How many dancers have eating disorders

Prevalence of eating disorders amongst dancers: a systemic review and meta-analysis

Review

. 2014 Mar;22(2):92-101.

doi: 10.1002/erv.2271. Epub 2013 Nov 26.

Jon Arcelus¹, Gemma L Witcomb, Alex Mitchell

Affiliations

Affiliation

¹ Loughborough University Centre for Research into Eating Disorders (LUCRED), Loughborough University, Loughborough, Leicestershire, UK; Eating Disorders Service, Leicester Partnership Trust, Bennion Centre, Leicester Glenfield Hospital, Leicester, UK.

PMID: 24277724
DOI: 10. 1002/erv.2271

Review

Jon Arcelus et al. Eur Eat Disord Rev. 2014 Mar.

. 2014 Mar;22(2):92-101.

doi: 10.1002/erv.2271. Epub 2013 Nov 26.

Authors

Jon Arcelus¹, Gemma L Witcomb, Alex Mitchell

Affiliation

¹ Loughborough University Centre for Research into Eating Disorders (LUCRED), Loughborough University, Loughborough, Leicestershire, UK; Eating Disorders Service, Leicester Partnership Trust, Bennion Centre, Leicester Glenfield Hospital, Leicester, UK.

PMID: 24277724
DOI: 10. 1002/erv.2271

Abstract

Eating disorders in dancers are thought to be common, but the exact rates remain to be clarified. The aim of this study is to systematically compile and analyse the rates of eating disorders in dancers. A literature search, appraisal and meta-analysis were conducted. Thirty-three relevant studies were published between 1966 and 2013 with sufficient data for extraction. Primary data were extracted as raw numbers or confidence intervals. Risk ratios and 95% confidence intervals were calculated for controlled studies. The overall prevalence of eating disorders was 12.0% (16.4% for ballet dancers), 2.0% (4% for ballet dancers) for anorexia, 4.4% (2% for ballet dancers) for bulimia and 9.5% (14.9% for ballet dancers) for eating disorders not otherwise specified (EDNOS). The dancer group had higher mean scores on the EAT-26 and the Eating Disorder Inventory subscales. Dancers, in general, had a higher risk of suffering from eating disorders in general, anorexia nervosa and EDNOS, but no higher risk of suffering from bulimia nervosa. The study concluded that as dancers had a three times higher risk of suffering from eating disorders, particularly anorexia nervosa and EDNOS, specifically designed services for this population should be considered.

Keywords: EDNOS; anorexia; ballet; bulimia; dance; eating disorders; epidemiology; meta-analysis; review.

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The Link Between Ballet and Eating Disorders

With graceful lines and layers of tulle, the world of dance is certainly one of beauty. From a young age, dancers are taught about poise, musicality and movement – all of which must come together in a performance of flawless grace.

Within the world of dance, however, the pressures to constantly perform with such beauty and elegance can require a certain “dancer’s body type”. As a result, eating disorders are unfortunately common, especially among teenage girls who are developing both physically and mentally. Here’s what parents should know about the link between ballet and eating disorders and how you can encourage positive teen body image.

Prevalence of Eating Disorders in Ballet

In the United States, eating disorders affect approximately 30 million Americans at some point in their lifetime, which is approximately 9% of the entire population. However, in dance, it’s estimated that 12% of dancers as a whole struggle with an eating disorder. Further, eating disorders in ballet dancers are 10 times more common than non-ballet dancers.

Why is this? Why do dancers find themselves at a higher risk of developing an eating disorder? Below we will outline some of the reasons.

Image Credit: WikimediaImages

The Pressure to Have a Perfect Dancer’s Body Type

It may be hard to understand why dancers have higher rates of eating disorders without being aware of the dance world. There are many pressures that dancers face both on and off stage that can lead to lack of confidence and unhealthy habits. Understanding the extreme expectations that dancers face on a daily basis can help paint a picture of why so many might develop an eating disorder.

Often girls take up ballet in childhood and continue to maintain the extracurricular activity through high school and even college. As their bodies develop and grow during puberty, they may be concerned of how it will affect their ballet performance. Further, with rehearsals and practices in front of large mirrors and wearing tight body-hugging leotards, teens are able to constantly be critiquing their bodies and comparing themselves to other dancers.

Control

For those teenagers who train in ballet, whether professionally or recreationally, it’s a process of pushing your body’s limits and constantly working towards increased control and discipline. In spite of this, our bodies are wired a certain way, and when puberty hits, we realize that we can’t necessarily control how we’re shaped, even if it doesn’t align with expectations. In other words, curves are often unacceptable in a dancer’s world, and many dancers will find the need to control the way their body looks in the same way that they learn to control how it moves.

