NCSEM Education

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.

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

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.