Experience and Strength with Eating Disorder Recovery in Female Athletes
Kimberly Dennis, MD

Eating disorders and disordered eating are commonly experienced by female
athletes, but sorely under recognized by coaches, teachers, parents,
therapists and physicians. I use the term disordered eating to include
sub-clinical eating disorders as well as eating disorders which meet
full DSM-IV-TR criteria for anorexia nervosa, bulimia nervosa, eating
disorder not otherwise specified, and binge-eating disorder.
There are several core features of the illness of eating disorders, which may
be particularly exacerbated in the athletic arena for females.

is one core feature of eating disorders and other addictive processes.
In my clinical experience, the level of institutional denial of eating
disorders in athletes exceeds that of non-athlete females with eating
disorders. The fire of denial can be fed by coaches who rely on the
exceptional talent and extreme drive for success that many athletes
possess to win games, titles, awards, etc. When a female athlete is
still winning or competing and ill, it may be easier to disavow an
active problem with food or eating.

character trait that has been shown by clinical research to be
abundantly present in patients with eating disorders is perfectionism.
Competitive athletes rely on precision and “perfect” execution of
planned movements, behaviors, training rituals in order to succeed and

itself is another trait commonly seen in individuals with eating
disorders. Finally, the psychosexual implications of being a female may
also contribute to the increased prevalence and risk of disordered
eating among female athletes. Most athlete role models are men (with
the exception of aesthetic sports such as dance, cheerleading,
synchronized swimming). The female athlete may feel more pressure to
masculinize her body and become more muscular. She may also seek to
avoid menstruation, with its inherent cyclical fluctuations affecting
our bodies and moods, since stability, consistency, and control are
important for athletic performance and success. The triggering of such
traits and their perceived importance in successful athletes are a
set-up for female athletes with genetic, familial, psychosocial
predispositions for eating disorders.

Co-occurring addictive use of performance-enhancing substances, anorexigenic
substances, and family histories of addiction or eating disorders can
add to a female athlete’s risk of developing an eating disorder.
Prevention, early detection, and appropriate intervention are essential
to avoid long-term health consequences such as osteoporosis, cardiac
problems, digestive problems, neurological sequelae, and death.

Early Detection – what to look for: 

  • increased concern about body composition, body fat;
  • increased
    concern about “healthy eating” and rigid behavior around food (eating
    fat free, not eating certain food groups, eating alone or in
  • social withdrawal, loss of intimacy or closeness with peers and family members;
  • rapid weight loss or gain; going to the bathroom after meals;
  • unmanageability in other areas of life (school, relationships, substances/intoxication);
  • loss of menses or irregularity of menses.

Tips for women on how to avoid eating disorder behaviors while training: 

  • exercise and train with a partner or in groups with other women (avoid isolation and secrecy around exercise and food);   
  • replenish fluids and follow a well-balanced food plan (including enough protein, iron, calcium, and fat intake);
  • get guidance and help from a sports nutritionist;
  • contact your physician if you begin to experience menstrual irregularity or lose menses;
  • take 1-2 days off per week;
  • avoid looking at “calories burned” displays on cardio equipment;
  • seek professional
    help if you start to experience unmanageability in your eating, exercise, or weight and/or body concerns;
  • avoid using diuretics, laxatives, stimulants, steroids for performance or training enhancement;
  • women
    with histories of eating disorder: continue to receive maintenance care
    from a professional, continue to attend 12-step recovery groups for
    people in recovery from eating disorders.

Tips for coaches and school administration:

  • provide education around prevention and recognition of eating disorders particularly to staff and coaches for female athletes;
  • provide education around prevention and recognition of eating disorders to female athletes;
  • make appropriate treatment recommendations for athletes who are suspected of having an illness;
  • work
    with treatment team professionals to set clear expectations around
    necessary recovery parameters to resume or maintain athletic
  • foster a culture of safety around the athlete asking for help and expressing concerns about weight;
  • allow for and enable a female athlete to express when a training schedule feels like too much or feels too intense;
  • be part of the solution, rather than part of the problem (denial, shaming, etc.).

you think you have an eating disorder, please seek help from a
treatment professional, school counselor, coach, parent and/or 12-step
meeting for eating disorder recovery such as Eating Disorders Anonymous
or Overeaters Anonymous. A variety of treatment settings are available,
from outpatient to residential, and early intervention is a key factor
in reducing the long-term health, athletic, emotional and spiritual
consequences of having an eating disorder.

a treatment professional with the luxury of working at a residential
treatment center for girls and women, and as well as the outpatient
setting in private practice, I am afforded the exquisite opportunity to
bear witness to good treatment outcomes–full, long-term
remission-which are more likely with early and appropriate
intervention. The food/body/weight obsession is merely a symptom of
underlying conditions. Being able to facilitate a normalization of
eating behaviors, to ensure medical stability, and then get to
underlying issues of how to live and live fully as a woman is a process
I am grateful to be part of on a daily basis.

girls and women in recovery from eating disorders learn to live life as
one female athlete among many, begin to repair broken family
relationships, embark on the journey of healing trauma, experience the
development of close peer relationships, regain the ability to
participate as a strong and healthy female athlete, and develop a
loving and empowered relationship with themselves. One of the strengths
of female athletes with eating disorders is their love for the sport.
To be able to mobilize this love in the service of increasing
motivation to recover from an eating disorder can be a critical factor
in successful treatment of female athletes with eating disorders.

A message of hope for full recovery, and “sober” or “abstinent”
participation in athletics is important to convey to female athletes
acutely ill with anorexia, bulimia or other eating disorders. The role
of ongoing care and a slow gentle pace of recovery are equally
important. It is a blessing for me to be involved in recovery from such
a devastating and deadly illness, especially with female athletes–a
group of girls and women who are so talented and beautiful and strong
just as they are, just as the women they were created to be.

Dr. Kimberly Dennis is the Medical Director of Timberline


She will be speaking in Arizona on November 14th for the IAEDP AZ Chapter.

Knolls is a residential treatment center for adolescent & adult
females, treating eating disorders and substance abuse.

For more information please call 1-877-257-9611



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