The purpose of this study was to examine and compare eating characteristics and body image disturbances in female NCAA Division I and III athletes in the mainstream sports of basketball, softball, track/cross country, volleyball, soccer, tennis, swimming/diving, and ice hockey. Female collegiate athletes (N = 118) from Division I and III universities completed the EAT-26 and MBSRQ. Personal demographics and anthropometric data including height, weight, BMI and Body Fat estimates were also assessed. The study found that 49.2% (Division I) and 40.4% (Division III) of female athletes were in the subclinical eating disorder range. Results assessing body satisfaction, reported that 24.2% of Division I female athletes and 30.7 % of Division III female athletes were either very dissatisfied or mostly dissatisfied with their overall appearance. Results also showed that Division I female athletes were less satisfied with their appearance evaluation (body areas satisfaction, and lower torso). Division III female athletes reported higher levels of bulimic behaviors and weight preoccupation. The results indicate that athletes in refereed female sports are at risk for eating disorders, and that body image risk factors vary between NCAA competition divisions. This research provides sport professionals with a better understanding of risk factors influencing the prevalence of eating disorders between female athletes’ divisional competition levels.
**Key words:** body dissatisfaction, eating disorders, NCAA division, collegiate female athletes, eating disorder risk factors
Eating disorders are among the four leading causes of disease that may lead to disability or death (2). Eating disorders have the highest mortality rate of any mental health illness (41). Approximately nine million Americans suffer from an eating disorder with a lifetime prevalence rate of 0.9% – 4.5% and approximately 10% of college women suffer from a clinical or near clinical eating disorder (19,22).
Body image refers to the self-perception and attitudes an individual holds with respect to his or her body and physical appearance. Body image is a complex synthesis of psychophysical elements that are perpetual, emotional, cognitive, and kinesthetic. Cash and Fleming (10) defined body image as “one’s perceptions and attitudes in relation to one’s own physical characteristics” (p. 455). Body dissatisfaction focuses on body build and is often operationalized as the difference between ideal and current self selected figures (7).
Body dissatisfaction is a significant source of distress for many females. Gender is reported to be a convincing risk factor for disordered eating since females are 10 times more likely to develop an eating disorder compared to males (14). Research shows that the size of the “ideal” woman is far smaller than the size of the average woman (25). “The overwhelming evidence of female gender as a risk factor for the development of an eating disorder highlights the importance of determining the factors that put women at risk, particularly the sociocultural context in which these disorders develop” (31, p. 766).
Risk factors that accompany eating disorders are multi-factorial in nature. Research has revealed that sociocultural, developmental, personality, athletic, trauma, familial, and biological factors are critical identifiable areas that house potential eating disorder risk factors (31). Within these specific areas, body image dissatisfaction and low self-esteem are two situational aspects typically associated with individuals who are at risk for developing an eating disorder. In an early study on body dissatisfaction (5), 23% of the women expressed dissatisfaction with various parts of their body. The particular areas problematic for women were the abdomen, hips, thighs, and overall weight. When the study was replicated in the mid-1980s (11), the percentage of females dissatisfied with their body increased to 38%, with the same general body areas being defined by the participants. These same general body areas were also identified in a more recent study (16) in 56% of women.
Considerable scientific attention has been directed toward the potential role that sport involvement play in an athletes’ development of attitudes and behaviors about disordered eating. Female athletes experience a higher rate of eating disorders than non-athletes (4,24,43). Female athletes have an eating disorder prevalence of 15% to 62% compared to 0.5% to 3% in late adolescent and young adult female non-athletes (21). Researchers (33) assessed disordered eating in female collegiate athletes (N = 204) from three NCAA universities. The responses to the Questionnaire for Eating Disorder Diagnoses (Q-EDD) found 72.5% (n = 148) of the female athletes were asymptomatic, 25.5% (n = 52) symptomatic, and 2.0% (n = 4) eating disorder (29). Compared to recent research (8,39), this research study found a higher percentage of female athletes who were symptomatic. Athlete’s prevalence rate is an important factor, but understanding variables associated with increasing or decreasing risk factors for disordered eating is significant etiological information that should be evaluated (32).