Competition

Like many professions, dance is a competitive one and, unfortunately, often has a lot to do with what a dancer looks like. In fact, dancers are part of the larger group of performing artists that encounter physique qualifications in job descriptions. Additionally, if you’re one of many in the “corps de ballet” (the large group that dances together), it’s often expected that you look almost the same as your peers. Put simply, to succeed in the dance world, you often need to conform and maintain certain weight or image expectations. The unspoken competitiveness could drive teens to poor body image and eating disorders.

Image Credit: extremis

Preventing Teen Eating Disorders in Ballet Dancers

Given the prevalence of teenage eating disorders among ballet dancers, it is important for parents to proactively support their sons and daughters in maintaining positive body image. Below are a few tips of what parents can do.

Encouraging Confidence

An important aspect of preventing and treating eating disorders and unhealthy body image expectations, is to encourage self-love. It is important that teens first feel comfortable and confident in their own skin and embrace their unique physiques.

Monitor Thoughts

Encourage your teen to monitor their thoughts. Ask them to notice what they think about their own body image. If they find themselves often thinking negatively about their appearance, encourage them to replace these thoughts with positive affirmations like “my body is beautiful and unique just the way it is.”

Avoid Comparisons

We are often our harshest critics and these critiques often come when we compare ourselves to others. Encourage your teen to be confident in who they are and avoid comparing them to others in their class or on their team. If your teen starts to compare themselves to others, encourage them to list or focus on their strengths and gifts that they contribute.

Look to Role Models

People are becoming more aware of unrealistic body image expectations that are constantly being portrayed in the media and beyond. In the world of dance and sports particularly, many athletes and professional dancers are starting to speak out against body image expectations in competitions. For a teenager to hear this type of messaging around ballet and eating disorders from role models, it may make more of an impact than for a parent to be delivering it.

Help for Poor Teen Body Image

At the end of the day, it’s important for your teen to know that they can continue training in ballet or whatever their sport of choice is that they love without compromising their health and well-being. Having an open dialogue with your teen on body image may help change their perception of themselves. There are many organizations that offer informative materials on eating disorders including:

Academy for Eating Disorders (AED): aedweb. org
National Association of Anorexia Nervosa and Associated Disorders: anad.org
National Eating Disorders Association (NEDA): nationaleatingdisorders.org

If your teen needs additional support on the journey to a healthier and more comfortable body image, please contact us. Our specialists are ready and willing to help and care for those suffering from eating disorders or body dysmorphia.

Feature Image: skeeze

Eating disorders | Tervisliku toitumise informatsioon

Eating disorders are psychiatric illnesses that damage a person's physical and mental health and impair their overall quality of life - relationships, work and personal development suffer.

Eating disorders disrupt the connection with one's own body, resulting in highly problematic eating behavior. Weight and body shape are overemphasized, underweight is idealized, and various methods are used to lose weight or prevent weight gain. nine0003

Approximately 8% of women and 2% of men will develop an eating disorder during their lifetime. Eating disorders occur in any population, regardless of gender, age, ethnicity, or socioeconomic status. However, they are most common in girls and young women.

Eating disorders are a group of diseases that are distributed differently in different classifications. The most common eating disorders are anorexia ( anorexia nervosa ), bulimia ( bulimia nervosa ) and compulsive overeating ( binge-eating disorder ).

The term "eating disorder" is often erroneously used as a synonym for selective eating disorder, as both are associated with eating disorders. However, the reasons for them are different: an eating disorder is caused by a desire to control weight, while in a selective eating disorder, eating certain foods causes anxiety or fear. nine0003

Other eating disorders

Anorexia, bulimia and binge eating disorders are the three most common and well-known eating disorders. However, often not all of the symptoms of a person with an eating disorder correspond to one specific disorder. In such cases, these disorders are referred to as "atypical" or "other eating disorders". A common myth is that in such cases the course of the disease is milder and treatment is treated more lightly. However, this is erroneous, since the name of the disease indicates only its diagnostic criteria, and not the severity or course. nine0003

All eating disorders, no matter how they are called or classified, are dangerous conditions that impair quality of life and require treatment.

