Most people have heard of anorexia nervosa, one of the most widely known eating disorders, but fewer people are aware that anorexia can come in a number of different forms. There’s atypical anorexia, which is when someone meets all the criteria for anorexia except for low body weight, and anorexia binge-purge subtype, which includes episodes of binge eating and purging alongside restriction. Then there’s anorexia athletica, a condition that’s lesser known and less firmly defined, but still serious. Read on to learn more about anorexia athletica, who it affects, its health risks, and how to get help.

What is anorexia athletica?

According to Megan Hellner, MPH, Director of Nutrition and Physical Activity Research at Equip, anorexia athletica describes “the obsessive pursuit of thinness or leanness in athletes, accompanied by severe calorie restriction.” A person with anorexia athletica will exercise compulsively—often with a focus on performance as well as body weight or size—while also dieting or failing to properly refuel their body.

Hellner explains that, as it’s currently defined in the literature, the term anorexia athletica only applies to athletes, but similar drives for thinness accompanied by restriction and problematic exercise is also common outside of sports circles.

How does anorexia athletica differ from other eating disorders?

One of the main differences between anorexia athletica and other eating disorders is that anorexia athletica isn’t recognized as a distinct mental disorder in the DSM-5, and, Hellner says, the term is rarely used in practice or research. “The syndrome was coined by the American College of Sports Medicine. The resistance to using the term in practice is due to the idea that anorexia athletica isn’t different enough from other restrictive eating disorders to warrant a separate diagnosis,” she explains.

“When it comes to treating athletes with eating disorders, we think of them as ‘unique not special,’” Hellner goes on. “What we mean by that is that athletes are subject to all the same consequences of undernourishment as their non-athlete counterparts.” In other words, anorexia athletica isn’t distinct enough to need its own diagnostic label or a specific treatment approach, but that doesn’t make it any less serious or concerning.

There are, however, some differences between anorexia athletica and similar conditions, like anorexia. For one, a person with anorexia may eat a very small amount of food, and while people with anorexia athletica may do the same, the latter often involves eating less food than your body needs to sustain its level of physical activity. In other words, someone with anorexia athletica might eat what looks to be a normal amount, but it’s still far from adequate to meet their energy needs given how intensely they’re training or working out. Another key difference between anorexia nervosa and anorexia athletica is that anorexia athletica exclusively appears in the context of sports, and disordered behaviors are often driven by a desire to improve performance or stay in peak physical condition, as opposed to a fear of weight gain or body image distress.

How common is anorexia athletica?

Because anorexia athletica isn’t considered a distinct mental health diagnosis, there’s not a lot of research on its exact prevalence. However, given the fact that athletes are at a higher risk for developing eating disorders in general, we can assume that a sizable proportion of them are struggling with anorexia athletica.

According to research, athletes have two to three times the risk of developing an eating disorder as compared to their non-athlete peers. In one study of elite and pre-elite female athletes, researchers found that 80% had symptoms of relative energy deficiency in sport (RED-S), a group of symptoms that occur when calorie intake is too low to meet the demands of training (which is also a defining characteristic of anorexia athletica). Studies also show that about half of adolescent athletes across genders and sports don’t eat enough food for the amount of physical activity they’re doing.

What are the health risks of anorexia athletica?

As Hellner explained, many of the health risks of anorexia athletica are similar to those of other restrictive eating disorders. Because a person with anorexia athletica isn’t eating enough to properly refuel, their body is deprived of the nutrients it needs to thrive or even function. This can lead to a whole host of serious health complications, including:

• Stunted growth
• Heart problems, like slowed heart rate, low blood pressure, or heart attack
• Gastrointestinal issues, like constipation or gastroparesis
• Poor bone health, osteoporosis
• Weakened immune system
• Arthritis
• Amenorrhea or irregular periods
• Infertility
• Pregnancy complications

The bottom line is this: despite not having its own entry in the DSM, anorexia athletica is a serious condition that can lead to lasting health consequences if left untreated.

