(Morissette, 1995)

Sometimes . . . is never quite enough.
If you're flawless, then you'll win my love.
Don't forget to win first place.
Don't forget to keep that smile on your face,
Be a good boy--
Try a little harder.
You've got to measure up,
And make me prouder.
How long . . . before you screw it up?
And how many times do I have to tell you to hurry up?!
With everything I do for you,
The least you can do is keep quiet.
Be a good girl--
You've gotta try a little harder.
That simply wasn't good enough
To make us proud.
I'll live through you,
I'll make you what I never was!
If you're the best, then maybe so am I,
Compared to him compared to her--
I'm doing this for your own damn good!
You'll make up for what I blew--
What's the problem . . . why are you crying?
Be a good boy,
Push a little farther now.
That wasn't fast enough
To make us happy.
We'll love you
Just the way you are--
If you're perfect.

Copyright 1997, University of Toronto: School of Physical and Health Education


Tara Lipinski dazzled the world with her winning performance in the 1997 World Figure Skating championships in Lausanne, Switzerland. Her skill and athletic prowess were most apparent in her flawless execution of the first ever "triple-triple" combination jump in women's figure skating; she proved to be unbeatable. On one hand, it is magical to witness a captivating performance of someone as talented and graceful as Tara, who can perform the strenuous physical tasks inherent to world-class figure skating with such mastery that it appears effortless. On the other hand, it is unreasonable to expect such innovative feats of strength, balance, energy and style from this newest generation of figure skaters, who seem to get younger and smaller as the years progress. Tara Lipinski became the youngest world figure skating champion at the delicate age of fourteen. She is 4 feet, 8 inches tall and weighs in at only 75 pounds (Smith, 1997:A21). This is fast becoming the norm within sports such as figure skating, diving and gymnastics, which place an extraordinary emphasis on leanness of appearance (O'Connor, Lewis and Kirchner, 1995; Sundgot-Borgen, 1994; Taub and Blinde, 1992; Stoutjesdyk and Jevne, 1993). As high-performance sports continue to challenge athletes to acquire more skills and establish newprecedents within the arena of elite competition, the expectations of their bodies to emulate a certain look are intensifying and becoming too narrowly defined. The pressure to be "the best"--to go farther, to go faster, to aim higher and harder, and to accomplish it all at a younger age--is taking its toll by fostering unrealistic expectations of young athletes' bodies. The correlation between pathogenic weight-control, exercise, and specifically athletics, has received considerable attention in the literature of sports medicine, nutrition, and psychology, due to the high prevalence of athletes with body image disturbance and eating disorders (Garner and Rosen, 1991; Brownell, Rodin and Wilmore, 1992; Taub and Blinde, 1992; Anderson et al., 1995; O'Connor, Lewis and Kirchner, 1995).

This paper will examine the current literature as it pertains to aspects of perfectionism in athletes with eating disorders. The intention is to establish a contemporary theoretical base, with which to raise some informal speculation (personal theories on the subject) and suggest practical applications to deal with the problems of anorexia and bulimia nervosa among athletes.

Theories of Perfectionism

Previous research on perfectionism has dealt largely with clinical populations, resulting in a general bias toward a negativistic, pathologically-inclined conceptualization (Pacht, 1984; Flet, Hewitt and Dyck, 1989). Recent studies (Mitzman, Slade and Dewey, 1994; Terry-Short, Owens, Slade and Dewey, 1995) have finally begun to investigate the possibility of distinguishing aspects of perfectionism on the basis of perceived consequences, or between its positive and negative attributes, as opposed to a singular conception of "neurotic" perfectionism. This newer epistemology allows for a more multidimensional postulation of the concept. Athletes in particular, are a unique lot from which to study aspects of perfectionism; they are generally used in research samples to demonstrate the difference between "positive" and "negative" perfectionism against a clinically-defined control group. This distinction will be elaborated on further in the ensuing section. Athletes with eating disorders are even more of an interesting sample, because of the implied aberration from their typical traits or roles as, "healthy," "fit" (connoting mental as well as emotional fitness), "achievers" and "winners." This ostensible "clash" of positives and negatives--the classic "athletes-as-role-models," and clinical maladies such as depression and eating disorders--presents a unique phenomenological combination which has not been explored previously in the perfectionism literature. This is precisely the relationship that will be addressed in the subsequent text.

