Schoo l of Gradua te S tud ies in par t ia l fu lf i l lmen t of the requ iremen ts for the degree of

AN INVESTIGATION OF EATING PATHOLOGY , EMOTION REGULATION , AND STRESS IN UNIVERSITY STUDENT ATHLETES .

by © Chr is Duggan A d isser ta t ion subm i t ted to the

Schoo l of Gradua te S tud ies in par t ia l fu lf i l lmen t of the requ iremen ts for the degree of

Doctorate of Psycho logy , Department of Psycho logy , Facu lty of Sc ience Memor ia l Un ivers i ty of Newfound land

May 2019

S t . John’s , Newfound land and Labrador

Abs trac t

Research inves t iga t ing ea t ing pa tho logy in un ivers i ty s tuden t ath le tes tends to sugges t tha t s tuden t a th le tes exh ib i t lower r isk for ea t ing pa tho logy and lower leve ls of body d issa t isfac t ion than the ir non-a th le te coun terpar ts . G iven tha t body d issa t isfac t ion has been shown to pred ic t ea t ing pa tho logy , i t is poss ib le tha t s tuden t a th le tes exh ib i t lower ea t ing pa tho logy r isk as a resu l t of the ir re la t ive ly low er leve ls of body

d issa t isfac t ion . G iven tha t s tudent a th le tes engage in regu lar and in tense phys ica l ac t iv i ty , i t is l ike ly tha t the ir bod ies mo re c lose ly ma tch the cu l tura l idea l ( lean) , wh ich wou ld exp la in the re la t ive ly low leve ls of body d issa t isfac t ion obser ved in prev ious s tud ies . There is ev idence to sugges t tha t regu lar engagemen t in phys ical ac t iv i ty is an effec t ive emo t ion regu la t ion s tra tegy . Emot ion regu la t ion invo lves the aw areness and accep tance of emo t ions , the ab i l i ty to behave in accordance w i th des ired goa ls when exper ienc ing nega t ive emo t ions , and the ab i l i ty to use s i tua t iona l ly appropr ia te emo t ion regu la t ion s tra teg ies . D iff icu l t ies in emo t ion regu la t ion ar ise when one of these processes is

d isrup ted and d iff icu l t ies in emo t ion regu la t ion have been assoc ia ted w i th h igher r isk for ea t ing pa tho logy .

The curren t research inves t iga ted the re la t ionsh ips be tween a thle t ic s ta tus , ea t ing

pa tho logy , and d iff icu l t ies in emo t ion regu la t ion in a samp le of 123 ma le and fema le

s tuden t non-a th le tes and 85 ma le and fema le s tuden t a th le tes . It was hypo thes ized tha t the

s tuden t a th le tes wou ld repor t lower leve ls of ea t ing pa tho logy r isk and h igher leve ls of

body sa t isfac t ion than the s tuden t non-a th le tes . Add i t iona l ly , i t was pred ic ted tha t s tuden t

a th le tes wou ld repor t fewer d iff icu l t ies in emo t ion regu la t ion than the s tuden t non-

a th le tes and tha t d iff icu l t ies in emo t ion regu la t ion wou ld med i a te the re la t ionsh ip be tween a th le t ic s ta tus and ea t ing pa tho logy .

In genera l , the resu l ts of the curren t s tudy were cons is ten t w ith the pred ic t ions , in

tha t the s tuden t a th le tes repor ted s ign if ican t ly lower l ike l iho od of scor ing w i th in the

range of c l in ica l concern on an ea t ing pa tho logy assessmen t . Add i t iona l ly , the s tuden t

a th le tes repor ted s ign if ican t ly h igher scores on an index of body sa t isfac t ion and lower

scores on an index of d iff icu l t ies in emo t ion regu la t ion , bu t the d ifference mere ly trended

towards s ign if icance for d iff icu l t ies in emo t ion regu la t ion . F i na l ly , the curren t s tudy

demons tra ted tha t the re la t ionsh ip be tween scores on an ea t ing pa tho logy assessmen t and

a th le t ic s ta tus were med ia ted by d iff icu l t ies in emo t ion regu lat ion in a samp le of ma le

and fema le s tuden t a th le tes and s tuden t non-a th le tes . Th is sugges ts tha t s tuden t a th le tes

repor ted less ea t ing pa tho logy as a resu l t of fewer d iff icu l t ies in emo t ion regu la t ion .

Acknow ledgments

There are a number of ind iv iduals w i thou t the suppor t of whom t h is pro jec t wou ld no t have been poss ib le . F irs t ly , I w ish to convey my mos t s incere apprec ia t ion to my superv isor , Dr . O lga Hea th , who never fa i led to encourage me and was a lways ava i lab le for 5 :30 mee t ings . I wou ld a lso l ike to ex tend thanks to the members of my comm i t tee , Dr . Ken Fow ler and Dr . LeAnne Pe thr ick , for the ir gu idance and cons truc t ive feedback dur ing the comp le t ion of th is d isser ta t ion .

I wou ld a lso l ike to ex tend my gra t i tude to severa l o ther facu lty and s taff

members who con tr ibu ted to my success . Dr . Ma lco lm Gran t was a lways w i l l ing to mee t for d iscuss ions abou t mu l t ivaria te s ta t is t ics and responded to my ques t ions w i th pa t ience . Ms . Brenda Crewe , whose encouragemen t to f in ish my thes is has been unwaver ing . I wou ld a lso l ike to thank Dr . Jacque l ine Car ter-Ma jor and Dr . Jul ie Gosse l in for your suppor t through my cha l lenges and successes in th is program .

F ina l ly , I wou ld l ike to ded ica te th is pro jec t to my paren ts , Gera ld Duggan and Eva Duggan , and to my bro ther , James Duggan . There is no way I cou ld have succeeded in th is endeavor w i thou t your c ons tan t care and unders tand ing . The f inanc ia l suppor t was a lso cruc ia l ly impor tan t . I can never tru ly repay the g if ts you a l l have g iven me over the course of th is degree , bu t I w i l l do my bes t to pay i t forward to every c l ien t w i th whom I work .

Thank-you .

Tab le of Con ten ts

Abs trac t . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . i i

Acknow ledgmen ts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . iv

Tab le of Con ten ts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .v

L is t of Tab les . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . ix

L is t of F igures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .x

L is t of Append ices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. x i i 1 . CHAPTER ONE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1

1 .1 Forward . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

1 .2 Ea t ing Pa tho logy in the Genera l Popu la t ion . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

1 .3 Ea t ing Pa tho logy : E t io logy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

1 .4 Ea t ing Pa tho logy : Assessmen t . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

1 .5 Ea t ing Pa tho logy in A th le tes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

1 .6 S tuden t A th le tes and Ea t ing Pa tho logy : L i tera ture Rev iew . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

1 .6 .1 S tuden t a th le tes compared to s tuden t non-a th le tes . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

1 .6 .2 Body d issa t isfac t ion in s tuden t a th le tes and s tuden t non-a th le tes . . . . . . . . . . . . . . . . . . . . 27

1 .6 .3 Ma le s tuden t a th le tes compared to fema le s tuden t a th le tes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31