What are the symptoms of anorexia athletica?

Because there’s no formal criteria for anorexia athletica, there isn’t one definitive set of symptoms. However, Hellner says, “based on how most of the people with symptoms of anorexia athletica tend to present, they would likely meet criteria for anorexia nervosa or atypical anorexia.”

It’s also important to recognize that even the same eating disorder diagnosis can show up differently from person to person, and that many eating disorders share some symptoms. That said, there are a number of distinct signs to look out for that might indicate anorexia athletica.

Behavioral symptoms of anorexia athletica

• Exercising more than is necessary or healthy (exercising more than peers in their sport, using their sport as an excuse to exercise excessively)
• Consistently training beyond what is prescribed by a coach or trainer
• Exercising despite injury, illness, or bad weather
• Prioritizing exercise over other aspects of life, including work, school, relationships, and daily responsibilities
• Hiding exercise
• Restricting food intake
• Using exercise to compensate for eating

Anorexia athletica shares many behavioral symptoms with exercise addiction, which is another unofficial condition. Both involve excessive exercise, but anorexia athletica differs in that the excessive exercise occurs alongside calorie restriction, which isn’t always the case with exercise addiction.

Physical symptoms of anorexia athletica

• Weight loss
• Plateau or decline in athletic performance
• Fatigue or low energy
• Frequent injury or re-injury
• Injuries that are slow to heal
• Growth of excess hair on the body
• Irregular, missed, or absent periods
• Lightheadedness or dizziness
• Needing a longer recovery time between workouts, practices, or competitions

Psychological symptoms of anorexia athletica

• Anxiety, guilt, or distress when unable to exercise
• Mood changes
• A perfectionist attitude in maintaining what’s perceived as peak physical condition
• Irritability
• Problems with concentration or focus
• Low self-esteem.
• Feeling that their training or exertion level is “never enough”
• Social withdrawal

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What causes anorexia athletica?

As with all eating disorders, there isn’t one single cause of anorexia athletica. Rather, it emerges out of a combination of different factors, which can be genetic, biological, social, psychological, or environmental. However, there are a few things that can increase a person’s risk of developing anorexia athletica, both on a societal level and on an individual level

Societal and cultural factors

One of the biggest risk factors for anorexia athletica is, unfortunately, the culture we live in. Because of our society’s obsession with thinness and weight loss, behaviors that are actually disordered and harmful are often treated as normal or even praiseworthy—and this can be especially pronounced among athletes.

Some of the specific cultural factors that might contribute to anorexia athletica include:

• Fitness and gym culture promoting an unhealthy relationship with exercise (think phrases like “no days off,” “never skip a workout,” or “no pain no gain”)
• Diet culture normalizing restrictive eating behaviors
• Social media influencers promoting extreme exercise habits and body comparison
• The pressure to maintain a specific physical condition for peak athletic performance
• Pressure from coaches, trainers, or teammates to perform at a certain level
• Sports-related body assessments, like weigh-ins, judging criteria, or tight-fitting uniforms
• Participating in weight-sensitive sports like wrestling, ballet, gymnastics, distance running, or figure skating

Individual factors

Certain people can also be more vulnerable than others to developing an eating disorder. Some things that might increase a person’s risk of anorexia athletica include:

• Perfectionism, including a desire for peak athletic performance
• Doubts related to personal abilities
• Social uncertainty
• Body image concerns and a strongly idealized image of a “good” body
• Impulsivity or lack of self-control
• A history of depression or other mood disorders
• Childhood obesity

How is anorexia athletica treated?

Despite the fact that anorexia athletica isn’t a distinct eating disorder diagnosis, it is a serious and harmful condition that often occurs in the context of another eating disorder, like anorexia nervosa or atypical anorexia. Conditions like this don’t go away on their own, and almost always require professional support to overcome. The good news is that if you’re worried that you or a loved one might be struggling with anorexia athletica or a similar eating disorder, there are a number of different evidence-based options for recovery.