Normal vs. Neurotic

Positive perfectionism can be interpreted most simply as "a function of positive reinforcers" (Terry-Short, et al., 1995:664), and is considered more "healthy" and "normal" than negative perfectionism, where the individual behaves in certain "neurotic" or "unhealthy" ways to avoid negative consequences. Mitzman, et al. (1994) distinguish between normal and neurotic perfectionism by the motivation and incentive behind performing certain tasks. In normal perfectionism, "[r]ealistic targets are set by the individual, who is motivated primarily by the pleasure and rewards associated with success", whereas neurotic perfectionism involves having "excessively high standards" whereby "lapses or mistakes are seen as disastrous" and the individual is "driven primarily by a fear of failure" as opposed to the thrill of success (516). Despite their achievements, neurotic perfectionists will experience feelings of inferiority because of a tendency to think "telescopically"(Adderholdt-Elliot, 1991:68); this essentially denotes viewing one's met and unmet goals through both ends of a metaphoric telescope. According to Adderholdt-Elliot, neurotic perfectionists will "magnify" their unmet goals and "minify" or downplay the goals which they have already achieved, so that "met" expectations are deemed insignificant and minute. In relation to competitive sport, an example of telescopic thinking would be an Olympic medal-winning athlete who downplays this incredible accomplishment by saying that she "only" won silver, or "only" won a single medal. Going from one level to another within the specified increments of competitive sport may also influence one's sense of accomplishment; being the top competitor at the provincial or state level may be considered insubstantial to the athlete once she has begun competing at the national or international level. Here, she is forced to judge herself against a more elite pool of competitors, on a higher plane of performance standards. Certainly, the intimidation factor is appreciable.

One of the most notable authors in the literature on perfectionism, D.E. Hamachek (1978), explains how individuals who originate from environments of "conditional positive approval" learn that if they are to be loved, they cannot afford to be less than perfect (29). Therefore, their "sense of self" is defined primarily in terms of performance standards. For some athletes, this strain of theory is especially poignant; the performance defines their public image and how well the audience responds to them. For athletes like Tara Lipinski, or American, Olympic, and world champion gymnast, Dominique Moceanu, performance defines them respectively, as cherished American "sweethearts" in sport. This kind of "indirect" affection between spectator and performer also generates some intriguing questions, one of which is, how do athletes at such vulnerable ages of 14, 15 or 16 deal with the conceivable possibility of disappointing their fans? If a performance, for any given reason, is not up to par with the athlete's established standards, the sporting public's fickle endearments can be easily swayed and granted to someone else. The athlete, who might very well be trained in the physical sense, such that she can perform extraordinary feats on command, is not necessarily trained in the experiential, emotional or psychological sense, such that she is capable of handling the pressures of public expectation, failure, and their own media portrayal. This issue is further exacerbated by the increasing trend of younger athletes competing at elite, international levels.

Hamachek's theory of defining one's sense of self through performance standards, pertains well to the aspects commonly associated with neurotic perfectionism. The neurotic perfectionist will generally embody a combination of traits: dichotomous (all-or-nothing) thinking, the setting of unreasonable standards, the compulsive reaching toward impossible goals, and the questioning of self-worth with productivity and accomplishment (Adderholdt-Elliot, 1991; Mitzman et al., 1994). Clearly, the terminology is vague with respect to its methodological validity (i.e., how does one categorically define "unreasonable," "compulsive," and "impossible" in these instances?); however, clarification, in using explicit examples when referring to these distinctions, is helpful in this regard.

