The prevalence and psychosocial correlates of British athletes' eating psychopathology

Eating disorders pose long-lasting physiological and psychological consequences, and have one of the highest mortality rates amongst mental illnesses (Harris & Barraclough, 1998). In recent years, athletes have been frequently identified as at more risk of developing eating disorders, and problematic eating attitudes and behaviours than the general population (e.g., Sundgot-Borgen & Torstveit, 2004). Athletes with eating disorders not only risk compromising their performance, but also their health and general wellbeing (Currie & Morse, 2005). Therefore, the identification of the prevalence, as well as the potential factors that is likely to contribute to eating disorders in athletes present a valuable avenue for research. The first study of this thesis examined the prevalence of potential eating disordered cases amongst a sample of elite, developmental, and recreational British athletes, as well as a control group of British non-athletes. Gender and sport type differences between and within these aforementioned performance standards were also examined in this study. Results demonstrated that while recreational athletes and non-athletes reported greater disturbed eating psychopathology, there were no significant differences in the prevalence of probable cases of eating disorder between elite, developmental, recreational, and non-athletes. However, there was a trend for a higher number of non-athletes and recreational athletes (males and females, regardless of sport type) to be classified as potential cases with clinical eating disorders. In addition, a higher number of females from the elite and non-athlete performance standards were classified as eating disordered than their respective male counterparts. Thus, these findings provide evidence to suggest that eating disorders pose a cause for concern in less competitive athletes and those that do not engage in organised sport at all. Guided by the established maintenance factors associated with eating disorders within the general population (see Fairburn, Cooper, & Shafran, 2003), Studies 2 and 3 reflect a series of cross-sectional investigations aimed to test the association between a range of interpersonal difficulties and eating psychopathology. These studies were designed to fill the iv gap in the current eating disorder literature by examining multiple pathways between both situational (i.e., relationship quality with parents, coaches, and teammates) and dispositional interpersonal difficulties (i.e., attachment styles) and eating psychopathology via the mediating variables of perfectionism, self-esteem and depression. Mediational analyses in Study 2 revealed that relationship quality with parents and coaches as defined by social support, interpersonal conflict, and insecure attachment styles were indirectly related to athletes‟ eating psychopathology via the mediating roles self-critical perfectionism, selfesteem, and depression. However, the quality of relationship with teammates was not associated to athletes‟ eating psychopathology. Study 3 further examined the association between eating psychopathology and situational interpersonal difficulties (i.e., relationship quality with mother, father, and coaches), as well as dispositional interpersonal difficulties (i.e., social anxiety and loneliness) among a sample of athletes and non-athletes. Mediational analyses revealed that the quality of the relationship with the father, and levels of loneliness were indirectly related to athletes‟ eating psychopathology via the mediating role of depression, while social anxiety was found to be both directly and indirectly related (via depression) to athletes‟ eating psychopathology. In the case of non-athletes, the quality of the relationship with both the mother and the father, levels of social anxiety and loneliness were indirectly related to eating psychopathology via the mediating role of depression, self-esteem, and self-critical perfectionism. Furthermore, this study provided evidence to suggest that dispositional interpersonal difficulties may be more robust independent predictors of athletes‟ and non-athletes‟ eating psychopathology than situational interpersonal difficulties (i.e., relationship quality with significant others). Collectively these studies suggest that the psychosocial mechanisms hypothesised to be involved in eating disorders within the general population closely resemble that of athletes. Employing a prospective research design, Study 4 examined the predictive role of situational and dispositional interpersonal difficulties in athletes‟ eating psychopathology. Conducted over a 6 month period, the findings of this study revealed that only situational interpersonal difficulties as reflected in the quality of the relationship with coaches and teammates were associated to athletes‟ eating psychopathology, over and above their initial eating psychopathology. Moreover, the study highlighted interpersonal conflict within the coach-athlete relationship as the only independent predictor of athletes‟ eating v psychopathology. Therefore suggesting that conflict with the coach should be considered as a potential risk factor in the development of eating disorders amongst athletes. The final study tested the main constructs underlying the transdiagnostic cognitive behavioural theory of eating disorders (Fairburn et al., 2003) within an athletic population. Results revealed that elevated eating psychopathology may arise from an interaction of “interpersonal difficulties”, low self-esteem, high levels of self-critical perfectionism, and depressive symptoms. Moreover, findings of this study demonstrated that the tested model is invariant across athletes‟ sport type and performance standard, but not across gender. Thus suggesting that the psychosocial processes involved in eating disorders are the same regardless of the type of sport, and the performance standard that an athlete competes in. Overall, the findings of the current research revealed that while the prevalence of eating disorders may be considerably lower within the British athletic population than the general population, there is still cause for concern, given the high prevalence detected in recreational athletes, as well as the high number of competitive athletes engaging in inappropriate compensatory weight control behaviours (i.e., excessive exercise and selfinduced vomiting). Moreover, the results of the latter studies suggest that psychosocial factors are important and pertinent factors to consider in the aetiology of eating disorders amongst athletes. As a whole, this thesis makes a significant contribution to furthering our understanding of the prevalence and psychosocial correlates of eating psychopathology amongst British athletes.