Disordered Eating and the Female Athlete
Eating Disorders Program at Laureate Psychiatric Clinic and Hospital
Schuler, P. B., A. Broxon Hutcherson, et al. (2004). "Body-shape perceptions in older adults and motivations for exercise." Perceptual and motor skills (Missoula, Mont.) 98(3 Part 2): 1251-1260.
This study examined the relationships among age, sex, exercise and body-image dissatisfaction in older adults and evaluated the role of body-shape dissatisfaction as a motivation to exercise. A pencil-and-paper questionnaire was administered to 175 older adults (101 women and 74 men) ranging in age from 50 to 98 years (M = 72 yr., SD = 9) to obtain general information, information regarding exercise participation, motivations for exercise and body-shape perceptions. A body-shape dissatisfaction score was calculated using the difference between the participant's choice for current and ideal body shape from a nine-figure body-silhouette scale. Present study findings suggested that both older adult men and women expressed a desire for a thinner body shape independent of age and current participation in exercise. In addition, the results indicated that body-shape dissatisfaction did not motivate this sample to engage in regular exercise: physical health and physical fitness emerged as the most important motivations to exercise.
Cameron, E. M. and F. R. Ferraro (2004). "Body satisfaction in college women after brief exposure to magazine images." Perceptual and motor skills (Missoula, Mont.) 98(3 Part 1): 1093-1099.
Female undergraduates were divided into groups based on their rated body dissatisfaction (n = 45 operationally defined as Satisfied, n = 45 as Dissatisfied). These groups were then randomly assigned to one of three magazine categories: fashion, fitness-and-health, and news. Measures of Body Satisfaction, Depression, Anxiety, Self-esteem, Fear of Fat, Eating Attitudes, and Control of Weight were taken. Significant group main effects were found on Depression, Trait Anxiety, Eating Attitudes, Fear of Fat, and Self-esteem. A significant main effect for media was found for scores on Body Satisfaction, with the fitness-and-health Dissatisfied group reporting decreased body satisfaction following magazine exposure. No interactions were found. It appears women who are dissatisfied with their bodies may be at risk for a further decrease in body satisfaction after even a 15-min. exposure to fitness and health magazines but further follow-up measures were not made.
Sundgot Borgen, J. and M. K. Torstveit (2003). "The Female Athlete Triad: the role of nutrition." Schweizerische Zeitschrift fuer Sportmedizin und Sporttraumatologie / Revue suisse de medecine et de traumatologie du sport / Rivista svizzera di Medicina e traumatologia dello sport (Bern) 51(1): 47-52.
In response to the number of studies concluding that some female athletes are suffering from menstrual dysfunction, disordered eating, reduced bone mass and stress fractures, the American College of Sports Medicine coined the term "The Female Athlete Triad" in 1992. The Female Athlete Triad is a serious syndrome compromising three interrelated components: (i) disordered eating; (ii) amenorrhoea; and (iii) osteoporosis. Female athletes who develop one or all components of the Triad often start with dieting. Dieting behaviour often leads to energy deficit, menstrual irregularities and increased risk for loss of bone mass. Severe eating disorders may cause morbidity and mortality. The Female Athlete Triad is a syndrome that can be prevented. Therefore, all individuals, including the athletes themselves, coaches, administrators and family members, who are involved in recreational and competitive sport, should be educated about these disorders, and strategies for each sport should be developed to prevent, recognize and treat the Female Athlete Triad.
Cobb, K. L., L. K. Bachrach, et al. (2003). "Disordered eating, menstrual irregularity, and bone mineral density in female runners (Problemes nutritionnels, irregularite des cycles, et densite minerale osseuse chez les femmes pratiquant la course de fond.)." Medicine and science in sports and exercise (Hagerstown, Md.) 35(5): 711-719.
Purpose: To examine the relationships between disordered eating, menstrual irregularity, and low bone mineral density (BMD) in young female runners. Methods: Subjects were 91 competitive female distance runners aged 18-26 yr. Disordered eating was measured by the Eating Disorder Inventory (EDI). Menstrual irregularity was defined as oligo/amenorrhea (0-9 menses per year). BMD was measured by dual x-ray absorptiometry. Results: An elevated score on the EDI (highest quartile) was associated with oligo/amenorrhea, after adjusting for percent body fat, age, miles run per week, age at menarche, and dietary fat, (OR (95 % CI): 4.6 (1.1-18.6)). Oligo/amenorrheic runners had lower BMD than eumenorrheic runners at the spine (-5 %), hip (-6 %), and whole body (-3 %), even after accounting for weight, percent body fat, EDI score, and age at menarche. Eumenorrheic runners with elevated EDI scores had lower BMD than eumenorrheic runners with normal EDI scores at the spine (-11 %), with trends at the hip (-5 %), and whole body (-5 %), after adjusting for differences in weight and percent body fat. Runners with both an elevated EDI score and oligo/amenorrhea had no further reduction in BMD than runners with only one of these risk factors. Conclusion: In young competitive female distance runners, (i) disordered eating is strongly related to menstrual irregularity, (ii) menstrual irregularity is associated with low BMD, and (iii) disordered eating is associated with low BMD in the absence of menstrual irregularity.
Lane, A. (2003). "Relationships between attitudes towards eating disorders and mood." Journal of science and medicine in sport (Belconnen, A.C.T.) 6(2): 144-154.
The purpose of the present study was to examine whether gender moderates the relationship between mood and attitudes toward eating disorders in athletes. 165 athletes (Male=99; Female=66) completed the Eating Attitudes Test (EAT), the Profile of Mood States-A (POMS-A), and the Hospital Anxiety Depression Scale (HADS). To test the proposed moderating effect, multisample structural equation modelling was used with equality constraints placed on relationships between mood and EAT scores. Results indicated that relationships between mood and EAT scores did not differ significantly between males and females (CFI=.988), thereby demonstrating that gender did not have a moderating effect. Mood significantly accounted for 38% of the variance in EAT scores in males and 29% of the variance in females, with depressed mood scores showing the strongest relationship with EAT scores. Findings support the use of mood profiling in applied work, and suggest negative mood, particular depressed mood, might be masking a disordered eating attitude. It is suggested that follow-up interviews should be conducted with athletes who report symptoms of depressed mood to ascertain its cause and that further research is needed to investigate the nature of disordered eating attitudes in athletes.
(2003). ""Energy availability" and the female athlete triad." Sports medicine digest (Hagerstown, Md.) 25(6): 63.
Female athlete triad involves three inter-related conditions - disordered eating, athletic amenorrhea, and premature osteoporosis. Recent research suggests that, the trigger for low bone mineral density may begin with disruptions to "energy balance" or low "energy availability".
Papanek, P. E. (2003). "The female athlete triad: an emerging role for physical therapy." JOSPT: The journal of orthopaedic and sports physical therapy (Alexandria, Va.) 33(10): 594-614.
