Athletes and Eating Disorders; what parents and coaches need to know…

Elizabeth Hunkins is a therapist at Aurora Behavioral Health Center in Summit

Elizabeth Hunkins is a therapist at Aurora Behavioral Health Center in Summit

Sport activities offer such an array of benefits for individuals from improved confidence, self-esteem, social skills and healthy activity.  But when does having “fun” cross the line that places an individual at risk for possible eating disorder?

Competition in athletics can be a factor that leads to psychological stress, which increases risk factors for disordered eating patterns in males and females.  A study in 1992 found that 62 percent of females in sports suffered from eating disorders (  It is believed that since that study was completed that eating disorders among athletes continue to be on the rise.  Many parents, coaches and even physicians fail to recognize the signs of eating disorders in these individuals.  Athletes are at a greater risk of medical complication due to the demands they place on their body.

There are too many stories of athletes that have suffered from this disease. In July of 1994, top US gymnast, Christy Henrich died of multiple organ failure after a US judge told her she was “too fat and needed to lose weight to make the team”, and subsequently dropped to 47 pounds. She resorted to anorexia and bulimia, which eventually took her life.  Cathy Rigby, another Olympian suffered with this disease for 12 years and went into cardiac arrest two different times (  Not only is this happening on the elite level, it is happening on every level of competition in sports.

What are some early warning signs of an eating disorder in an athlete?

  • Rapid weight loss
  • Going to bathroom after meals
  • No breaks in weekly training (should have 1-2 days off per week)
  • Increased concern about body fat/calorie intake
  • Rigid behavior around food (refuses food groups, eating fat free/eating in isolation)
  • Social withdrawal from family and peers
  • Preoccupied with training/exercise and becomes upset if unable to workout
  • Will continue to workout even when ill/sick
  • Other areas in life becomes unmanageable (relationships, work, school)
  • Loss or irregular menses

Coaches need to educate themselves on the dangers of eating disorders and recognize early warning signs and intervene.  Education needs to be provided on healthy nutrition, and proper refueling.  Coaches need to be positive, encouraging and motivating; not harsh, negative and critical to athletes.  Parents should attend a training session to observe their child and the coach’s training.  A parent should not witness a coach pressuring their child to “WIN at any cost”.

Coaches should encourage athletes to develop a healthy routine with adequate emphasis on eating, hydration and life balance. Coaches should praise their efforts and their achievements.  If there are negative comments about an athlete’s appearance/weight and performance, then it is time to change coaches/programs for the well-being of the individual and seek assistance from a professional.

Liz Hunkins, LCSW is a therapist at Aurora Behavioral Health Center in Summit

If you or someone you know may be struggling with an eating disorder, please contact Aurora Behavioral Health Services at 877-666-7223 or visit our web site at Aurora Behavioral Health Services


How can art therapy be used to treat eating disorder?

Art therapy is part of the holistic treatment approach applied to treat eating disorders at Aurora Psychiatric Hospital. Patients can develop self-awareness, adopt better coping mechanisms, improve cognitive functions, and find pleasure in art making.

The purpose of art therapy is fundamentally on healing.  Art therapy helps patients creatively express emotions they may be having difficulty expressing verbally.

It is vital that patients express their emotions. Many times abusive or deadly behaviors are used to numb the pain of not speaking up and out. Obsessions with food and weight are often attempts to cope with unresolved emotional issues such as depression, rage, powerlessness, and loss.

Art therapy is a special tool that can help provide access to those hidden feelings in a safe and non-threatening way. Patients in the Eating Disorder Program at Aurora Psychiatric Hospital participate in both guided art and open art studios in an effort to strengthen and apply their inner resources towards recovery. Art therapy techniques are used to explore the issues that have led to compulsive eating, binging, purging, starving, over-exercising, laxative abuse, etc. Art Therapy is offered as a creative source and an outlet for patients to overcome blocked feelings. Emphasis is on discovering new ways to nurture oneself.

Art therapy is often intimidating to people. Many patients think they’re not artists or they can’t draw or they’re not creative. But art therapy is about the creative process, not the creative product. Patients connect with their inner experiences and find a way to express something that they may not be able to do easily with words. That’s one reason art therapy is a natural fit for eating disorders. It takes away the shame and helps people feel empowered.

A range of materials and mediums can be used, including pencils, watercolors, clay, collages and more. If someone is feeling anxious, overwhelmed, or out of control they might prefer markers or pencils, which help foster a sense of control. Someone who is feeling “stuck” or needing to break out might try a more fluid media, like watercolor paint. And someone who doesn’t want to draw at all can use collage, for example.

Looking at the visual representation of a particular issue provides helpful understanding of the emotions involved. So a person can examine how they feel and behave currently vs. how they want to feel or behave and explore what’s keeping them from functioning the way they want to in a situation or relationship. It’s a skill that can continue to be used at home after treatment as well. Art can be used as a positive coping skill to incorporate into a long term recovery plan.

If you or someone you know is struggling with an eating disorder contact Aurora Psychiatric Hospital Eating Disorders Program

Aurora Behavioral Health Services offers complete mental health treatment options, provided by highly trained professionals in a caring, confidential manner to meet individual and family needs.  If you or someone you know needs help, contact us — online or by phone at 1-877-666-7223 — as soon as possible.

What is the Maudsley approach to treating anorexia?

Anorexia nervosa was initially recognized more than 125 years ago and today has one of the highest mortality rates among all the mental health disorders.  Advancements have been made to help treat this disease, but it continues to be on the rise.

