The Impact of Eating Disorder Risk on Sports Anxiety and Sports Confidence in Division III Female Athletes

Submission by JoAnne Barbieri Bullard1, Psy.D.*

1* Instructor, Health and Exercise Science Department, Rowan University,

JoAnne Barbieri Bullard is an instructor in the Health and Exercise Science Department at Rowan University. Bullard is also a Doctor of Sport Psychology and Performance and a Certified Strength and Conditioning Specialist.


Eating disorder risk is important to assess not only regarding possible impact on the performance ability of an athlete, but also for the health risks athletes could experience. The purpose of this study is to evaluate eating disorder risk and the impact on sports anxiety and sports confidence of Division III female student-athletes. The results were based off of the Eating Attitudes Risk-26 Questionnaire to examine eating disorder risk, the Sport Anxiety Scale-2 to examine trait anxiety in sport settings, and the Sources of Sport Confidence Questionnaire to examine sources of sport confidence. The methodology included an informed consent form, demographics questionnaire, Eating Attitudes Risk-26 Questionnaire, Sport Anxiety Scale-2, and the Sources of Sport Confidence Questionnaire. Analyses were completed utilizing bivariate correlations and regression analysis. The results of this study showed that eating disorder risk was significantly correlated with only one variable of sports confidence, labeled as physical self-presentation, and no variables of sports anxiety. Athletic departments, athletic trainers and coaching staffs can utilize these findings to effectively work with student-athletes in a preventative manner.

Key words: eating disorder risk, sports anxiety and sports self-confidence 


College athletes experience stress not only in sporting environments, but also while transitioning into a college setting and attaining sociocultural acceptance (6, 8). The increased stress, anxiety, and academic demands have been correlated with body image dissatisfaction and disordered eating behaviors, which can impact physical health and psychosocial morbidity (2, 4, 6, 8). Eating disorders, such as anorexia nervosa and bulimia nervosa, have been correlated with mood and anxiety disorders, perfectionism, and impulsivity (2, 8, 9, 13). The rate of eating disorders among college students has continued to increase every decade (17). Although men may fall victim to eating disorders, women have been found to account for 95% of these disorders (3).

Female athletes experience a higher likelihood of eating disorder risk as compared college students that do not participate in athletics (3, 4, 6, 13, 17). This may be due to factors within the sport environment, the drive to be lean and thin, and body dissatisfaction (2, 3). Dissatisfaction has also been found to increase the likelihood of developing behaviors associated with disordered eating (16). The negative effects of disordered eating, low weight, and low energy can be associated with the female athlete triad classified as disturbances in menstruation, osteoporosis, and eating disorders (4, 10, 14).

Anxiety and self-confidence are both important aspects of sports performance (18). Athletes with high levels of anxiety are likely to experience negative effects on performance (1). Although anxiety may improve sports performance, if an athlete has negative thoughts and self-doubts that decrease self-confidence, performance will be debilitated (7). Results show that athletes with increased levels of self-confidence and both somatic and cognitive anxiety have elevated levels of performance (15). The ability for an athlete to believe in abilities is monumental. Athletes possessing self-control were found to have increased self-confidence and perceived performance would be enhanced (7). The relationship between self-confidence and performance is apparent. Self-confidence assists an athlete in using coping strategies to assist with controlling anxiety through sport performance (1).

Athletes experiencing eating disorders are likely to have inhibited sport performance due to the psychological and psychopathology features (4). Although some may hold the belief that losing weight and restricting calories will improve athletic performance, results found to deteriorate performance due to reasons such as glycogen depletion and dehydration (4). Some athletes may also turn towards bulimia in an effort to lose weight, but bulimia has also been found to be detrimental to sports performance due to dehydration and negative caloric balance (4). Research shows how sport performance is impacted when eating disorders are present, but there is a lack of research examining how sports performance is impacted with eating disorder risk among female athletes regarding anxiety and confidence levels.



The target population of this study was Rowan University Division III female student-athletes during the 2014 spring semester. The 60 student-athletes were members of the softball, basketball, soccer, swimming and diving, and volleyball teams.


Demographic information and consent.To conduct this study, each participant received an informed consent form acknowledging volunteer participation in the study. To avoid collecting information that would identify each individual, participants were asked to report year of education and year of participation rather than specific age. The choices for education year included: Freshman, Sophomore, Junior, and Senior. The choices for participation year included: 1st, 2nd, 3rd, and 4th. The demographic information included: year of education; year of participation; transfer student status; sport(s); in-season or off-season athlete status; status as a starter or non-starter in most recent season; individual or team sport athlete status; and captain status.