1 .6 .4 Lean spor t s tuden t a th le tes compared to non- lean spor t s t uden t a th le tes . . . . . . . . . 33

1 .7 Emo t ion regu la t ion and d iff icu l t ies in emo t ion regu la t ion .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41

1 .8 The Curren t S tudy : Purpose and Hypo theses . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46

2 . CHAPTER TWO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .50

2 .1 Des ign . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50

2 .3 Assessmen t . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50

2 .4 Par t ic ipan t Recru i tmen t . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60

2 .5 Procedure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61

2 .6 S ta t is t ica l Ana lyses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65

3 . CHAPTER THREE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .69

3 .1 Recru i tmen t and Re ten t ion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69

3 .2 Da ta Screen ing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71

3 .3 Samp le Charac ter is t ics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74

3 .4 Descr ip t ive S ta t is t ics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76

3 .5 Ea t ing Pa tho logy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85

3 .5 .1 A th le t ic S ta tus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85

3 .5 .2 Sex D ifferences . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87

3 .5 .3 A th le t ic s ta tus by sex in terac t ion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89

3 .6 Body Sa t isfac t ion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89

3 .6 .1 A th le t ic S ta tus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89

3 .6 .2 Sex D ifferences . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90

3 .6 .3 A th le t ic S ta tus by sex in terac t ion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91

3 .7 Lean and Non- lean spor t s tuden t a th le tes . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91

3 .7 .1 Ea t ing pa tho logy and re lat ive lean emphas is . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92

3 .7 .2 Ea t ing pa tho logy and sex in lean and non- lean spor t s tuden t a th le tes . . . . . . . . . . . . . 94

3 .7 .3 Re la t ive lean emphas is and sex in terac t ion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95

3 .7 .4 Body sa t isfac t ion in lean and non-lean spor t s tuden t a th l e tes . . . . . . . . . . . . . . . . . . . . . . . . . . 96

3 .8 Perce ived S tress in S tuden t ath le tes and S tuden t non-a th le t es . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98

3 .9 D iff icu l t ies in Emo t ion Regu la t ion in S tuden t a th le tes and S tuden t non-a th le tes 101

3 .10 Ea t ing Pa tho logy and D iff icu l t ies in Emo t ion Regu la t ion : A Med ia t iona l Mode l . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104

4 . CHAPTER FOUR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .106

4 .1 Overv iew of Curren t F ind ings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109

4 .1 .2 Ea t ing pa tho logy in lean and non- lean spor t s tuden t a th letes . . . . . . . . . . . . . . . . . . . . . . . . 114

4 .1 .3 Sex d ifferences in ea t ing pa tho logy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118

4 .1 .4 Perce ived s tress in s tuden t a th le tes and s tuden t non-a th l e tes . . . . . . . . . . . . . . . . . . . . . . . . . 123

4 .1 .5 D iff icu l t ies in emo t ion regu la t ion in s tuden t a th le tes and s tuden t non-a th le tes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125

4 .2 Me thodo log ica l Cons idera t ions : S treng ths and L im i ta t ions . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 130

4 .3 C l in ica l Imp l ica t ions and Recommenda t ions . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 134

4 .4 D irec t ions for Fu ture Research . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135

4 .5 Conc lus ion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138

5 . References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .139

6 . Append ices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .175

L is t of Tab les

1 Tab le 3 . 1 D is tr ibu t ion o f Par t ic ipan ts From A th le t ic Teams Samp led . . . . . . . . . . . . . . . . . . . . . . . .70   2 Tab le 3 . 2 Skewness , Kur tos is , and Z-Scores . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .73   3 Tab le 3 . 3 Demograph ic Charac ter is t ics o f the S tuden t A th le te and S tuden t Non-

a th le te Samp les . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .70   4 Tab le 3 . 4 Descr ip t ive S ta t is t ics for the S tuden t A th le te and S tuden t Non-a th le te

Samp les . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .77  

5 Tab le 3 . 5 Summary o f Regress ion Ana lys is for Sobe l 's Tes t o f Med ia t ion . . . . . . . . . . . . . . . . .106

5 Tab le 3 . 5 Summary o f Regress ion Ana lys is for Sobe l 's Tes t o f Med ia t ion . . . . . . . . . . . . . . . . .108

L is t of F igures

1 F igure 3 . 1 S tudy Recru i tmen t . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .69   2 F igure 3 . 2 Ma le and Fema le par t ic ipan ts ' To ta l EAT-26 scores (d iv ided by samp le) . 7 8   3 F igure 3 . 3 Propor t ion o f S tuden t a th le tes and S tuden t non-a th le tes Scor ing w i th in the range o f c l in ica l concern on the EAT-26 (D iv ided by sex) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .79   4 F igure 3 . 4 Propor t ion o f ma le and fema le s tuden t a th le tes endors ing ea t ing pa tho logy behav iors on the SCOFF . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .80   5 F igure 3 . 5 Propor t ion o f ma le and fema le s tuden t a th le tes scor ing w i th in the range o f c l in ica l concern on the SCOFF . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .80   6 F igure 3 . 6 Ma le and Fema le par t ic ipan ts ' mean BASS I tem response (d iv ided by

samp le) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .81   7 F igure 3 . 7 Ma le and Fema le par t ic ipan ts ' mean DERS scores (d iv ided by samp le) . . .82   8 F igure 3 . 8 Ma le and Fema le par t ic ipan ts ' HIDS s tress i tem scores (d iv ided by

samp le) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .84  

9 F igure 3 . 9 Mean PSS-10 scores for Ma le and Fema le S tuden t a th le tes . . . . . . . . . . . . . . . . . . . . . . .85  

10 F igure 3 . 10 S tuden t a th le tes and S tuden t non-a th le tes To ta l EAT-26 scores . . . . . . . . . . . . .86  

11 F igure 3 . 11 Propor t ion o f S tuden t A th le tes and S tuden t Non-a th le tes Scor ing w i th in

the Range o f C l in ica l Concern on the EAT-26 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .86  

12 F igure 3 . 12 Ma le and Fema le par t ic ipan ts ' To ta l EAT-26 scores . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .87  

13 F igure 3 . 13 Propor t ion o f ma le and fema le s tuden t a th le tes scor ing w i th in the range

o f c l in ica l concern on the SCOFF . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .89  

