Lecture 11: Doping & Eating Disorders

Question 1

what are 4 kinds of performance-enhancing drugs (PEDs)

Answer 1

1. Anabolic-Androgenic Steroids (AAS): mimic the effects of testosterone; stimulate proteins (helps the body build muscle mass and therefore increase in strength and endurance), helps athletes recover from workouts more quickly by reducing muscle damage (work out more frequently and at more intense levels) and increase feelings of aggression
   –> leads to increases in male-related traits such as facial hair and deeper voice
2. Erythropoietin (EPO): increases production of red blood cells, which increases the oxygen flow to the muscles and may reduce muscle fatigue
3. Stimulants: stimulate the central nervous system and increase heart rate and blood pressure, which in turn improves endurance, decreases fatigue, and increases alertness and aggressiveness
4. Beta-blockers: slow down the heart rate and relax the muscles, which can decrease anxiety and tension (specifically for sports that require steady hands)

Question 2

what are performance-enhancing drugs (PEDs)

Answer 2

= drugs that are intentionally taken with the goal of improving performance in some way, such as by improving strength, reducing pain, or decreasing anxiety

Question 3

what are 3 facts related to the prevalence of PEDs

Answer 3

• it is more prevalent in athletes than in non-athletes
• usage prevalence is dependent on the sport, with more risks in sports such as weightlifting and bodybuilding
• athletes may be reluctant to share their use of illegal PEDs, which influences knowledge on prevalence; prevalences seem to be higher when using anonymous measures

Question 4

what are 3 facts about the prevalence of recreational drug use in athletes

Answer 4

• results are mixed, some studies suggest that athletes use less drugs, but also use more alcohol
• alcohol use seems to be potentially dependent on team vs individual sports (more in teams) and on gender (more in males)
• athletes who use one type of drug, are more likely to also use another (–> combining PED use and recreational drug use)

Question 5

what are endocrine (6), cardiovascular (6), musculoskeletal (3) and dermatological risks (2) related to AAS use

Answer 5

Endocrine:
- gynecomastia = male breast growth and risk of breast cancer
- testicular atrophy (shrinkage)
- diminished libido
- infertility
- menstrual irregularities
- masculinization

Cardiovascular:
- lipid profile changes
- elevated blood pressure
- decreased myocardial function (heart)
- left vertricular hypertrophy (thickening of the heart muscle)
- polycythemia = increased red blood cell volume (elevated risk of heart attack)
- arrythmia = heart rate/beat problems

Musculoskeletal:
- risk of tendon tears
- skeletal muscle injury
- intramuscular abscess

Dermatological:
- acne
- male pattern baldness

Question 6

explain drug dependence

Answer 6

= getting psychologically and physically addicted to having the substance in their body. Athletes may start taking a particular drug intending to only use it once or twice, but then find themselves addicted and unable to stop.
–> nearly 1/3 of steroid users will develop dependence

Question 7

what are factors predicting drug use [physical (3), psychological (3), social (5)]

Answer 7

Physical motivations:
- desire to improve performance (because of higher income, endorsements, and fame that results from doing well)
- controlling weight
- coping with pain and injuries
–> usually people see few or no costs; short-term rewards vs long-term consequences

Psychological motivations:
- cope with negative feelings (eg. the pressure of competitions)
- cope with the stress of balancing athletics with academic and social demands
- coping with feelings of insecurity and low self-esteem

Social motivations:
- pressure from peers
- closeness and trust in relationship with coach –> potential for them to influence intentions/behaviors
- belief that PED/drug use is more common that it actually is
- doping stance; personal standard regarding health and morality, stance towards cheating
- doping stigma; misinformation, lack of knowledge, lack of direction from coaches

Question 8

explain the HAARLEM study

Answer 8

this was study on AAS use among male dutch recreational athletes and the effects; there were some side effects and negative consequences, but many were not that severe or prevalent
–> suggests that some negative effects may not be as pronounced as they are thought to be

Question 9

what are 3 psychological motivations that influence drug use

Answer 9

• athletes who are lower in self-esteem and higher in depression are more likely to use drugs
• pursuing sports for extrinsic reasons are more likely to use such drugs (less concerned about fairness)
• personality traits such as sensation seeking also have a positive influence on drug use

Question 10

explain the study that was done on how athletes belief that they had taken a drug infleunced their performance

Answer 10

Athletes who believed they had taken the performance-enhancing substance ran faster than those who believed they had not taken the drug, regardless of whether they had actually received the drug. Moreover, athletes who took the drug without their knowledge were not faster than those who were aware they did not receive the drug. This finding suggests that at least part of the impact of PEDs on performance is caused by expectancies rather than their physical effects.