The error in lumping together all athletes as a collective group in the perfectionism literature, is that they tend to be mass-represented as positive, "normal" perfectionists, likely because of the positive attributes affiliated with sport in general (Terry-Short, et al., 1995). Within the context of training for a particular event, or activity, athletes may have more of an opportunity to "hide" behind the positive stereotype of their preconceived role, while still behaving in destructive and unhealthy ways. One need only examine the growing literature on eating disorders or substance abuse to realize that athletes from a multitude of sports are not embodying, typifying, or living the healthy, "cereal-box," picture-perfect lifestyles which are expected of them, en masse (Davis, et al., 1994; Blouin and Goldfield, 1995; Anderson, et al., 1995). The dangers of this combination of ideal "healthy role models" and the actual dysfunctional behaviour among some athletes, are multifarious and interrelated. First and foremost, there is the risk of the athlete's detrimental behaviour going by undetected. This can occur from a number of reasons: by maintaining a weight within a "normal" range despite employing harmful measures to lose; by affiliating exclusively with other perfectionists in the same sphere so that dysfunctional thinking and/or behaviour actually become the norm among the group; and by the personal biases, attitudes, and level of ignorance from coaches, parents, trainers, and even other athletes on issues of nutrition, obesity and eating disorders (Griffin and Harris, 1996). These are all salient points and will receive their due elaboration in a later section, entitled Practical Guidelines: Detection for Coaches, Trainers, Parents and Other Athletes. Second, if the athlete's destructive behaviour is a covert plea for attention and/or help (for whatever reason), and it does go by unnoticed, she might feel as though her love and acceptance from others are solely dependent on her role as "athlete" and not as a person, in general; in essence, her feelings and her sense of self might be invalidated. Third and finally, by labelling a person with positive or negative descriptors such as, "role model" or "bulimic," there is a risk involved with respect to how the label becomes self-interpreted. This will be touched upon in the following section.

Labelling Theory, Deviance and Perfectionism

One of the most intriguing things to understand about athletes who develop eating disorders is their history of obedience and conformity; throughout their sporting careers, they have been trained, formed, and raised to perform and obey their coaches, their judges, and in essence, "the rules." Athletes conform to strict standards of action and appearance--everything from uniform, to bodily movement, to weight. They move according to the proper rules and regulations of their respective sports, and they receive their notoriety and public acceptance based on how well they comply with these standards. Consequently, it is not hard to see how an eating disorder can be considered both, an effort at "overconformity" (Orbach, 1979:21) to Western cultural standards of appearance, and an overt statement of deviance, in the sense that the athlete is doing something pathological and "abnormal" to her body. In their study on the meanings attached to their eating anomalies, McLorg and Taub (1987) summon this very topic by declaring that:
individuals who develop anorexia nervosa and bulimia are conformist in their strong commitment to other conventional norms and goals . . . [m]oreover, pre-anorexics and -bulimics display notable conventionality as "model children," the "pride and joy" of their parents, accommodating themselves to the wishes of others. (182, my italics)

Athletes who participate in competitive sport often live their lives according to strict guidelines and working schedules: dietary regimens, training programs, travel itineraries, competition meets, technical and artistic performance requirements, team rosters, codes of behaviour and conduct, etcetera. They conform to so many set standards that it is not difficult to comprehend how their bodies can become yet another arena over which they must control, conquer, and win.

Issues of deviance and labelling are deeply intertwined when discussing aspects of eating disorders. Lemert (1951; 1967) defines primary deviance as, "a transitory period of norm violations which do not affect an individual's self-concept or performance of social roles" (1951:26), so therefore, the initial behaviour of fasting or binging and purging, in any of its forms, delineates the "primary" stage of deviance for those with eating disorders. Secondary deviance is a considerably more threatening condition because it involves the internalization of the deviant behaviour: "secondary deviance is generally prolonged, alters the individual's self-concept, and affects the performance of his/her social roles" (McLorg and Taub, 1987:185). This acceptance of one's aberrant identity may come about from being labelled outright, as deviant. A heightened awareness to an athlete's erratic eating and/or training behaviours may ultimately lead one to label her with an eating disorder. Entitling someone with the "anorexic," "bulimic," "bulimarexic," or "eating disordered" label may have various, conflicting effects. Indeed, it may cause an athlete to take pride in her deviant behaviour, since restrictive diets and regimented exercise represent extended efforts at self-control, self-mastery, strength and willpower. Correspondingly, if she is labelled anorexic, but doesn't see herself as "thin enough" to warrant the label granted to the stereotypical, emaciated figure of an anorexic, she might take further measures to "live up to" that classification. In fact, McLorg and Taub's (1987) study discovered that, when the anorexics in their sample of support-group members were first termed as such by friends, family, or medical personnel, they vigorously denied the label: "[t]hey felt they were not 'anorexic enough,' not skinny enough" (184). On another point along the eating disorder continuum, many labelled bulimics resent their designation and deem the title to be humiliating and offensive because it implies that they lack the willpower to withstand food totally, hence, they consider themselves "failed anorexics" (own term). Even more specifically, the subset of athletes with eating disorders may feel as though they are simply being "ultra healthy" by intensifying their training regimens or restricting their nutritional intake, and may begrudge the label of "anorexic" or "bulimic" altogether.