Over the last thirty years, participation by girls and women in organized athletics has increased dramatically. This presents unique challenges in the area of sports medicine, orthopaedics, and pediatrics. While the benefits of participation in sports and exercise vastly outweigh the risks of permanent injury, an evolving concern is the number of stress fractures in active women. The female athlete triad ("triad") describes the coexistence of 3 distinct medical conditions that may occur in athletic girls and women. Originally, the triad included eating disorders, amenorrhea, and osteoporosis. Presently, it includes eating disorders/disordered eating behavior, amenorrhea/oligomenorrhea, and decreased bone mineral density (osteoporosis and osteopenia). Briefly, when coupled with inadequate nutrition, the high caloric expenditure of exercise training results in a sustained negative caloric balance or low energy availability, which is exquisitely sensed by the hypothalamus, initiating a complex neuroendocrine adaptive cascade. This cascade is associated with changes in the hypothalamic-pituitary-ovarian axis, such that estrogen levels are decreased, resulting in reproductive dysfunction that may include amenorrhea, oligomenorrhea, or anovulation. Low estrogen in otherwise young healthy women, like menopause, is associated with decreased bone mineral density and increased risk of fractures. The triad is not an inevitable consequence of participation in sports or physical activity at any level; however, exercise may contribute to the disruption of caloric balance. The triad is a complex disorder that requires intervention by a multidisciplinary team. Physical therapists bring a unique expertise to the team. The present review summarizes each component of the triad, component linkage, and the role of physical therapy in prevention, assessment, and intervention.
Lofshult, D. (2003). "Vegetarianism & disordered eating." IDEA health and fitness source (San Diego, Calif.) 21(9): 16.
Briefly overviews a study examining the eating attitudes and behaviours of self-reported vegetarian female university students in order to identify risk behaviours and attitudes for disordered eating. The study concludes that vegetarians may be at greater risk for developing eating disorders.
(2003). "Disordered eating." World clinic series (Fort Lauderdale, Fla.) 352003, 309 316, Total No. of Pages: 8.
Discusses the symptoms and underlying psychology of eating disorders in swimmers.
Black, D. R., L. J. S. Larkin, et al. (2003). "Physiologic Screening Test for eating disorders/disordered eating among female collegiate athletes." Journal of athletic training (Dallas, Tex.) 38(4): 286-297.
Objective: To develop and evaluate a physiologic screening test specifically designed for collegiate female athletes engaged in athletic competition or highly athletic performances in order to detect eating disorders/disordered eating. No such physiologically based test currently exists. Methods: Subjects included 148 (84.5 %) of 175 volunteer, National Collegiate Athletic Association Division I (n = 92), club (n = 15), and dance team (n = 41) athletes 18 to 25 years old who attended a large, Midwestern university. Participants completed 4 tests: 2 normed for the general population (Eating Disorders Inventory-2 and Bulimia Test-Revised); a new physiologic test, developed and pilot tested by the investigators, called the Physiologic Screening Test; and the Eating Disorder Exam 12.0D, a structured, validated, diagnostic interview used for criterion validity. Results: The 18-item Physiologic Screening Test produced the highest sensitivity (87 %) and specificity (78 %) and was superior to the Eating Disorders Inventory-2 (sensitivity = 62 %, specificity = 74 %) and Bulimia Test-Revised (sensitivity = 27 %, specificity = 99 %). A substantial number (n = 51, 35 %) of athletes were classified as eating disordered/disordered eating. Conclusions: The Physiologic Screening Test should be considered for screening athletes for eating disorders/disordered eating. The Physiologic Screening Test seems to be a viable alternative to existing tests because it is specifically designed for female athletes, it is brief (4 measurements and 14 items), and validity is enhanced and response bias is lessened because the purpose is less obvious, especially when included as part of a mandatory preparticipation examination.
Kruskall, L. J., L. J. Hohnson, et al. (2002). "Eating disorders and disordered eating - are they the same?" ACSM's health and fitness journal (Indianapolis, Ind.) 6(3): 6-12.
Identifies the risks and symptoms of both disordered eating and eating disorders, and discusses possible help and treatment that the fitness professional can provide.
Leydon, M. A. and C. Wall (2002). "New Zealand jockeys' dietary habits and their potential impact on health (Habitudes dietetiques des jockeys neo zelandais et leur impact potentiel sur la sante.)." International journal of sport nutrition and exercise metabolism (Champaign, Ill.) 12(2): 220-237.
The purpose of this study was to determine the nutritional status, eating behaviors, and body composition of 20 jockeys working in the New Zealand Racing Industry. Seven-day weighed food records showed the mean daily energy intake for male and female jockeys was 6769 +/- 1339 kJ and 6213 +/- 1797 kJ, respectively. Energy and carbohydrate intakes were below the recommendations for athletes, and the jockeys did not meet the RDI for a number of micronutrients. Of the jockeys, 67 % used a variety of methods to make weight, including: diuretics, saunas, hot baths, exercise, and the restriction of food and fluids. A number of jockeys (20 %) showed signs of disordered eating. Forty-four percent of jockeys were classified as osteopenic, and a number of factors may have contributed to this outcome, namely: reduced calcium intake, delayed menarche (14.5 years) in female jockeys, alcohol intake, and smoking. Percent body fat of male and female jockeys was 11.7 +/- 2.9 and 23.6 +/- 3.8, respectively. Current weight restrictions imposed on jockeys by the horseracing industry impacts on their nutritional status, which may compromise their sporting performance and both their short- and long-term health.
Haase, A. M., H. Prapavessis, et al. (2002). "Perfectionism, social physique anxiety and disordered eating: a comparison of male and female elite athletes." Psychology of sport and exercise (New York) 3(3): 209-222.
To examine the relationship between Positive and Negative Perfectionism and Social Physique Anxiety (SPA) and the extent to which these two variables predict disturbed eating attitudes in male and female elite athletes. A cross -sectional survey was used. Athletes (n = 316) completed measures of Positive and Negative Perfectionism, SPA, disordered eating and social desirability. Zero- and first-order (partial) correlations were examined to determine the relationship between Positive and Negative Perfectionism and SPA. Hierarchical regression analyses were used to examine how two individual difference variables, perfectionism and SPA, relate and contribute to disordered eating. For both male and female athletes, Negative Perfectionism was significantly related to SPA. For males, Positive Perfectionism made a small, yet significant, contribution (i.e. 6 %) in predicting disturbed eating attitudes. For females, Negative Perfectionism and SPA uniquely and in combination significantly contributed 41 % of the variance in the prediction of disturbed eating attitudes. These findings suggest that Negative Perfectionism is strongly linked with SPA and that, in females, SPA is an additional psychosocial variable to consider in the relationship between Negative Perfectionism and disordered eating. Copyright 2002 Elsevier Science Ltd.
Blaydon, M. J., K. J. Lindner, et al. (2002). "Metamotivational characteristics of eating-disordered and exercise-dependent triathletes: an application of reversal theory." Psychology of sport and exercise (New York) 3(3): 223-236.