Athletic factors promoting eating disorder development were first identified through research that began in the 1980s, which found particular sports induced higher rates of disordered eating behaviors (1,17). Even though physical activity may develop self-esteem and encourage physical and emotional well-being, there is verification that female athletes are at greater risk for developing disordered eating than their peers who are non-athletes (6). Female athletes encounter the same sociocultural pressures that of non – athletes, however the increased demand of sport – related pressures may independently or dependently increase their risk of eating disordered attitudes and behaviors (40). Coaches, sponsors, and families may all play a role in influencing an athlete’s weight and shape. Negative comments from those that surround and evaluate the athlete may trigger the onset of abnormal eating behaviors leading to an eating disorder (12,28).
The type of sport may also play a role in predisposing an individual to eating disorders based on struggles with body performance satisfaction. Specific sports where performance is judged on body leanness, shape and movement such as ballet, gymnastics, figure skating, diving, and cheerleading have a higher incidence of eating disorders (1,42,47). Shape judged sports such as gymnastics, diving, cheerleading, and dance place more importance on the individual’s body appearance, which may lead to body shape discontent among competitors (47). Researchers also report that 15% to 65% of women in “thin build” sports such as gymnastics or ballet have pathogenic eating patterns known to influence or manipulate the history and development of the eating disorder (27,44). Participation in competitive “thin build” sports in conjunction with personality traits associated with disordered eating could put these individuals at an even greater risk for developing an eating disorder (15, 44). The personality trait of many perfectionist increase disordered eating behaviors for female athletes (20). Researchers (26) compared athletes and non-athletes and reported perfectionism was the only factor that significantly distinguished the groups. In addition, Wilmore (46) reported that athletes high in perfectionism had an increased drive for thinness than athletes low in perfectionism. Refereed sports such as basketball place a stronger emphasis on training and do not rely as much on body appearance; therefore athletes participating in these sports may be less likely to be associated with disordered eating patterns (47).
Most research to date focuses on Division I female athlete’s prevalence rates, while female athletes regardless of NCAA division, experience similar sport specific pressures associated with body image disturbances. Limited research has compared prevalence between NCAA divisions, eating attitudes, and body image disturbances in female athletes. Research has reported that the prevalence of disordered eating, unhealthy dieting, and distorted body image in the athletic population ranges from 12% to 57% (30). Elite female athletes who suffer from eating disorders put themselves at greater risk for serious illnesses and/or death (38). Research has shown that more than one-third of female Division I NCAA athletes report attitudes and symptoms placing them at risk for an eating disorder (2). The National Collegiate Athletic Association study that surveyed student athletes from 11 Division I schools (N = 1,445) reported 1.1% of the female athletes met DSM-IV criteria for bulimia nervosa while 9.2% of female athletes had clinically significant symptoms of bulimia nervosa. This study also reported 0% female athletes met the DSM-IV criteria for anorexia nervosa while 2.85% of the female athletes had clinically significant symptoms of anorexia nervosa (24). Researchers believed the results suggest that Division I female athletes are at significant risk for the progression of eating disorder thoughts and behaviors. The study also stressed the need for future research to examine non-elite Division I, II and III schools since eating disorder risk factors may be higher among lower tier schools. Comparing divisional levels of competition in NCAA athletics could be an important aspect to understanding risk factors involved in the developmental process of an eating disorder.
The purpose of this study was to examine and compare eating characteristics and body image disturbances in female NCAA Division I and III athletes in mainstream sports of basketball, softball, track/cross country, volleyball, soccer, tennis, swimming/diving, and ice hockey. This study also examined female body part dissatisfaction and eating attitudes utilizing the Multidimensional Body Self-Relations Questionnaire (MBSRQ) and Eating Attitudes Test (EAT-26). These findings may assist coaches, strength and conditioning coaches, and athletic trainers in understanding disordered eating and body image disturbances across various female sports in different competition divisions.