14 F igure 3 . 14 S tuden t a th le tes and S tuden t non-a th le tes mean BASS i tem responses . . .90  

15 F igure 3 . 15 Ma le and fema le par t ic ipan ts ' mean BASS i tem responses . . . . . . . . . . . . . . . . . . . . .91   16 F igure 3 . 16 Lean spor t and non- lean spor t s tuden t a th le tes ' To ta l EAT-26 scores . . .92   17 F igure 3 . 17 Propor t ion o f lean and non- lean s tuden t a th le tes scor ing w i th in the range o f c l in ica l concern on the EAT-26 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .93   18 F igure 3 . 18 Propor t ion o f lean and non- lean s tuden t a th le tes scor ing w i th in the range o f c l in ica l concern on the SCOFF . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .94   19 F igure 3 . 19 Ma le and Fema le s tuden t a th le tes To ta l EAT-26 scores . . . . . . . . . . . . . . . . . . . . . . . . .95   20 F igure 3 . 20 Lean and Non- lean spor t s tuden t a th le tes ' mean BASS i tem responses . .96   21 F igure 3 . 21 Ma le and Fema le s tuden t a th le tes mean BASS I tem response . . . . . . . . . . . . . . . .98   22 F igure 3 . 22 S tuden t a th le te and s tuden t non-a th le te par t ic ipan ts ' mean HIDS s tress i tem scores . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .99   23 F igure 3 . 23 Ma le and Fema le par t ic ipan ts ' HIDS s tress i tem scores . . . . . . . . . . . . . . . . . . . . .100   24 F igure 3 . 24 Ma le and Fema le par t ic ipan ts ' HIDS s tress i tem scores (d iv ided by samp le) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .100   25 F igure 3 . 25 S tuden t a th le te and s tuden t non-a th le te par t ic ipan ts ' mean DERS scores . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .102   26 F igure 3 . 26 Ma le and Fema le par t ic ipan ts ' mean DERS scores . . . . . . . . . . . . . . . . . . . . . . . . . . . . .102   27 F igure 3 . 27 Ma le and Fema le par t ic ipan ts ' mean DERS scores (d iv ided by samp le).

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .104  

28 F igure 3 . 28 Sobe l’s Tes t o f Med ia t ion (DERS) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .106  

28 F igure 3 . 28 Sobe l’s Tes t o f Med ia t ion (BASS). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1068  

L is t of Append ices

Append ix A . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .175  

Append ix B . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .180  

Append ix C . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .185  

Append ix D . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .187  

Append ix E . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .188  

Append ix F . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .189  

Append ix G . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .192  

Append ix H . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .194  

Append ix I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .195  

Append ix J . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .196  

An Inves t iga t ion of Ea t ing Pa tho logy , Emo t ion Regu la t ion , and Stress in Un ivers i ty S tuden t A th le tes .

1 . CHAPTER ONE 1 .1 Forward

The curren t research was under taken , in par t , because of increas ing anecdo ta l repor ts from the un ivers i ty counse l l ing cen tre and a th le t ics depar tmen t of a th le tes

exper ienc ing ea t ing pa tho logy . Prev ious s tud ies wh ich have inves t iga ted eat ing pa tho logy in s tuden t a th le tes have y ie lded somewha t m ixed resu l ts ; howeve r , the da ta sugges ts tha t some s tuden t a th le tes exh ib i t grea ter r isk for ea t ing pa tho logy than o thers . Hence , the curren t s tudy was des igned to inves t iga te the preva lence of ea ting pa tho logy r isk in a samp le of un ivers i ty s tuden t a thle tes from a m id-s ized A t lan t ic Canad ian Un ivers i ty . Add i t iona l ly , the curren t research was des igned to iden t ify po ten t ia l h igh r isk groups w i th in a spec if ic un ivers i ty popu la t ion ( i .e . fema le s tuden t a th le tes and non-a th le tes , lean spor t s tuden t a th le tes) .

Wh i le the curren t s tudy resu l ts were no t homogeneous , prev ious research tends to

sugges t tha t s tuden t a th le tes exh ib i t lower r isk for ea t ing pa tho logy than the ir non-a th le te

peers . Add i t iona l ly , researchers have repor ted tha t s tuden t a th le tes tend to score lower on

assessmen ts of body d issa t isfac t ion than s tuden t non-a th le tes , wh ich may exp la in the

lower r isk for ea t ing pa tho l ogy . By v ir tue of engag ing in regu lar phys ica l ac t iv i ty , i t is

l ike ly tha t s tuden t a th le tes’ bod i es more c lose ly ma tch the cu ltura l ly def ined idea l , wh ich

can exp la in the ir tendency to be more sa t isf ied w i th the ir bod ies than s tuden t non-

a th le tes . Fur thermore , regu lar phys ica l ac t iv i t y has been associa ted w i th decreases in d iff icu l t ies in emo t ion regu la tion and d iff icu l t ies in emo t ion regu la t ion have been shown to pred ic t ea t ing pa tho logy . As su ch , the curren t s tudy was a lso des igned to inves t iga te d iff icu l t ies in emo t ion regu la t ion in s tuden t a th le tes and s tuden t non-a th le tes as they re la te to ea t ing pa tho logy r isk . On ly one s tudy was loca ted wh ich inves t iga ted d iff icu l t ies in emo t ion regu la t ion and ea t i ng pa tho logy in un ivers i ty s tudent a th le tes and non-a th le tes (Wo l lenberg , Shr iver , & Ga tes , 2015) . However , the prev ious s tu dy inc luded on ly fema le par t ic ipan ts and as such , the curren t s tudy expanded th is l ine of inqu iry by inc lud ing ma le par t ic ipan ts .

1 .2 Eat ing Patho logy in the Genera l Popu lat ion

Ea t ing d isorders are ser ious psyc h ia tr ic cond i t ions wh ich are charac ter ized by d is turbed ea t ing behav iours , pa thogen ic we igh t con tro l behav iours , and d is tor t ions of body image wh ich resu l t in phys ica l and /or psychosoc ia l impa irm en t (APA , 2000) . A t the ou tse t of the curren t s tudy the D iagnos t ic and S ta t is t ica l Manu a l of Men ta l D isorders-IV- TR (DSM-IV-TR ; APA , 2000) was the mos t recen t vers ion of th is m anua l and as such , the term ea t ing d isorder w i l l refer to one of the 3 d iagnosab le cond i t ions l is ted in the DSM-IV-TR , anorex ia nervosa (AN) , bu l im ia nervosa (BN) , and ea ting d isorder no t o therw ise spec if ied (EDNOS) (APA , 2000) . The fac t tha t the DSM-IV-TR is a

ca tegor ica l c lass if ica t ion sys tem means tha t ind iv idua ls are c l ass if ied as be long ing to one

of the three ea t ing d isorder ca tegor ies or are cons idered no t to have an ea t ing d isorder .

The c l in ica l cr i ter ia for each of the d iagnosab le ea t ing d isorders are l is ted in Append ix A

(Tab le A1) and fea tures wh ich are typ ica l ly assoc ia ted w i th c l i n ica l presen ta t ions of

ea t ing d isorders have been l is ted in Append ix A (Tab le A .2) . S imp ly pu t , AN is

charac ter ized by d is tor ted body image and fear of ga in ing we ight wh ich leads to severe d ie tary res tr ic t ion and resu l ts in s ign if ican t ly low body we ight for the persons’ sex and deve lopmen ta l leve l . BN is charac ter ized by recurren t b inge ing ep isodes (consum ing an excess ive amoun t of food and losing con tro l) fo l lowed by compen sa tory behav iours , such as se lf- induced vom i t ing or laxa t ive abuse , in order to avo id we igh t ga in . F ina l ly EDNOS is charac ter ized by the presence of c l in ica l ly s ign if ican t symp toms of an ea t ing d isorder wh ich do no t mee t the d iagnos t ic thresho ld for an AN or BN d iagnos is . The presence or absence of an ea t ing d isorder mus t be assessed by a qua l if ied hea l th profess iona l based on the c l in ica l cr i ter ia .