To compare triathletes with exercise dependence and/or eating disorders on their metamotivational characteristics using the framework of Reversal Theory. Participants were classified according to their scores on an eating disorder and an exercise dependence questionnaire into a primary, a secondary, an eating disorder, and a no dependence or disorder group. These groups were contrasted on measures derived from the Motivational Style Profile ((1998) Personal. Indiv. Diff., 24, 7). Triathletes (n = 171) completed instruments at competitive events in either Hong Kong or Switzerland. MANOVA and follow-up ANOVA were applied to measures of dominances and saliences. There were significant differences in dominances and saliences between the exercise dependent and other groups, while the secondary group was significantly more telic dominant than the primary group. The eating disordered groups were significantly more mastery dominant than the no dependence group. There was a significant group by status interaction effect. The four groups were associated with different psychological profiles, but this association was moderated by the triathletes' status as professional or amateur. The appropriateness of the commonly used terms 'primary' and 'secondary' with regard to exercise dependence is questioned. Copyright 2002 Elsevier Science Ltd.
Golden, N. H. (2002). "A review of the female athlete triad (amenorrhea, osteoporosis and disordered eating)." International journal of adolescent medicine and health (Tel Aviv) 14(1): 9-17.
Warren, M. P., R. H. Ramos, et al. (2002). "Exercise-associated amenorrhea: are altered leptin levels an early warning sign?" Physician and sportsmedicine (New York) 30(10): 41-46.
Although the exact cause of the female athlete triad (amenorrhea, disordered eating, and osteoporosis) is unknown, recent research implicates leptin, a hormone that is secreted by adipocytes. Leptin may be an important indicator of nutritional status and may also play a role in reproductive function. Physicians who develop a plan for early recognition and treatment of exercise-induced amenorrhea now may prevent the more serious consequences of osteopenia and osteoporosis later.
(2002). "Disordered eating patterns may lead to eating disorders." Active living (Collingwood, Ont.) 11(5): 24.
A brief introduction to the category of eating disorders that is called "Eating Disorders Not Otherwise Specified (EDNOS)". Symptoms and treatment options are also provided.
Paquette, M. C., R. Leung, et al. (2002). "Development of a body image program for adult women." Journal of nutrition education and behavior (Hamilton, Ont.) 34(3): 172-174.
Describes the development, implementation, evaluation and future refinements of a program designed to improve the body image of non-eating-disordered women between 20 and 60.
Manore, M. M. (2002). "Dietary recommendations and athletic menstrual dysfunction (Conseils en matiere de dietetique et dysfonctionnement du cycle menstruel de l' athlete.)." Sports medicine (Auckland, N.Z.) 32(14): 887-901.
Exercise-induced or athletic menstrual dysfunction (amenorrhoea, oligomenorrhoea, anovulation, luteal phase deficiency, delayed menarche) is more common in active women and can significantly affect health and sport performance. Although athletic amenorrhoea represents the most extreme form of menstrual dysfunction, other forms can also result in suppressed estrogen levels and affect bone health and fertility. A number of factors, such as energy balance, exercise intensity and training practices, bodyweight and composition, disordered eating behaviours, and physical and emotional stress levels, may contribute to the development of athletic menstrual dysfunction. There also appears to be a high degree of individual variation with respect to the susceptibility of the reproductive axis to exercise and diet-related stresses. The dietary issues of the female athlete with athletic menstrual dysfunction are similar to those of her eumenorrhoeic counterpart. The most common nutrition issues in active women are poor energy intake and/or poor food selection, which can lead to poor intakes of protein, carbohydrate and essential fatty acids. The most common micronutrients to be low are the bone-building nutrients, especially calcium, the B vitamins, iron and zinc. If energy drain is the primary contributing factor to athletic menstrual dysfunction, improved energy balance will improve overall nutritional status and may reverse the menstrual dysfunction, thus returning the athlete to normal reproductive function. Because bone health can be compromised in female athletes with menstrual dysfunction, intakes of bone-building nutrients are especially important. Iron and zinc are typically low in the diets of female athletes if meat products are avoided. Adequate intake of the B vitamins is also important to ensure adequate energy production and the building and repair of muscle tissue. This review briefly discusses the various factors that may affect athletic menstrual dysfunction and two of the proposed mechanisms: the energy-drain and exercise-intensity hypotheses. Because energy drain can be a primary contributor to athletic menstrual dysfunction, recommendations for energy and the macro- and micronutrients are reviewed. Methods for helping the female athlete to reverse athletic menstrual dysfunction are discussed. The health consequences of trying to restrict energy intake too dramatically while training are also reviewed, as is the importance of screening athletes for disordered eating. Vitamins and minerals of greatest concern for the female athlete are addressed and recommendations for intake are given.
Carson, J. D. and E. Bridges (2002). "Position statement: abandoning routine body composition assessment. A strategy to reduce disordered eating among female athletes and dancers." Bulletin International Council of Sport Science and Physical Education (Aachen)(36): 63.
List of recommendations by the Canadian Academy of Sport Medicine centering on the belief that routine body composition evaluation should be abandoned for female athletes and dancers.
Burckes Miller, M. and L. J. Burak (2002). "Sports participation and disordered eating behaviors and beliefs of middle school girls." American journal of health education (Reston, Va.) 33(6): 338-343.
The purposes of this study were to examine and describe the disordered eating behaviors and beliefs of middle school female athletes and to determine whether a relationship exists between the number and type of sports participation and disordered eating behavior among the young athletes. Two hundred twenty-six girls in five schools completed surveys that addressed sports participation and behaviors and beliefs related to eating disorders. The students participated in a mean of 4.6 sports, and reported an average of 2.1 weight dissatisfied beliefs and restrictive or disordered eating behaviors. No relationships were found between the number of sports the girls played and their disordered beliefs and behaviors.
Nagel, M. (2002). Perfectionism, mood states, and disordered eating in female athletes and performers, Lewiston, N.Y., Edwin Mellen Press, c2002, 98 p.; 24 cm.
CONTENTS: Preface; Foreword; Introduction;  Types of eating disorders;  Theories of eating disorders;  Symptoms of eating disorders;  Risks and complications of eating disorders;  Prevalence of eating disorders;  Eating disorders, family, and society;  Starvation in female athletes;  Disordered eating and athletic performance in females;  The female athlete triad;  Mood states, disordered eating, and athletic performance in females;  Attitudes;  Perfectionism;  Parents, coaches, peers, and media;  Implications and recommendations for parents and coaches;  Measurements of eating disorders, mood states, and perfectionism; [Appendix] Perfectionism, mood states, and disordered eating in female ballet dancers: a case study; Summary; Bibliography; Index.
Vinci, D. M. (1999). "The female athlete triad: body image and disordered eating." Athletic therapy today (Champaign, Ill.) 4(4): 16-17.
Lang, M. C. (1998). Female body-building: exploring muscularity, femininity and bodily empowerment, Thesis (M.A.)-University of British Columbia, 1998; includes bibliography (leaves 112-122).