Participants (N = 118) included Division I (n = 41) and Division III (n = 87) female athletes from National Collegiate Athletic Association (NCAA) member institutes of the following sports: basketball, softball, track/cross country, volleyball, soccer, tennis, swimming/diving, and ice hockey. The convenient sample participants were voluntary, anonymous, and in accordance with university and federal guidelines for human subjects.
Each athlete completed questionnaires assessing participant demographics and athletic involvement (sport, division). Eating behavior patterns were assessed utilizing the Eating Attitudes Test (EAT-26) and attitudes concerning body image were assessed with the Multidimensional Body-Self Relations Questionnaire (MBSRQ). Anthropometric measurements (height and weight) and body fat measurements were taken on each athlete. (Omron Fat Loss Monitor, Model HBF-306C). The Fat Loss Monitor (Omron Fat Loss Monitor, Model HBF-306C) displays the estimated value of body fat percentage by bioelectrical impedance method and indicates the Body Mass Index (BMI). The bioelectrical impedance, skinfold, and hydrostatic weighing methods have all been shown to be reliable measures of body composition (r = .957 – .987) (23).
##### Eating Attitudes Test (EAT-26)
Eating Attitudes Test (EAT-26) was used to differentiate participants with anorexia nervosa, bulimia nervosa, binge-eating, and those without disordered eating characteristics. It is a 26-item measurement consisting of three subscales: 1) dieting, 2) bulimia and food perception, and 3) oral control. Scoring for this instrument was a Likert scale of six possible answers (always, usually, often, sometimes, rarely, never). Scores ranged from zero to three for each question and a total score greater than 20 indicates excessive body image concern that may identify an eating disorder (Garner et al., 1982; Williamson et al., 1987). EAT-26 has been proven to be a reliable measurement (r = .88) (17). The total score of the EAT-26 and the Drive for Thinness scale of the Eating Disorder Inventory (EDI) have reports of a 90% agreement (37).
##### Multidimensional Body-Self Relations Questionnaire
The Multidimensional Body-Self Relations Questionnaire: The Multidimensional Body-Self Relations Questionnaire (MBSRQ) is a 69 item self-report inventory for the assessment of self-attitudinal aspects of the body image construct. The MBSRQ measures satisfaction and orientation with body appearance, fitness, and health. In addition to seven subscales (Appearance Evaluation and Orientation, Fitness Evaluation and Orientation, Health Evaluation and Orientation, and Illness Orientation), the MBSRQ has three special multi-item subscales: (1) The Body Areas Satisfaction Scale (BASS) approaches body image evaluation as dissatisfaction-satisfaction with body areas and attributes; 2) The Overweight Preoccupation Scale assesses fat anxiety, weight vigilance, dieting, and eating restraint; and 3) The Self-Classified Weight Scale assesses self-appraisals of weight from “very underweight” to “very overweight.” Internal consistency for MBSRQ subscales range from .74 – .91. This questionnaire has been studied and used extensively in the college population. Internal consistency for the subscales of the MBSRQ ranged from .67 to .85 for males and .71 to .86 for females (9).
#### Descriptive statistics
Participants in the study included 118 female athletes from NCAA Division I (34.7%) and Division III (73.7%) universities. Participants reported their ethnicity as 80.5% White (n =95), 16.1% Black (n =19), .02% Hispanic (n =2), .01% Asian (n =1), and .01% as other (n = 1). The female athletes had a mean age of 19.81 years + 1.29 and a mean body fat percentage of 21.17% + 5.07 (Table 1). There was no significant difference between the divisions in regards to body fat percentage F (1,117) = .727, p = .395.
#### Test for Significance
A multiple analysis of variance (MANOVA) was conducted to determine the effect of NCAA Divisional Status (I or III) on eating characteristics and body image (Table 2). Significant differences were found between Division I and III, Wilks’s Lambda = .664, F(17, 114), p<.0001.
