Lecture 11: doping and eating disorders

Question 1

Performance enhancing drugs

Answer 1

drugs that are intentionally taken with the goal of improving performance in some way, such as by improving strength, reducing pain, or decreasing anxiety. In body-building: Performance- and image-enhancing drugs (PIEDs)

Question 2

Erthyropietin

Answer 2

• increases the production of red blood cells which increases the flow of oxygen to the muscles
• reduces muscle fatigue

Question 3

Anabolic-androgenic steroids

Answer 3

• stimulates proteins which can build muscle mass and increases in strength and endurance
• reduced muscle results in improved recovery times
• can involve increase in aggression-> increased facial hair and deeper voice

Question 4

Stimulants

Answer 4

These stimulate the central nervous system, increase heart rate and blood pressure resulting in impoved endurance, decreased fatigue, increased alertness and aggressiveness. Vary in effects and legality, can issue therapeutic use exemptions

Question 5

Beta-blocker

Answer 5

Can slow down the heart rate and relax muscles which decreases anxiety and tension

Question 6

What are the differences between anabolic and catabolic functioning?

Answer 6

When you’re in an anabolic state, you’re building and maintaining your muscle mass. When you’re in a catabolic state, you’re breaking down or losing overall mass, both fat and muscle.

Question 7

Risks related to AAS use

Answer 7

• endocrine: (testicular atrophy, libido changes, decreased sperm count, infertility, menstrual irregularities in women, masculinization in women, enlargement of breast tissue)
• cardiovascular (lipid profile changes, elevated blood pressure, decreased myocardial function, ventricular hypertrophy, arrythmia, increased red blood cells)
• musculoskeletal: risk of tendon tears, skeletal muscle injuries, pus in tissue caused by bacteria
• psychological (addiction, mania, depression, aggression and mood swings)
• liver (toxicity, benign liver tumour and malignant cancerous tumour)
• dermatological (acne, male pattern baldness)

Question 8

What did the HAARLEM study find?

Answer 8

They looked at AAS use in athletes, and found that anabolic steroids are used in cycle with a duration between 6 and 18 weeks, but each cycle is rarely identical

Question 9

What are the physical reasons for doping?

Answer 9

To improve performance thorugh increasing strength, endurance, alertness and aggression and/or decreasing fatigue, reaction time and anxiety. Some individuals would choose immediate rewards vs long-term goals (would choose to win every competition for the next 5 years even if they would die)-> Goldmann-Dilemma

Question 10

What did the psychosocial meta-analysis results find?

Answer 10

• no gender differences
• some co-occurrence btw supplement use and doping but no longitudinal association
• small to medium association from risk factors to doping use, high association to intentions
• intention behaviour gap is large

Question 11

Risk factors for doping use

Answer 11

• pro-doping intentions
• pro-doping norms
• supplement use
• pro-doping attitudes
• substance use
• exposure to appearance/fitness media
• antisocial behaviour
• body dissatisfaction
• ill-being
• high training volume
  Protective factors:
• positive morality
• self-efficacy

Question 12

Risk factors for doping intentions

Answer 12

• negative morality
• pro-doping attitudes
• pro-doping norms
• body dissatisfaction
• supplement use
• ill-being
• maladaptive motivation
  protective factors
• positive morality
• self-efficacy
• adaptive motivation

Question 13

What is the role of the athlete entourage in athlete attitudes?

Answer 13

Athlete entourage= complex and extensive network of people who interact with the athlete
- closeness and trust in coach relationship can influence doping intentions and behaviours
- peers through role-modelling, team culture, sudden performance changes, strong team morals, support systems and resources

Question 14

How does doping stance and doping stigma

Answer 14

doping stance- personal standards regarding health morality
doping stigma: misinformation, lack of knowledge, lack of educational activities, lack of direct action from coaches can influence athletes in favour of doping, displacement of responsibility

Question 15

Performance enhancement attitude scale

Answer 15

Main tool for measuring attitudes towards doping
- male participants score slightly higher but not significant differences
- positive associations in attitudes to doping and moral disengagement
- more lenient attitudes among drug users in comparison to clean athletes

Question 16

How do scores on the PEAS relate to Dark Triad Traits?