Question 11

explain the Goldmann-Dilemma

Answer 11

participants were asked if they could take PEDs for 5 years and win everything without getting caught, but then they would die, if they would do it
–> it was thought that 60% of athletes would do it, but a newer study suggested that only 2/212 people said they would do it

Question 12

explain the results of a study done investigating attitudes about doping, with the Performance Enhancement Attitude Scale (PEAS)

Answer 12

• Although male participants, score slightly higher, differences are not
  significant
• Differences in attitudes between users and non-users: more lenient among
  drug users in comparison to clean athletes (but still generally negative!)
• Positive associations attitudes to doping and moral disengagement
• Association with Dark Triad Traits: positive associations with machiavellianism and psychopathy

Question 13

explain the study done on “doping as cheating”

Answer 13

Participants were asked to rate how much they considered someone a cheater; one was a college athlete using steroids, the other was a student taking adderall for a midterm
- Participants rated the steroid user as more of a cheater than the adderall user
* Differences between the scenario changed as a function of past steroid use
* Participants who did sports rated the steroid user as more of a cheater
- Participants perceived the need to take steroids in order to succeed as lower
- Possible reason: Zero-sum reasoning → Success in zero-sum tasks (e.g. athletic competition) necessarily implies another’s failure

Question 14

summarize the findings on EDs and compulsive exercise

Answer 14

• 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 15

what 2 (personality related) factors influence eating pathology

Answer 15

1. Perfectionism: having and striving for high personal standards
2. Rigidity: pattern of resisting the acquisition of new behaviour patterns by holding onto previous and non-adaptive styles of performance

Question 16

explain anorexia athletica

Answer 16

= symptoms of anorexia that are found in athletes, but is not formally recognized in the DSM/ICD; sport-induced, subclinical eating disorder

Question 17

what are ways of decreasing substance abuse (prevention, detection, legislation)

Answer 17

Prevention: creating supportive environment, addressing reasons why people take drugs, education about the dangers of drug abuse, information about legal sanctions, and athletes are taught coping skills

Detection: regular doping controls and punishment for positive tests
–> this is very expensive (because many new drugs are always getting developed) and not everything can be tested; sometimes people get unfairly punished

Legislation: make acquiring these substances more difficult (eg. making anabolic steroids illegal)

Question 18

what are 2 prevention and intervention programmes

Answer 18

1. ATLAS (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 effects on steroid use and intention to use
2. ATHENA (Athletes Targeting Healthy Exercise & Nutrition Alternatives)
   - Targeted at female adolescent athletes
   - Steroid use not in the center of the program, focus on eating
   - Evidence indicates decreased intentions for steroid/creatine use and intentions for unhealthy weight loss
   - Mediation of effects via social norms and self-efficacy for healthy eating

Question 19

what are 2 types of eating disorders and their broad criteria

Answer 19

1. Anorexia nervosa:
   A. Restriction of energy intake relative to requirements, leading to a significantly
   low body weight
   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.
2. Bulimia nervosa:
   A. Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:
   - Eating, in a discrete period of time, large amounts of food
   - A sense of lack of control overeating during the episode (eg. feeling like you can’t stop)
   B. Recurrent inappropriate compensatory behaviors in order to prevent weight gain
   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 20

distinguish between disordered eating (DE) and eating disorders (ED) (5 points)

Answer 20

• 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 in DE, but they do in ED
• Thoughts of food and eating do not occupy most of the day in DE, in EDs thoughts are obsessional and occur most of the day
• Functioning usually remains intact in DE, in EDs functioning is impaired
• There may be preoccupation with ‘healthy eating’ or significant attention to caloric or nutritional parameters of most foods eaten but intake remains acceptable in DE, in EDs there are significant dietary restrictions
• While exercise may not be regularly used in excessive amounts to purge calories, there may be a cognitive focus on burning calories when exercising in DE; in EDs there is more exercise then recommended and it is explicitly used as a means of purging calories