This study aimed to build upon the literature on women's athleticism by using bodybuilding as a vehicle for exploring associations between women's muscularity, notions of gender and bodily empowerment. Feminist cultural analyses of women's bodybuilding have claimed that muscularity is constrained by gendered meanings surrounding the sport and the female body (cf. Bordo, 1993; Coakley, 1994; Schulze, 1990). The purpose was to explore how personal interpretations of muscularity by competitive female bodybuilders contributed to their definitions of gender and empowerment through the body. Three competitive female bodybuilders were recruited. Ethnographic techniques were employed, including observations of subjects' training sessions, ongoing field notes, and individual in-depth interviews to uncover the women's interpretations of their muscularity, gender and bodily empowerment. Data analysis involved organization of the data into themes using the computer program NUD.IST. The women re-defined certain values and expectations of femininity based on norms of discipline and restriction (cf. Bartky, 1993; Kissling, 1991; Willis, 1990). As such, it was revealed that muscularity contained possibilities for transforming common cultural images of the female body and meanings surrounding women's athleticism (cf. Birrell & Theberge, 1994; Hesse-Biber, 1996; Markula, 1993). From this, the women gained a sense of bodily empowerment, which they defined as self actualization through confidence building, a positive body image, discipline, independence, inner strength and self awareness. This reinforced the idea that shifted understandings of gender through muscularity exist as one route to women's bodily empowerment as they function to replace dominant meanings which limit women (cf. Horden, 1993; Obel, 1996; Theberge, 1987). The women's sense of empowerment related to their visions of gender and their bodies in that these challenged traditional symbols of male dominance, involved independence and physical 'space-taking', and provided role models of female capability extending beyond the personal (cf. Hall, 1990; Hargreaves, 1994; Nelson, 1994). This analysis contributes to the existing literature by questioning the contention that bodybuilding does not constitute a form of empowerment because it is limited by the dominant ideologies of female body image, behaviour and sport surrounding it (cf. Bryson, 1990; Mansfield & McGinn, 1993; Miller & Penz, 1991).
Nardini, M. (1998). Body image, disordered eating, and obligatory exercise among women fitness instructors, Thesis (M.S.)-Indiana University, 1998; includes bibliography (leaves 90-97).
This study investigated body image, eating behaviors, and obligatory exercise among women fitness instructors. A questionnaire including demographic information, the Drive for Thinness (DT), Bulimia, and Body Dissatisfaction subscales of the EDI-2, the Figure Rating Scale, and the Obligatory Exercise Questionnaire was completed by 148 women fitness instructors attending a fitness convention. Participants were evaluated for percent body fat, using 3-site skinfold measurement. The data were analyzed via ANOVA and stepwise regression analysis. Significance was set at p<.05. Sixty-four percent of the instructors perceived an ideal body as one which was thinner than their current body, and 44% were obligatory exercisers. On the DT subscale, 6.8% of the sample scored above a cutoff score used to screen for eating disorders. Body dissatisfaction was not related to physical characteristics, but rather to psychological variables. Multiple regression analyses identified DT as the single most important predictor for bulimic behavior, body dissatisfaction, obligatory exercise, and control of food intake (R2=.58). Despite having a lower average body fat compared with age matched norms, these instructors were as dissatisfied with their bodies as both college age women and women athletes. DT and obligatory exercise scores were lower than some women athletes considered at-risk.
Benson, J. E., Engelbert-Fenton, K. A., Eisenman, P. A. (1996). Nutritional aspects of amenorrhea in the female athlete triad. International Journal of Sport Nutrition, 6 (2), 134-145.
AB: Female athletes experience a high incidence of menstrual abnormalities. This has critical health consequences because amenorrheic athletes are at greater risk of developing osteopenia and bone injury compared to normally menstruating athletes or nonathletic normally cycling females. Female performers and athletes are also at risk for developing disordered eating behaviors. There appears to be a connection between menstrual dysfunction, athletic training, and disordered eating, but how they relate is not fully understood. In this paper we explore how low calorie intakes, nutritional inadequacies, vegetarianism, low body fat stores, and specific training behaviors may contribute to the abnormal menstrual patterns seen in this population. Recommendations for the detection and prevention of eating and training problems and consequent menstrual abnormalities are included.
Berga, S. L. (1996). Stress and ovarian function. American Journal of Sports Medicine, 24 (6 Suppl), S36-S37.
Bluhm, M. A. (1996). The female athlete triad. Olympic Coach, 6 (1), 6-7.
Crossen, K., & Raymore, L. A. (1997). Body attitudes and participation in physical activity: Are they related for adolescent females?. New Zealand Journal of Sports Medicine, 25 (3), 42-45.
AB: The present study sought to examine whether attitudes towards the body were related to leisure-time involvement in fourteen types of physical activity for females between the ages of fourteen and seventeen. While previous research has established links between adolescent female body satisfaction and negative outcomes such as eating disorders, the nature of the relationship between body satisfaction and participation in physical activity has yet to be determined; different authors have found different types of relationships. A sample of 266 female Christchurch adolescents completed a self-administered questionnaire that examined involvement in physical activity and body attitudes as measured by the Body Attitude Questionnaire (1). The results suggested that perceptions of fitness and strength were related to the largest number of physical activities. Females who were highly involved in running and athletics/harriers indicated negative body attitudes on the largest number of dimensions.
David, P., Johnson, M.A. (1998). The role or self in third-person effects about body image. Journal of Communication, 48 (4), 37-58.
AB: Examined the perceived effect of idealized media images on self and classmates of 144 females (mean age 22 yrs) for 3 levels of outcome undesirability: (1) perception of ideal body weight, (2) effect on self-esteem, and (3) likelihood of developing an eating disorder. Ss completed self-esteem and social physique anxiety scales, watched a video on the idealized female body in popular media, and then completed a questionnaire on the effect of media on self and others. Results indicate a significant 3rd-person effect, which widened as the outcome increased in social undesirability. Ss with high self-esteem exhibited stronger 3rd-person effect than Ss with low self-esteem. The overall pattern of findings suggests that 2 related but distinct processes might be involved in the 3rd-person effect: (1) a general process associated with self-esteem, which explains perceived effect of media both on self and others; and (2) a specific process tied to situational personal vulnerability, which explains perceived effect on self, but does not explain perceived effect on others.
Drinkwater, B. L. (1996). The female athlete triad. Strength and Conditioning, 18 (2), 31.
Drinkwater, B. (1994). Physical activity, fitness, and osteoporosis. In Claude Bouchard and Roy Shephard (Eds.) Physical activity, fitness, and health: International proceedings and consensus statement (pp. 724-736). Champaign, IL: Human Kinetics Publishers 724-736.
Drinkwater, B. (1992). Amenorrhea, body weight, and osteoporosis. In K. Brownell and J. Rodin, (Eds.) Eating, body weight, and performance in athletes: Disorders of modern society (pp. 235-247). Philadelphia, PA: Lea & Febiger.
AB: Discusses the relationships among low body weight, amenorrhea, and osteoporosis in female athletes. Chapter: the "postmenopausal" young athlete / techniques of measuring bone mass / skeletal areas at risk / factors determining the extent of bone loss / can lost bone be regained / treatment ((c) 1997 APA/PsycINFO, all rights reserved.
