"The emphasis is on a prototype and it places the athlete
at a higher risk for developing a disorder," she said. "Sometimes
the athlete wants to improve personal performance by losing
extra weight. It starts innocently and then becomes an obsession."
Other times, the disorder might stem from other reasons.
"Sometimes the disorder is not even related to the sport.
Some reasons might be sexual abuse, alcohol abuse, or body
image. Everyone is so different," said Gray.
The NYU dietician also said that many eating disorder sufferers
do not fall into either anorexia or bulimia, but usually
a combination of both. "Some restrict total calories and
purge whatever they are eating. Others restrict [eating]
during the day and binge at night, using food to help cope,"
she explained. "I try to help them understand that it’s
less about food and more about other things."
Treatment for anorexia athletica is often as complicated
as the syndrome itself.
"Once an athlete is found to suffer from disordered eating,
then she is usually sent to a nutritionist and a physician,
until she shows enough progress to participate in sports.
Even during the time that they’re not cleared, they’ll still
be active, maybe not necessarily 100 percent, but they’ll
still be there, supporting their teammates," said Price,
the NYU athletic trainer.
"Athletes come to treatment in many ways. One way is if
they’re discovered, if someone finds that they are doing
this behavior, particularly the vomiting. Or they may be
found to have the warning signs of the Triad, or they may
find performance is declining and come in to be checked,"
said Otis.
"By and large, it is very unlikely for them to come into
treatment voluntarily," she added, "unless they have, what
I call, ‘hit bottom,’ where they’re vomiting nine times
a day, or have lost so much weight that everybody on their
team or their competitors are making fun of them."
Gray explained that many eating disorder victims are afraid
of food. "I try to let them know that all foods can fit
into a healthy diet," she said, acknowledging that in many
cases, treatment can last up to eight years and in severe
cases, patients are required to come in at least once a
week.
According to Gray, athletes with eating disorders do not
always bring their sporting lives to a complete halt. "[Sports]
is one thing they look forward to and it’s a part of them,"
she said, adding that confidentiality is always a priority.
"We don’t tell the coach or parents [about the disorder]
without consent."
Period Problems
As a result of anorexia, the menstrual cycle often suffers,
sometimes seen as a benefit to athletes who sometimes think
their periods impede training.
Otis’ experience with her patients confirms this view.
"I’ve had some women tell me that their coaches say ‘If
you’re still having your period, you’re not training hard
enough,’" she explained.
A 27-year-old in California suffered from primary amenorrhea
while training as a dancer in high school.
"I got my period at 16, although irregularly. When I was
training, I wouldn’t get it," she remembered, adding that
at age 18, her periods stopped for three years, forcing
her to use birth control pills to induce menstruation.
"Back then, doctors felt it was a normal part of training
to lose your period, that it was a good thing, a sign of
training, which makes me very angry now because it’s not,"
she said.
"Everyone thought I was so healthy, but on the inside I
was drowning in this. There are a lot of coaches who wouldn’t
view that [amenorrhea] as a problem; they just think it’s
a sign of optimal fitness and athletic training," said the
former dancer, who still suffers from menstrual irregularity.
Sheri Albert, a registered dietician at the UCLA
Arthur Ashe Student Health and Wellness Center, said
lack of nutrition can trigger amenorrhea, the second symptom
of the Triad.
"The ‘red flag’ of the Triad is the loss of the period.
The energy that you put into your body is not sufficient
for the amount that you are putting out," said Albert. "There
are many athletes out there that train tremendously hard
hours every day but are still getting their periods because
they have adequate energy to support what they’re demanding
of their bodies."
Otis believes that amenorrhea can lead to more serious
problems. "While women are not getting their periods, they
are infertile, but once the problem is corrected, fertility
should return. Some other problems associated with amenorrhea
that haven’t been researched yet are whether women are at
an increased risk for cancer of the uterus or heart disease."
