Eating psychopathology in athletes: methods of identification and intervention

Background: The incidence of eating psychopathology in athletes is considerably higher than in the general population. Facilitating the early identification and successful management of eating problems in this group is therefore essential. Objectives: The thesis aimed to improve our empirical understanding of the identification and management of eating problems in athletes. Three areas were investigated. First, a measure of compulsive exercise was evaluated as a method of identification of eating psychopathology in athletes. Second, the thesis explored coach methods of identification and management of eating problems among their athletes. Finally, athlete experiences of disclosing and seeking treatment for eating disorders were explored. Main findings: The Compulsive Exercise Test was found to be a useful measure in screening for eating psychopathology in athletes. Track and field coaches relied heavily on the physical symptoms of disordered eating when identifying potential eating problems in athletes. Coaches described difficulties in identifying eating psychopathology in athletes, and in signposting athletes to appropriate support. Individual differences in the perceived value of disclosing an eating disorder were discovered among athletes currently seeking treatment. Lastly, athletes described struggling to engage with their eating disorder treatment programme, particularly where exercise was restricted or reduced. Implications: The findings suggest a need for greater support, education and resources for coaches and sports professionals in identifying and facilitating treatment access among their athletes. The Compulsive Exercise Test may be one way to assist sports professionals in identifying athletes with elevated levels of eating psychopathology. Athletes may be more willing to engage with treatment programmes when they are closely involved in goal setting and their exercise and sporting commitments are incorporated where possible

Responses of track and field coaches to athletes with eating problems

This study aimed to explore how track and field coaches respond to athletes with eating problems. Eleven experienced coaches participated in semi-structured interviews exploring their responses to, and challenges faced when, working with athletes with eating problems. The analysis revealed three themes relating to the strategies employed by coaches. The first theme indicated a supportive approach, where coaches were proactive in seeking support and in reducing training at the early stages of an eating problem. The second theme outlined an avoidant approach, characterized by coach reluctance to be involved in managing eating problems, and a lack of confidence in their knowledge of eating disorders. The third theme involved a confrontational approach, where coaches employed strict rules and engaged in coercion to persuade athletes to seek treatment. All of the coaches reported facing challenges in persuading athletes to seek treatment and were frustrated by the lack of available support. The study highlights the importance of providing resources and support services where coaches can seek advice. Coach-education packages can utilize the findings to highlight the strengths and limitations of different coach strategies, and to reinforce the importance of their role in identification and intervention when eating problems in athletes are suspected

Identifying and preventing disordered eating among athletes : perceptions of track and field coaches

Objective: This study aimed to identify the strategies employed by coaches when identifying disordered eating (DE) among track and field athletes. Design: This was a qualitative study and an inductive thematic analysis was conducted. Method: Semi structured interviews were conducted with eleven track and field coaches, with experience of coaching at national and international level. The interviews were recorded, transcribed verbatim and analysis was conducted. Results: Track and field coaches reported using physical, social and performance indicators to identify disordered eating in their athletes. Coaches also monitored their athletes' eating attitudes and behaviors. Weight loss (both observed and objectively monitored) was considered to be a key indicator of disordered eating. Coaches placed a high level of importance on weight for performance, and an “ideal” female athlete body. Previous experiences of detecting disordered eating and a close relationship with the athlete facilitated the identification of disordered eating. Athlete secrecy and masking behaviors, difficulties in communication and coaches' stereotypical beliefs were found to complicate the identification process. Conclusions: This study highlights the need for additional information, advice and guidance for track and field coaches to improve their knowledge and confidence in identifying disordered eating among their athletes

Evaluating a motivational and psycho‐educational self‐help intervention for athletes with mild eating disorder symptoms: A mixed methods feasibility study

Objective The primary aim was to assess the feasibility of undertaking a study evaluating the novel Motivational and Psycho-Educational Self-Help Programme for Athletes with Mild Eating Disorder Symptoms (MOPED-A). A mixed-methods approach was adopted to explore the feasibility of recruiting and retaining participants, and to evaluate the acceptability of measures, procedures and the intervention. A secondary aim was to explore the potential efficacy of MOPED-A in reducing athletes' eating disorder symptoms. Method Thirty-five athletes were recruited. Participation involved completing MOPED-A over a 6-week period and completing self-report measures at baseline (T1), post-intervention (T2) and 4-week follow-up (T3). A subsample (n = 15) completed an interview at T2. Results Retention was good throughout the study (n = 28; 80%). Quantitative and qualitative feedback suggested the format, delivery, content and dosage of MOPED-A were acceptable. Athletes valued that the intervention was tailored to them, and this facilitated both participation and completion. Over a third of participants reported disclosing their eating difficulties and deciding to seek further support. Large reductions in eating disorder symptoms were detected at T2 and sustained at T3. Conclusions The MOPED-A intervention can be feasibly implemented, is acceptable to participants, and demonstrates potential for reducing symptoms in athletes. A larger, controlled trial is warranted