Dueck, C. A., Matt, K. S., Manore, M. M., Skinner, J. S. (1996). Treatment of athletic amenorrhea with a diet and training intervention program. International Journal of Sport Nutrition, 6 (1), 24-40.
AB: The purpose of this study was to determine the effect of a 15-week diet and exercise intervention program on energy balance, hormonal profiles, body composition, and menstrual function of an amenorrheic endurance athlete. The intervention program reduced training 1 day/week and included the use of a sport nutrition beverage providing 360 kcal/day. Three eumenorrheic athletes served as a comparison group and were monitored over the same 15-week period. The amenorrheic athlete experienced a transition from negative to positive energy balance, increased body fat from 8.2 to 14.4 percent, increased fasting luteinizing hormone (LH) from 3.9 to 7.3 mlU/ml, and decreased fasting cortisol from 41.2 to 33.2 ug/dl. The eumenorrheic subjects showed a 0.4 percent reduction in body fat, a decrease in follicular phase levels of LH from 7.9 to 6.5 mlU/ml, and no change in cortisol. These results suggest that nonpharmacological treatment can contribute to reestablishing normal hormonal profiles and menstrual cyclicity in amenorrheic athletes.URL: http://www.humankinetics.com/
Fasting, K. (1997). The female athlete triad: Anorexia and bulimia. In, Donnelly, P. (ed.), Taking sport seriously: Social issues in Canadian sport (pp. 143). Toronto: Thompson Educational Publishing.
Finkenberg, M.E., DiNucci, J.M., McCune, S.L., Chenette, T., McCoy, P. (1998). Commitment to physical activity and anxiety about physique among college women. Perceptual & Motor Skills, 87 (3, Pt 2), 1393-1394.
AB: Compared scores on the Commitment to Physical Activity Scale and the Social Physique Anxiety Scale from 258 women (aged 18-24 yrs), including 108 athletes, 87 kinesiology majors, and a control group of 63 Ss. Mean commitment to physical activity (PA) of the control group was significantly lower than the means of the other groups; the mean on anxiety about social physique was significantly higher. These results indicate that the group with the highest commitment to PA had the lowest anxiety about physique, and, conversely, the group with the lowest commitment to PA had the highest score on anxiety.
Fogelholm, M., Lichtenbelt, W. V., Ottenheijm, R., & Westerterp, K. (1996). Amenorrhea in ballet dancers in the Netherlands. Medicine and science in sports and exercise, 28 (5), 545-550.
AB: The prevalence of amenorrhea was studied among 113 professional and student ballet dancers in Netherlands (mean age 23.3 yr, SD 4.8). Sixty-one dancers not on oral contraceptives were included in the subsequent analyses. Six cases (prevalence 9.8 percent, 95 percent confidence interval: 2.4-17.2) with secondary amenorrhea (less than or equal to 4 cycles per year; previous menstruation greater than or equal to 3 months prior to the study; menarche greater than or equal to 1 yr prior to the study) were found. Two dancers had primary amenorrhea (no menarche at the age of greater than or equal to 16). There was a negative correlation between the age of menarche and the number of menstrual cycles during 12 months preceding the study (r = -0.46, P = 0.001). Body composition (four-compartment model), amount of dancing (recorded), resting energy expenditure (ventilated hood), dietary intake (recorded), and indices of eating disorders (Eating Disorders Inventory, EDI) were studied in 15 of the dancers, 5 amenorrheic and 10 eumenorrheic. No significant differences were found between the amenorrheic and eumenorrheic dancers. An explanation for the lower prevalence of amenorrhea in ballet dancers in the Netherlands, compared with U.S. dancers, was not obvious. Relatively low EDI scores (25.8, SD 14.5) in a subsample of 24 dancers could indicate less rigid emphasis on leanness and dieting.
Frederick, C.M., Morrison, C.S. (1998). A mediational model of social physique anxiety and eating disordered behaviors. Perceptual & Motor Skills, 86 (1), 139-145.
AB: In the present study correlations among scores on social physique anxiety, social behavior inhibition, and eating-disordered behaviors and traits were hypothesized on the basis that social physique anxiety would be correlated with personality disturbances associated with eating disorders and mediated by social inhibition and eating disordered behaviors: 79 college-aged women completed the Garner's Eating Disorders Inventory, the Social Physique Anxiety Scale, and a measure of social behavior inhibition. A mediational path analysis showed scores on social physique anxiety significantly moderately related to scores for eating disordered traits, mediated by scores on eating disordered behaviors. Results support the assumption that eating-disordered behavior may begin with milder symptomatology such as high scores on social physique anxiety.
Fruth, S. J., & Worrell, T. W. (1995). Factors associated with menstrual irregularities and decreased bone mineral density in female athletes. The Journal of Orthopaedic & Sports Physical Therapy, 22 (1), 26-38.
AB: Menstrual irregularities occur in some female athletes. The most extreme form of menstrual irregularity is amenorrhea, which has been linked to significant decreases in vertebral bone density and increase in injury prevalence. Many authors have sought to determine the causal factors of athletic amenorrhea, some of which include hormonal status, training and physical parameters, nutritional balance, and psychological stress. The purpose of this paper was to compare studies that have examined the relationship of these variables to menstrual irregularities and bone density. Controversy exists regarding the relative contribution of these variables. The etiology is likely multifactorial and should be evaluated as such. Clinicians treating female athletes must be knowledgeable about the negative consequences associated with menstrual irregularities. Furthermore, it is critical that clinicians provide thorough patient education in order to prevent injuries and the long-term loss of bone density. Appropriate medical and/or psychological referral of the athlete with menstrual irregularities may be necessary.
Gleaves, D. H., Williamson, D. A., & Fuller, R. D. (1992). Bulimia nervosa symptomatology and body image distubance associated with distance running and weight loss. British Journal of Sports Medicine, 26 (3), 157-160.
AB: To investigate the hypothesis that problems characteristic of eating disorders may often be associated with distance running, 20 women who had lost weight through distance running were compared with a control group who did not exercise and had not lost weight and a comparison group of bulimia nervosa patients. Dependent variables were measures of depression, bulimia nervosa symptomatology, and body image disturbance. No differences were found between the runner group and the normal controls. Bulimics differed from runners and controls on most measures. Thus, the results did not support the proposition that weight loss through running leads to problems related to eating and body image. The failure to find disturbances in body image in runners suggests that body image disturbances are not a direct result of weight loss, as suggested by some theorists.
Haase, A.M., Prapavessis, H. (1998). Social physique anxiety and eating attitudes: Moderating effects of body mass and gender. Psychology, Heatlh & Medicine, 3 (2), 201-210.
AB: One purpose of the study was to examine the relationship between social physique anxiety and eating attitudes in a university population. A 2nd purpose was to determine if body mass and gender served to moderate social physique anxiety-eating attitude relations. 85 university students completed the Social Physique Anxiety Scale, the Eating Attitude Test and the Marlowe-Crowne Social Desirability Scale. A Body Mass Index (BMI) was calculated from the height and weight measurements of the participant. Hierarchical multiple regression analyses showed that, after accounting for social desirability effects, social physique anxiety scores were positively related to disturbed eating attitude scores. In addition, both BMI and gender served to moderate the social physique anxiety-disturbed eating attitudes relationship. More importantly, however, these moderator variables were shown to operate interactively to influence that relationship. That is, relations between social physique anxiety and disturbed eating attitudes were maximized for females with lower BMI scores.