Causes of Eating Disorders

There is never one single cause of an eating disorder. These are complex diseases, in the development of which a combination of many factors plays an important role. Genetic, biological and environmental factors always play a role. Modern social representations, including the culture of diets and the cult of slimness, contribute to the development of psychological vulnerability, which can become a fertile environment for the formation of eating disorders. Probably for the same reasons, a higher incidence of eating disorders is observed in sports in which weight is of great importance, and among representatives of professions focused on appearance. However, it should be emphasized that browsing social networks or playing a certain sport does not contribute to the development of the disease. There are many factors involved in the development of the disease that are usually beyond the control of the individual. However, it is often more practical and even more important to identify the factors that support the disease, since changing them is associated with better treatment outcomes. nine0003

Treatment Options for Eating Disorders

Eating disorders can be life-threatening illnesses with a long and chronic course; they have one of the highest mortality rates of any psychiatric illness. Treating eating disorders is often a lengthy and complex process. However, early intervention is paramount to achieve a good treatment outcome.
Diagnosis and treatment of an eating disorder usually begins with the family physician. Family sisters can provide advice on healthy eating. Psychiatrists are specialists in the diagnosis and treatment of eating disorders as a psychiatric illness. The participation of a clinical psychologist or psychotherapist is also important. nine0003

There are two centers in Estonia that specialize in the treatment of eating disorders: the Department of Eating Disorders of the Mental Health Center of the Tallinn Children's Hospital treats children and adolescents, and the Department of Eating Disorders of the Psychiatric Clinic of the Tartu University Hospital treats adolescents and adults.

For more information about eating disorders and advice on what to do if you suspect a loved one has an eating disorder, visit peaasi.ee. nine0003

Eating disorders

Eating disorders are a type of mental health disorder that is accompanied by eating disorders. It is common for a person in this state to consume much less or more food than he actually needs.

Eating disorders are diseases that can aggravate health conditions or lead to other problems related to the functioning of the heart and kidneys. There are treatments that can help. nine0003

Types of eating disorders

The main types of eating disorders are listed below.

Overeating Uncontrolled overeating. A person in this state loses control of himself and eats a very large amount of food in a short period of time. People with compulsive overeating continue to eat even after they have eaten. They often eat until they feel severe discomfort. After that, they usually experience feelings of guilt, shame, and depression. Overeating too often can lead to weight gain and obesity. Binge eating disorder is the most common eating disorder in the United States. nine0055
Bulimia A type of eating disorder that is also characterized by episodes of overeating, after which the person vomits or takes laxatives. People with this type of eating disorder also tend to over-exercise or fast. People with bulimia nervosa may be slightly underweight, normal, or overweight.
Anorexia nervosa People with anorexia nervosa avoid food, severely restrict food intake, or eat only certain foods in very small amounts. They may consider themselves overweight even if they are very underweight. Anorexia nervosa is the least common of the three eating disorders, but is often the most serious. It has the highest mortality rate of any mental disorder. nine0055

Causes of eating disorders

The exact cause of the eating disorder is not known. Researchers believe that eating disorders may be caused by a combination of factors. These include genetic, biological, behavioral, psychological and social factors.

This condition of a person can also be caused by the use of psychoactive substances.

Factors that may be involved in the development of eating disorders are listed below. nine0003

Genetics. People who have relatives with an eating disorder are at greater risk of developing the condition.
Peer pressure. For young people this can be a very powerful force influencing their behaviour. Pressure may come in the form of ridicule, bullying, or insults due to body size and weight. A history of physical or sexual abuse can also contribute to the development of an eating disorder in some people. nine0055
Emotional health. Perfectionism, impulsive behavior, difficult relationships can contribute to a person's low self-esteem and make them vulnerable to developing eating disorders.

Who is at risk for eating disorders?

Eating disorders can develop at any age in anyone, but are more common in women. Eating disorders often appear during adolescence or early adulthood. nine0003

The following are factors that increase the risk of an eating disorder in some people.

Age Eating disorders are much more common in adolescence and before the age of 20 years.
Gender Women and girls are more likely to be diagnosed with an eating disorder.
Family history A parent, sibling or sibling has an eating disorder.
Diet Dieting too long can lead to an eating disorder.
Stress Life changes such as a transfer to another school, enrollment in an educational institution, a new job or divorce can be a stressor for developing an eating disorder.
Vocations and Occupations Eating disorders occur among some sports, dancers, etc.

Symptoms of eating disorders? nine0048

Symptoms of eating disorders vary depending on the type of disorder.

Overeating symptoms

Eating large amounts of food in a short period of time (e.g. 2 hours)
Eating even when full or not hungry
Eating until discomfort will set in
Meal alone or in secret to avoid embarrassment, shame
Feelings of anxiety, shame, or guilt about eating
Frequent dieting, possibly without weight loss

Also, during bouts of uncontrollable overeating, a person may consume food poorly chewed and faster than usual.

Symptoms of bulimia nervosa

Symptoms of bulimia nervosa include the same symptoms as overeating, plus attempts to rid the body of the food eaten or radical methods aimed at reducing body weight may be undertaken. nine0003

Vomiting or use of laxatives
Excessive exercise
Fasting

Emotional symptoms of bulimia include low self-esteem, overly associated with body image, feeling out of control, guilt or shame about eating behavior.