##### Disordered Eating Behaviors
Base frequency scores indicated that 49.2% of Division I female athletes and 40.4% of Division III female athletes scored a 20 or higher on the EAT-26. A follow – up ANOVA reported no significant differences between 20 or higher EAT-26 scores and NCAA Division, F (1, 117) = 1.732, p = .190. A significant difference was found between divisions on the bulimia subscale of the EAT-26, F (1, 117) = 9.107, p = 003. No significant differences were found between division for the EAT-26 dieting subscale, F (1, 117) = .125, p = .724 and oral control subscale F (1, 117) = 2.123, p = .148.
##### Body Disturbance
The results of the MANOVA indicated a significant difference between divisions on the MBSRQ, F(17,114 ) = 3.391, p = .000. The results of the MBSRQ, which assessed body satisfaction, found that 24.2 % of Division I female athletes and 30.7 % of Division III female athletes were either very dissatisfied or mostly dissatisfied with their overall appearance. In addition, a difference was found between Division I and III athletes for appearance evaluation, F (1, 3) = 10.525, p = .001, body areas satisfaction F (1, 3) = 8.36, p = .004, lower torso F (1, 3) = 5.975, p = .016, and overweight preoccupation F (1, 3) = 17.895, p = .000. Division I female athletes were less satisfied with their appearance evaluation, body areas satisfaction, and lower torso than Division III female athletes. Division III female athletes were more weight preoccupied than Division I female athletes.
The main purpose of this study was to examine and compare the eating attitudes and body image satisfaction in female NCAA Division I and III athletes in mainstream sports of basketball, softball, track/cross country, volleyball, soccer, tennis, swimming/diving, and ice hockey. Limited research is available comparing eating disturbances between NCAA divisions so the information acquired may help explain the prevalence of body image disturbances and eating disorder among college female athletes at different levels of competition.
The results of this study indicated that 49.2% (Division I) and 40.4% (Division III) of the female athletes scored 20 or higher on the EAT-26, putting them in a subclinical eating disorder range (18). Comparative research studies using the EAT-26 reported percent subclinical populations of females athletes to be 15.2%, N = 425 (3); 5.8%, N = 190 (13); and 10.2%, N = 59 (36). The current research study did not find a significant difference between subclinical population scores and division, however both Division I and Division III female athletes had a considerably higher subclinical eating disorder female athletic population compared to these previous studies. This finding may be an important implication because the desire to be thin does not always result in clinically diagnosed signs and symptoms of anorexia or bulimia. If left undetected, subclinical eating disorders may result in dysfunctional social interaction, decreased physical performance reduced physical health, and an increase in the propensity for athletic injury.
Between divisions, a significant difference was found on the bulimia subscale of the EAT-26. Division III female athletes struggled more with bulimic behaviors compared to the Division I female athletes. This finding agrees with previous research suggesting that disturbed eating behavior may be higher among lower tiered athletes (35). Bulimic behaviors may be viewed as more destructive to athletic performance so the elite competitive athletes (Division I) may be deterred from participating in such behaviors. Bulimic behaviors may also require a greater level of secrecy, so elite competitive female athletes competing may avoid such behaviors due to increased time commitment, travel requirements, and contact they experience with their coaches and athletic trainers.
It has been reported that female athletes participating in judged sports such as gymnastics, cheerleading, and dance are more prone to eating disorders compared to those who participate in referred sports such as basketball, swimming, and softball (26,34,47). The assessment of body satisfaction through the MBSRQ found that 24.2 % of Division I female athletes and 30.7 % of Division III female athletes were either very dissatisfied or mostly dissatisfied with their overall appearance. We believe that our findings warrant further investigation into the relationship of female athlete’s body dissatisfaction and those participating in referred sports.