Sport Anxiety Scale-2.In order to identify the levels of anxiety athletes in this study were asked to rate fifteen questions regarding reactions to playing sports before or during competition. A 4-point Likert scale was utilized for each question ranging from not at all to very much. Scoring of this questionnaire was categorized into three categories: Somatic, Worry, and Concentration Disruption. Each category was calculated based off the ratings for specific questions. Questions 2, 6, 10, 12, and 14 were grouped with Somatic; Questions 3, 5, 8, 9, and 11 were grouped with Worry; and Questions 1, 4, 7, 13, and 15 were grouped with Concentration Disruption.

Eating Attitudes Test (EAT-26). The Eating Attitudes Test (EAT-26- is a valid and reliable screening tool for eating disorders by using three subscales, including dieting, bulimia and food preoccupation and oral control widely used on college campuses and clinical settings (3, 8, 14, 16). This self-reporting instrument has been found to be cost-effective for screening female athletes (3).

There are three areas of criteria that may suggest seeking assistance of a professional which are the EAT-26 scores, behavioral questions and BMI (5). Individuals are considered at risk of an eating disorder and should consider reaching out to a professional if a score at or above 20 on the EAT-26; if answered yes to any of the behavioral questions and if considered to be underweight according to their BMI score (5).

Participants inputted information regarding height and weight to determine BMI. For the second section, participants answered 26 items on a six point Likert scale, ranging from always to never to determine EAT-26 score. For the behavioral questions, participants answered five questions on a five point Likert scale ranging from never to once a day or more.

The Sources of Sport-Confidence Questionnaire (SSCQ).The SSCQ assessed the athlete sources of sport-confidence through the use of a 41-item questionnaire (11) Nine sources of sports confidence are measured including mastery, demonstration of ability, mental and physical preparation, physical self-presentations, social support, coach leadership, vicarious experience, environmental comfort, and situational favorableness (11). Responses were based on a 7-point Likert scale ranging from not at all important to of highest importance (11).

Results and Discussion

There were 60 participants of the Rowan University Division III female student-athlete population (n=60). All participants received identical questionnaire packets and were asked to volunteer to respond to each questionnaire honestly. Table 1 depicts the descriptive data of the variables assessed throughout the questionnaires.

Demographic Questionnaire

Education year and participation year.Of the 60 participants, 35% indicated being a freshman, 30% indicated being a sophomore, 23.3% indicated being a junior, and 11.7% indicated being a senior. In regard to participation year, 38.3% indicated being in the1st year of participation, 28.3% indicated being in the2nd year of participation, 20% indicated being in the 3rd year of participation, and 11.7% indicated being in the 4th year of participation.

  1. A total of six (10%) participants identified as being a transfer student, whereas 54 (90%) identified as never having transferred.
  2. Of the student-athletes in this population, 21 identified as soccer athletes, followed by 17 swimming and diving athletes, 11 softball athletes, nine volleyball athletes, and one basketball athlete. One of the participants was a dual athlete, participating in both softball and swimming and diving.

Current Season.Out of the 60 participants, 20% identified as in-season athletes, whereas 80% identified as off-season athletes.

  1. Out of the 60 participants, 39 (65%) identified as being a starter, while 21 (35%) identified as being a non-starter.

Sport Classification.Majority of the participants (95%) identified as being a team-sport athlete, whereas 5% identified as being an individual-sport athlete.

Captain Status. Of the 60 participants, eight (13.4%) identified as captains in the last season, as compared to the 86.7% which were not.

Sport Anxiety Scale-2

The results of this questionnaire assisted in answering if participants differed in comparison with each other regarding levels of anxiety, including somatic, worry and concentration disruption. The mean and standard deviation for these questions are shown in Table 1. A one-way repeated measures ANOVA showed there was no statistically significant difference among the levels of anxiety of these subject (n=60). The results of the ANOVA indicated Wilks Lambda = .316, F(2 58) = 62.89, =.684. A bivariate correlation analysis was utilized to measure the relationship among EAT-26 scores and somatic, worry, and concentration disruption variables, in which no significant correlation was found.