What treatment looks like

Because anorexia athletica isn’t in the DSM, there’s not much research on the best evidence-based treatment strategy, but it’s likely that approaches that work for other eating disorders will be successful. “Anorexia athletica is treated in the same manner as other restrictive eating disorders, with the caveat that it’s important to be sensitive to the unique needs of athletes, including sport culture and team dynamics,” says Hellner.

As with treatment for all eating disorders, the first step is to normalize eating habits and address any nutritional deficiencies or physical issues related to undernourishment. This usually involves working with a registered dietitian to create and stick to a meal plan, and sometimes a medical provider who can monitor any health complications.

Treatment also involves working with a licensed therapist, who might use modalities like cognitive behavioral therapy (CBT) or dialectical behavioral therapy (DBT) to help patients challenge problematic thought patterns and behaviors as well as address any underlying causes of the eating disorder. It can be extremely powerful to involve family, friends, and other loved ones into eating disorder treatment, and for those with anorexia athletica, it might be particularly helpful to include coaches, trainers, or teammates.

One unique consideration for treating anorexia athletica is the role of the athlete’s sport in recovery. “We often need to pause on training for a period of weeks to months so that we can make sure the individual is safe to engage in any exercise,” says Hellner. “The return to sport is generally gradual, and guided by the athlete's support system. We want to see hormone function normalize, weight and body fat restore, and injuries heal before we place any additional demands on a body that is already compromised from malnutrition. The team will work together to help the athlete address their food and body issues in a way that enables them to enjoy longevity in their sport.”

How to get started with treatment

If you’re worried that you or a loved one might be dealing with anorexia athletica, it’s important to get a professional assessment. While anorexia athletica isn’t an official diagnosis, it often occurs in the context of another eating disorder and its symptoms can be extremely harmful on their own.

You can take our eating disorder screener to better understand how concerned you should be, but if something seems off, we highly recommend you talk to a doctor, mental health provider, or eating disorder specialist. You can also schedule a call with our team to talk through your concerns and get an expert opinion.

Don’t wait to get helpIf you’re worried about anorexia athletica or another eating disorder, talk to someone on our team.

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Preventing anorexia athletica in athletes

While anorexia athletica can commonly occur in athletes, it's important to understand that you can be a successful athlete without developing anorexia athletica or an unhealthy relationship with exercise. “All athletes—across sport and gender—are more vulnerable to eating disorders than their non-athlete counterparts,” Hellner explains, but says there are steps they can take to mitigate this risk. To protect against anorexia athletica or another eating disorders, athletes can:

• Work with an experienced, weight-inclusive sport dietitian, who is also eating disorder savvy.
• Resist the urge to conform to a particular “athletic aesthetic,” and remember that you can be (and have been) successful in your sport with the body you have.
• Reach out to a trusted support person for help if you are struggling (emotionally or physically) to fuel properly for training.
• Familiarize yourself with RED-S signs and symptoms. Hellner recommends Project RED-S as a great resource for athletes and sport professionals.
• Remember that prioritizing your health and well-being is important for many reasons, and is essential if you want to continue in your sport (or any sport) throughout your lifespan.

Tips for coaches and trainers

It’s also important to recognize the role that coaches and trainers can play in protecting athletes from disordered thoughts and behaviors around eating and exercise. Below are some tips for creating a safe environment for all athletes, which you can consider sharing with coaches or trainers:

