Chapter 12 Disordered Eating and Exercise Patterns in Athletes

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The Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), lists which one of the following as a criterion for anorexia nervosa? Persistent lack of recognition of seriousness of current low body weight Feeling that one can not stop eating or control what or how much one is eating Misuse of laxatives and diuretics Recurrent self-induced vomiting to prevent weight gain

Persistent lack of recognition of seriousness of current low body weight

The best description of "normal" eating is ____. unplanned systematic flexible ritualistic

flexible

For adults, a weight corresponding to a BMI of ____ or less is considered significantly low or less than minimally normal. 11 15 17 21

17

An individual demonstrates some signs of both anorexia nervosa and bulimia nervosa but does not fully meet the criteria for either. How would this condition be characterized? Anorexia nervosa, purging type Binge eating disorder Eating disorder not otherwise specified "Normal" eating

Eating disorder not otherwise specified

Anorexia nervosa means loss of appetite due to nervousness, which describes the first symptom that usually occurs. True False

False

Coaches' comments and behaviors are the primary cause of athletes' eating disorders. True False

False

Disordered eating is hard to define but easy to recognize. True False

False

Which of the following characteristics is least likely associated with anorexia athletica? Voluntary excessive exercise Weight cycling Losing body fat to improve performance Lifelong struggle with abnormal eating patterns

Lifelong struggle with abnormal eating patterns

What is the likely cause of the amenorrhea in those diagnosed with the Female Athlete Triad? Extremely low body fat stores Low energy availability Increase in stress hormones due to exercise Contraceptive techniques that result in absent menstruation

Low energy availability

Amenorrhea in female athletes is associated with low estrogen secretion that results in the loss of calcium from bone. True False

True

Anorexia nervosa is characterized by a refusal to maintain a minimum body weight and an intense fear of gaining weight. True False

True

Any female athlete can be at risk for the Female Athlete Triad. True False

True

An unhealthy obsession with healthy eating describes ____. anorexia athletica anorexia nervosa bulimia nervosa orthorexia nervosa

orthorexia nervosa

What is the prevalence of anorexia nervosa in late-adolescent and early-adult females? 0.5-1.0% 1-3% 8-10% 12-15%

0.5-1.0%

What is the prevalence of bulimia nervosa in late-adolescent and early-adult females? 0.5-1.0% 1-3% 8-10% 12-15%

1-3%

For adults, a weight corresponding to a BMI of ____ or less is considered significantly low or less than minimally normal. 11 15 17 21

17

The incidence of exercise dependence or excessive physical activity may be as high as ____ percent among patients with diagnosed eating disorders. 20 40 60 80

80

Which of the following criterion is least likely to indicate secondary exercise dependence? Impaired physical and behavioral functioning Unsuccessful efforts to control exercise Absence of an eating disorder Lying about exercise volume

Absence of an eating disorder

How do the terms eating disorder and disordered eating compare? These are interchangeable terms. Disordered eating is a precise term while eating disorder is a general term. An eating disorder has specified criteria but disordered eating is not well defined. Disordered eating has specified criteria but an eating disorder does not.

An eating disorder has specified criteria but disordered eating is not well defined.

Why does the International Olympic Committee Medical Commission recommend that coaches not be involved in determining or evaluating an athlete's weight or body composition? Coaches always choose a weight that is too low. Coaches typically have the most influence over an athlete's behavior. Coaches do not have the time to closely monitor the athlete's diet. Coaches cause eating disorders.

Coaches typically have the most influence over an athlete's behavior.

Which condition listed below is the most prevalent in athletes? Anorexia nervosa. Bulimia nervosa. Disordered eating. All of the above have approximately the same prevalence.

Disordered eating.

Which of the following is true regarding male athletes and eating disorders? Eating disorders have only been documented in female athletes. Eating disorders have been documented in males but only in wrestlers and bodybuilders. Eating disorders in male athletes have been reported but the prevalence is low. The prevalence of eating disorders in male athletes is approaching that of female athletes.

Eating disorders in male athletes have been reported but the prevalence is low.

What are the three distinct but interrelated factors associated with the Female Athlete Triad? Health, fitness, and longevity Anorexia nervosa, bulimia nervosa, and anorexia athletica Appearance, performance, and optimal body weight Energy availability, menstrual function, and bone mineral density

Energy availability, menstrual function, and bone mineral density

Which term is used to describe normal menstruation? Amenorrhea Eumenorrhea Periodization Luteinization

Eumenorrhea

What characterizes body dysmorphic disorder (BDD)? Excessive concern with perceived body defects Being severely underweight Being severely obese Displaying and eating disorder

Excessive concern with perceived body defects

Diagnosing exercise dependence or voluntary excessive exercise is relatively easy because the diagnostic criterion is specific for the maximum amount of exercise that should be performed in a week. True False

False

Eating disorders are psychiatric diseases; therefore, treatment programs are limited to psychological therapy. True False

False

High-volume weight-bearing exercise offsets the loss of bone mineral density that would otherwise occur in amenorrheic athletes. True False