Haberland, C. A., Seddick, D., Marcus, R., & Bachrach, L. K. (1995). A physician survey of therapy for exercise-associated amenorrhea: A brief report. Clinical Journal of Sport Medicine, 5 (4), 246-250.
Harber, V. (1996). Female athlete triad (FAT). Fitness Informer, 13 (1), 10-12.
Hausenblas, H.A., Mack, D.E. (1999). Social physique anxiety and eating disorder correlates among female athletic and nonathletic populations. Journal of Sport Behavior, 22 (4), 502-513.
AB: Examined social physique anxiety and eating disorders among female divers. 36 elite female divers (mean age 16.33 yrs), 39 female athletes from other sports (mean age 17.35 yrs), and 39 female non-athlete controls (mean age 17.38 yrs) completed the Eating Disorder Inventory--2 (D.M. Garner, 1991) (EDI-2) and the Social Physique Anxiety Scale (E. A. Hart et al, 1989) (SPAS). Results show that divers had significantly lower SPAS scores than others. EDI-2 scores of the 3 groups were similar. Though divers participate in a sport that requires an unusual degree of physique presentation, findings suggest that divers are not at high risk for eating disorders.
Holderness,-C.-C; Brooks-Gunn,-J; Warren,-M.-P. (1994). Eating disorders and substance use: A dancing vs a nondancing population. Medicine and Science in Sports and Exercise, 26 (3), 297-302.
AB: The association between eating disorders, substance use, and emotional distress is well recognized in the literature. To determine whether dancers who are known to be at risk for eating disorders were also at risk for other emotional disorders, the co-occurrence of eating disorders, substance use, and emotional distress is well recognized in the literature. To determine whether dancers who are known to be at risk for eating disorders were also at risk for other emotional disorders, the co-occurrence of eating disorders, substance use, and emotional distress among dancers (N = 50) and nondancers (N = 56) was examined. These young adult women were part of a longitudinal study of the complications of decreased bone density. Participants filled out questionnaires about eating behavior, substance use, and emotional functioning. A clinical interview determined the existence of eating disordered eating between the two subject groups. Associations existed within each group, however. Many associations including substance use and emotional distress were found among the nondancers, while no associations were found among the dancers. Thus, eating disorders in a group of subjects at risk because of professional pressures to remain thin revealed a profile which differed significantly from that of women developing eating disorders in the general population.
Hurley, L. S., & Roncarati, A. (1997). A profile of the female athlete triad. Athletic Therapy Today, 2 (2), 14-19. URL: http://www.humankinetics.com/
Johnson,-C; Tobin,-D.-L. (1991). The diagnosis and treatment of anorexia nervosa and bulimia among athletes. Athletic Training, 26 (2), 119-120; 122-123; 125-128.
AB: Anorexia nervosa and bulimia are eating disorders that affect predominantly adolescent and young adult women. Anorexia nervosa is characterized by a relentless pursuit of thinness that is achieved through self-starvation. Bulimia involves episodes of binge-eating followed by some form of undoing behavior such as self-induced vomiting, laxative abuse, fasting, or excessive exercise. This manuscript reviews the clinical characteristics, epidemiology, and some of the current theories of etiology of eating disorders. It also presents some of our views concerning effective asessment and treatment. Throughout the review, we highlight some of the special problems associated with athletes who have eating disorders. Overall, the primary task of the authors is to inform various professionals involved with athletes about the presence of these disorders. Our hope is that this effort will heighten awareness regarding eating disorders which will, in turn, facilitate early detection and intervention.
Joy, E., Clark, N., Ireland, M. L., Martire, J., Nattiv, A., & Varechok, S. (1997). Team management of the female athlete triad. Part I: what to look for, what to ask. Physician and Sportsmedicine, 25 (3), 94-96; 101-102; 104; 107-108; 110.
AB: The female athlete triad of disordered eating, amenorrhea, and osteoporosis affects many active women and girls, especially those in sports that emphasize appearance or leanness. Because of the athlete's psychological defense mechanisms and the stigma surrounding disordered eating, physicians may need to ask targeted questions about nutrition habits when assessing a patient who has a stress fracture or amenorrhea, or during preparticipation exams. Carefully worded questions can help. Physical signs and symptoms include unexplained recurrent or stress fracture, dry hair, low body temperature, lanugo, and fatigue. Targeted lab tests to assess nutritional and hormonal status are essential in making a diagnosis that will steer treatment, as are optimal radiologic tests like dual-energy x-ray absorptiometry for assessing bone density.
Joy, E., Clark, N., Ireland, M. L., Martire, J., Nattiv, A., & Varechok, S. (1997). Team management of the female athlete triad. Part 2: optimal treatment and prevention tactics. Physician and Sportsmedicine, 25 (4), 55-57; 60; 65-69.
AB: Multidisciplinary management of the female athlete triad (disordered eating, amenorrhea, and osteoporosis) is optimal, but what exactly does it entail? With the primary care physician as the point person, the healthcare team addresses the underlying causes of disordered eating through such measures as drawing up a contract for returning to play, resolving nutrition issues, exploring psychotherapy options, and, sometimes, prescribing antidepressants. Hormone replacement therapy and conservative or orthopedic intervention for stress fractures may also be required. Communication among the members of the treatment team is crucial, and athletic trainers especially can provide valuable input. Prevention strategies need to involve education of coaches, teachers, trainers, parents, and others who work closely with female athletes.
Note: Second of two roundtable articles on the Female Athlete Triad, the former is cited above.
Katula, J.A., McAuley, E., Mihalko, S.L., Bane, S.M. (1998). Mirror, mirror on the wall . . .exercise environment influences on self-efficacy. Journal of Social Behavior & Personality, 13 (2), 319-332.
AB: Examined whether exercise environments of differing evaluative potential influence exercise self-efficacy and the degree to which physiological, social, and cognitive variables contribute to the variation in that efficacy. The authors manipulated the exercise environment by having 34 males (mean age 212.5 yrs) vs females (mean age 21.17 yrs) exercise under three conditions: (a) a standard laboratory condition, (b) in the same laboratory but in front of a full-length mirror, and (c) in an exercise location of the participant's choice. A significant interaction effect of sex and condition on exercise self-efficacy was found. Simple effects analyses indicated that women's efficacy expectations relative to exercise significantly declined in the mirror condition compared to the men. Hierarchical multiple regression analysis indicated that exercise history, gender, aerobic power, social physique anxiety, and physical self-efficacy significantly predicted exercise self-efficacy in the mirror condition but not the laboratory or natural conditions. These findings are discussed from a self-presentation and self-awareness perspective.