A significant difference was also reported on the MBSRQ subscales between Division I and III athletes for appearance evaluation, F (1, 3) = 10.525, p = .001, body areas satisfaction F (1, 3) = 8.36, p = .004, lower torso F (1, 3) = 5.975, p = .016, and overweight preoccupation F (1, 3) = 17.895, p = .000. Division I female athletes were less satisfied with their appearance evaluation, body areas satisfaction, and lower torso than Division III female athletes. Division III female athletes were more weight preoccupied than Division I female athletes. A performance-related drive for thinness through appearance evaluation, body areas satisfaction and lower torso may have a greater impact on female athletes that compete in higher level divisions such as Division I. Being weight preoccupied may not be as closely associated with physical performance measures as compared to general body dissatisfaction.
Even though this was a well-designed study and used a diverse sample of female athletes, it is not without limitations. The participant sample was limited in racial/ethnic minorities, therefore future research should examine female athletic samples with greater racial/ethnic diversity. This research also compared Division I female athletes to Division III female athletes. Increasing the number of institutes and divisions would greatly benefit the findings of this study. Lastly, although a diverse group of female athletic teams was represented in this study, equal number of female athletes from each team was not available due to the sports each institution offered, scholarships, and general participation. For example, ice hockey could only be evaluated at the Division III level. It is possible that the results would have varied if there were equal participant representation. Future research should examine a greater number of institutions at varied divisions to increase participant representations among each sport.
Our results indicate that refereed female sports are at risk for eating disorders and body image risk factors vary between NCAA competition divisions of female sports. Body dissatisfaction factors that may lead to serious eating disorders will continue to impact the female athletic audience due to added pressures innate to sport performance. Female athletes, regardless of sport, show evidence of risk for developing an eating disorder. Understanding what motivates the developmental process to accelerate in sport may vary depending on level of competition. The educational and scholarly implications of this research project include contributing to the body of literature in the area of body image and eating attitudes of female athletes and providing professionals with a better understanding of the risk factors that influence the prevalence of eating disorders at varied levels of competition.
### Applications in Sport
These findings may assist coaches, strength and conditioning coaches, and athletic trainers in understanding disordered eating and body image disturbances across various female sports in different competition divisions. Professionals that work with female athletes understand the sensitive nature of optimizing performance without compromising overall health. Recognizing and identifying prevention indicators for body image disturbances that lead to disordered eating will assist professionals when dealing with at risk female athletes in varied levels of competition of referred sports. This information will also greatly benefit programs aimed at ceasing the progression of disordered eating
1. Abraham, S. (1996). Characteristics of eating disorders among young ballet dancers. Psychopathology, 29, 223-229.
2. Academy of Eating Disorders. (2008) Statistics and study findings: Burden and prevalence of eating disorders. Retrieved from <http://www.aedweb.org> on January 31, 2008.
3. Beals, K.A., & Manore, M.M. (2002). Disorders of female athlete triad among collegiate athletes. International Journal of Sports Nutrition and Exercise. 12(3), 281 – 293.
4. Berry, T.R., & Howe, B.L. (2000). Risk factors for disordered eating in female university athletes. J. Sport Behavior, 23(3), 207–218.
5. Berscheid, E., Walster, E., & Bohrnstedt, G. (1973) The happy American body: a survey report. Psychology Today, 7(6), 119.
6. Brownell, K.D., Rodin, J., & Wilmore, J.H. (1992). Eating, Body Weight and Performance in Athletes: Disorders of Modern Society. Lea and Febiger, Philadelphia, PA.
7. Candy, C.M., & Fee, V.E. (1998). Underlying dimensions and psychometric properties of the eating behaviors and body image test for preadolescent girls. Journal of Clinical Child Psychology, 27(1), 117-127.
8. Carter, J.E., and Rudd, N.A. (2005). Disordered eating assessment for college student athletes. Women in Sport and Physical Activity Journal, 14, 62–75.
9. Cash, T.F. (2000). The multidimensional body-self relations questionnaire users’ manual. Available from the author at www.body-images.com or through email (TCash@odu.edu).
10. Cash, T.F., & Fleming, E.C. (2002). The impact of body-image experiences: Development of the Body Image Quality of Life Inventory. International Journal of Eating Disorders, 31, 455-460.