False

Most wrestlers that use self-induced vomiting and laxatives to "make weight" also have eating disorders. True False

False

Normal eating is defined as meeting all of the body's physiological needs. True False

False

Suppression of menstruation in female athletes is due to low body fat stores. True False

False

The term "mixed eating disorder" is also used to describe anorexia athletica and anorexia nervosa. True False

False

Those with bulimia nervosa are usually obese. True False

False

Those with bulimia nervosa most commonly purge by using laxatives. True False

False

Weight cycling is a common characteristic of both anorexia athletica and anorexia nervosa. True False

False

If the presence of an eating disorder is suspected, which is the most appropriate course of action for a coach to take? Give the athlete time to resolve the issue before taking any action. Ask an assistant coach or athletic trainer to talk directly to the athlete. Meet with the athlete and casually discuss his or her food intake. Immediately refer the athlete to a trained professional for further evaluation.

Immediately refer the athlete to a trained professional for further evaluation.

Which of the following best describes the condition known as muscle dysmorphia? Excessive protein synthesis in skeletal muscles. Severe psychological distress if not able to exercise. Lack of increase in muscle mass despite appropriate eating and exercise. Preoccupation and dissatisfaction with muscle size.

Preoccupation and dissatisfaction with muscle size.

What effect does amenorrhea in athletes have on stress fractures? Prevalence of stress fractures is higher in those with amenorrhea due to lower bone mineral density. Prevalence of stress fractures is lower in those with amenorrhea due to lower bone mineral density. Prevalence of stress fractures is higher in those with amenorrhea due to higher bone mineral density resulting from exercise. Prevalence of stress fractures is higher in those with amenorrhea due to higher bone mineral density common in all athletes.

Prevalence of stress fractures is higher in those with amenorrhea due to lower bone mineral density.

What is weight cycling? Rotating types of weight-bearing activities Alternating between dieting and bingeing Repeated weight loss and weight gain Riding a bicycle with added weights in order to accelerate loss of body fat

Repeated weight loss and weight gain

Which condition is much more prevalent in males than in females? Anorexia athletica. The Adonis complex. Bulimia nervosa. Binge-eating.

The Adonis complex.

Why are eating disorders classified as psychiatric diseases? The fundamental causes involve issues such as body image and control. Eating disorders are caused by a chemical imbalance in the brain. Eating disorders have few physiological effects. Health insurance reimbursement is higher for psychiatric diseases.

The fundamental causes involve issues such as body image and control.

What is one of the reasons why combat athletes, such as wrestlers, who restrict food and purge to "make weight" are not considered to have an eating disorder? They possess the psychological pathology that accompanies eating disorders but it is not severe. They do not base their self-esteem on weight. They do not fall within the normal range on tests of eating attitudes. They are immune to developing eating disorders.

They do not base their self-esteem on weight.

Which statement is true about an athlete's progression from a normal eating pattern to disordered eating and then to an eating disorder? This progression always occurs due to the pressures that athletes face. This progression is influenced only eating behaviors, and is independent of exercise behaviors. This progression is driven exclusively by psychological stresses. This progression is caused by many factors, including inappropriate eating and dieting, training demands, and psychological stresses.

This progression is caused by many factors, including inappropriate eating and dieting, training demands, and psychological stresses.

Athletes with and without disordered eating patterns share many features of their diet and exercise patterns but differ in their actions and perspectives. True False

True

Eating disorders and disordered eating differ in their degree of severity. True False

True

Eating disorders are classified as psychiatric diseases because control, body image, and self-esteem are underlying factors. True False

True

In females, the prevalence of bulimia nervosa is greater than the prevalence of anorexia nervosa. True False

True

In those with anorexia athletica, the primary purpose of a low body weight is performance rather than appearance. True False

True

Irregular or absent menstruation results in a loss of bone mineral density and is associated with a greater incidence of lower leg stress fractures in distance runners. True False

True

It is recommended that coaches not suggest to an athlete that weight should be reduced because of the influence the coach has over an athlete's behavior. True False

True

Little is known about eating disorders and disordered eating in males. True False

True

Many highly trained athletes monitor their caloric intake but one of the distinguishing features of an athlete with a disordered eating pattern is that caloric intake is inadequate. True False

True

Normal eating in elite athletes is hard to define but is typically characterized by discipline but not obsession. True False

True

Normal eating involves moderate restraint. True False

True

One of the results of a prolonged energy deficit is the suppression of menstruation in female athletes. True False

True

Sports considered at high risk for development of disordered eating include bodybuilding, lightweight rowing, and distance running. True False

True

The onset of anorexia nervosa is most common during late adolescence and early adulthood. True False

True

Which behavior would least likely to be associated with a binge-eating disorder? Eating much more rapidly than normal Eating until feeling uncomfortably full Using compensatory behaviors to prevent weight gain Feeling disgusted with oneself, depressed, or guilty after bingeing

