Anorexia Athletica – When Sports and Starvation Become Addictions

07. July 2022

The disorder anorexia nervosa (so-called anorexia) is now well known, but what is behind the term anorexia athletica? Those affected by anorexia athletica also exhibit disturbed eating behavior, but primarily pursue the goal of achieving top athletic performance through severe weight reduction. Unfortunately, due to the malnutrition and the emaciated body, the opposite usually occurs and the athletes often endanger their entire career.

Important: The number of people affected varies greatly between 8 and 62 percent depending on the sport. Young women between the ages of 15 and 25 are particularly frequently affected.

At what point does sport become an addiction?

Sports are healthy – aren’t they? Every magazine, every guidebook and every TV commercial propagates that exercise not only keeps us physically fit, but also mentally fit. But where is the point between a healthy amount of sports and too much sports? Basically, we speak of a sports addiction when excessive sporting activity is linked to the following accompanying symptoms:

Withdrawal symptoms: As soon as the person concerned is not active in sports, physical and psychological symptoms such as nervousness, feelings of guilt, sleep disorders or depression occur.

Compulsivity: The person affected does not feel the need to exercise out of positive emotions, such as the joy of exercise or experiencing nature, but feels a strong inner compulsion.

Development of tolerance: Over time, sports addicts need more and more intense training sessions to achieve the state of satisfaction.

Loss of control: The addiction to sports is experienced as externally controlled. Despite the desire to limit sports, attempts to do so are unsuccessful.

Neglect of social activities: Due to the fact that sports is the main focus, social contacts and other activities lose importance.

Ignorance of negative effects: Despite serious physical or psychological problems caused by the addiction, it is maintained.

Sweating and starving – A dangerous combination

Very often, sports addiction occurs together with an eating disorder such as anorexia. Alternatively, it can be a concomitant of the eating disorder or develop first through the compulsive perfection of the body – in this case we speak of so-called anorexia athletica. Since the full picture of a classic eating disorder is often not or not yet present, it is not a separate medically recognized diagnosis, but without a doubt a serious and increasingly common problem. Some criteria of anorexia athletica are:

  • Weight loss of more than five percent below normal weight according to BMI
  • No organic disease is the cause of the weight loss
  • Body schema disorder
  • Severe fear of weight gain
  • Food restriction < 1200 kcal/day
  • Laxative behavior
  • Compulsive physical activity
  • Binge eating

The occurrence of anorexia athletica and thus the combination of a sports addiction and eating disorder is also so common precisely because their causes are similar. The escape into compulsive calorie counting, the preoccupation with the body and its performance are used to escape problems. In both diseases there is the hope to increase social recognition and thus a low self-esteem. Likewise, a strong need for control and low conflict ability are usually present. Both food regulation and success in sports become measures of one’s feelings. Failures can trigger inferiority complexes, depression or even self-hatred in both eating disorders and sports addiction.

But what distinguishes anorexia athletica from “classic” anorexia?

As mentioned earlier, the boundaries are fluid. Anorexia athletica includes many criteria that also apply to those affected by anorexia, but it places the goal of improved athletic performance and recognition in the foreground. Classic anorexia is primarily about weight loss, which is usually sought through unresolved conflicts and a lack of autonomy. Those affected by anorexia atheletica also often have a more realistic attitude towards their body shape. In this case, the symptoms may also be associated only with periods of competition and disappear again after the end of the athletic career.

Health consequences of anorexia athletica

Unfortunately, the combination of an eating disorder and sports addiction is particularly dangerous. The health consequences are also significantly dependent on the duration of the disease – the longer it lasts, the more the following areas are damaged:

Bone metabolism: insufficient nutrient supply can lead to a lack of estrogen, which is responsible for osteoporosis. As a result of the decrease in bone mass and density, fatigue fractures or fractures can occur more easily. Caries can also be a consequence.

Hormonal balance: Growth hormone levels are subject to fluctuations, which has negative consequences in terms of body growth. Likewise, elevated cortisol levels alter thyroid hormones, causing insulin metabolism reactions. Especially in women, the disturbed hormone balance can lead to irregular or even absent periods.

Other risks: There is an increased risk of infection due to the disturbed metabolic processes as well as the risk of cardiac arrhythmias due to the fluctuations in the electrolyte balance.

Frequently affected sports

Sports in which weight has a significant influence on performance can promote the development of anorexia athletica:

  • Sports with high aesthetic demands such as ballet, figure skating, gymnastics, gymnastics, dancing, high diving or synchronized swimming
  • Weight class sports such as boxing, rowing, wrestling or horse racing
  • Endurance sports such as marathon or triathlon

And what is the therapy?

Anorexia athletica cannot be reconciled with a successful athletic career in the long term and entails worshipful health consequences. However, those affected and their relatives can have hope; a number of proven therapeutic measures exist.

The first thing to think about is treatment in the context of psychotherapy. On the one hand, there is behavioral therapy, in which the focus is on changing eating behavior as well as attitudes toward the body and dealing with the social environment. On the other hand, psychodynamic therapy concepts can also help, which place their emphasis on identifying and working through the causative factors. In addition to psychotherapy, close medical care should be provided. The assessment and continuous monitoring of the physical condition is important in order to counteract or mitigate the classic accompanying symptoms such as osteoporosis or hormonal fluctuations. In this context, weight stabilization has top priority. In the event of an acute health risk, inpatient hospitalization may also be necessary. The distance from the usual environment is often crucial to establish healthier behavior patterns.

References
  • Federal Institute for Sports Science: https://www.bisp.de/SharedDocs/Downloads/Publikationen/Athletenbrosch%C3%BCren/Ess_Stoerungen.pdf?__blob=publicationFile&v=1, accessed on 25.06.2022.
  • Deutscher Ärzteverlag GmbH: https://www.aerzteblatt.de/archiv/7199/Die-essgestoerte-Athletin, accessed on 20.06.2022.
  • Kleinert, Jens; Zeeck, Almut; Ziemainz, Heiko: Sports addiction and pathological exercise behavior. Stuttgart, 2020.
Verena Klein
Autor:in Verena Klein
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