Eating Attitudes Test (EAT-26)

Participants were screened for possible eating disorder risk through the EAT-26. Table 1 depicts participants mean and standard deviation results based on the averaged EAT-26 scores. Based on the scale, any score over 20 is labeled high risk and the participant should consider seeking professional help. Of these 60 participants, three (5%) were considered high risk. Other variables included with the EAT-26 were body mass index (BMI) scores and behavioral questions.

A bivariate correlation analysis, depicted in Table 2, was utilized to compute the Pearsons correlation coefficient and significance levels to measure relationships among EAT-26 scores and BMI values for participants. The total number of participants examined was 59 since three participants did not fully complete the BMI section of this questionnaire. The Pearson correlation calculation resulted in a positive value and relationship between EAT-26 scores and BMI (r=.122).

The Sources of Sport-Confidence Questionnaire (SSCQ)

Fifty-nine participants completed the SSCQ assessing sources of sports confidence. Table 1 provides the participants mastery, demonstration of ability, mental and physical preparation, physical self-presentation, social support, coach leadership, vicarious expertise, environmental comfort and situational favor mean and standard deviation scores based on the SSCQ. A bivariate correlation analysis was utilized to determine the relationship among eating disorder risk through the EAT-26 and SSCQ variables through the use of the Pearsons correlation coefficient and significant levels. Significant correlations at the 0.01 level (2-tailed) were found between EAT-26 scores and the physical self-presentation variable, shown in Table 3. Based on a bivariate correlation analysis between anxiety and sports confidence variables, significant correlations were found at the .05 level (2-tailed) between demonstration of ability and somatic anxiety variables and at the .01 level (2-tailed) between demonstration of ability and worry variables, shown in Table 4.

A standard regression analysis was conducted for EAT-26 scores using somatic, worry, concentration disruption, mastery, demonstration of ability, mental and physical preparation, physical self-presentation, social support, coach leadership, vicarious experiences, environmental comfort, and situational favor score as predictors, shown in Table 5. The R squared value was .265 showing the strength of association between variables.


In an attempt to determine if anxiety levels differed among respondents, the Sports Anxiety Scale-2 questionnaire was utilized. Highest overall mean scores resulted with the worry variable, followed by somatic variable and concentration disruption, respectively. Results indicated no significance regarding these three variables of anxiety as indicated by the repeated measures ANOVA. In addition, no significant correlations were found among EAT-26 scores and anxiety variables based on a bivariate correlation.

The EAT-26 was utilized to determine if respondents were considered at risk for eating disorders. Approximately 43.6% of the respondents EAT-26 scores resulted above the mean score of 6.65 which was based off of a scale with the highest score of 20, meaning that seeking professional assistance was suggested. Although this percentage is below 50%, this study shows that female-student athletes are still vulnerable to eating disorder risks (3, 4, 6, 13, 17). No significant findings were present between BMI scores and EAT-26 scores suggesting that a female-athletes BMI does not predict the likelihood of eating disorder risk.

Significant correlations at both the 0.05 level and the 0.01 level were found between the demonstration of ability variable of the SSCQ questionnaire and both somatic anxiety and worry anxiety, respectively. This supported research regarding the correlations between athletes anxiety and self-confidence (15, 18). Significant correlations at the 0.01 level resulted among the physical self-presentation variable of the SSCQ questionnaire in relation to EAT-26 scores. Results indicated that female student-athletes could be at an elevated risk of eating disorders if there is focus on physical self-presentation, followed by vicarious experiences, as a marker of sports confidence could be at an elevated risk of eating disorders.


This research study contributes to the field of sport psychology. The information gathered in this study will help athletic departments, athletic trainers and coaching staffs by providing information that can be utilized to proactively work with female student-athletes in an attempt to decrease eating disorder risks. The results of this study provided insight regarding the sport anxiety variables such as somatic, worry, and concentration disruption, and sport confidence variables that impact eating disorder risk. Future research of the impact on female student- athletes participating in sports, other that what was conducted in this study, and also other divisions of female student-athletes seems apparent. Physical self-presentation was the only variable of sport confidence significantly correlated to EAT-26 scores. These results showed that female student-athletes focusing on physical self-presentation are more likely to be at risk of developing eating disorders as compared to female student-athletes that do not stress as much emphasis on this sport confidence variable.




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Table One

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Table Three


Table Four


Table Five



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