasons. Adolescents are full of changing neurochemicals, subjected to stress and trying to establish their place in society. Now with the difficulties that social media and the pressure to get into college add, the urge to fit a specific physical criterion is incredibly high.

Often this can lead to a sort of high-functioning anxiety or depression where students excel but at a significant emotional cost. This can occur concurrently to an eating disorder as well, which compounds the difficulty and can lead to a scenario where the child’s health and well-being are at serious risk.

We’re going to examine how high school and collegiate athletics can impact a student with an eating disorder. This includes the intense physical danger that comes with being highly active while also restricting or purging food, and how the strain of performance in athletics can make an eating disorder worse. Finally, we’ll talk about how to identify an eating disorder in your loved ones and the best possible route to recovery in the long term.

Restrictive Versus Purging Eating Disorders

The two most prevalent eating disorders are anorexia nervosa and bulimia nervosa, both being typified by a different behavior.

Anorexia nervosa usually manifests as a restrictive pattern of eating, where the patient avoids eating or dramatically restricts calories. Eating behaviors can be highly ritualized as well; eating only a certain number of food items, eating only if they have gotten a requisite amount of physical activity and so on.

While eating disorders often arise because of a feeling that the patient has lost control of some aspect of their life, restrictive patterns are usually even more indicative of this. A patient who is suffering from a restrictive eating disorder like anorexia nervosa will have a broad range of physical and psychological symptoms:

Physical symptoms of restrictive eating disorders

  • Complaints of being cold all the time, bluish skin at the extremities from poor circulation
  • Fainting spells
  • Extreme fatigue
  • Slow wound healing and repeated infectious illness from a reduced immune response
  • Muscle weakness from chronic malnourishment
  • Hair loss
  • Poor cognition, memory impairment, and confusion

The majority of the physical symptoms are due to constant functioning with less than necessary calories. This can lead to damage and eventual breakdown of the various bodily systems, and can often require hospitalization.

Psychological symptoms of restrictive eating disorders

  • Moodiness
  • Obsession with a certain body type, or their overall physical appearance
  • Preoccupation with examining themselves in the mirror, especially if this behavior wasn’t present prior
  • Ritualized eating habits
  • Reduction in interaction with peer groups or previously-loved hobbies. It’s worth noting that athletes who present with restrictive eating disorders will often dedicate more time to their hobbies as they pertain to their primary sport, but less time to socializing within the context of that sport.

Restrictive eating disorders, especially in teens, can be difficult to identify. Many young women feel societal pressure to conform to media-presented body standards and this will affect their way of eating. Disordered eating isn’t necessarily the same as an eating disorder, but it can lead to bulimia or anorexia if attention isn’t paid to the underlying causes. Again, a history of anxiety, depression and especially PTSD can act as influencing variables, as the psychological manifestations of these disorders can mask the onset of emotional difficulty that comes with eating disorders. Additionally, PTSD patients are at significantly higher risk to develop an eating disorder than the general public, independent of other variables.

Bulimia nervosa primarily presents with purging behavior, which usually consists of periods of binge eating followed by vomiting or use of laxatives. A person with bulimia or other purging eating disorders will go through these periods of bingeing and purging regularly, which can have profound physical and mental effects. These will also present differently than with a restrictive eating type, though behavior patterns — especially regarding eating — can be markedly similar.

Physical symptoms of a purging eating disorder

  • Yellowing and erosion of the teeth from vomiting
  • Callousing of the knuckles and fingertips of one hand, from inducing vomiting
  • Hair loss
  • Frequent illness and poor wound healing
  • Hoarseness
  • Anemia and chronic coldness

These symptoms are almost all a direct result of the mechanism of purging; a patient with a purging eating disorder may not present as malnourished as a restrictive type. The physical symptoms, however, are still manifestations of extreme damage to the body and need an intervention just as critically as a restrictive disorder. 

Psychological symptoms of purging eating disorder

  • Difficulty with studies, especially memory
  • Moodiness and isolation
  • Highly ritualized eating, such as only eating when alone to hide the bingeing aspect of the disorder. This is typical of binge eating disorder as well, where the same high volumes of food are eaten but there is no period of purgation.
  • Hiding food, especially food wrappers
  • Changes in a social group or peer activities

How Purging And Restricting Eating Disorders Especially Affect Athletes

The psychological and emotional toll that these disorders take on students can be highly distressing, but for athletes, the distress is compounded. Because high school and college athletics are highly competitive, the eating disorders can arise out of a need to create control or, paradoxically, to gain a physical advantage over other students. The problem arises specifically to athletes because of the extreme physical and mental strains they are under. Problems specific to athletes with eating disorders are:

  • Lowered bone density due to poor nutrition cause fractures and breaks to be far more likely
  • Increased strain on muscles without nutrient reload can cause rhabdomyolysis, where the skeletal muscle breaks down
  • Decreased ability to recover, which coupled with an obsessive dedication to their sport can dramatically increase the chance of catastrophic injury
  • In the case of purging disorders, the constant exposure of the trachea to stomach contents can cause spasms that make breathing difficult, which can make athletics dangerous
  • In both restrictive eating disorders like anorexia nervosa and purging types like bulimia nervosa, the chance for arrhythmias is higher during peak physical output. This is because either through reduced eating or purging, electrolytes become imbalanced, increasing the likelihood of a cardiac event.

