307.50 Eating Disorder Not Other Wise Specified is the diagnosis for individuals who do not meet the criteria for any specific category (Diagnostic and Statistical Manual, 2000, p. 594). Today, EDNOS diagnoses significantly outnumber cases of anorexia and bulimia. In fact, Eating Disorders: The Journal of Treatment and Prevention reported findings that 50 to 70 percent of the individuals who present for treatment of an eating disorder are being diagnosed with this illness (Weiner, 2013). Regularly, the severity of this diagnosis is overlooked by the general public because individuals often don?t present with abnormally low body mass indices, and aren?t exhibiting typical binge/purge behaviors. Since manifestations of this disorder present behaviorally many individuals go undiagnosed, misdiagnosed, and untreated. This high level of complexity means that the women, men, and children with eating disorders are presenting with more medical and psychiatric comorbidities, and associated behaviors and phobias are often more severe (?Program Design Supporting Emerging,? 2011).
Eating Disorders are often described as diseases of disconnection both biologically and psychologically. (Tantillo & Sanftner, 2010, p. 102). They include non-modifiable and modifiable behavioral risk factors. Examples of biogenetic, non-modifiable risk factors include the underdevelopment of the pre-frontal cortex, temperament, and disturbances in GABA, Dopamine, Norepinephrine, and Serotonergic system. Just as Obesity has been linked to Melacortin-4 (MC4R) receptor mutations, restrictive eating disorders are linked to Brain Derived neurotrophic factor (BDNF) which acts downstream from MC4R. Humans with low serum BDNF levels display an aberrant eating behavior. BDNF levels might be involved in the severity of eating disorders (EDs) through the modulation of psychopathological traits that are associated with the ED phenotype (Scherag, Hebebrand, & Hinney, 2010). To compound the complexity of biological risk factors eating disorders also have a strong familial link.
Health and fitness professionals can be the most influential by increasing their understanding of EDNOS. It is important to recognize warning signs and increase awareness of maladaptive behaviors. Interestingly, the very same perfectionist, overachieving and people-pleasing temperament that fuels achievement in athletic competition, both elite and casual, closely mirrors the personality traits of those individuals who tend to develop eating disorders. For both male and female athletes, the combination of these traits, along with the body shape and weight-focused demands of many competitive sports creates the perfect storm that can trigger eating disordered thoughts and behaviors (Weiner, 2012). If that?s not significant enough, research published back in 1999 found at least one-third of female college athletes have some type of eating disorder (Johnson, Powers, & Dick, 1999). Identifying sings of eating disorders can be difficult because they closely mirror characteristic signs of over training. Some indicators include a decrease in performance, an increase in training frequency, an increased prevalence of overuse injuries, GI problems, loss of concentration, withdrawal, and avoiding eating in the presence of others.
Many individuals that struggle with eating disorders are very high functioning and characteristically surround themselves with subcultures where everyone exhibits the same behavioral patterns related to exercise and food, such as bodybuilding, CrossFit, gymnastics etc. The athlete can often times be completely unaware or fail to make the connection that their thoughts and beliefs systems about food are impairing their psychosocial functioning. Denial and defensive attitudes are common when the issue is confronted. If restrictive eating is advocated for at the highest level of sport like it is in CrossFit and Figure/Bodybuidling then that has an even bigger impact on athletes. Phone applications, diet journals, calorie counting, and food measuring can all increase the severity of obsessive disorders so commonly found in competitive individuals.
Toxic societal values emphasizing appearance, control, competition, and ultra-independence are behaviors that increase the?disconnection of perceived mutuality (Tantillo & Sanftner, 2010, p. 102). CrossFit for example, is beneficial because it abhors social isolation which is a hallmark behavior of advancing eating disorders. However, a paradox exists with the esteem of social media. There is a colossal amount of disconnection associated with digital communication. Instantaneous uploading of pictures on sites specifically developed on an award, or ?like? system perpetuates the compulsivity of competition as it relates in this case specifically to body image. Individuals striving in restrictive ways to ?win? diet challenges with the added pressure of photos being made public have the capacity to create a self-inflicted, peer encouraged pressure systems that can lead to social isolation, depression, and exacerbated behaviors of EDNOS. Harvard Medical School compared the rates of eating disorders in urbanized regions who have access to social media, to regions of Fiji where as little as 8% of households owned a television and determined those exposed to social media increased their risk of developing an eating disorder by 60%.