I t is usefu l to no te tha t ea t ing disorder symp toms and c l in ica l cr i ter ia , wh i le re la ted , are no t in terchangeab le terms . Ea t ing d isorder symp toms refer to the though ts , fee l ings , behav iours , and phys io log ica l charac ter is t ics wh ich typ ify ea t ing d isorders , such as b inge ing , purg ing , body image d is turbance , and d ie tary res tric t ion (S t ice , Ng , & Shaw , 2010) . The DSM-IV-TR l is ts ea t ing d isorder symp toms w i th the add i t ion of frequency or in tens i ty qua l if iers , for examp le , purg ing is a symp tom of ea t i ng d isorders and the

c l in ica l cr i ter ia spec if ies the number of purg ing ep isodes per week wh ich sa t isf ies the cr i ter ia (APA , 2000) . The qua l if iers a l low for a c learer de l ine a t ion of the boundar ies be tween d iagnos t ic ca tegor ies and be tween the presence or absence of a d iagnosab le ea t ing d isorder .

I t m igh t appear tha t mak ing an e a t ing d isorder d iagnos is is a re la t ive ly

s tra igh tforward process when us ing the DSM-IV-TR ca tegor ica l mode l . However ,

because EDNOS is a d iagnos is of exc lus ion , there are no c lear cl in ica l cr i ter ia w i th wh ich to prov ide a de term ina t ion of a pos i t ive “case .” The manua l s ta tes tha t “ the Ea t ing

D isorder No t O therw ise Spec if ied ca tegory is for d isorders of ea t ing tha t do no t mee t the cr i ter ia for any spec if ic Ea t ing Disorder” , wh ich cons t i tu tes recogn i t ion tha t ind iv idua ls who do no t mee t the fu l l cr i ter ia for AN or BN can s t i l l suffer from a c l in ica l ea t ing d isorder . An EDNOS d iagnos is is warran ted when an ind iv idua l suffers c l in ica l ly

s ign if ican t d is tress or impa irment in da i ly l ife and the ir presen ta t ion does no t fu l ly mee t the cr i ter ia for AN or BN bu t c le ar ly represen ts a pa t tern of ea t ing d isorder symp toms (APA , 2000 ; Schw i tzer , Bergho l tz, Dore , & Sa l im i , 1998) . Indeed , research ind ica tes tha t ind iv idua ls w i th EDNOS exh ib i t comparab le leve ls of d isab i l i ty , psychosoc ia l

impa irmen t , and d is tress as those d iagnosed w i th AN or BN (Garfinke l , L in , Goer ing , Spegg , Go ldb loom , Kennedy , & . . . Woods ide , 1996 ; R icca e t a l . , 2001 ; Turner & Bryan t- Waugh , 2004) . Add i t iona l ly , there is emp ir ica l da ta wh ich ind ica tes tha t ind iv idua ls who presen t w i th sub- thresho ld ea t ing pa tho logy can and do progress to sa t isfy DSM-IV-TR cr i ter ia for a d iagnosab le eat ing d isorder (S t ice e t a l . , 2008a ; S t ice , K i l len , Hayward , &

Tay lor , 1998) . Thus , the ev idence ind ica tes tha t ea t ing d isorder symp toms are no t s imp ly

presen t or absen t , bu t ra ther occur on a con t inuum of sever i ty and , as such , exper ts have

sugges ted tha t ea t ing d isorder symp tomo logy is be t ter concep tual ized from a d imens iona l

perspec t ive , ra ther than ca tegorica l perspec t ive (Fa irburn & Ha rr ison , 2003 ; W r igh t ,

Krueger , Hobbs , Markon , Ea ton , & Slade , 2013) . Hence , i t is imp or tan t to cons ider bo th

c l in ica l and subc l in ica l leve ls of ea t ing pa tho logy because bo th are assoc ia ted w i th hea l th

r isks , d is tress , and func t iona l impa irmen t . Fur thermore , the term ea t ing pa tho logy w i l l

refer to the fu l l spec trum of though ts , fee l ings , behav iours , and phys ica l charac ter is t ics wh ich typ ify d isordered ea t ing , regard less of d iagnos t ic s ta tus .

I t has been es t ima ted tha t 600 ,000 to 990 ,000 Canad ians may mee t the d iagnos t ic cr i ter ia for an ea t ing d isorder, a t any g iven t ime (LeB lanc , 20 14) . W i th respec t to spec if ic d iagnoses , the DSM-IV-TR l is ts the l ife t ime preva lence (propor tion of ind iv idua ls who have exper ienced the d isorder a t some po in t in the ir l ife t ime) of AN for fema les as 0 .5 % and 0 .05% for ma les and the l ife t ime preva lence of BN among women to be

approx ima te ly 1%–3% and 0 .1 – 0 .3% for men (APA , 2000) . The age range dur ing wh ich ea t ing pa tho logy typ ica l ly man ifests before or co inc id ing w i th the t im ing of

undergradua te s tud ies (APA , 2000 ; Mica l i , Hagberg , Pe tersen , & Treasure , 2013 ; Vo lpe , Tor tore l la , Manch ia , Mon te leone, A lber t , & Mon te leone , 2016) , w h ich sugges ts tha t un ivers i ty s tuden ts may be a t increased r isk for the deve lopment of ea t ing pa tho logy . Fur ther suppor t for th is idea comes from s tud ies wh ich have inves t iga ted ea t ing

pa tho logy in un ivers i ty s tuden ts and repor ted ra tes of AN and BN wh ich were h igher than wou ld be expec ted based on the preva lence es t ima tes ob ta ined from commun i ty samp les (E isenberg , N ick le t t , Roeder, & K irz , 2011 ; Hoerr , Bokram , Lugo , B iv ins , & Keas t , 2002) . For examp le , da ta from the Amer ican Co l lege Hea l th Assoc ia t ion’s Na t iona l Co l lege Hea l th Assessmen t (2007) ind ica ted a l ife t ime preva lence of AN as 3% for fema les and 0 .4% for ma les and a l ife t ime preva lence of BN for 2% of fema les and 0 .2%

of ma les . Preva lence da ta a lso sugges ts tha t fema les are s ign ifican t ly more l ike ly to

deve lop an ea t ing d isorder than are ma les , as ev idence by s ign if ican t ly h igher ra tes of AN

and BN repor ted by fema le par t ic ipan ts (E isenberg , N ick le t t , Roeder , & K irz , 2011 ;

Hoerr , Bokram , Lugo , B iv ins , & Keas t , 2002 ; M ica l i , Hagberg , Petersen , & Treasure , 2013 ; Vo lpe , Tor tore l la , Manch ia , Mon te leone , A lber t , & Mon te leone , 2016) .