Answer 16

Positively for Machiavellianism and psychopathy, negatively for narcissism

Question 17

How are the perceptions to cheating different in sports compared to academics?

Answer 17

More likely to see steroid use as cheating than adderall use (those who did sports rated the steroid user as more of a cheater). Participants perceived the need to take steroids to success as lower. Zero-sum reasoning could be related as success in these takes implies another’s failure

Question 18

What are the different approaches?

Answer 18

Detection and deterrence approach: regular doping controls and punishments for positive tests but costly as new developments needed to detect new drugs and procedures and not everything can be tested.
Intervention approaches: targeted at adolescents to enhance personality development and moral values, and easier access

Question 19

What are the different programs?

Answer 19

Athletes training and learning to avoid steroids program: targeted at male adolescent athletes, interactive classroom and exercise sessions in small groups, peer and coach education. Evidence shows some effects on steroid use and intentions
Athletes targeting healthy exercise and nutrition alternatives: targeted at female adolescent athletes, focus on eating, decreased intentions for steroid/creatine and unhealthy weight loss, mediation of effects through social norms and self-efficacy for healthy eating

Question 20

What is the disordered eating continuum?

Answer 20

Normal eating, dieting/restrictive eating, abnormal eating (subclinical), eating disorders (clinical. There is a distinction between abnormal eating/disordered eating and eating disorders

Question 21

Disordered eating characteristics

Answer 21

• Pathogenic behaviours used to control weight (eg, occasional restricting, use of diet pills, bingeing, purging or use of saunas or ‘sweat runs’) may occur but not with regularity
• Thoughts of food and eating do not occupy most of the day
• Functioning usually remains intact
• There may be preoccupation with ‘healthy eating’ or significant attention to caloric or nutritional parameters of most foods eaten but intake remains acceptable
  -While exercise may not be regularly used in excessive amounts to purge calories, there may be a cognitive focus on burning calories when exercising

Question 22

Eating disorders characteristics

Answer 22

• Restricting, bingeing or purging often occur multiple times per week
• Obsessions with thoughts of food and eating occur much of the time
• Eating patterns and obsessions preclude normal functioning in life activities
• Preoccupation with ‘healthy eating’ leads to significant dietary restriction
• Excessive exercise beyond that recommended by coaches may be explicitly used as a frequent means of purging calories

Question 23

What are eating disorders?

Answer 23

a definite disturbance of eating habits or weight-control behavior that could result in a clinically significant impairment of physical health or psychosocial functioning. Involves clinical treatment, perceptual/attitudinal distortions like fear of gaining weight

Question 24

Anorexia nervosa DSM-5 criteria

Answer 24

A. Restriction of energy intake relative to requirements, leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health. Significantly low weight is defined as a weight that is less than minimally normal or, for children & adolescents, less than that minimally expected.
B. Intense fear of gaining weight or of becoming fat, or persistent behavior that interferes with weight gain, even though at a significantly low weight.
C. Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight.

Question 25

Bulimia nervosa DSM-5 criteria

Answer 25

A. Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:
1. Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than what most individuals would eat in a similar period of time under similar circumstances.
2. A sense of lack of control overeating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating).
B. Recurrent inappropriate compensatory behaviors in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, or other medications; fasting; or excessive exercise.
C. The binge eating and inappropriate compensatory behaviors both occur, on average, at least once a week for 3 months.
D. Self-evaluation is unduly influenced by body shape and weight.
E. The disturbance does not occur exclusively during episodes of anorexia nervosa.

Question 26

What is the prevalence of eating disorders among athletes?

