**Treatment Strategies for Eating Disorders in Collegiate Athletics**

Kendra Ogletree-Cusaac and Toni M. Torres-McGehee *University of South Carolina, Columbia, SC United States* 

## **1. Introduction**

36 New Insights into the Prevention and Treatment of Bulimia Nervosa

blood sugar levels. This may disrupt the appetite control mechanisms and the utilisation and deposition of energy. Serotonin is implicated in appetite regulation (there may be a particular role in carbohydrate balance); disruptions in serotonin levels may be affected by the impact of insulin on its precursor, tryptophan, and in turn acute tryptophan depletion may lead to an increase in calorie intake and irritability in bulimia nervosa and may be related to decreased mood, increased rating in body image concern and subjective loss of control of eating in people who have recovered from bulimia nervosa (National

Bulimia nervosa is a common health problem in young people, has been reported worldwide both in developed regions and emerging economies, and its prevalence is arising. It can lead to serious medical complications. However, studies from the US and continental Europe suggest that only a fraction of people with bulimia receive specialised treatment for their eating disorder. The alimentary canal is the front line for the eating disorder patient. Therefore, the expression of the disease in the gastrointestinal tract may have a critical role in early diagnosis and management of the disease. New treatment strategies are now available, and evidence-based management of this disorder is possible. A specific form of cognitive behaviour therapy is the most effective treatment, although few

American Psychiatric Association. (1994). *Diagnostic and statistical manual of mental disorders*

Anderson L, Shaw JM, McCargar L. (1997). Physiological effects of bulimia nervosa on the

World Health Orgaganization. (1992). *International statistical classification of diseases and related health problems (ICD-10)*. ISBN 92-4-1546492, Geneva, Switzerland. Treasure J, Claudino AM, Zucker N. (2010). Eating disorders. *Lancet*, Vol.375, (February

Fairburn CG, Harrison PJ. (2003). Eating disorders. *Lancet,* Vol.361, (February 2003), pp. 407-

National Collaborating Centre for Mental Health. (2004) National Clinical Practice

Guideline: eating disorders: core interventions in the treatment and management of anorexia nervosa, bulimia nervosa, and related eating disorders. National Institute

gastrointestinal tract. *Can J Gastroenterol*, Vol.11, No.5, (July-August 1997), pp. 451-

*(4th edn)*, ISBN 0-89042-062-9, Washington, USA.

for Clinical Excellence. Available from 27.10.2009 at http://www.nice.org.uk/search/guidancesearchresults.

Collaborating Centre for Mental Health, 2004).

patients seem to receive it in practice.

9, ISSN 0835-7900.

16, ISSN 0140-6736.

2010), pp. 583-93, ISSN 0140-6736.

**7. Conclusions** 

**8. References** 

Eating disorders such as Anorexia Nervosa, Bulimia Nervosa, not otherwise specified eating disorders, and binge eating disorder are on the rise in collegiate athletes and aesthetic dancers (Greenleaf, Petrie, Carter, & Reel, 2009; Johnson, Powers, & Dick, 1999; Torres-McGehee et al., 2009; Torres-McGehee, Monsma, Gay, Minton, & Mady, In Press). Due to the nature of specific sports and pressures of sport participation, eating disorder symptoms and etiology in athletes are slightly different than their non-athletic counterparts. Therefore, it is critical that treatment for eating disorders is unique to athletes. Preferably, the treatment of the athlete should be multi-dimensional (e.g., psychosocial interventions, nutritional management, and pharmacological interventions when necessary).

Treatment of Anorexia Nervosa in the early 1900s was considered a biologically based disease resulting from hormonal insufficiencies; therefore, treatment focused on correcting hormonal imbalances such as pituitary extract, insulin, estrogen, thyroid extract, and corticosteroids (Brumberg, 1998; Parry-Jones, 1985). Incorporation of psychotherapy was integrated as part of treatment in the 1930s. Bulimia on the other hand was not defined as a specific eating disorder until the late 1970s (Russel, 1979); and treatment then was primarily centered around eliminating patient's hungry appetites by imposing strict diets and prescribing medicines that were supposed to warm the stomach creating a sensation of being full. Additionally, individuals who have clinical eating disorders, like Bulimia, characteristically have low mood and higher-than-average levels of depressive symptoms, and are at greater risk of clinical depression (Fairburn et al., 1999; Fisher et al., 1995; Palmer, 1998; Muscat & Long, 2008). It was theorized by Koenig and Wasserman (1995) that the high rates of co-morbidity found between eating disorders and depression may, in part, be caused by common features such as negative self-evaluation and general dissatisfaction with one's physical appearance (Muscat & Long, 2008). It is plausible that precursors to binge-eating which is the disordered eating behavior that can lead to Bulimia appear to be depression symptoms and low self-esteem. Therefore, psychologists integrate strategies to alleviate depressed mood that is often plagued with Bulimia Nervosa (Gleaves., 2000).