The ava i lab le ev idence sugges ts tha t EDNOS may be the mos t comm on d iagnos is seen in ou tpa t ien t se t t ings (Fa irburn & Bohn , 2005 ; R icca e t a l. , 2001 ; Turner & Bryan t- Waugh , 2004) and i t has been es t ima ted tha t in samp les of adu l ts suffer ing from ea t ing pa tho logy , the EDNOS ca tegory may represen t as much as 60% of ea t ing d isorder d iagnoses (Fa irburn & Bohn , 2005) . However , as men t ioned above , the exc lus ionary na ture of the EDNOS d iagnos is makes i t d iff icu l t to prov ide a pos i t ive d iagnos is w i thou t an in-dep th assessmen t by a qua l ified hea l th profess iona l . Th is process is cos t ly for researchers in terms of bo th t im e and mone tary resources and many researchers have focused on inves t iga t ing AN and BN. Thus , the true preva lence o f even c l in ica l leve ls of ea t ing pa tho logy are not we l l known bu t i t is c lear tha t the cu rren t da ta l ike ly

underes t ima tes the rea l ra tes w i th wh ich ind iv idua ls suffer from c l in ica l ly s ign if ican t ea t ing pa tho logy , as ev idenced by the large propor t ion of EDNOS d iagnoses repor ted in c l in ica l popu la t ions wh ich are not be ing fu l ly represen ted in research popu la t ions . G iven th is lack of c lar i ty , i t is impor tan t to con t inue to s tudy the na ture of ea t ing pa tho logy in order to prov ide more accura te preva lence es t ima tes .

Unders tand ing the ac tua l ra tes w ith wh ich ind iv idua ls in the co mmun i ty are

suffer ing from ea t ing pa tho logy is of concern to hea l thcare pro fess iona ls because of the

myr iad of ser ious hea l th consequences assoc ia ted w i th ea t ing patho logy . Research has

ind ica ted a l ink be tween ea t i ng pa tho logy and hea l th prob lems such as , os teoporos is

(Fa irburn , & Harr ison , 2003 ; Johnson , Cohen , Kasen , & Brook , 2002 ; R igo t t i ,

Nussbaum , Herzog , & Neer , 1984) , card iac dysfunc t ion (Koschke , e t a l . , 2010 ;

Tak imo to , e t a l . , 2004) , and prema ture dea th (Arce lus , M i tche l l, Wa les , & N ie lsen , 2011 ; Wade , W i lksch , & Lee , 2012) . As a resu l t , researchers have pursued an unders tand ing of the r isk fac tors and pa thogen ic pr ocesses wh ich lead to ea t ing d isorders in the genera l popu la t ion . Through emp ir ica l research , exper ts have endeavored to deve lop effec t ive in terven t ions and proac t ive ly ide n t ify h igh-r isk ind iv idua ls w ith the goa l of preven t ion and ear ly in terven t ion .

1 .3 Eat ing Patho logy: Et io logy

The ava i lab le ev idence s trong ly sugges ts tha t the e t io logy of ea t ing pa tho logy is mu l t ifac tor ia l in na ture and mos t exper ts agree on a b iopsychosoc ia l concep tua l iza t ion , wh ich in tegra tes r isk fac tors from b io log ica l , psycho log ica l , and soc ia l doma ins in exp la in ing the deve lopmen t of ea t ing pa tho logy (Le Grange , 2016; Leung , Ge l ler , &

Ka tzman , 1996) . Researchers have iden t if ied a number of var iab les assoc ia ted w i th the deve lopmen t of ea t ing pa tho logy wh ich are beyond the scope of the curren t d iscuss ion , such as fam i ly dynam ics (M inuch in , Rosman , & Baker , 1978 ; Shoebr idge & Gowers 2000) , a t tachmen t re la t ionsh ips (Ward e t a l . 2000a ,b ; Hawor th-Hoeppner 2000) , and gene t ics (K lump , Perk ins , Bur t , McGue , & Iacono , 2007 ; O 'Connor, Bur t , VanHuysse , &

K lump , 2016) . However , e t io log ical mode ls of ea t ing pa tho logy ( Pe tr ie & Green leaf , 2007 ; S t ice & Agras , 1998 ; S tr iegel-Moore , S i lbers te in , & Rod in , 1986) tend to

emphas ize four key psychosoc ia l var iab les in the deve lopmen t and ma in tenance of ea t ing

pa tho logy : 1) Pressure to achieve an idea l body , 2) Body d issa t isfac t ion , 3) Nega t ive

affec t , and 4) Emo t ion Regu la t ion .

1) Pressure to ach ieve an idea l body . The soc iocu l tura l env iron men t w i th in wh ich one l ives s ign if ican t ly impac ts the be l iefs and va lues of the m embers of tha t soc ie ty (Nasser , 1988 ; X ie e t a l . , 2006) and mode ls of soc iocu l tura l inf luences on the

deve lopmen t of ea t ing pa tho logy emphas ize the key ro les p layed by med ia and peers (Pe tr ie & Green leaf , 2007 ; S t ice & Agras , 1998 ; S tr iege l-Moore , S i lbers te in , & Rod in , 1986) . In con temporary cu l ture , ind iv idua ls are inunda ted w i th med ia (e .g . , te lev is ion , adver t is ing , soc ia l med ia ) wh ich commun ica te soc ie ty’s idea ls surround ing the s tandard of beau ty and how i t re la tes to persona l va lue . There is ev idence to suppor t the no t ion tha t the body idea l commun ica te d in popu lar med ia tends to be unrea l is t ic and

una t ta inab le (Browne l l , 1991) and as a resu l t many ind iv idua ls in terna l ize an imposs ib le s tandard and fee l pressure to ach ieve a body shape tha t is physio log ica l ly imposs ib le (Keery , van den Berg , & Thompson , 2004 ; Shroff & Thompson , 2006; S t ice &

Wh i ten ton , 2002) . Trad i t iona l ly , soc ie ty’s messages have targe ted women (S tr iege l- Moore , S i lbers te in , & Rod in , 1986), however , men have been exper ienc ing increased pressure to ach ieve an unrea l ist ic body idea l over the pas t two decades as we l l (Pe tr ie &

Green leaf , 2007) . Researchers have prov ided da ta wh ich ind ica te tha t ind iv idua ls who exper ienced more pressure to ach ieve an idea l body a lso repor ted increased leve ls of body d issa t isfac t ion (S t ice , 2001a ; Ty lka & Sub ich , 2004) , in add i t ion to increased l ike l ihood of deve lop ing fu tur e ea t ing pa tho logy (S t ice , 2002) .

2) Body d issa t isfac t ion . Body d issat isfac t ion is a con t inuous c ons truc t , in wh ich

ind iv idua ls can exh ib i t re la t ive sa t isfac t ion , ind if ference , or re la t ive d issa t isfac t ion w i th

the ir bod i ly appearance (Cas h , 2000) . Body d issa t isfac t ion is def ined as a d iscrepancy