11. Cash, T.F., Winstead, B.A., & Janda, L.H. (1985). Your body, yourself: A reader survey. Psychology Today, 20(4), 30-44.
12. Cobb, K.L., Bachrach, L.K., Greendale, G., Marcus, R., Neer, R., Nieves, J. et al. (2003). Disordered eating, menstrual irregularity, and bone mineral density in female runners. Medical Science, Sport, and Exercise, 35, 711-719.
13. Dunn, D., Turner, L.W., & Denny, G. (2007). Nutrition knowledge and attitudes of college athletes. The Sport Journal. 10(4), Retrieved July 5th, 2010, from <http://www.thesportjournal.org/article/nutrition-knowledge-and-attitudes-college-athletes>
14. Fairburn, C.G., & Beglin, S. J. (1990). Studies of the epidemiology of bulimia nervosa. American Journal of Psychiatry, 55, 425-432.
15. Fulkerson, J.A., Keel, P.K., Leon, G.R., & Dorr, T. (1999). Eating disordered behaviors and personality characteristics of high school athletes and nonathletes. International Journal of Eating Disorders, 26, 73-79.
16. Garner, D.M. (1997). The 1997 body image survey results. Psychology Today, 30(1), 30-57.
17. Garner, D.M. & Garfinkel, P.E. (1979). The eating attitudes test: An index of the symptoms of anorexia nervosa. Psychological Medicine, 9, 273-279.
18. Garner, D.M., Olmsted, M.P., Bohr, Y., & Garfinkel, P.E. (1982). The eating attitudes test: Psychometric features and clinical correlations. Psychological Medicine, 12, 871-878.
19. Gurze Books. (2010). Eating disorder statistics. Retrieved July 14th, 2010, from http://www.bulimia.com/client/client_pages/eatingdisorderstats.cfm
20. Hausenblas, H. & Carron, A. (1999). Eating disorder indices and athletes: An integration. Journal of Sport and & Exercise Psychology, 21, 230-258.
21. Hinton, P.S. & Kubas, K.L. (2005). Psychosocial correlates of disordered eating in female collegiate athletes: validation of the ATHLETE questionnaire. Journal of American College Health, 54, 149 – 156.
22. Hudson, J.I., Hiripi, E., Pope, H.G., & Kessler, R.C. (2007). The prevalence and correlates of eating disorders in the national comorbidity survey replication. Biological Psychiatry, 348-358.
23. Jackson, A.S., Pollock, M.L., Graves, J.E., & Mahr, M.T. (1988). Reliability and validity of bioelectrical impedance in determining body composition. Journal of Applied Physiology, 64, 529-534.
24. Johnson, C., Powers, P.S., & Dick, R. (1999). Athletes and eating disorders: The national collegiate athletic association survey. International Journal of Eating Disorders, 26, 79 – 88.
25. Katzmarzyk, P.T., & Davis, C. (2001). Thinness and body shape of Playboy centerfolds from 1978 to 1998. International Journal of Obesity and Related Metabolic Disorders, 25, 590-592.
26. Krane, V., Stiles-Shipley, J.A. Waldron, J., & Michalenok, J. (2001). Relationship among body satisfaction, social physique anxiety, and eating behaviors in female athletes and exercisers. Journal of Sport Behavior. 24(3), 247-265.
27. Macleod, A.D. (1998). Sport psychiatry. Australia New Zealand Journal Psychiatry. 32, 860-866.
28. McLean, J.A., Barr, S.I., & Prior, J. C. (2001). Dietary restraint, exercise and bone health in young women: Are they related? Medical & Science in Sport & Exercise, 33, 1292-1296.
29. Mintz, L.B., O’Halloran, M.S., Mulholland, A.M., & Schneider, P.A. (1997). Questionnaire for eating disorder diagnoses: Reliability and validity of operationalizing DSM-IV criteria into a self-report format. Journal of Counseling Psychology, 44, 1997.