Current treatments focus on both the underlying psychopathologies and the obvious behaviors using protocols including: individual, family, and group psychotherapy; nutritional counseling; medications; exercise therapy, and experiential therapies (e.g., art, music, movement). This chapter will examine current treatment and prognosis strategies for comorbid conditions among collegiate athletes. The goal of this chapter is to provide

Treatment Strategies for Eating Disorders in Collegiate Athletics 39

sociological and psychological issues related to disordered eating in the general population, athletes experience issues such as evaluation criteria, sport-specific weight restrictions, peer comparison, peer and coach pressure, and athletic performance demands (Moore et al., 2007). Also due to sport pressures, athletes are probably less likely to personally seek treatment for Bulimia Nervosa. If athletes are slow to seek treatment, that extends the

The collegiate student athlete experiences life transitional issues similar to other college students, such as independence, responsibility, coping strategies, and building new relationships. In addition to these experiences, collegiate student athletes have transitional issues related to their sport, such as adjusting to a new team structure (i.e., coaches, teammates, trainers, etc.), balancing sport and academics, and the pressures of being a student-athlete (i.e., peers, expectations, media). The practitioner needs to be thoroughly knowledgeable about the complexities of eating disorders in athletes, for example, knowing the physical warning signs, general psychosocial functioning, emotion regulation, parental and coaching pressures, weight restrictions for competition, perceptions about body size and shape, perceived environmental control, self-worth, and any other factors that may place an athlete at risk for developing an eating disorder (Moore et al., 2007). Thus, interventions developed for athletes need to address general and sport-specific factors regarding the presence of Bulimia and disordered eating behaviors (Smith & Petrie, 2008).

The cognitive-behavioral theory for treatment of eating disorders such as Bulimia Nervosa, stresses that central to the maintenance of Bulimia is clients' dysfunctional scheme for selfevaluation. This self-evaluation is largely or even exclusively, in terms of their shape and weight and their ability to control them (Fairburn & Cooper, 2010). Cognitive behavioral theory can also be used to identify dysfunctional thought patterns (e.g., "I am a bad person") that trigger eating disordered behaviors (Stien et al., 2001), and reestablishing those thought patterns to reduce behaviors. This dysfunction is observed throughout all facets of their life, including dietary intake and restraint, perceived body image, and methods related to weight control. If the dysfunctional scheme is central to the maintenance of bulimic symptoms and is considered the core psychopathology, this criterion is especially problematic when working with collegiate student athletes. Collegiate student athletes with Bulimia Nervosa or disordered eating symptoms potentially experience the dysfunctional scheme for self-evaluation significantly differently from their nonathlete peers. They tend to internalize the pressures of their sport and physical appearance and it is not clear that their self-evaluation regarding their athletic potential as related to their physical appearance is

Another essential feature of Bulimia Nervosa is binge eating episodes. The cognitivebehavioral theory proposes that binge eating is largely a product of the clients' distinctive form of dietary restraint, which then maintains the core psychopathology by intensifying concerns about their ability to control their eating and weight (Cooper & Fairburn, 2010). Athletes are trained to pay attention to their dietary intake particularly as it relates to the interaction of their physique and athletic performance. It is inherently expected that athletes exhibit some form of dietary restraint which can inadvertently lead to the disordered eating cycle of dietary slips and binges. Purging and compensatory behaviors could be viewed as shortcuts to those slips and binges. However, they do not realize that vomiting, for example, only retrieves part of what has been eaten and that laxative misuse has little or no effect on

potential success of intervention applied for treatment.

**2.2 Cognitive behavioral theory** 

always considered dysfunctional.

clinicians/professionals with a deeper understanding of current treatments strategies tailored to collegiate athletes. It should be emphasized that this approach is a team approach that integrates a multi-dimensional approach by the dietitian, physician, athletic trainer, psychologist, coach and other health professionals as needed.