The Anorectic-Bulimic Conflict and Approach-Avoidance Theory

Proper labelling of an eating disorder is essential in selecting appropriate intervention strategies, initiating treatment options, and understanding the effects on the person being labelled. Eating disorders and their expression are determined by a multiplicity of variables, and must be recognized from a variety of angles so as not to pigeonhole someone under a false title. Holmgren et al., (1983; From, Schlundt and Johnson, 1990) suggest that the various groups of people with eating disorders share the common traits of an "anorectic-bulimic conflict" (23). This fundamental conflict involves the control of food intake and is approach-avoidance, in character. On the anorexic side, the desire to become thinner and the fear of getting fatter, motivates the individual to limit food consumption and reduce body weight through dieting. On the bulimic side, there is a strong biological push towards eating food and a tendency to lose control over food consumption, once eating has commenced.

Other authors have noted that, due to the fear of weight gain, individuals with eating disorders develop an approach-avoidance conflict to food (Vogler, 1993; Harper-Giuffre and MacKenzie, 1992). At any time, one of the two tendencies may win out over the other. When the approach to food is dominant, binge eating occurs. After binge eating, the fear of weight gain strengthens the avoidance response which motivates behaviours like vomiting, laxative abuse, fasting, and excessive exercise. After a period of food restriction, the strength of the food preoccupation increases and drives the individual toward eating and the possibility of losing control and binging. The alternation between approach and avoidance accounts for the behavioural manifestations of eating disorders and for changes in body weight over time. Patients who rapidly alternate between approach (binge eating) and avoidance (purging) are considered to be engaged in bulimic behaviour. Those who immerse themselves in behaviours of avoidance for long periods of time are first diagnosed "preclinical anorexic" (Schlundt and Johnson, 1990: 24) and after sufficient weight loss has occurred, are considered anorexic.

According to Holmgren, patients may be in the anorexic phase, the bulimic phase, or a transitional period at any given time (24). This theory functions well as a labelling tool for eating disordered patients, and athletes in particular, because of their tendency to fluctuate between binging, purging, and restricting at any given time. For the anorexic athlete who has completed her competitive season, she might enter a binging phase because she no longer has to worry about her appearance being judged in competition. For the lightweight rower who wishes to make a specific "weight class" for competition, this event might propel her into a pre-clinical anorexic phase. Holmgren's conceptualization has some advantages over the approach embodied in the DSM-III-R (APA, 1987) in that it avoids making arbitrary distinctions between individuals who differ solely in body weight. Body weight, rather than being a feature that enters into the diagnosis, is merely a complication or consequence of the particular phase of the eating disorder. Holmgren's anorectic-bulimic conflict allows the attending clinician, coach or parent to be prepared realistically, for changes in body weight and lapses between anorexic and bulimic behaviour patterns. The clinician specifically, need not be concerned with changing the diagnosis when these lapses occur; instead, he or she can attend to the underlying problem of weight phobia and the resulting approach-avoidance conflict with its various behavioural manifestations.

Overall, assigning the label of "eating disorder" to an athlete can result in several different scenarios; consequently, recognizing what kind of athlete is at risk, and determining which sports are most susceptible to body image disturbances and weight preoccupation, are imperative.

Athletes and Eating Disorders: Who Is At Risk?