Other Concerns Of Eating Disorders In High School And Collegiate Athletes

One of the most difficult problems that arises when a student-athlete develops an eating disorder is the fact that their dedication to their sport can mask many of the symptoms of the disorder. An athlete will hide symptoms of injury or burnout to avoid falling behind or losing their spot on the team, and the risk of injury and physical burnout is much higher with an eating disorder. This makes them extremely dangerous for student-athletes in particular. 

Another concern is that someone who already exercises a lot due to the conditioning needed for their sport will often over-exercise as a reaction to eating. In both purging and restrictive types of eating disorders, exercise is a control for calories and in some cases, students may injure their muscles by compulsively working out. Coupled with poor nutrition, this can lead to hospitalization.

The need to possess a high degree of strength and dedication to athletics means students are often pressed to extremes:

  • Hours of highly taxing drills every day
  • Practices in extreme heat 
  • Self-imposed goals that are not within the realm of reasonableness. This is likely due to the same distortion that causes the eating disorder; no matter their body type, they’re not satisfied. Even at high levels of athletic ability, they feel they are not adequate.

All of these variables can cause a major health event, or set a student up for one in the future. Additionally, severe amounts of exercise without rest or proper nutrition can cause lifetime physical damage. This is why your role as a parent or loved one is extremely important; if you can identify the signs and symptoms of an eating disorder in your student, you can take the first steps towards full recovery.

Helping Your Student-Athlete Recover From An Eating Disorder

While the potential for physical damage from an eating disorder is high, especially in athletes, the chance for recovery is also very real if proper intervention is put in place. As a loved one, your role is to help identify the signs and symptoms of pathological eating and make yourself available to the student in a nonjudgmental way. If you spot what could be signs of an eating or exercise disorder, then the next step is to talk to your child. Some ways to broach the subject are:

  • Sit them down by yourselves in a comfortable, non-threatening place with which you’re both familiar
  • Ask them what’s been bothering them, or if they have anything they’d like to talk to you about.
  • Say you’ve noticed that they are behaving differently but again, do not approach this in a judgmental way. Simply state that you wanted to know if everything is alright, or if they have something with which they need help.

The goal is to not attack them in any way; this is a disorder and it’s not their fault. Given an open forum where they are comfortable and one-on-one, patients are often much more likely to simply express what’s going on, and that can include pathological eating behavior. Often these mental health problems get so bad that people don’t know how to ask for help; simply making it known that you want to listen can be enough to get them to admit they need assistance.

Once your loved one expresses her desire to engage in therapy, you need to utilize the best possible system for recovery from eating disorders. Studies have shown that outpatient therapy in a home-like setting is the best chance that eating disorder patients have for a full recovery. When compared to in-patient hospitalization, dedicated therapy clinics like Clementine have a dramatically higher lifetime recovery rate.

In particular for athletes, a program that integrates nutrition, exercise, medical doctors and counseling is necessary to assist in recovery. The staff at Clementine has decades of experience specifically treating eating disorders, and their combination approach can identify key factors that can confound recovery. They provide group therapy in a safe, comfortable setting so that patients can see they are not alone.

Registered dietitians and trainers can help put food and exercise in a healthy context that your loved one can adopt and integrate into the practice of their sport. The key is identifying pathological behavior and fixing it for the long term. This is done by putting the feeling of self-efficacy in the hands of the patient. People who feel their health is determined by their actions are far more likely to stay recovered. This all-inclusive treatment style allows for concurrent resolution of psychological and physical barriers to recovery.

Finally, one of the most important reasons to use an outpatient facility like Clementine is because they have a robust aftercare system. They will work with dietitians, doctors, and counselors outside their clinics to ensure your loved one has support in every facet of their life going forward. Clients who enter into an aftercare routine following treatment are significantly more likely to maintain recovery for a lifetime.

By paying close attention to your loved one, especially if they seem to be reacting poorly to the stress of athletics, social antagonists or school life in general, then having a frank, nonjudgmental conversation can be the best bet to get them on the road to recovery. Clementine systems can be the expert you need to help your loved one thrive and lead a life that incorporates athletics and a healthy relationship with food. 


Melissa Spann, PhD, LMHC, CEDS-S

Melissa Orshan Spann, PhD, LMHC, RTY 200, is Chief Clinical Officer at Monte Nido & Affiliates, overseeing the clinical operations and programming for over 50 programs across the U.S. Dr. Spann is a Certified Eating Disorder Specialist and clinical supervisor as well as an accomplished presenter and passionate clinician who has spent her career working in the eating disorder field in higher levels of care. She is a member of the Academy for Eating Disorders and the International Association of Eating Disorder Professionals where she serves on the national certification committee, supervision faculty, and is on the board of her local chapter. She received her doctoral degree from Drexel University, master’s degree from the University of Miami, and bachelor’s degree from the University of Florida.