be tween an ind iv idua ls’ perce ived rea l and idea l body , wh ich leads to fee l ings of d iscon ten t and unhapp iness abou t one’s own body . There is ev idence to suppor t the no t ion tha t , through norma l d ie t and exerc ise , mos t ind iv idua ls are no t ab le to change the ir bod ies to ma tch the soc ia l l y prescr ibed idea l (Browne l l , 1991 ; Pope , Gruber , Cho i , O l ivard ia , Ph i l l ips , 1997) . As a resu l t , ind iv idua ls who have in terna l ized an unrea l is t ic and una t ta inab le body idea l are more l ike ly to perce ive a subs tan t ia l d iscrepancy be tween the ir ac tua l and idea l bod ies . However , the rea l- idea l body d is crepancy does no t fu l ly charac ter ize the cons truc t of body d issa t isfac t ion ; ind iv idua ls mus t a lso ascr ibe grea t persona l va lue to bod i ly a t trac t iveness . Indeed , ind iv idua ls w ith in con temporary wes tern cu l ture are con t inuous ly exposed to med ia commun ica t ing soc ie ty’s va lue of the idea l body and , as a resu l t , ind iv idua ls who in terna l ize th is va lue in add i t ion to exper ienc ing a s ign if ican t body d iscrepancy are more l ike ly to exper ience negat ive fee l ings abou t the ir bod ies (Rodgers , McLean , & Pax ton , 2015 ; S t ice , 2002) . Body d issa t isfac t ion is though t to increase r isk for ea t in g pa tho logy through i ts effec t on nega t ive affec t and d ie t ing behav iour . There is ev idence to sugges t tha t ind iv idua ls who h igh ly va lue phys ica l appearance and exper ience a substan t ia l rea l- idea l body d iscrep ancy are more l ike ly to exper ience nega t ive affec t in response to a perce ived lack ing in body image and

a t trac t iveness (S t ice , 2001a) . Add i t iona l ly , s tud ies have sugges ted tha t ind iv idua ls who

exper ience d is tress as a resul t of a rea l- idea l body d iscrepanc y are more l ike ly to engage

in d ie t ing behav iour in order to d ecrease or e l im ina te the d iscrepancy be tween the ir

ac tua l and idea l bod ies (S t ice, 2002) . Suppor t for th is no t ion has been no ted in s tud ies

wh ich have repor ted tha t par t icipan ts’ in i t ia l leve ls of body d issa t isfac t ion pred ic ted la ter

increases in nega t ive affec t (S t ice , 2001a) and ea t ing pa tho log y symp tomo logy (S t ice , Rohde , Bu tryn , Shaw , & Mar t i , 2015) .

3) Nega t ive affec t . Nega t ive affec t can be def ined as sub jec t ive d is tress or the tendency to reac t w i th nega t ive emo t ions to s tressfu l s i tua t ion s and inc ludes such fee l ings as anger , wear iness , shame , fear , and irr i ta t ion (Wa tson , C lark, & Te l legen , 1988) . As men t ioned above , nega t ive affec t is though t to evo lve in response to body d issa t isfac t ion and lead to ea t ing pa tho logy through effor ts to reduce the uncom for tab le exper ience of nega t ive affec t . More spec if ica l ly , i t is though t tha t ind iv idua ls in i t ia l ly engage in s tra teg ies , such as d ie t ing and exerc ise , to reduce the ir rea l-idea l body d iscrepancy and d issa t isfac t ion w i th the ir bod ies and the ir assoc ia ted exper ience of nega t ive affec t . Researchers have found suppor t for th is propos i t ion from research in wh ich samp les of par t ic ipan ts w i th AN were recrui ted and assessed for d ie tary re s tr ic t ion and nega t ive affec t . For examp le , a s tudy of fema les prev ious ly d iagnosed w ith AN repor ted tha t par t ic ipan ts engaged in h igher ra tes of d ie tary res tr ic t ion fo llow ing an increase in se lf- repor ted nega t ive affec t (Enge l e t a l . , 2013) . However , there is a lso a tendency for ind iv idua ls w i th ea t ing pa tho logy to engage in b inge ing ep isode s , dur ing wh ich ob jec t ive ly large quan t i t ies of food are consumed , a behav iour wh ich is un l ike ly to

decrease a perce ived rea l- idea l body d iscrepancy and subsequen t body d issa t isfac t ion and nega t ive affec t . Th is sugges ts tha t ea t ing pa tho logy behav iours m i t iga te the exper ience of nega t ive affec t by some means o ther than reduc ing body d iscrepancy and body

d issa t isfac t ion .

4) Emo t ion Regu la t ion . As ment ioned above , the exper ience of ne ga t ive af fec t is sub jec t ive ly uncomfor tab le and indiv idua ls tend to seek to reduce the ir exper ience of nega t ive affec t . When ind iv idua ls use s tra teg ies to inf luence t he in tens i ty or dura t ion of an emo t iona l exper ience or response , such as the exper ience of gr ief , i t is known as emo t ion regu la t ion (Gra tz & Roemer , 2004) . When these s tra teg ies are ineffec t ive or invo lve ma ladap t ive behav iors i t resu l ts in d iff icu l t ies in emo t ion regu la t ion , wh ich is in turn assoc ia ted w i th ea t ing pa tho logy (Ho l l iday , Uher , Landau , Co l l ier , & Treasure , 2006) . There is research to sugges t tha t ind iv idua ls engage in ea t ing pa tho logy in

response to exper iences of negat ive affec t and w i th the goa l of down-regu la t ing nega t ive emo t iona l exper iences (Hea ther ton & Baume is ter , 1991) . Suppor t for th is no t ion is found in research wh ich has demons tra t ed tha t nega t ive affec t is one of the mos t common tr iggers of b inge ea t ing (Deaver , M i l tenberger , Smy th , Me id inge r , & Crosby , 2003) . Indeed , research has documen ted increases in nega t ive affec t in par t ic ipan ts and found tha t they were assoc ia ted w i th i ncreased l ike l ihood of the par tic ipan ts engag ing in subsequen t b inge ing behav iour (Coo ley & Toray , 2001a ; F ie ld e t a l . , 1999 ; K i l len e t a l . , 1996 ; S t ice , 2001a ; S t ice & Agras , 1998) . Add i t iona l ly , research has demons tra ted a connec t ion be tween emo t ion regu la t ion and d ie tary res tr ic t ion . More spec if ica l ly , par t ic ipan ts w i th AN d iagnoses have repor ted h igher leve ls of emo t ion regu la t ion d iff icu l t ies (Brockmeyer e t a l . , 2012 ; Harr ison , Su l l ivan , Tchan tur ia , & Treasure , 2010) and reduced to lerance to d istress (Hambrook e t a l . , 2011) than hea l thy con tro l

par t ic ipan ts . Fur thermore , researchers have found tha t par t ic ipan ts w i th AN repor ted

h igher ra tes of d ie tary res tr ic t ion fo l low ing an increase in self-repor ted nega t ive affec t

(Enge l e t a l . , 2013) . Thus , ea t ing pa tho logy is though t to funct ion , a t leas t par t ia l ly , to regu la te the exper ience of nega t ive affec t .

In summary , emp ir ica l ly based e t io log ica l mode ls of ea t ing pa th o logy sugges t tha t ea t ing pa tho logy deve lops , in p ar t , as a resu l t of soc iocul tura l va lues of idea l body and a t trac t iveness . Research sugges ts tha t an unrea l is t ic body idea l and beau ty is

commun ica ted to members of soc ie ty through med ia and peers , and those who are unab le to a t ta in and va lue the id ea l body deve lop body d issa t isfac t ion. G iven tha t our cu l ture h igh ly va lues bod i ly a t trac t iveness (Nasser , 1988) , some ind iv idua ls deve lop nega t ive affec t in response to no t mee t ing the cu l tura l ly sanc t ioned idea l . F ina l ly , ind iv idua ls who are d issa t isf ied w i th the ir bod ies turn to ea t ing pa tho logy behav iours in order to more c lose ly approx ima te the idea l socie ta l referen t , wh i le decreas i ng the exper ience of nega t ive affec t . Research a lso suppor ts the no t ion tha t ind iv idua ls engage in ea t ing pa tho logy as a means of down-regu la t ing the ir exper ience of nega t ive affec t w i thou t spec if ic effor ts to reduce body d issa t isfac t ion .