30. Montenegro, S.O. (2006). Disordered eating in athletes. Athletic Therapy Today, 11, 60- 62.
31. Mussell, M.P., Binford, R.B., & Fulkerson, J.A. (2000). Eating disorders: Summary of risk factors, prevention programming, an prevention research. The Counseling Psychologist, 28, 764-796.
32. Petrie, T.A., & Greenleaf, C. (2007). Eating disorders in sport: From theory to research to intervention (pp. 352–378). In G. Tenenbaum & R. Eklund (Eds.), Handbook of Sport Psychology 3rd ed. Wiley & Sons, Inc, Hoboken, NJ.
33. Petrie, T.A., Greenleaf, C., Reel, J., & Carter, J. (2009). Personality and sychological factors as predictors of disordered eating among female collegiate athletes. Eating Disorders: The Journal of Treatment and Prevention, 17, 302 – 321.
34. Powers, P.S. (2000). Athletes and eating disorders. Healthy Weight Journal, 14(4), 59-62.
35. Powers, P.S., & Johnson, C. (1996). Small victories: Prevention of eating disorders among athletes. Eating Disorders: The Journal of Treatment and Prevention. 4, 364-367.
36. Raymond-Barker, P., Petroczi, A., & Quested, E. (2007). Assessment of nutritional knowledge in female athletes susceptible to female athlete triad syndrome. Journal of Occupational Medicine and Toxicology. 2, Retrieved January 27th, 2010, from <http://www.occup-med.com/content/2/1/10>
37. Raciti, M.C. & Norcross, J.C. (1987). The EAT and EDI: Screening, interrelationships and psychometrics. International Journal of Eating Disorders, 6, 579-586.
38. Ryan, J. (1995). Little girls in pretty boxes: The making and breaking of elite gymnasts and figure skaters. New York: Doubleday.
39. Sanford-Martens, T.C., Davidson, M.M., Yakushko, O.F., Martens, M.P., Hinton, P., & Beck, N.C. (2005). Clinical and subclinical eating disorders: An examination of collegiate athletes. Journal of Applied Sport Psychology, 17, 79–86.
40. Smith, A. & Petrie, T. (2008). Reducing the risk of disordered eating among female athletes: A test of alternative interventions. Journal of Applied Sport Psychology, 20, 392 – 407.
41. Sullivan, P.F. (1995)/ Mortality in Anorexia Nervosa. American Journal of Psychiatry, 152(7), 1073 – 1074.
42. Sundgot-Borgen, J. (1994). Risk and trigger factors for the development of eating disorders in female elite athletes. Medical & Science in Sports & Exercise, 14, 59-63.
43. Sundgot-Borgen, J., & Torstveit, M.K. (2004). Prevalence of eating disorders in elite athletes is higher than in the general population. Clinical Journal of Sport Medicine, 14(1), 25–32.
44. Warren, M.P. & Shantha, S. (2000). The female athlete. Baillière’s Clinical Endocrinology and Metabolism, 14, 37-53.
45. Williamson, D., Goreczny, A., & Duchman, E. (1987). Behavioral and psychophysiological assessment of bulimia. Annals of Behavioral Medicine, 9, 8-11.
46. Wilmore, J.H. (1996). Eating disorders in the young athlete. In O. Bar-Or (Ed.), The child and adolescent athlete (pp. 287-303). Oxford, England: Blackwell.
47. Zucker, N.L., Womble, L.G., Williamson, D.A., & Perrin, L.A. (1999). Protective factors for eating disorders in female college athletes. Eating Disorders, 7(3), 207-219.
### Corresponding Author
Kim Kato, Ed.D.
PO Box 13015, SFA Station
Nacogdoches, TX 75962-3015
Dr. Kim Kato is an Assistant Professor in Health Science in the Department of Kinesiology and Health Science at Stephen F. Austin State University in Nacogdoches, Texas.
**Kim Kato**, EdD, NSCA-CPT
Stephen F. Austin State University
**Stephanie Jevas**, PhD, ATC, LAT
Stephen F. Austin State University
**Dean Culpepper**, PhD, CC-AASP
Lubbock Christian University