Conceptualising, assessing, and treating disordered eating in athletes

Abstract

Elite athletes are typically at elevated risk for disordered eating, including clinical eating disorders, which in turn is associated with a myriad of negative health and performance outcomes. In attempts to reduce these negative outcomes, several strides have been made over the past few decades in our scientific understanding of disordered eating in elite athletes. Much of this research conducted to date has been grounded in the broader evidence-base for eating disorders in the general population. Whilst this may be an economical approach, elite athletes face many unique experiences regarding their eating, physical activity, body composition, and appearance, raising doubts about whether this broader evidence-base can be directly translated to this specific population. Specifically, the identification and integration of athlete-specific factors may improve our understanding of the conceptualisation, assessment, aetiological understanding, and, therefore, the accuracy and effectiveness of interventions for disordered eating in elite athletes – as was the aim of this doctoral thesis. The findings highlighted the high prevalence of disordered eating in elite athletes, across demographic characteristics (e.g., gender, sport type), which was associated with missing more days from training/competition due to injury over time. The ADE was supported as a psychometrically valid measure of disordered eating in this population. The reviews identified multiple risk factors for disordered eating in elite athletes, including athletes-specific factors and broader societal factors. Whilst a number of these factors were cross-sectionally associated with disordered eating in the ASPIRE baseline sample, only weight pressures in sport and drive for leanness for performance predicted increased disordered eating among athletes over time. These findings emphasise the scope of disordered eating in elite athletes, beyond only those who meet criteria for an eating disorder. Theoretical implications include the identification of athlete-specific risk factors and proposal of a new aetiological model of disordered eating in elite athletes, providing avenues for future research. Practical implications include guidance for athletes, training staff, sports organisations, and international regulating bodies regarding primary (e.g., reducing risk factors and preventative interventions), secondary (e.g., screening and early intervention), and tertiary (e.g., athlete-specific treatments) intervention.

Date of Thesis submission	2025
Original language	English
Awarding Institution	Western Sydney University
Supervisor	Deborah Mitchison (Supervisor), Phillipa Hay (Supervisor) & Emma George (Supervisor)