Answer 26

• difficult to assess as behaviours are hidden
• mixed but athletes are at a greater risk of showing signs of disordered eating
• female uni athletes: 2% diagnosable ED, 25.5% subclinical symptoms
• non-elite athletes show a lower risk than elite athletes

Question 27

What are the physical consequences?

Answer 27

• Cardiovascular: low blood pressure, heart damage, cardiac arrest
• Hypothermia
• Amenorrhea (i.e., absence of a menstrual period)
• Comprised reproductive health in women (long-term)
• Malnutrition, deficiencies
• (Permanent) metabolism changes
• Osteoporosis

Question 28

Psychological consequences of eating disorders

Answer 28

Amongst others:
▪ Body image disturbance
▪ Anxiety and depression → suicidal thoughts
▪ External locus of control
▪ Obsessive-compulsive symptoms
▪ Poor self-esteem
▪ Social withdrawal

Question 29

Behavioural consequences of eating disorders

Answer 29

▪ Avoidance of eating situations and secret eating
▪ Body checking
▪ Excessive weighting
▪ Sleep disturbances
▪ Substance abuse
▪ Excessive/obligatory exercise
▪ Exercising despite injury

Question 30

What is compulsive exercise?

Answer 30

• A state in which exercise has become a compulsive behavior → relieve anxiety / distress associated with perceived negative consequences when not exercising
• Compulsion to exercise excessively even when consequences are harmful
• Goals: Burn calories & mood control
• Fear of the negative consequences of not exercising is a maintaining factor for compulsive exercise
• Often, one of the last symptoms to subside and a significant risk factor for relapses

Question 31

What are personality predispositions?

Answer 31

Perfectionism: having and striving for high personal standards
Rigidity: pattern of resisting the acquisition of new behaviour patterns by holding onto previous and nonadaptive styles of performance

Question 32

What is anorexia athletica?

Answer 32

Not formally recognized in DSM/ICD and not accepted as a disorder separate from anorexia nervosa. Seen as a sport-induced subclinical eating disorder

Question 33

What is relative energy deficiency in sport?

Answer 33

Original triad is energy availability, menstrual function and bone health. RED-S: Impaired physiological function including, but not limited to, metabolic rate, menstrual function, bone health, immunity, protein synthesis, cardiovascular health caused by relative energy deficiency.

Question 34

What personality traits are risk factors?

Answer 34

• Perfectionism → Strong commitment & high standards
• Motivation → External pressure, wanting to outperform others
• (Low) self-esteem & anxiety

Question 35

How is the type of sport a risk factor?

Answer 35

”lean” sports: distinct advantage of thin body shape (endurance sports, weight-class sports, aesthetic sports)
Female: Aesthetic sports higher risk compared to endurance, technical and ball sports
Male: Antigravity sports higher risk compared to endurance and ball sports

Question 36

Coach and peer pressure as a risk factor

Answer 36

• pressure from coaches and peers to be thin is positively associated with ED and dangerous weight control techniques
• pressure can be subtle
• not gender specific as male athletes experience pressure to reach a goal weight

Question 37

Sociocultural factors

Answer 37

• College athletes perceiving weight pressure from television, movies, and magazines show higher rates of disordered eating behavior
• 50% of male athletes felt pressure from media images of men’s bodies, and 80% expressed some type of dissatisfaction with their bodies
  muscle dysphoria → preoccupation with becoming more lean and muscular

Question 38

How can we prevent and intervene?

Answer 38

• provide knowledge to emphasize healthy eating and exercise habits to athletes and coaches
• emphasize fitness and performance than weight
• early identification: difficult in lean sports, coaches have low confidence in identifying ED and fear approaching athletes
• change rules and regulations for minimum weight classes, rethink weight classes and weighing procedures

Question 39

What is an example criteria to assess risk?

Answer 39

High risk red light: no competition, supervised training allowed when medically cleared for adapted training, use of written contract
Moderate risk: compete once medically cleared under supervision, may train if following the treatment plan
Low risk: full sport participation