Background: Eating disorders are a complex and multifaceted illness, requiring professionals to be especially attuned when it occurs within the sport environment. Although several theoretical frameworks and approaches have been shown to be effective when treating athletes, providers need to be particularly sensitive and responsive to some frequent challenges that athletes are likely to encounter throughout eating disorder treatment. Common themes that often emerge when treating athletes with eating disorders in both outpatient and intensive treatment levels of care will be discussed as will suggested corresponding clinical interventions.
Objectives: Following this presentation, participants will be able to:
- Learn about commonalities that athletes with eating disorders often experience during treatment.
- Anticipate and respond to specific challenges that both athletes and providers are likely to encounter across levels of care.
- Learn about specific treatment targets and interventions to support and facilitate an athlete’s eating disorder treatment.
- Eating Disorder = Injury
- Difficulties Similar to Physically Injured Athletes
- Grieving the temporary (or permanent) loss of sport
- Limited interaction with teammates
- Patience and time needed for healing
- ED = tendinitis of physical injuries
- Uncertainty about regaining prior level of performance
- Eating Disorder = Injury
- Sport Performance Concerns Due To:
- Decreased training volume/intensity
- Changes in body weight/composition
- Modification of food intake
- Eating Disorder = Injury
- Clinical Interventions
- Facilitate mourning process (Lynch, 1988; Rotella, 1995)
- Identify (and utilize) helpful support
- Sport family
- Friends/family
- Athlete ED support group
- Perfectionism
- Inability to:
- Rest in strengths or attributes
- Acknowledge efforts
- Celebrate accomplishments
- Where is the end point?
- Fear driven
- Absence of self-compassion
- Perfectionism
- Clinical Interventions
- Target fear that is driving perfectionism
- Exposure to intolerable emotions/situations
- Socratic questioning
- Foster greater tolerance of perceived failures
- Develop self-compassion
- Strengths-based approach
- Over Identification w/ Sport/ED
Being vs. doing
- Identity often comprised from accomplishments
- Athlete identity vs. additional identities
- Problems w/ ED/sport as primary source of identity
- Over Identification w/ Sport/ED
- Clinical Interventions
- Understand role of sport in individual’s life
- Sensitivity to disruptions in sport participation, school, and/or sport performance due to ED
- Utilize athlete-patient’s athlete identity to support adherence to treatment targets
- Meal plan/training compliance
- Facilitate expansion of identity and self-worth
- Confidence
- Erosion of confidence
- Over-confident
-
- Clinical Interventions
- Preparation (treatment/time)
- Goal: independence and autonomy
- Pursue opportunities that foster confidence
- Reflect growth/change
- Develop a healthy amount of fear....of a relapse
- Body Image Distress
- Intertwined with mood disturbances/behaviors
- Contextual (de Bruin et al., 2011)
- Vulnerability and uncertainty
- Comparisons
- Body dissatisfaction = ED symptomatology (Brannan et al., 2009)
- Body Image Distress
-
Rigid eating patterns and exercise behaviors perceived to alleviate distress
- Time-limited
- Tolerance developed over time
- When deviations from food/exercise occur:
- Increase in anxiety
- Heightened body image distress and perseveration of body
- Compensatory behaviors
- Self-destructive behaviors
- Body Image Distress
- Fluid, changes throughout treatment
- Clinical Interventions
Cognitive dissonance and mindful self-compassion (Petrie & Greenleaf, 2012;
- Cognitive dissonance (Stice, Shaw, Becker, & Rohde, 2008)
- Mindful self-compassion (Kabat-Zinn, 2003; Neff, 2003)
Riley Nickols, is a counseling and sport psychologist and the Director of the Victory Program at McCallum Place, the nation’s only residential eating disorder treatment facility specifically for athletes. Dr. Nickols obtained an MS in Sport Psychology from Ithaca College and a PhD in Counseling Psychology from Fordham University. He regularly speaks to athletes, coaches, and sports medicine personnel about issues related to disordered eating and unbalanced exercise in sport. Additionally, Dr. Nickols consults with eating disorder professionals on best practices for integrating exercise during treatment. Dr. Nickols maintains a private practice in St. Louis, MO where he primarily works with athletes addressing both clinical and performance concerns. He is sensitive to the unique demands of recovery in relation to training and competing in sport. In addition to competing in endurance sports for over 15 years, Dr. Nickols is a running coach and a USA Triathlon coach.