1 .4 Eat ing Patho logy: Assessment

There are a number of me thods curren t ly in use for assess ing eat ing pa tho logy , rang ing from se lf-repor t measures (Garner , O lms ted , Bohr , & Gar f inke l , 1982 ; Morgan e t a l . , 1999 ; Garner , O lms tead , & Po l ivy , 1983) , to sem i-s truc tured in terv iews (S t ice , Mar t i , Spoor , Presne l l , & Shaw , 2008 ; Fa irburn & Cooper , 1993) and s truc tured c l in ica l

in terv iews (APA , 2000) . In c l in ica l trea tmen t se t t ings ea t ing p a tho logy assessmen t of ten

inc ludes eva lua t ions of med ica l s ta tus , nu tr i t ion , fam i ly , and body image . However , for

research purposes many of these op t ions are undes irab le because of the t ime and

resources requ ired . Add i t iona l ly , s truc tured assessmen ts , such as the S truc tured C l in ica l

In terv iew for DSM-IV-TR Ax is I D isorders , are ex treme ly t ime consum ing and requ ire

tra in ing and a reg is tered profess i ona l to adm in is ter . As such , researchers of ten re ly on

se lf-repor t ins trumen ts because they can prov ide some of the same informa t ion as the in-

dep th assessmen ts w i thou t the same t ime comm i tmen t or resources requ ired . Researchers

have ava i lab le to them too ls which can assess for genera l ea t in g pa tho logy r isk (e .g . ,

EAT-26 ; Garner , O lms ted , Bohr , & Garf inke l , 1982) , spec if ic r is k fac tors or symp toms

(e .g . , EDI Dr ive for th inness subsca le ; Garner , O lms tead , & Po livy , 1983) , or spec if ic

ea t ing d isorders (e .g . , Bu l im ia Tes t-Rev ised ; The len , Farmer , Wonder l ich , & Sm i th ,

1991) . Hence , w i th respec t to research des ign , the assessmen t ins trumen t emp loyed

large ly def ines the way in wh ic h the ea t ing pa tho logy cons truc t is concep tua l ized and can

grea t ly inf luence the observed preva lence ra tes . I t is for th is reason , among o thers , tha t

researchers mus t be carefu l when se lec t ing and descr ib ing the resu l ts of an ea t ing

pa tho logy assessmen t ins trumen t (Green leaf & Pe tr ie , 2007) . Indeed , an ins trumen t

wh ich was des igned to assess for DSM-IV-TR ea t ing d isorder cr i ter ia wou ld be expec ted

to y ie ld much lower ra tes of ea t ing pa tho logy when compared to the ra tes expec ted to be

observed when us ing an ins trumen t des igned to assess for genera l ea t ing pa t ho logy r isk .

A comp le te rev iew of the curren t ly ava i lab le ea t ing pa tho logy assessmen ts is beyond the

scope of the curren t d iscuss ion . However , an unders tand ing of the ea t ing pa tho logy

assessmen t ins trumen ts wh ich were mos t common ly used in prev ious s tud ies is necessary

in order to cr i t ica l ly eva lua te the ex tan t l i ter a ture . Thus , for the sake of c lar ify ing the

rev iew of s tuden t a th le te ea ting pa tho logy research , four frequ en t ly emp loyed assessmen t ins trumen ts are rev iewed i n the fo l low ing paragraphs .

The Ea t ing D isorder Inven tory-II (EDI-II ; Garner , 1991) is a 91- i tem , se lf-repor t ins trumen t wh ich was des igned t o assess the a t t i tud ina l , behav ioura l , and psycho log ica l symp toms charac ter is t ic of ea t ing d isorders . The ins trumen t does no t prov ide a to ta l score bu t ra ther y ie lds 8 subsca le scores and researchers common ly use on ly three : 1) Dr ive for Th inness subsca le (des ire to lose we igh t and fear of fa t) , 2) Body D issa t isfac t ion subsca le (body image d is turbance) , 3) Bu l im ia subsca le ( tendenc ies for uncon tro l lab le b ing ing and se lf- induced vom i t ing) . I tems are answered us ing a s ix po in t L iker t sca le from never (1) to a lways (6) and h igher scores i nd ica te grea ter leve ls of the ea t ing pa tho logy symp tom correspond ing to the subsca le (Garner , 1991) .

The Ques t ionna ire for Ea t ing D isorder D iagnos is (QEDD ; M in tz e t a l . , 1997) is a 50 i tem d iagnos t ic ins trumen t which was des igned to assess for DSM-IV-TR (APA , 2000) ea t ing d isorder cr i ter ia . The i tem responses are comb ined w i th dec is ion ru les in order to prov ide an imp l ica t ion of the presence of a d iagnosab le ea t ing d isorder . Responden ts are c lass if ied as e ither 1) Ea t ing d isordered (AN , BN , EDNOS) , 2) Symp toma t ic (ex treme body- image d is turbance and subc l in ica l pa t ho log ica l ea t ing behav iours) , or 3) Nonsymp tomat ic (do no t repor t any of the d ia gnos t ic cr i ter ia for an ea t ing d isorder) . The cr i ter ion val id i ty of the QEDD was suppor ted by s trong

concordance ra tes be tween s tructured c l in ica l in terv iews (98% a ccuracy) and the QEDD

c lass if ica t ion .

The Ea t ing A t t i tudes Tes t – 26 i tem vers ion (EAT-26 ; Garner , O lms ted , Bohr , &

Garf inke l , 1982) is a se lf-report ques t ionna ire wh ich was des igned to assess pa tho log ica l ea t ing a t t i tudes . I tems are scored on a 6-po in t L iker t sca le rang ing from "never" to

"a lways" and h igher scores ind ica te a grea ter r isk for ea t ing disorders . The deve lopers a lso prov ided a cu toff score grea ter than or equa l to 20 , wh ich ind ica tes c l in ica l concern and ind iv idua ls who score a t or above th is number are adv ised to fo l low-up w i th a profess iona l for an in-dep th ea t ing pa tho logy assessmen t . The EAT-26 has been a par t icu lar ly usefu l screen ing too l to assess ea t ing pa tho logy r isk in h igh schoo l , co l lege , and o ther spec ia l r isk samp les (Garner , Rosen & Barry , 1998) . T he 26- i tem vers ion (Garner e t a l . , 1989) has been shown to be a h igh ly re l iab le and va l id measure of ea t ing d isorder r isk (Lee , Kwok , L iau , & Leung , 2002 ; M in tz & O 'Ha l loran , 2000) .

The SCOFF (Morgan e t a l . , 1999) . The SCOFF is a 5 i tem se lf-repor t

ques t ionna ire des igned for use as a screen ing too l for AN and B N (Morgan e t a l . , 1999) .

