Model: Daniela Ilieva Illustration: Anna Bearne Photography: Levi Bunyan
Daniela Ilieva cropped
Eating Disorders

Female Athletes, Eating Disorders, Self Esteem and Body Image

By Antigone Lanitis
Model: Daniela Ilieva
Illustration: Anna Bearne
Photography: Levi Bunyan
November 2018

There has been a vast increase in female involvement in sports over the past four decades. Female athletes have challenged gender stereotypes, encouraged us to perceive our bodies as vehicles that can achieve much more than just be aesthetically appealing and shown us that being strong is not solely a male trait. Nevertheless this does not make them immune to eating disorders, as a plethora of studies seem to agree that female athletes are potentially at risk of developing an eating disorder.


Eating disorders such as anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED) and feeding and eating conditions not elsewhere classified are all clinically acknowledged mental disorders outlined by the American Psychiatric Association and the World Health Organisation. Eating disorders are diagnosed with the use of distinct criteria and categorised by key distresses with food, body shape and weight that in turn lead to disturbed eating behaviours like fasting, skipping meals, starvation, binge eating, purging and use of laxatives, diuretics, diet pills and excessive exercise.


One of the criteria for an eating disorder diagnosis is BMI. BMI offers a simple numeric measure of a person’s thickness or thinness, enabling health professionals to deliberate weight problems more objectively with their patients. BMI was intended to be used as a simple means of categorising average sedentary (physically inactive) populations, with an average body composition. BMI is defined as the body mass divided by the square of the body height. BMI does not take into consideration body composition, muscle mass or fat. Hence athletes that may weigh more than the average individual due to their higher muscle mass but present unhealthy pathological eating behaviours would most likely not be diagnosed with an eating disorder.

Daniela Ilieva

The prevalence of eating disorders seems higher amongst women under the age of 25. Studies suggest that female athletes are at the same risk of developing an eating disorder as non-athletes. However female athletes that partake in aesthetic sports such as ballet and gymnastics are at a higher risk of developing an eating disorder than the general population. Hence participating in a sport that values strength and performance more than aesthetics contributes to a lower risk of developing distressed eating behaviours.

Body image encompasses the way we perceive, think and feel about our body. Body image can be largely influenced by sociocultural pressures. Some psychologists suggest that our self-esteem is greatly influenced by our body image. Self-esteem is affected by the way we see ourselves and affects the way we see the world around us, as quite often we see what we expect to see. This can also be said about body image. Individuals with eating disorders will often have low self-esteem and negative body image.


In her book Mirror, Mirror Dr Linda Papadopoulos identifies several thinking errors that contribute to negative body image and self-esteem. These include:

• All or nothing thinking. Having extreme cognitions either about our body shape or our eating habits. For example “If I don’t fit into this size jeans I am fat” or “I already had one cookie and ruined my diet might as well have the whole pack now since I won’t be able to have one again”.

• Maximising the negatives. Focusing on the things one does not like about themselves instead of the things you like or the whole picture. For example “My coach says that I am looking stronger she must mean I’m gaining weight”.

• Personalising everything. Letting things that have nothing to do with you affect you. For example someone you know not saying hello to you in the middle of a busy street whilst they were rushing and on their phone. Hence thinking that they did not say hello because they don’t like you and not because they probably did not see you.

• Jumping to conclusions with insufficient evidence. For example thinking that you were pared up with someone new in training because your coach thinks you are not strong enough to keep up with your usual partner.

• Seeing everything as a catastrophe. Thinking of the worst case scenario, like I won’t perform as well during training because I had a donut three nights ago.

• Identifying ones negative thought patterns and replacing them with positive or alternative thoughts could be helpful for individuals with low self-esteem and distorted body image. Female athletes are said to be more conscious and aware of their bodies and provided that their career is also reliant on their bodies being in peak condition their body image and self-esteem may suffer from these negative thinking traps.

Even though the majority of women and female athletes will not suffer from an eating disorder they may still have an unhealthy preoccupation with food. Our relationship with food is emotionally charged and can be ridden with guilt because of its association with body image. Hence how we perceive our body and food can dictate whether it is an ally or the enemy. In Western cultures where the ideal body is slim and we are bombarded with images of thin models, diet plans and healthy eating blogs it may seem hard to develop a healthy perception of dieting and eating.

Model: Daniela Ilieva Illustration: Anna Bearne Photography: Levi Bunyan
Levi Bunyan

Female athletes are often required to follow a certain diet in order to be in a specific weight range, perform better or look a certain way. The constant pressure to diet and think about what you eat and how you are supposed to look may feel overwhelming and yet again may promote negative thinking patterns. However there are several ways in which to prevent the development of these negative cognitions when dieting. These include:

• Reinforcing your non dieting narrative. Do things that you like that do not involve being around food. For example going to an art exhibition, playing a musical instrument or going for a walk.

• Setting yourself non eating rewards. Like treating yourself to a massage, a long bath or that new sports bra you’ve had your eye on for weeks.

• Reminding yourself of why you are doing it instead of focusing on what you are depriving yourself of.

• Avoiding blaming yourself or feeling guilty when things don’t go to plan. Focus on being aware of maybe why this has happened instead of beating yourself up about it.

If you feel that you or someone you know has been affected by issues brought up in this article contact your GP or beat at

Antigone was born and raised in Cyprus and was interested in charitable work and mental health from a young age, contributing to local causes throughout her upbringing. Whilst she wanted to be an actuary after school and studied Business Statistics and Marketing at Reading University as her first degree her passion for psychology lead her to do a second degree in Psychology at City University of London. She then on continued her studies whilst working as a support worker with individuals on the autism spectrum attaining a diploma in Counselling Psychology, before going on to the Doctorate of Counselling Psychology at City University of London.

Antigone Lanitis

During her doctorate she was able to work with diverse populations and presentations in a variety of settings. She has worked with children, adolescents and adults, with anxiety, mood disorders and eating disorders, utilising person centred, CBT, psychodynamic, systemic and integrative approaches. She has also been able to work as part of an NHS multidisciplinary team specialising in eating disorders and has conducted groups for young adults preparing for university after having recovered from an eating disorder.