Detecting disordered eating among recreational exercisers; exploring the role of personal trainers

This study aimed to understand how personal trainers identify and manage disordered eating among their clients. Semi-structured interviews were undertaken with eleven UK based personal trainers to document their experiences of working with clients exhibiting symptoms of disordered eating. The interviews were recorded, fully transcribed and subjected to a thematic analysis. The findings suggest that personal trainers rely on external cues to identify disordered eating among clients such as changes to physical appearance, exercise behaviours and performance. The findings also revealed that personal trainers lack knowledge and hold misconceptions about disordered eating. Such misconceptions influenced their ability to identify and manage potential problems among their clients. Participants described the need for further education and guidelines to increase their knowledge and confidence in identifying and managing disordered eating among their clients. The findings from this study will be useful for professional bodies and practitioners in the development of guidelines and educational material for personal trainers

The Compulsive Exercise Test : confirmatory factor analysis and links with eating psychopathology among women with clinical eating disorders

Background: This study aimed to determine the psychometric properties of the Compulsive Exercise Test (CET) among an adult sample of patients with eating disorders. Method: Three hundred and fifty six patients and 360 non-clinical control women completed the CET and the Eating Disorders Examination questionnaire (EDE-Q). Results: A confirmatory factor analysis revealed that the clinical data showed a moderate fit to the previously published five factor model derived from a community sample (Taranis L, Touyz S, Meyer C, Eur Eat Disord Rev 19:256-268, 2011). The clinical group scored significantly higher than the non-clinical group on four of the five CET subscales, and logistic regression analysis revealed that the CET could successfully discriminate between the two groups. A Receiver Operating Curve analysis revealed that a cut-off score of 15 on the CET resulted in acceptable values of both sensitivity and specificity. Conclusions: The CET appears to have a factor structure that is acceptable for use with an adult sample of patients with eating disorders. It can identify compulsive exercise among patients with eating disorders and a cut-off score of 15 is acceptable as indicating an appropriate cut-off point

Responses of track and field coaches to athletes with eating problems

This study aimed to explore how track and field coaches respond to athletes with eating problems. Eleven experienced coaches participated in semi-structured interviews exploring their responses to, and challenges faced when, working with athletes with eating problems. The analysis revealed three themes relating to the strategies employed by coaches. The first theme indicated a supportive approach, where coaches were proactive in seeking support and in reducing training at the early stages of an eating problem. The second theme outlined an avoidant approach, characterised by coach reluctance to be involved in managing eating problems, and a lack of confidence in their knowledge of eating disorders. The third theme involved a confrontational approach, where coaches employed strict rules and engaged in coercion to persuade athletes to seek treatment. All of the coaches reported facing challenges in persuading athletes to seek treatment and were frustrated by a lack of available support. The study highlights the importance of providing resources and support services where coaches can seek advice. Coach education packages can utilise the findings to highlight the strengths and limitations of different coach strategies, and to reinforce the importance of their role in identification and intervention when eating problems in athletes are suspected

Female athlete experiences of seeking and receiving treatment for an eating disorder

Clinical eating disorders are common among athletes; however research has yet to explore the process of seeking and receiving treatment for an eating disorder in this population. Semi-structured interviews were conducted with 13 female athletes currently receiving treatment for an eating disorder. A total of three themes emerged: challenges to treatment seeking, feeling out of place, and coping with exercise transitions. Athletes reported low levels of eating disorder literacy and lacked motivation to engage with therapy due to a lack of perceived relevance. Athletes found it challenging to relinquish exercise behaviours in treatment and expressed concerns around managing a return to sport. It may be necessary to provide additional support to athletes when embarking on and leaving treatment programs, particularly with regards to managing expectations about exercise

Exploring the link between self‑compassion and compulsive exercise amongst women

Objectives Self-compassion, defned as the ability to be accepting and loving towards oneself, has been identifed as a potential protective factor against the development of body dissatisfaction and eating disorders (ED). In contrast, compulsive exercise is a core feature in the development and progression of EDs and is often employed as a maladaptive coping strat egy for negative emotions and body image concerns. However, the relationships between self-compassion and compulsive exercise attitudes and behaviours are as yet unexplored. Methods A total of 539 Spanish female university students (Mage=20.03, SD=2.22) completed measures of compulsive exercise, frequency of compensatory exercise, self-compassion, eating disorder symptoms, and anxiety and depression. Results Hierarchical multiple regressions showed that lower levels of self-compassion signifcantly predicted some compul sive exercise elements (namely, weight control exercise and lack of exercise enjoyment) after controlling for ED symptoms, anxiety, depression and age. However, frequency of compensatory exercise was unrelated to self-compassion elements. Findings from the mediation models suggest an indirect efect of self-compassion on the association between compulsive exercise and ED symptoms. Conclusions The fndings suggest a signifcant link between low self-compassion and greater harmful exercise attitudes and behaviours towards exercise. Further research is needed to clarify whether self-compassion may be a core feature in the development and maintenance of harmful attitudes and behaviours towards exercis