Katz, J. L. (1988). Eating disorders. In M. Shangold & G. Mirkin, (Eds.), Women and exercise: Pysiology and sports medicine (pp. 248-263). Philadelphia: F.A. Davis
Klock, S. C., & DeSouza, M. J. (1995). Eating disorder characteristics and psychiatric symptomatology of eumenorrheic and amenorrheic runners. International Journal of Eating Disorders, 17 (2), 161-166.
Lantz, C.D., Hardy, C.J., Ainsworth, B.E. (1997). Social physique anxiety and perceived exercise behavior. Journal of Sport Behavior, 20 (1), 83-93.
AB: Determined the relationship between social physique anxiety and exercise behavior and examined the moderating effects of gender, age and depression. 300 18-60 yr olds completed a demographic sheet as well as the Social Physique Anxiety Scale (SPAS), the Beck Depression Inventory and the Minnesota Heart Health Physical Activity Questionnaire. Results showed that the magnitude of the relationship between the SPAS and the Minnesota Heart Health Physical Activity were most significant within males with lower and higher Beck Depression Inventory scores. A significant negative relationship between the SPAS and the Minnesota Heart Health Physical Activity scores were found. Exercise behavior was best predicted by the SPAS scores, gender age and depression. Therefore, it appeared that social physique anxiety was negatively related to exercise behavior and that both the magnitude and form of this relationship were moderated by gender, age and depression.
Lenskyj, H. J. (1993). Running risks: compulsive exercise and eating disorders. In C. Brown & K. Jasper (Eds.), Consuming passions: Feminist approaches to weight preoccupation and eating disorders (pp. 91-108). Toronto: Second Story Press.
Lox, C.L., Osborn, M.C., Pellett, T. (1998). Body image and affective experiences of subjectively underweight females: Implications for exercise behavior. Journal of Applied Biobehavioral Research, 3 (2), 110-118.
AB: Studied whether subjectively underweight college-aged females reported similar psychological and emotional states as women who perceived themselves as being overweight. 28 females (18-27 yrs. old) were assessed via a questionnaire consisting of measures of social physique anxiety, body dissatisfaction, depression proneness, and self-esteem. Ss reported low to moderate degrees of social physique anxiety, body dissatisfaction, depression proneness, and self-esteem. Additionally, higher feelings of physique anxiety were modestly associated with lower levels of self-esteem and higher levels of body dissatisfaction and depression. Results indicate that women who perceived themselves as being too thin experienced similar psychosocial issues as women who perceived themselves as being overweight in previous studies. Implications for exercise behavior are discussed.
Martin, J.J. (1999). Predictors of social physique anxiety in adolescent swimmers with physical disabilities. Adapted Physical Activity Quarterly, 16 (1), 75-85.
AB: Examined predictors of social physique anxiety (SPA) in adolescent swimmers with physical disabilities. Participants were 57 swimmers (27 females, 30 males, aged 16-19) with various physical disabilities representing their countries (England, Ireland, Scotland, US, and Wales) in an international swimming competition. A three-way ANOVA revealed significant differences in SPA between countries and among disabilities but not gender. Stepwise multiple regression results indicated that self-esteem and the self-identity subscale of the Athletic Identity Measurement Scale (AIMS) were the best predictors of SPA but that gender, country, and type of disability were not significant.
Nattiv, A., Puffer, J. C., & Green, G. A. (1997). Lifestyles and health risks of collegiate athletes: A multi-center study. Clinical Journal of Sport Medicine, 7 (4), 262-272.
O'Connor, P. J., Lewis, R. D;., Kirchner, E. M. (1995). Eating disorder symptoms in female college gymnasts. Medicine and Science in Sports and Exercise, 24 (4), 550-555.
AB: In study 1, 21 females provided both honest and dishonest answers to the Eating Disorders Inventory-2 (EDI-2). It was found that the EDI-2 can be easily faked. The fake profile was used to screen subjects in a second study, in which 25 gymnasts and 25 matched controls were assessed on symptoms of eating disorders, energy intake, menstrual history, and bone mineral density (BMD). A Hotelling's T2 test (Wilks' lambda = 0.70) revealed that the gymnast and control groups did not differ significantly on the EDI-2 subscales; however, both groups exhibited scores on the Drive For Thinness (DFT) subscale of the EDI-2 that were higher than the published average for college women. More gymnasts (61 percent) than controls (24 percent) reported an absence of their menstrual cycle of 3 months or more. A higher percentage (8/11, 73 percent; X2 = 4.7, P is less than 0.05) of the subgroup with elevated DFT scores (i.e., is greater than 14) reported having this disruption of their menstrual cycle compared with those with lower DFT scores (13/33, 39 percent). DFT scores were negatively related to energy intake (r = -0.48) and whole body BMD (r = -0.47). It is concluded that (a) DFT scores may be useful in identifying gymnasts at risk for problems associated with eating disorders, and (b) response distortion must be considered in future research using the EDI-2.
Otis, C., Drinkwater, B., Johnson, M., Loucks, A., & Wilmore, J. (1997). The female athlete triad. Medicine & Science in Sports & Exercise, 29 (5).
AB: The "female athlete triad" is a syndrome occurring in physically active girls and women. Its interrelated components are disordered eating, amenorrhea, and osteoporosis. Pressure placed on young women to achieve or maintain unrealistically low body weight underlies development of the triad. Adolescents and women training in sports in which low body weight is emphasized for athletic activity or appearance are at greatest risk. Girls and women with one component of the triad should be screened for the others. Alone or in combination, female athlete triad disorders can decrease physical performance and cause morbidity and mortality. Based on the existing evidence of the magnitude and seriousness of the problems associated with the female athlete triad, the American College of Sports Medicine strongly advises that specific strategies be developed to prevent, recognize, and treat this syndrome.
Perry, A. C., Crane, L. S., Applegate, B., Marquez-Sterling, S., Signorile, J. F., & Miller, P. C. (1996). Nutrient intake and psychological and physiological assessment in eumenorrheic and amenorrheic female athletes: A preliminary study. International Journal of Sport Nutrition, 6 (1), 3-13.
AB: The present study showed that amenorrheic athletes (AAs) scored higher on the Eating Attitudes Test (EAT) than eumenorrheic athletes (EAs), indicating more aberrant eating patterns in the first group. Scores on the EAT were inversely correlated with fat intake, simple carbohydrate intake, and percentage saturation of iron and were positively correlated with total iron binding capacity for the total sample. Physiological assessment of athletes revealed that there were no significant differences between groups in serum lipoproteins, with both EAs and AAs having serum lipid profiles indicative of low cardiovascular risk. Furthermore, low-density lipoprotein cholesterol was the only lipoprotein significantly and positively correlated with serum estradiol levels for the entire sample. The present study was in agreement with previous work showing that scores on the EAT represent a primary difference between EAs and AAs; the present study was somewhat different than previous work in that serum lipoproteins were not significantly related to menstrual status. URL: http://www.humankinetics.com/
Putukian, M. (1995). Female athlete triad. Sports Medicine and Arthroscopy Review, 3 (4), 295-307.