Question 21

explain prevalence of eating disorder in sports

Answer 21

• most research indicates that athletes are at somewhat greater risk of showing signs of disordered eating—even if not clinically diagnosable— than are nonathletes
• may be more prevalent in women; 20% of elite female athletes and 8% of elite male athletes had clinical or subclinical eating disorders compared with 9.1% of female nonathletes and 0.5% of male nonathletes

Question 22

what are physical/medical (7), psychological (6) and behavioral (7) consequences of eating disorders

Answer 22

Physical / medical:
- 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

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

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

Question 23

what are predisposing factors of eating disorders for personality (3), type of sport, coach and peer pressure and sociocultural factors

Answer 23

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

Type of sport:
- ”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

Coach and peer pressure:
- Pressure from coaches & peers to be thin is positively associated with ED and dangerous weight control techniques (e.g., vomiting, diuretics & laxative use)
—> Pressure can be subtle (comments about weight, eating habits)
—> Not gender specific: Male athletes also experience pressure to reach a goal weight

Sociocultural factors:
- College athletes perceiving weight pressure from television, movies, and magazines (media) 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 24

what are 4 ways of preventing and identifying eating disorders

Answer 24

1. Provide knowledge to emphasize healthy eating and exercise habits
   –> Not only to athletes but also to (male) coaches
2. Emphasize fitness and performance instead of weight (ability > appearance)
3. Early identification
   –> Extremely difficult in “lean” sports
   –> Coaches: Low confidence in identifying ED and fear of approaching athletes → need for specific criteria & training on how to screen
4. Change rules and regulations
   –> Minimum weight classes, rethink weigh classes and weighing procedures

Question 25

explain theFemale Athlete Triad and what the updated version of this syndrome is called and what it looks like

Answer 25

Female Athlete Triad = three interrelated components: energy availability (EA), menstrual function, bone health
–> aetiological factor underpinning the Triad is an energy deficiency relative to the balance between dietary energy intake (EI) and the energy expenditure required to support homoeostasis, health and the activities of daily living, growth and sporting activities

Relative Energy Deficiency in Sport (RED-S) = syndrome resulting from relative energy deficiency that affects many aspects of physiological function including
- metabolic rate
- menstrual function
- bone health
- immunity
- protein synthesis
- cardiovascular and psychological health
The underlying problem of RED-S is an inadequacy of energy to support the range of body functions involved in optimal health and performance.
–> also prevalent in men

Question 26

what are 10 potential performance effects of RED-S

Answer 26

• decreased endurance performance
• decreases training response
• decreased muscle strength
• decreased glycogen stores
• decreased judgment
• decreased coordination
• decreased concentration
• increased injury risk
• irritability
• depression

Question 27

what are 2 treatment strategies of RED-S

Answer 27

• increase in energy intake and reduction in exercise, or a combination of both
• weight gain (to recover menstrual function and bone health)

Question 28

what are 7 recommendations for athlete entourage

Answer 28

1. Educational programmes on RED-S, healthy eating, nutrition, EA, the risks of dieting and how these affect health and performance.
2. Reduction of emphasis on weight, emphasising nutrition and health as a means to enhance performance.
3. Development of realistic and health-promoting goals related to weight and body composition.
4. Avoidance of critical comments about an athlete’s body shape/weight.
5. Use of reputable sources of information.
6. Promotion of awareness that good performance does not always mean the athlete is healthy.
7. Encouragement and support of appropriate, timely and
   effective treatment.

Question 29

what are 3 recommendations for how sports organisations can deal with RED-S

Answer 29

1. Preventative educational programmes
2. Rule modifications/changes to address weight-sensitive issues in sport
3. Policies for coaches on the healthy practice of managing athlete eating behaviour, weight and body composition

Question 30

what are 3 recommendations for research into RED-S

Answer 30

1. The aetiology and treatment of athletes with RED-S including males, ethnic and disabled populations;
2. Design and validation of tools to accurately measure EA in the clinical setting;
3. The validation of screening tools and treatment programmes such as the RED-S Risk Assessment Model and RED-S RTP Model.