Research on the subject of sport and exercise as related to eating disorders has become quite extensive within the last decade. Revisions of the diagnostic tests, the DSM-III-R and the BULIT-R (Bulimia Test; Thelen, et al., 1991) to include "excessive exercise" as components of anorexia nervosa and bulimia nervosa, resulted in clinicians and researchers finding more cases where sport and exercise have been used as purging techniques than was thought previously in the eating disorder literature (Yeager et al., 1993; Kennedy, Ravelski and Dionne, 1994; Sundgot-Borgen, 1994). The general theory about sport and eating disorders is that the sports environment fosters: an emphasis on obtaining an optimal weight for athletic performance; pressure from coaches, parents, and other participants to reduce body size for competition; perfectionist, compulsive and conformist personality traits of many athletes; and an emphasis on judging appearance in certain sports. This actuates into a subculture that may amplify sociocultural pressures to be thin, and thus, may increase some athletes' risk of developing eating disorders (Petrie, 1993; Taub and Blinde, 1992). It has been hypothesized that athletes who participate in sports that consider leanness a consequential trait, are at greater risk for eating disorders and related problems (Stoutjesdyk and Jevne, 1993; Sundgot-Borgen, 1994; Griffin and Harris, 1996). These sports include everything from gymnastics to judo, ballet dancing to body building, and figure skating to wrestling (although, mostly for men). Admittedly, research has concentrated its efforts on more of the "aesthetic" sports like gymnastics and figure skating, due to the high prevalence of athletes who have been clinically diagnosed with eating disorders from those realms. Accordingly, the concern lies with the asymmetry in the tabulation of incidence rates of pathogenic weight-control or body image disturbances among: endurance sports (running, triathlon, cycling, swimming), technical sports (diving, track and field, alpine skiing), weight-dependent sports (karate, lightweight rowing, wrestling, judo), ball games (volleyball, baseball, tennis), or power sports (weightlifting, body building, sprinting). Overall, the research indicates that, despite a lack of breadth among the range of sports and activities, eating disorders are most prevalent within aesthetic sports and weight-dependent sports, where the athlete is being judged not only on her athletic ability, but also for her appearance. When appraising the literature for trends and links between various populations in the domain of sport, it helps to focus on one or two studies which probe further and expand our understanding of these problems.

Two such studies, worth mentioning for their unique perspective and notable contribution to the current body of literature, include the Blouin and Goldfield examination of "Body Image and Steroid Use Among Male Bodybuilders" (1995); and the investigation by Sundgot-Borgen on "Risk and trigger factors for the development eating disorders in elite female athletes" (1994). Blouin and Goldfield tested the hypothesis that male bodybuilders may be at risk for the same type of body dissatisfaction that anorexics exhibit, but from the opposite standpoint. The term "reverse anorexia", describes the fear and belief held by many male bodybuilders, that they are too small when in fact, they are actually large and muscular (160). This attitude may account for many "unhealthy or dangerous practices" associated with the sport, such as steroid use and dehydration (Blouin andGoldfield, 1995:160; Anderson et al., 1995:52). The results of this study indicate that there is a subgroup of male bodybuilders who "exhibit a profile of body-related attitudes and psychological characteristics similar to those commonly seen among eating disorder patients and associated with anabolic steroid use" (163). Using standard, clinical inventories like the EDI (Eating Disorder Inventory; Garner, Olmstead, and Polivy, 1983), the Rosenberg Self-Esteem Scale (Rosenberg, 1965) and the BDI (Beck Depression Inventory; Beck, Ward, and Mendelson, 1961), Blouin and Goldfield reveal that male bodybuilders experience greater body dissatisfaction than other athletes (164). Specifically, the bodybuilders report a "drive for bulk" to gain weight and enlarge various body parts (as opposed to the anorexic "relentless pursuit of thinness") in spite of the fact that they are more muscular and heavier than most other athletes in comparison (164). Of striking interest, is the fact that all the bodybuilders in this inquiry share a "demand" for perfection (be it physical, or otherwise), feelings of ineffectiveness, low interoceptive awareness, and low self-esteem (164). The authors cite that the experience of being underweight as a young adolescent male has a significant negative impact on body image, self-esteem, and social adjustment (164). While the bodybuilders in Blouin and Goldfield's investigation were not underweight by any means, their perceived ideal body was exceedingly larger than their current body, which provides surprisingly similar commonalities in the literature on body image distortion between this subgroup and eating disorder patients. This correlation is evidence that more research on body image disturbance needs to be done on a wider scale, among different types of athletes and between sexes as opposed to being relegated only to female athletes.