Using compensatory behaviors to prevent weight gain

Which statement best fits with a description of normal eating? Eating only nutritious foods and trying to consume a perfect diet Eating even when not hungry Extreme control over amount and type of food Using moderate constraint in food selection to get nutritious food, but not missing out on pleasurable food

Using moderate constraint in food selection to get nutritious food, but not missing out on pleasurable food

In which sport are athletes likely to meet the criteria for anorexia athletica but rarely for anorexia nervosa or bulimia nervosa? Gymnastics Wrestling Ballet Long-distance running

Wrestling

Amenorrhea is defined as an ____. abnormally high concentration of estrogen-related hormones absence or suppression of menstruation excess production of testosterone in females absence of normal testosterone production in males

absence or suppression of menstruation

The best definition of excessive exercise is ____. exercise equivalent to running more than 50 miles/week exercise equivalent to running more than 100 miles/week exercise equivalent to running more than 150 miles/week being unable to determine the amount of exercise that is excessive

being unable to determine the amount of exercise that is excessive

Anorexia nervosa and bulimia nervosa share many clinical features, although ____ is a major difference between these two conditions. body image psychological pathology body weight emphasis on diet

body weight

Osteopenia is defined as a low ____. bone mineral density bone mineral density with changes in bone microarchitecture calcium intake in the presence of amenorrhea calcium intake over several decades

bone mineral density

Disordered eating ____. is indicated by being underweight is indicated by being a normal weight is indicated by being overweight cannot be predicted by body weight

cannot be predicted by body weight

Low energy availability is defined as a(n) ____. energy expenditure that routinely exceeds energy intake low energy intake caused by an eating disorder hormonal disruption that results in the delayed uptake of glucose reduced metabolic rate due to self-imposed starvation

energy expenditure that routinely exceeds energy intake

If a female athlete is having almost non-existent menstrual periods, experiencing recurrent upper respiratory tract infections, and resolving to train more and eat less than usual, she may ____. have anorexia athletica and need immediate attention have disordered eating, but will not need treatment not need to be approached because her behaviors are common to athletes have anorexia athletica, a form of anorexia that does not need treatment

have anorexia athletica and need immediate attention

Two methods used by individuals with bulimia nervosa to prevent food from being absorbed are vomiting and ____. diuretics laxatives enemas starvation

laxatives

Disordered eating in athletes is particularly hard to define because an athlete's normal eating pattern may be one of ____. no restraint mild restraint normal restraint extreme restraint

mild restraint

Another name for reverse anorexia is ____. bulimia muscle dysmorphia overeating anorexia nervosa, binge-eating/purging type

muscle dysmorphia

Studies conducted in amenorrheic distance runners suggest that ____. long-duration, weight-bearing exercise compensates for the loss of bone mineral density associated with amenorrhea bone mineral density declines in the first six months and then stabilizes due to long-duration, weight-bearing exercise osteopenia and osteoporosis do occur despite long-duration, weight-bearing exercise loss of bone mineral density is primarily a result of very low calcium intake, not exercise

osteopenia and osteoporosis do occur despite long-duration, weight-bearing exercise

Because some athletes must follow fairly strict eating guidelines to support their training, recovery, and performance goals, it is ____. particularly hard to define normal eating in athletes easy for them to follow the well-defined guidelines for normal eating nearly impossible to achieve suggested they follow a restrictive diet plan

particularly hard to define normal eating in athletes

A binge is described as eating a large amount of food that is ____. greater than 2000 calories in 2 hours or less relative to the individual's usual pattern of eating, in 2 hours or less greater than 2000 calories in 30 minutes or less relative to the individual's usual pattern of eating, in 30 minutes or less

relative to the individual's usual pattern of eating, in 2 hours or less

The two subtypes of anorexia nervosa are ____. anorexia nervosa and bulimia nervosa anorexic nervosa and anorexia athletica restricting type and binge-eating/purging type restricting type and athletica type

restricting type and binge-eating/purging type

Therapy for bulimia nervosa should focus most on issues surrounding both self-esteem and ____. self-control family history a perfect diet exercise patterns

self-control

The most common method of purging by those with bulimia is ____. laxatives self-induced vomiting the use of ipecac enemas

self-induced vomiting

A normal amount of exercise is ____. enhanced by a low body weight more achievable if athletes employ a restrictive diet supportive of training and performance impossible to determine

supportive of training and performance

One sign of disordered eating is _____. the tendency of eating when hungry and stopping when full the inability to eat when hungry and stop when full including small amounts of junk food in diet occasional overeating

the inability to eat when hungry and stop when full

Diagnosing anorexia nervosa takes skill because ____. it must be determined if a person is below the normal weight for any given age and height it must be determined if a person is above the normal weight for any given age and height there is not a single normal weight for any given age and height people rarely seek treatment for this condition

there is not a single normal weight for any given age and height

In most cases of anorexia nervosa, weight loss is achieved primarily by ____, and ____ may be a secondary method used. voluntary starvation; excessive exercise excessive exercise; overuse of laxatives self-induced vomiting; voluntary starvation overuse of laxatives; excessive exercise

voluntary starvation; excessive exercise


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