Health and fitness professionals have a unique challenge to promote an environment that is proactive in advocating for the wellness of athletes over which they have stewardship. They have a responsibility to provide sensitivity, confidentiality, and support to achieve productive outcomes (?Eating Disorders in Athletes,? n.d.). Eating disorders usually start with an attempt to lose weight- essentially to ?diet.? The impetus often occurs at the times in the individual?s life when they are confronted with issues they find difficult (Newell, 2010, p. 21). Coaches and fitness professionals can mitigate risks by being mindful to emphasize performance over physical appearance and avoid promoting restrictive eating strategies such as ?Paleo Challenges.? Also, limiting revealing clothing is preferred as it has the propensity to exacerbate eating disorder behaviors in athletes and promote insecurity surrounding body dissatisfaction. Avoiding self taken ?selfie? photographs of abdominal regions, and correlating images of extremely low body fat with success in CrossFit is highly discouraged. Understanding and respecting the fragility of the athletes and clients of whose fitness lives and habits are being molded is encouraged among fitness professionals and CrossFit Coaches. Prevention and early intervention by increasing self-awareness may not be enough to solve complex psychosocial problems but it will undoubtedly prevent further harm.
Eating disorders have the highest mortality rate of any mental illness at 20% (Newell, 2010, p. 20). Health and fitness professionals play a vital role in creating cultural sensitivity in such a critical market. Expanding resource intelligence when situations exceed the scope of qualification is also of key importance. Being mindful of what types of conversations and actions are taking place in gyms and affiliates surrounding dieting and body image, and demonstrating prudence in relation to photos that are chosen to represent facilities on social networking sites is imperative for exhibiting exemplary professionalism.
For more information on Eating disorders and the role of Health and Fitness professionals please visit the National Eating Disorders website. https://www.nationaleatingdisorders.org/
References
Diagnostic and Statistical Manual of Mental Health Disorders (4th ed.). (2000). Washington, DC: American Psychiatric Association.
Eating Disorders in Athletes [Blog post]. (n.d.). Retrieved from Eating Recovery Center website: http://www.eatingrecoverycenter.com/wp-content/uploads/2012/01/Eating-Disorders-in-Athletes-Flyer-for-Website-2.pdf
Johnson, C., Powers, P.S., & Dick, R. (1999). Athletes and Eating Disorders: The National Collegiate Athletic Association Study. International Journal of Eating Disorders, 26, 179-188.
Newell, C. (2010). Early recognition of eating disorders. Practice Nurse, 39, 20-25.
Program Design Supporting Emerging Eating Disorder Pathology in Children and Adolescents. (2011). The Road to Recovery, 1(4).
Scherag, S., Hebebrand, J., & Hinney, A. (2010). Eating Disorders: the current status of molecular genetic research. European Child & Adolecent Psychiatry, 19(3), 211-226.
Snell, L., Crowe, M., & Jordan, J. (2010). Maintaining a therapeutic connection: nursing in an inpatient eating disorder unit. Journal of Clinical Nursing, 19, 351-358.
Tantillo, M., PhD, RN, CS FAED, & Sanftner, J., PhD. (2010). Measuring Perceived Mutuality in Women With Eating Disorders: The Development of the Connection-Disconnection Scale. Journal of Nursing Measurement, 18, 100-119.
Weiner, K., M.D., FAED, CEDS. (2012, July 3). Eating Disorders in Athletes. Retrieved February 11, 2013, from Huffington Post website: http://www.huffingtonpost.com/kenneth-l-weiner-md-faed-ceds/eating-disorders-athletes_b_1643383.html
Weiner, K., M.D., FAED, CEDS. (2013, January 14). Eating Disorder Not Otherwise Specified (EDNOS) Explained. Retrieved February 11, 2013, from Huffington Post website: http://www.huffingtonpost.com/kenneth-l-weiner-md-faed-ceds/ednos_b_2317325.html
Wendy Spin
Wendy is a coach and trainer at CrossFit Frontier in Cheyenne, WY. She is also a wildland firefighter, nursing student, blogger, and advocate for those who have struggled with eating disorders and addiction.
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Source: http://www.wodtalk.com/2013/03/19/recognizing-eating-disorders-in-athletes/
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