Sundgot-Borgen's examination of risk and trigger factors that may be responsible for precipitating the onset or exacerbation of eating disorders, also pushes beyond the typical scope of conventional studies. Her large sample size for one (N = 522), provides impressive statistics from which to make more valid generalizations and hypotheses. Not only does her research reinforce what has already been documented in the literature, that "eating problems occur with greatest frequency in sports where athletes are encouraged to be thin for either performance or appearance" (Sundgot-Borgen, 1994:417), but it also raises important issues about the role of the coach. This study identifies several risk factors associated with the development of eating disorders in athletes. Dieting at an early age, as a result of the coach recommending that the athlete lose weight to improve performance, is associated with the general adoption of pathogenic weight control methods. It is revealed that the risk for eating disorders increases if dieting is unsupervised (Sundgot-Borgen, 1994:418); athletes with eating disorders may not seek dietary supervision for fear their disorder will be discovered. In addition, the research uncovers that most athletes have little knowledge about proper weight loss methods and receive their information in haphazard ways (from friends, magazines, etc.). Such diets are unlikely to account for the high energy requirements necessitated by strict training schedules or the fact that maturing females have special nutritional requirements. Sundgot-Borgen's study is especially poignant with respect to this paper, because of the value she places on proper nutrition for the pre-pubescent female athlete, which is the age cohort that comprises the population of the current generation of most aesthetic sports.

The question therefore remains, what can be done to prevent or intervene these problems within the context of competitive sport? The next section will provide practical ideas and possible topics for further discussion in: approaching athletes who exhibit clinical signs and symptoms, acknowledging the issues that surround weight-preoccupation and eating disorders, educating coaches, parents and other athletes, and questioning the current cultural context which allows these problems to flourish.

Practical Guidelines: Detection for Coaches, Trainers, Parents and Other Athletes

As mentioned previously, one of the worst possible scenarios for an athlete with an eating disorder is their behaviour going by undetected, and thereby untreated. A bulimic athlete might maintain her weight through destructive practices, and remain unnoticed, whereas an anorexic athlete might get "caught" because of her pronounced loss of body weight. The danger lies in both, letting the appearance of physical normalcy go by unquestioned as opposed to recognizing signs and symptoms of something more pathological, and in falsely assuming that, the thinner an eating disorder sufferer is, the more she needs help. This is a crucial point to underscore and take heed of. Some bulimics who purge with laxatives and/or emetics end up doing much more neuromuscular and skeletal damage to themselves than anorexics who solely restrict food intake. It is not just the outward appearance of those with eating disorders that define the extent of their affliction; it is the means by which they act self-destructively that marks the degree of decay in their sense of self-esteem.

The roles of the coach, trainer, parents, and even teammates are extremely important in the early recognition of signs and symptoms of disordered eating and weight preoccupation among athletes. Early detection is essential due to the serious life-threatening risks associated with the combination of intense exercise with anorexia nervosa and/or bulimia. In an attempt to educate coaches on the identification of signs and symptoms, Dr. Pierre Leichner (1986) itemizes a number of important predisposing factors and personality traits which are of particular relevance to athletes. Most of these signs are akin to the typical characteristics of neurotic perfectionism, mentioned earlier: "high self-expectations, a rigid and obsessional approach to reaching goals, difficulties in accepting less than 100 per cent performance, a high emphasis on emotional control, and an underlying sense of poor self-esteem" (66).

In terms of factors which encourage the development of destructive weight-control behaviour, it is imperative to understand how the type of sport played and the level of competition may act as catalysts in encouraging the athlete to feel overwhelming pressure to control her body and/or emotions. Sports which emphasize leanness for optimal performance, and judge athletes on the basis of appearance, are riskier to their participants in terms of fostering weight preoccupation and leading possibly, to eating disorders. Sports played on the varsity, national, international or professional levels demand high calibre athletes who can perform for the media, the crowd, their coach, their school, their country or even their sponsors. Endorsements constitute a large part of what drives many coaches to push their athletes as hard as they do. In order to maintain sponsorship for clubs and secure the coaches' own jobs and reputations, they must ensure the consistent, successful performances of their athletes, which may verily come at the expense of their athletes' physical well-being.