Symptoms of anorexia nervosa

Strong fear of gaining weight
Eating very little
Intense and excessive exercise
Extreme thinness
Distorted body image

Emotional symptoms of anorexia include irritability, social isolation, lack of mood, emotion, inability to understand the seriousness of the situation, fear of food, obsessions with food and exercise. Often, due to the fear of "getting fat", entire categories of foods are excluded from the diet.

Sequelae of eating disorders

Sequelae of bulimia nervosa

Over time, bulimia nervosa can cause health problems, some of which are listed below.

Chronic inflammation and sore throat
Enlarged salivary glands in the neck and jaw
Worn tooth enamel, increased sensitivity and tooth decay. This is caused by the action of gastric juice, each of which enters the oral cavity with the intentional stimulation of vomiting.
GERD (gastroesophageal reflux disease) and other gastrointestinal problems. nine0055
Severe dehydration
Electrolyte imbalance - imbalance of sodium, calcium, potassium and other minerals that can lead to stroke or heart attack
Thinning bones (osteopenia or osteoporosis)
Mild anemia
Muscle wasting and weakness
Thin, brittle hair and nails
Dry, spotted or yellowish leather
Deterioration of the hairline
Strong constipation
Low arterial pressure
Slow breathing and pulse
A constant sensation of the cold due feeling tired
Infertility
Violation of the structure and function of the heart
Brain damage
Multiple organ failure

Anorexia nervosa can be fatal. Some people with this disease die from complications caused by starvation. Some commit suicide. With anorexia, there is an extremely high suicidal risk, which is about 50 times higher than in a healthy person.

Some people with eating disorders may also have other psychiatric disorders, such as depression or anxiety.

Diagnosis of eating disorders

If you or a loved one has symptoms of an eating disorder, it is important to see a qualified professional as these disorders can have serious health consequences.

In order to make a diagnosis, the attending physician must perform a number of actions, some of which are listed below.

Your doctor will take your medical history and ask about your symptoms. It is important to be honest about your diet, exercise, and lifestyle. nine0055
Examine the patient
May order blood or urine tests to rule out other possible causes of symptoms
May perform other tests to see if the patient has other health problems related to the eating disorder. These may include a renal function test, an electrocardiogram, etc.

This will help diagnose and identify other disorders or complications related to the patient's current condition. nine0003

A mental health professional will conduct a psychological assessment. He may ask questions about eating habits, behaviors, and beliefs. Questions may be asked about diet history, exercise history, etc.

To be the basis for a diagnosis, symptoms must meet the criteria given in the Diagnostic and Statistical Manual of Mental Disorders, such as DSM-5 or ICD-10 .

Each eating disorder has its own diagnostic criteria that a mental health professional will use to determine which disorder is present. nine0003

It is not necessary to have all the criteria for a disorder to benefit from working with an eating psychiatrist.

Often, a person with an eating disorder has symptoms of another mental disorder that needs treatment. If possible, it is best to identify and eliminate all unwanted conditions at the same time. Thanks to comprehensive assistance from specialists, it is more likely that the disease will not return again or the effect of treatment will be longer. nine0003

Eating disorders treatment

An eating disorder treatment plan is tailored to the individual and needs of the patient. Treatment may include:

Psychotherapy This may be individual, group and/or family therapy. Psychotherapy may include cognitive-behavioral approaches that help identify and change negative and destructive thoughts. This method of treatment will also help the patient develop coping skills and adjust their own behavior. nine0055
Medical supervision including treatment of complications that may cause eating disorders.
Nutrition Counseling Doctors, nurses and consultants can help you eat right to achieve and maintain a healthy weight.
Medications Medication support can help treat some eating disorders.
Learn more

How many dancers have eating disorders

Prevalence of eating disorders amongst dancers: a systemic review and meta-analysis

Affiliation

Authors

Affiliation

Abstract

Similar articles

Cited by

Publication types

MeSH terms

The Link Between Ballet and Eating Disorders

Prevalence of Eating Disorders in Ballet

The Pressure to Have a Perfect Dancer’s Body Type

Control

Competition

Preventing Teen Eating Disorders in Ballet Dancers

Encouraging Confidence

Monitor Thoughts

Avoid Comparisons

Look to Role Models

Help for Poor Teen Body Image

Eating disorders | Tervisliku toitumise informatsioon

Other eating disorders

Causes of Eating Disorders

Treatment Options for Eating Disorders

Eating disorders

Types of eating disorders

Causes of eating disorders

Who is at risk for eating disorders?

Symptoms of eating disorders? nine0048

Overeating symptoms

Symptoms of bulimia nervosa

Symptoms of anorexia nervosa

Sequelae of eating disorders

Sequelae of bulimia nervosa

Diagnosis of eating disorders

Eating disorders treatment

Learn more