• Learn to recognize the signs and symptoms of eating disorders so you can help catch them early. Remember that eating disorders affect people of all body sizes. You can learn more about how eating disorders show up in athletes to better spot red flags.
• Be aware of providers who specialize in disordered eating in athletes so you can easily refer athletes to a specialist if needed.
• Avoid minimizing eating disorder symptoms as “normal” for athletes (for instance, low heart rate, loss of period, overuse injuries).
• Limit use of “diet” foods, diet talk, or supplement recommendations, and avoid demonizing food groups.
• If you feel inclined to make nutrition recommendations, focus on what athletes can add, not what they can remove.
• Emphasize the health risks of low weight and underfueling, both for overall health and for performance.
• Organize training and feedback around the body athletes have, not the body you want them to have.
• Avoid comments on weight or shape, including compliments.
• De-emphasize weight by evaluating current weight monitoring procedures, and reconsidering the need to check weight at all. If it is necessary, consider weighing athletes at a lower frequency and in a private setting, and be mindful of how you deliver feedback.
• Don’t automatically stop an athlete from participating in their sport if you find out they have eating problems, unless it’s warranted by a medical condition. Consider their mental and physical health when making decisions about their degree of participation.
• Explore your own values and attitudes regarding weight, dieting, and body image, and how these values and attitudes may inadvertently affect your athletes.

And most importantly, Hellner says, don’t underestimate the power you have as a coach: “Know that your leverage is a superpower for helping athletes get into treatment and recover!”

The Equip takeaway: what to remember about anorexia athletica

Anorexia athletica isn’t an official eating disorder diagnosis, but it is a cluster of concerning symptoms that often occurs alongside an eating disorder like anorexia nervosa or atypical anorexia. It’s important that athletes, their loved ones, coaches, and trainers are aware of anorexia athletic and its risks, and take steps to prevent and address disordered behaviors like excessive exercise and restrictive eating.

If you or a loved one are struggling with symptoms of anorexia athletica, it’s important to get help. A team of professionals can help promote a healthy relationship with exercise, eating, and body size that not only protects against harmful habits but also promotes longevity and performance in athletics.

FAQ about anorexia athletica

1. What is anorexia athletica?

Anorexia athletica is a condition that affects athletes and is defined by excessive and compulsive exercise alongside dieting or food restriction. Anorexia athletica isn’t an official eating disorder diagnosis in the DSM-5, but people who present with anorexia athletica symptoms often have another eating disorder, like atypical anorexia or anorexia nervosa.

2. What are the mental and physical health risks of excessive exercise?

Contrary to the messaging of the fitness industry, there is such a thing as too much exercise; overtraining or working out too much carries a number of different risks for both mental and physical health. Physical health risks include stunted growth, heart problems, poor bone health, arthritis, weakened immune system, gastrointestinal problems, and infertility or pregnancy complications. Mental health risks include depression, anxiety, mood changes, irritability, social withdrawal, problems with concentration or focus, and low self-esteem.

3. What are the warning signs of anorexia athletica?

The primary sign of anorexia athletica is excessive exercise alongside food restriction. This might show up in different ways, such as:

• Exercising more than is necessary or healthy
• Consistently working out more than peers or more than what’s prescribed by a coach or trainer
• Exercising while injured or sick, or in bad weather
• Prioritizing exercise over work, school, relationships, and daily responsibilities
• Hiding exercise
• Restricting food intake
• Using exercise to compensate for eating
• Frequent injuries

4. How can coaches help prevent anorexia athletica in athletes?

Coaches and trainers have a lot of power when it comes to helping prevent disordered behaviors around eating and exercise in the athletes they work with. They can protect their athletes against anorexia athletica and similar conditions by learning the early warning signs of eating disorders; de-emphasizing the importance of weight for performance; educating athletes about proper sports nutrition and why adequately fueling your body is vital for performance; and avoiding comments on weight and body size or shape, even if they’re complimentary.

5. What are the treatment options for anorexia athletica?

Because anorexia athletica isn’t an official diagnosis, there isn’t much research on specific treatment strategies. However, the approaches used for other restrictive eating disorders are likely to be effective.

A comprehensive treatment plan for anorexia athletica should include:

• A multidisciplinary care team, including a registered dietitian, licensed therapist, and medical provider. Involving a sports psychiatrist or someone who specializes in sports nutrition can also be helpful, as can mentors who have a similar background.
• Evidence-based treatment modalities, like cognitive behavioral therapy (CBT), dialectical behavioral therapy (DBT), or family-based treatment (FBT)
• The involvement of loved ones to help with accountability and protect against relapse
• A plan for taking a break from and returning to sport