AB: Menstrual dysfunction is very common in female athletes, with close to 40-60 percent of freshman college athletes giving a history of menstrual irregularity. Pathogenic eating behavior is also very common in female athletes, and these numbers appear to be on the rise. Both of these disturbances have established morbidity, and eating disorders have a mortality rate as high as 18 percent. Both anorexia and amenorrhea have also been associated with decreased bone mineral density. For the young athlete, low bone mineral density may put them at increased risk for stress fractures. There may also be a long-term risk for premature osteoporosis. Disordered eating, menstrual dysfunction, and osteoporosis have become known together as the "female athlete triad." This discussion will discuss these clinical entities, and methods to recognize and treat them. If these abnormalities are sought out and education is provided to the young female athlete, the hope is that these entities can be detected early on and the complications of the triad can be prevented.
Scott, D. (1996). Is something missing? A proper diet can help combat amenorrhea. Running Times, 233, 14; 16.
Schwerin, M.J., Corcoran, K.J., LaFleur, B.J., Fisher, L., Patterson, D., Olrich, T. (1997). Psychological predictors of anabolic steroid use: An exploratory study. Journal of Child & Adolescent Substance Abuse, 6 (2), 57-68.
AB: Examined social physique anxiety, upper body esteem, social anxiety, and body dissatisfaction as possible predictors of anabolic steroid (AS) use. Data were collected from 185 AS-using bodybuilders, non-using bodybuilders, athletically active exercisers, and non-exercising individuals (all Ss aged 17-49 yrs). Results indicate that the Upper Body Strength subscale of the Body Esteem Scale, the Body Dissatisfaction Index of the Eating Disorder Inventory, and age were the most significant predictors of AS use in this population. As each of these variables increase (i.e., upper body strength esteem, body dissatisfaction, and age), the probability of being an AS user increases. Results suggest the importance of psychosocial factors in understanding anabolic steroid use; further discussion involves the necessity of considering multiple reinforcers in predicting behavior.
Sokol, M.S., Gray, N.S., Heffernan, K., Troop, N., Polivy, J., McFarlane, T.L., Eklund, R.C., Rosen, J.C., Cash, T.F., Pruzinsky, T., Wing, R.R., Rohsenow, D.J., Baraona, E., McCaul, M.E., Hall, S., Husten, C.G. (1998). Body image and substance use. In E.A. Blechman, K.D. Brownell, et al. (Eds.), Behavioral medicine and women: A comprehensive handbook (pp. 350-430). New York, NY: The Guilford Press.
Sundgot-Borgen, J. (1994). Risk and trigger factors for the development of eating disorders in female elite athletes. Medicine and Science in Sports and Exercise, 26 (4), 414-419.
AB: This study examined risk factors and triggers for eating disorders in female athletes. Subjects included were all of the elite female athletes in Norway (N=603), ages 12-35 yrs, representing six groups of sports: technical, endurance, aesthetic, weight dependent, ball games, and power sports. The Eating Disorder Inventory was used to classify individuals at risk for eating disorders. Of the 117 athletes defined as at risk, 103 were administered a structured clinical interview for eating disorders. A comparison group was also interviewed, consisting of 30 athletes chosen at random from a pool not at risk and matched to the at-risk subjects on age, community of residence, and sport. Ninety-two of the at-risk athletes met criteria for anorexia nervosa, bulimia nervosa, or anorexia athletica. The prevalence of eating disorders was higher in sports emphasizing leanness or a specific weight than in sports where these are less important. Compared with controls, eating disordered athletes began both sports-specific training and dieting earlier, and felt that puberty occurred too early for optimal performance. Trigger factors associated with the onset of eating disorders were prolonged periods of dieting, frequent weight fluctuations, a sudden increase in training volume, and traumatic events such as injury or loss of a coach.
Talbott, S. (1996). The female athlete triad - not just for athletes. Strength and Conditioning, 18 (2), 12-16.
Task Force on USA gymnastics response to the female athlete triad. (1995, October/November). Technique, 15 (9), 18-20.
Taub, D.E., Blinde, E.M. (1992). Eating disorders among adolescent female athletes: influence of athletic participation and sport team membership. Adolescence, 27 (Winter), 833-848.
Thornton, B., Maurice, J.K. Physical attractiveness contrast effect and the moderating influence of self-consciousness. Sex Roles, 40 (5-6), 379-392.
AB: While previous research has considered public self-consciousness as a consequence of a contrast effect resulting from comparisons with more attractive others (B. Thornton and S. Moore, 1993), the present study examined its potential role in moderating the impact of an attractiveness contrast effect in the 1st place. Specifically, it was predicted that individuals with a greater predisposition toward public self-consciousness should be more responsive to a physical attractiveness contrast effect than those not so predisposed. Two separate studies with 195 female college students provided evidence of a moderating effect of public self-consciousness (trait) and public self-awareness (state) on the physical attractiveness contrast effect involving social comparison between the self and others. Generally, when exposed to photographs of attractive women with idealized physiques, women's self-perceptions of their own physical attractiveness, social physique anxiety, and social self-esteem were each negatively affected. However, these negative contrast effects were most apparent among women with high public self-consciousness (trait assessment, Study 1) or high public self-awareness (state inducement, Study 2).
Thorton, B., Maurice, J. (1997). Physique contrast effect: Adverse impact of idealized body images for women. Sex Roles, 40 (5-6), 433-439.
AB: Adherence to an attractiveness ideal was considered as a possible mediator of a physique contrast effect among 176 females (aged 17-28 yrs). Following exposure to photographs of models typifying idealized thin physiques, Ss answered several questionnaires including the Social Physique Anxiety Scale (E. A. Hart et al, 1989) and the Eating Disorder Inventory (D. M. Garner et al, 1983). Ss displayed decreased self-esteem and increased self-consciousness, social physique anxiety, and body dissatisfaction. Although Ss with low adherence to an attractiveness ideal seemed to be advantaged by having greater self-esteem, less self-consciousness, and lower physique anxiety or dissatisfaction than their high adherence counterparts, these Ss did not display any unique resistance to the contrast effect. High affirmation of an attractiveness ideal was associated with exceptionally high potential for disordered eating. Eating disorder potential did not show influence of the contrast effect, but long-term implications were considered.
Van De Loo, D. A., & Johnson, M. D. (1995). The young female athlete. Clinics in Sports Medicine, 14 (3), 687-707.
AB: This article reviews growth, development, and training response in the young female athlete. The female athlete triad of disordered eating, amenorrhea, and osteoporosis as it relates to the adolescent is discussed. Specific medical and psychological concerns in the adolescent population are summarized, and special considerations for preparticipation examinations are outlined.
Yeager, K., Agostini, R., Nattiv, A., & Drinkwater, B. (1993). The female athlete triad: Disordered eating, amenorrhea, osteoporosis. Medicine & Science in Sports & Exercise, 25 (7), 775-777.
AB: A constant focus on achieving or maintaining a prescribed weight goal may put the female athlete at risk for developing a disordered pattern of eating. This in turn may put the athlete at an increased risk of developing 2 associated disorders, amenorrhea and osteoporosis. Alone each disorder is worrisome and can yield considerable disability, but in combination the triad disorders are potentially fatal.