Many of the early signs of eating disorders are not specific and will be found in many athletes and casual exercisers; however, when several of these are observed simultaneously during a prolonged period (several weeks) they should alert the coach or parent to the possibility of a developing eating disorder. These signs may be first witnessed at meal times. They may include an unusual degree of preoccupation with the number of calories being eaten, a gradual restriction of the types of food eaten, an increasing number of excuses for not wanting to eat with others, a change in eating behaviours such as cutting food up in small amounts and chewing it for long periods, or alternatively, gulping down large amounts of food in a short span and disappearing shortly thereafter. During this time the person may also become more withdrawn socially, more irritable and depressed. Athletic performance may become more erratic. Approaching an athlete who is suspected of having an eating disorder requires tact and caution. Leichner (1986) advises an interview approach in a calm and private environment, because athletes are very often ashamed of their symptoms and anxious about the consequences of being "discovered." For them, the fear about weight gain, loss of control of eating, and dissatisfaction with their bodies are very real and should be accepted by the interviewer. But perhaps the most significant point to convey is that anorexia nervosa and bulimia nervosa must be considered serious problems irrespective of whether the sufferer is of "normal" weight or seriously underweight. If the behaviour and sense of self-worth are equally negative and destructive, then it should be reflected in the concern and response initiated.

Conclusion: Where To Go From Here?

There seems to be an inverse relationship between athletes' ages and body size and the physical expectations required from their performance. Athletes in many sports are getting younger and smaller as the years progress, and yet they are still expected to perform more feats, new stunts, and reach new records for the sake of being "the best". Athletes have been incorporated in the literature on perfectionism for decades, as the mass-representatives of positive, healthy perfectionism as opposed to their clinical counterparts of neurotic, negative perfectionists. This trend is beginning to change with the high prevalence of athletes with eating disorders and problems with weight preoccupation.

Clearly there are a number of sports like gymnastics, figure skating, and dance where success is not only determined by technical ability but by grace and physical appeal, and therefore, an ultra-slender form confers an important performance advantage. But as a consequence, the typical female athlete confronts body image pressures at a number of levels from those performance-related pressures reinforced by coaches and trainers, to those inherent in the judging criteria which give physically attractive athletes "the winning edge". Given previous research on women with eating disorders that focuses on personality characteristics related to perfectionism and high achievement expectations, the question remains, "to what degree are personal and contextual variables involved in eating disorders in high-performance athletes?"

More research is needed to determine how athletes from the technical, power, and other non-traditional sporting realms (in terms of not being traditionally related to the literature on eating disorders) are affected by sociocultural standards of appearance, as compared with their aesthetic and endurance-sport counterparts. There needs to be more education and awareness-raising of coaches, parents and athletes at all levels of competition and recreation alike, to bring this problem to the forefront and effect lasting change. There is also a lack of research on traditionally male-dominated sports and their expectations of appearance or performance as a function of body weight.

All of the issues raised in this paper are pivotal in the realms of sport, psychology, sociology, nutrition, and a number of other related fields; they must be taken seriously. The personal cost to the athlete is high because of the severe and even deadly consequences of eating disorders. Ultimately, the cost to the sports themselves will be exorbitant if participation is considered dangerous by health professionals, physical educators, and parents alike. Research on the development of eating disorders, treatment, awareness, continued education, and prevention must be considered a priority.

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Related Works

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Gendall, Kelly A., Sullivan, Patrick E., Joyce, Peter R., Carter, Frances A., and Cynthia M. Bulik. "The nutrient intake of women with bulimia nervosa." International Journal of Eating Disorders. 21(2)1997:115-127.

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Sands, Rob; Tricker, Julie; Sherman, Cheyne; Armatas, Christine; and Wayne Maschette. "Disordered eating patterns, body image, self-esteem, and physical activity in preadolescent school children." International Journal of Eating Disorders. 21(2)1997:159-166.

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