1. Clinical eating disorder diagnostic categories
1. Clinical eating disorder diagnostic categories
Clinical eating disorders represent a serious risk to athlete health and wellbeing. There are four categories of clinical eating disorder.1
- Anorexia Nervosa
- Bullimia Nervosa
- Binge Eating Disorder and
- Other Specified Feeding or Eating Disorders
Some of these illnesses you might have heard of before. We will briefly cover the main characteristics of these diagnostic groups, but it is important to remember that the presentation of eating problems may not always neatly fit into these groups. We will look at common signs and symptoms of eating problems later on in the course.
1. Anorexia Nervosa (AN)
Anorexia Nervosa (AN) is characterised by1:
- Food restriction, leading to a significantly low body weight (for age, gender, and developmental stage)
- Preoccupation with food and body weight, including an intense fear of weight gain despite low weight
- Self-esteem and self-worth is closely linked to body weight and shape.
Athletes with Anorexia Nervosa will likely2:
- Have strict rules about food
- Experience weight loss (gradual or sudden)
- Express an intense fear of fatness
- Engage in extra training beyond what has been prescribed by their coach
- Demonstrate increased fatigue, incidence of injuries and susceptibility to infection.
One athlete describes the change in her eating habits in the early stages of anorexia nervosa:
It started off with just restricting, I never ate a hot meal ever, I just used to eat cereal all the time, and then like the odd bit of toast. From there it went to nothing fatty at all. I wasn't really that bothered about calories, it was more about fat.
2. Bulimia Nervosa (BN)
Bulimic Nervosa is characterised by1:
- Recurrent episodes of binge eating: consuming very large amounts of food in short periods of time and feeling out of control, followed by compensatory behaviours to prevent weight gain.
- Compensatory behaviours can include self-induced vomiting, laxative abuse, diuretic misuse, fasting, or excessive exercise
- This binge-purge cycle occurs at least once a week for three months (see Figure 1.1)
- Self-esteem and self-worth is closely linked to body weight and shape.
Athletes with Bulimia Nervosa will likely2:
- Have low mood and poor self-esteem
- Experience fluctuations in weight; be preoccupied with food, weight and calories
- Disappear after meal times; engage in secret eating behaviours
- Experience gastrointestinal problems and/or vomiting unrelated to illness
- Engage in additional exercise behaviour beyond training programme.
One athlete describes how her bingeing and purging cycle started:
After one binge, I went to try and make myself sick. Then I realised that I could eat more and then get rid of it, so it kind of just got out of control quite quickly.
Figure 1.1: The Binge-Purge Cycle
3. Binge Eating Disorder (BED)
Binge Eating Disorder (BED) has been recently identified as a distinct clinical eating disorder. It is characterised by1:
- Recurring episodes of binge eating with episodes marked by feelings of lack of control. However, individuals do not engage in compensatory behaviours.
- Individuals are likely to experience feelings of guilt, embarrassment, distress or disgust after binge eating
- Binge eating episodes occur at least once a week for three months
- Binge eating disorder is distinct from just ‘overeating’. The volume of food consumed is often much larger, and bingeing is also associated with significant psychological distress.
Athletes with Binge Eating Disorder will likely2:
- Eat very quickly, and when not hungry
- Engage in secretive eating behaviour, hiding food or empty packets
- Experience significant weight gain
- Present with low mood and self-esteem.
One athlete describes her experience of bingeing:
The binges are pretty extreme. It's non-stop eating all day, like packets of biscuits, loads of chocolate bars, and loads of packets of crisps.
4. Other Specified Feeding or Eating Disorder (OSFED)
The final group of clinical eating disorders is a ‘catch-all’ residual category to capture non-typical eating disorders. Importantly these disorders can be just as serious in terms of their impact on health and performance. Some examples include1:
- Significant food restriction, but an athlete's weight still falls within, or above, the normal range.
- Purging behaviours in the absence of binge-eating episodes
- Individuals who chew and spit out large amounts of food.
It is important to remember that athletes may not always present with ‘typical’ eating disorders. They may move from one category of eating disorders to another (e.g., they may start off by restricting their food intake, but then may later start to engage in bingeing and purging behaviours). Any abnormal patterns of eating behaviour should be taken seriously and may require referral to a specialist. We will discuss the key signs and symptoms of eating problems in the next module.