Elizabeth Hunkins is a therapist with Aurora Behavioral Health Services.

Family based treatment (FBT) for anorexia nervosa (AN) is an outpatient treatment option that strives for weight restoration and addresses the adolescent’s development after weight has been restored.

This treatment model has been shown to demonstrate efficacy in numerous research studies, and consequently been a highly successful treatment alternative to higher levels of care.

One 2010 study, published in the Archives of General Psychiatry, showed 49 percent of those who had been in family therapy were in full remission, more than double the 23 percent of those who had been in individual therapy. And among patients who were in remission at the end of the treatment itself, only 10 percent of the family-therapy group had relapsed a year later, compared with 40 percent of those who had individual therapy.

In the Maudsley method of treatment, parents play an active role in the recovery process.  Parents are a key resource and essential for successful treatment for AN.  Maudsley does not believe there should be any “blame” on the family due to this illness or any hostility or criticism towards the adolescent.

Phase 1: Weight restoration:  The therapist’s focus with the family is about the dangers AN and severe malnutrition play, and assisting parents in re-feeding their child. The re-feeding stage is one of the most stressful points for the patient and also for the parents.  Therapists need to be mindful how this affects the entire family.  Helping the parents stay focused on the re-feeding and not get into power struggles with the illness is key.

The therapist helps the family understand the difference between their child and the illness, and continues to help towards the goal of weight restoration.  Usually during the beginning phase of treatment the therapist observes a family meal to provide an opportunity to assess the family’s interaction around food and then to assist/encourage parents in ways to help their child “eat a little more” as food is medicine.  Parents may need coaching that it is important to take time for themselves, as this can be stressful on a marriage.

Phase 2: Returning control over eating to the adolescent: The patient’s acceptance of the parents’ role in re-feeding, weight gain, and taking more control over the eating disorder behaviors are all positive signs that the family is entering phase 2 of treatment.  This phase encourages parents to help their child take more control over their eating and parents continue to maintain and watch over the adolescent’s physical health.  This phase will also begin to start discussing other family relationship issues that had to be postponed during the re-feeding phase.

Phase 3: Establishing health adolescent identity: This phase begins when the adolescent is able to maintain above 95% of ideal weight on his/her own.  Treatment shifts to the impact of AN and addressing other important treatment issues; identity issues, boundaries, personal autonomy, etc.

This treatment has shown great promise with those adolescents who have had AN if the family is willing to play an active role in treatment. Parents need to be aware of the time commitment this treatment will take prior to starting this treatment-as this treatment is not for every family.  The Maudsley therapist also believes in a treatment team approach, working with other medical professionals for the best successful outcome.

More information about the Maudsley approach can be found online at Maudsley Parents.

If you or someone you know may be struggling with an eating disorder, please contact Aurora Behavioral Health Services at 877-666-7223 or visit our web site at Aurora Behavioral Health Services.

Would you recognize if your friend or family member had an eating disorder?

I first showed signs of anorexia when I was a sophomore in high school. I began limiting food. I was a synchronized swimmer and wanted to lose weight to look better in a bathing suit. Rather than eating lunch, I’d study or talk to friends. I stayed late at school and skipped dinner. I exercised compulsively, sometimes working out all night. I didn’t want to sleep, because I wouldn’t be burning any calories. Keeping up the self-starvation became more difficult when I started going to Sweet 16 parties. I’d eat a salad or soup, a binge for me at that time. To compensate, I began purging and taking pills—laxatives, diet pills, water pills—25 or 30 a day. I lost weight. I always felt cold and often lightheaded. I fainted. I was very moody and temperamental. Toward the end, I developed fine baby hair on my tummy (a symptom of anorexia). The enamel on my teeth eroded from the stomach acid coming back up when I vomited. I needed many fillings.

Read more about Joan’s Story

Eating Disorders are serious, life-threatening illnesses – not choices – and it’s important to recognize the pressures, attitudes and behaviors that shape the disorder. Would you recognize if your friend or family member had an eating disorder? Parents, siblings and close friends play a significant role in guiding and supporting someone with an eating disorder. In many cases, individuals with eating disorders cannot recognize a need for help in themselves, and it takes a strong, caring individual to reach out. Most importantly, you need to know that there is hope. For those seeking recovery for a loved one, eating disorder treatment is available.

Some of the warning signs that may indicate an Eating disorder include:

  • Excessive weight loss – losing 15% or more of ideal body weight
  • Obsession with food calories and fat content
  • Dieting even when thin
  • Intense fear of gaining weight, even when underweight
  • Distorted self-image of excess weight even though not overweight.
  • preoccupation with size, body weight or shape
  • preoccupied with food, calories, nutrition, or cooking
  • Being secretive about food
  • Social isolation / avoid situations where food is served
  • Uses the bathroom frequently after meals.
  • Experiences frequent fluctuations in weight.
  • Loss of menstrual periods (secondary amenorrhea ) or delay in onset of period (menarche)
  • Excessive or increase in exercise
  • Feeling cold, especially in the hands and feet
  • Hair loss and/or growth of fine hair on the body
  • Over-use of laxatives or other weight loss products
  • Fainting or severe lightheadedness
  • Depression and/or anxiety
  • Heart palpitations

February 26 – March 3, 2012 is National Eating Disorders Awareness week. Access an Eating Disorders Screening Tool, or get information about Eating Disorder Treatment.

If you or someone you know may be struggling with an eating disorder, please contact Aurora Behavioral Health Services at 877-666-7223 or visit our web site at Aurora Behavioral Health Services.