Thrive into the Weekend (2.28.14)

[Thrive into the Weekend: A blog series designed to empower athletes to thrive in life and sport by encouraging intentional action]

By Kate Bennett, PsyD

In honor of Eating Disorder Awareness Week, practice expressing gratitude for your body. It is easy to judge, compare, and criticize; however, these thought processes inevitably lead to body dissatisfaction. Acceptance and positive body image begin with gratitude. Identify three things about your body that you are grateful for this weekend. Are you grateful for your strong legs that allow you to pedal your bike? Does your smile light up a room? Perhaps you are grateful for your hands that allow you to write, draw, hold, and touch. Thrive into the Weekend with body gratitude.

Image courtesy of

Image courtesy of

Discerning Between Athletic Pursuit and Eating Disorders

By Kate Bennett, PsyD

NEDAwareness Part 2: Athletes and Eating Disorders

On more than one occasion, athletes joked with me that “in order to be a good athlete you almost have to have an eating disorder.” While I understand where the statement comes from, I completely disagree: To be the best athlete you can be, you need to be physically and psychologically sound. Health and eating disorders are not synonymous, nor are eating disorders and peak performance. The very nature of eating disorders inevitably interferes with performance by negatively impacting overall health. When limiting the impact of eating disorders to performance, they have been known to decrease VO2 max and endurance, increase levels of fatigue, interfere with recovery, lead to injuries, and impair concentration during workouts and performances. Not to mention the negative impact on physical and psychological health.

Countless studies examined the variability of eating disorders among athletes and non-athletes. The research is inconclusive in terms of clearly demonstrating a higher occurrence within one population. However, it is clear that athletes face more risk factors related to the development of eating disorders then non-athletes. Sport culture in and of itself is a breeding ground for disordered eating behaviors. Hence my understanding of the “joke” I started with.

As a specialist in the treatment of athletes with eating disorders, I recognize that many athletes engage in disordered eating behaviors. I accept that disordered eating behaviors exist in sport in order to gain competitive edges and fine-tune bodies. I also understand the difference between goal-driven athletic pursuit and disordered eating behaviors gone too far. I specialize in detecting the nuances between “I am an athlete” and “you have an eating disorder.”

Rather than further promote disordered eating in sport by normalizing certain behaviors, let’s focus on what concerns me as a psychologist.

“Bonking”: Bonking is a term familiar to endurance athletes. It occurs when your body runs out of glycogen (fuel) in the middle of a workout and you do not have food on hand to refuel immediately. The outcome is that you find yourself fixating on the nearest gas station and what you will buy in order to fuel your body and return home. No athlete chooses to bonk as the period between recognizing hunger and the opportunity to refuel is dreadfully long and slow.

Translate that into eating disorder language: Athletes who find themselves constantly preoccupied by what they are going to eat, what they cannot eat, when they will eat, and what they just ate are likely in starvation mode. Human bodies are hard-wired to survive. When they do not get the fuel they need, they become preoccupied by meeting the most primitive and basic need they have: Food.

Preoccupation with Body Image: Typically, diets gone wrong in athletes begin with manipulating weight to improve performance. Focusing on weight, restricting intake, and exercising more to impact outward appearance versus working towards specific performance goals is a telltale sign of athletic pursuit gone too far.

Intention of Exercise: Clearly, working out and physical training is an essential component of developing athletic potential. However, increasing training loads without clear goals, exercising secretively, and adding workouts to negate caloric consumption are definitely causes for concern.

Lack of Fulfillment: Athletes engage in sport because they derive inherent satisfaction from it. Certainly, there are days and seasons when training is arduous; however, the gratification from participating in sport outweighs those periods. Lacking passion, joy, and fulfillment is concerning. Furthermore, feeling obligated, rigid, and obsessive about workouts may signal athletics gone wrong.

