Female athletes who have anorexia nervosa are similar to female non-athletes with that disorder, but there are some important additional factors to consider.

Athletics used to “legitimize” an eating disorder

The current climate in athletics includes an emphasis on low body fat and thinness. That emphasis, and the dedication and discipline required to comply with it, make it relatively easy for a female athlete to hide an eating disorder. Indeed, she may even receive praise and admiration for her self-control and denial of appetite.

An illusion of virtue

Emphasis on thinness and demands for self-discipline invite the female athlete to believe that she is being “good” when she restricts food. She also believes that if she is “good” for a long enough period of time, she will improve her performance, win more often, and achieve more glory. She equates weight loss with becoming quicker, faster, and stronger. Research indicates just the opposite, but she will not believe that dieting could make her weak and slow. Unfortunately, some coaches encourage the thinner-is-better delusion.

Denial of reality

Some female athletes with anorexia nervosa are able to compete remarkably well in spite of the disorder. They use their awards, medals, and personal-best achievements to dispute the claims of worried friends and family members that they are in danger. How, they say, could I be sick and still do so well in my sport?

Eventually performance will suffer, but the athlete, instead of admitting that undernourishment is to blame, will insist that she needs to lose even more weight, and exercise even more strenuously, to achieve previous levels of success.

Athletics used as an excuse not to eat

The female athlete has an extensive repertoire of excuses why she cannot eat: Because of all the competitions, her training schedule, practice sessions, skull sessions, and traveling, she does not have time to eat. Eating before practice or competition is impossible because she is nervous, because it will make her feel heavy and slow, because it will leave her bloated, because it will make her sick to her stomach. Eating afterwards leaves her nauseated. She cannot eat fat because she must lower her body fat percentage. With this last excuse, in one fell swoop, she removes many foods from her diet, including meat, which in moderate amounts is an excellent source of high quality protein.

Athletics used as an excuse to burn calories

The anorexic female athlete may be a compulsive exerciser and use workouts as one way of purging calories. She may believe that a serious athlete can never work too hard or too much, that “no pain, no gain” must be taken literally, to the point that pain is sought as a marker for achievement.

When confronted about excessive workouts, she may insist that if she were easier on herself, she would gain weight and then lose her ranking or her position on the team. She believes that even the smallest omission from her exercise regimen will cause her to “blimp up.” In her mind, the gain of even a pound or two would cause her performance to suffer.

Athletics used to create or maintain a fragile identity

The anorexic female non-athlete wants to be thin but may not have a well-defined picture of how her life will be better if she manages to lose weight. She insists, somewhat vaguely, that, “I’ll feel better about myself and be happier when I’m thinner.” In contrast, the anorexic female athlete, who may share this general sentiment, also believes that losing weight will help her achieve specific sports goals.

She uses her performance to define who she is, to create at least part of her identity. In too many cases, her role as an athlete is the only part of her life where she feels at least minimally competent and effective. If she is not able to participate in her sport, or if she is kept out of play by coaches who fear for her safety, she will feel diminished and experience great loss and distress.

Identity issues may be of primary importance when the athlete has trained for her sport since childhood. Gymnasts and ballet dancers have a higher incidence of eating disorders than that found in the general population. These individuals see themselves as gymnasts and dancers only, and anything, like weight gain, that is perceived to threaten performance is experienced with terror as a danger to a fragile and underdeveloped identity.