Chapter 12 Disordered Eating and Exercise Patterns in Athletes
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