At the end of the day, I accept sport culture for what it is and navigate my clinical work to respect the culture. However, disordered eating behaviors are always cause for concern because they may result in serious physical and psychological health consequences. Take a step back and ask yourself whether you or someone you know may be struggling. If so, reach out for help. With recovery comes freedom, joy, and passion.


Eating Disorder 101: Understanding the Different Diagnoses

By Kate Bennett, PsyD

Since specializing in the treatment of athletes and eating disorders, I find myself constantly trying to balance time and energy between two different worlds. In my mind, athletes and eating disorder recovery seamlessly merge together; however,  athletic and mental health professionals rarely intersect on their own. In support of Eating Disorder Awareness Week, I wrote a two-part blog to bridge the gap between the populations. My goal is to educate the sport culture on eating disorder prevention and treatment while also informing mental health professionals about athletics.

Part One: Creating a basic understanding of the different types of eating disorders.

Anorexia Nervosa (AN): This is a term most people are familiar with. AN is a clinical diagnosis associated with malnutrition, distorted body image, preoccupation with weight, size, and shape, and a pathological fear of weight gain. In women, it is also associated with amenorrhea (absence of menstruation). Anorexia Athletica is a term that is occasionally referenced. While not a formal diagnosis, it refers to a subclinical form of AN found among athletes.

A common misconception is that the illness is only associated with restricting food intake; however, there is a subtype of AN that includes compensatory behaviors such as purging food through vomiting or exercise.  Another misconception is that people struggling with AN are always noticeably underweight. While this is included in the diagnostic criteria, bodies come in all shapes and sizes. Therefore, people may restrict their intake and struggle significantly with food and weight preoccupation but do not “look the part.” This is known as Atypical Anorexia Nervosa. Despite not being obviously underweight to the naked eye, it does not mean the illness is any less severe. AN is the number one psychiatric killer among mental illnesses.

Bulimia Nervosa (BN): Another familiar term to some, BN is associated with bingeing and purging behaviors. Bingeing refers to an objective evaluation of eating significantly more than most people would in a sitting and is associated with feeling out of control when eating. Purging comes in many forms including vomiting, exercising, abusing over-the-counter medications such as laxatives, and abusing insulin (diabulimia). BN is not an effective means for weight loss and individuals struggling with this illness often appear “healthy” despite engaging in life-threatening behaviors to manage body image, size, and shape.

Binge Eating Disorder (BED): The newest classification of clinical eating disorders, BED is associated with binge eating in the absence of compensatory (purging) behaviors. Feelings associated with bingeing include guilt, shame, embarrassment, and disgust.

Other Specified Feeding or Eating Disorder (OSFED): This diagnostic category creates room for subclinical diagnoses (people struggling with one of the above illnesses but do not meet full diagnostic criteria) as well as Atypical Anorexia Nervosa (anorexic features without low weight), Purging Disorder (compensatory behaviors in the absence of bingeing), and Night Eating Syndrome (irregularities in the sleep-wake cycle that lead to restricted food intake during the day and significant caloric consumption during the evening and/or waking up in the middle of the night to eat).

Unspecified Feeding or Eating Disorder (UFED): Reserved for individuals struggling with disordered eating features that do not fit into any of the above categories.

The most important thing to recognize and accept is that eating disorders are not really about the food. Certainly, the illness is expressed in terms of food manipulation; however, the illness itself is a means to manage underlying thoughts, emotions, and experiences that create significant distress. Manipulation of food is a means to numb, restrict, and/or avoid underlying discomfort. Interrupting the eating disorder (normalizing meals and the relationship with food) coincides with facing the underlying issues. Therefore, people struggle to simply eat food or stop purging because they are now facing not only anxiety related to the food itself but also learning to manage everything that the illness suppressed. Recovery from an eating disorder not only takes willingness to establish a healthy relationship with food and one's body but also relies heavily on courage to talk about the hard things.


Check back on Wednesday for Part Two of this blog post, which will discuss the frequency of disordered eating behaviors among athletes and the distinction between athletic pursuit and clinical eating disorders.