I tems on the SCOFF are scored d i cho tomous ly (y /n) and ind iv iduals who answer yes to

two or more ques t ions are suspec ted to be suffer ing from AN or BN and shou ld seek

fo l low-up w i th a profess iona l for an in-dep th ea t ing pa tho logy assessmen t . The SCOFF

has , in one s tudy , demons tra ted exce l len t concordance w i th DSM-IV-TR ea t ing d isorder

d iagnoses prov ided by profess iona ls in a pr imary care se t t ing (Luck , e t a l . , 2002) . In th is

s tudy , the SCOFF was ab le to de tec t a l l true cases of AN and BN and seven of n ine cases

of EDNOS . As such , the SCOFF is used as a s imp le , f ive- i tem screen ing too l for AN and

BN .

1 .5 Eat ing Patho logy in Ath letes

Research inves t iga t ing ea t ing d is turbances and body we igh t issues in a th le tes f irs t ga ined momen tum in the ear ly 1980’s fo l low ing the dea th of a 22 year-o ld O lymp ic hopefu l gymnas t due to comp l ica t ions assoc ia ted w i th Anorex ia Nervosa (Bea ls , 2003) . In the wake of th is h igh ly pub l ic ized tragedy a number of e l i te fema le gymnas ts and ba l le t dancers came forward w i th the ir own s tor ies of s trugg le w i th ea t ing d isorders . Thus , a tenuous bu t troub l ing connec t ion was brough t to l igh t ; fema le a th le tes may exper ience a h igh r isk for ea t ing d isorders . In l igh t of these a th le tes’ persona l accoun ts of suffer ing from ea t ing d isorders exper ts h igh l igh ted the idea tha t these ind iv idua ls l ike ly exper ience ex treme pressure to con tro l the ir body we igh t and shape , above and beyond tha t exper ienced by fema les in t he genera l popu la t ion (Garner & Garf inke l , 1980 ; Bea ls , 2003) . As such , fema le a th le tes were ten ta t ive ly iden t if ied as a “h igh-r isk” group w i th regards to ea t ing d isorder deve lopmen t .

Researchers recru i ted samp les of ba l le t dancers and found suppor t for the idea tha t e l i te ba l le t da ncers exh ib i t h igher ea t ing pa tho logy than wou ld be expec ted based on commun i ty preva lence es t ima tes (Brooks-Gunn , Warren & Ham i l ton , 1987 ; Garner &

Garf inke l , 1980 ; ; Le Grange , T ibbs & Noakes , 1994 ; Szmuk ler , E is ler , G i l l ies , &

Hayward , 1985) and i t was pos tu la ted tha t a th le tes in genera l may represen t a h igh r isk

group w i th respec t to the deve lopmen t of ea t ing pa tho logy (B lack & Burckes-M i l ler ,

1988 ; Burckes-M i l ler & B lack , 1988 , 1991 ; S tr iege l-Moore , S i lbe rs te in , & Rod in , 1986 ;

W i lk ins , Bo land , & A lb inson , 1991) . I t has been argued tha t a thle t ic cu l ture is one in

wh ich grea t emphas is is p laced on a t ta in ing and ma in ta in ing the idea l body we igh t and

shape in order to perform and succeed in a th le t ics , in add i t ion to the genera l soc ie ta l pressures to be th in (Pe tr ie & Green leaf , 2007 ; S t ice & Agras , 1998 ; S tr iege l-Moore , S i lbers te in , & Rod in , 1986) . Subsequen t ly inves t iga tors sough t emp ir ica l suppor t for the idea tha t a th le tes across var i ous spor ts may exper ience ea t ing pa tho logy a t a ra te

d ispropor t iona te to tha t of non-a th le tes . A number of s tud ies have inves t iga ted ea t ing pa tho logy in a th le tes from d ifferen t spor ts and found tha t , once aga in , the a th le tes samp led repor ted h igher ra tes of ea t ing pa tho logy than wou ld be expec ted based on commun i ty preva lence es t ima tes (Ca labrese e t a l . , 1983 ; C lark , Ne lson , & Evans , 1988 ; S teen , & Browne l l , 1990 ; K ing & Mezey , 1987 ; Rosen & Hough , 1988 ; Rosen , McKeag , Hough , & Cur ley , 1986 ; Sykora , Gr ilo , W i lf ley , & Browne l l , 1993) . The nex t log ica l s tep in th is l ine of ques t i on ing was to inves t iga te whe ther or no t ath le tes d iffered from non- a th le te con tro ls in terms of ea t ing pa tho logy .

S tud ies wh ich compared a th le tes to non-a th le te con tro ls on ind ices of ea t ing pa tho logy have y ie lded m ixed resu lts . There is research ev idenc e to sugges t tha t a th le tes tend to exper ience h igher ra tes of ea t ing pa tho logy and engage in a w ider range of unhea l thy ea t ing and we igh t con trol behav iours than non-a th le te s (Brooks-Gunn , Burrow

& Warren , 1988 ; Ham i l ton , Brooks-Gunn & Warren , 1985 ; Pasman & Thompson , 1988 ; Wa lberg & Johns ton , 1991) . However , there is a lso research da ta wh ich sugges ts tha t a th le tes and non-a th le tes do no t d iffer in terms of the re la t ive ra tes of ea t ing pa tho logy (D iBar to lo & Shaffer , 2002 ; Ho lderness , Brooks-Gunn & Warren , 1994 ; K irk , S ingh &

Ge tz , 2001 ; K lock & DeSouza , 1995 ; Re ink ing & A lexander , 2005 ; Rosendah l ,

Bormann , Aschenbrenner , Aschenbrenner , & S trauss , 2008) . Fur thermore , there are

resu l ts from add i t iona l s tud ies wh ich imp ly tha t a th le tes may be a t lower r isk for ea t ing pa tho logy than non-a th le tes (Kur tzman , Yager , Landsverk , W iesmeier , & B idarka , 1989 ; Rosenv inge & V ig , 1993 ; W i lk ins , Bo land & A lb inson , 1991) . Taken toge ther , the resu l ts from s tud ies compar ing a th le tes to non-a th le te con tro ls appear to be more he terogeneous than the resu l ts from uncon tro l l ed inves t iga t ions , mak ing i t d iff icu l t to iden t ify genera l trends in the da ta .

Hausenb laus and Carron (1999) comp le ted a me ta-ana lys is wh ich inc luded resu l ts from n ine ty- two s tud ies compar i ng a th le tes to non-a th le tes and eva lua ted ind ices of BN , AN , and dr ive for th inness across s tud ies . Overa l l , th is me ta-ana lys is prov ided modes t suppor t for the no t ion tha t a th letes are a t increased r isk for deve lop ing ea t ing pa tho logy when compared to samp les of non-a th le tes . More spec if ica l ly , the resu l ts ind ica ted tha t bo th ma le and fema le a th le tes tended to repor t h igher scores on the ind ices of AN and BN than d id ma le and fema le non-a th le tes , a lbe i t , w i th sma l l effec t s izes and marked

he terogene i ty . In teres t ing ly , the fema le a th le tes and non-a th letes d id no t d iffer s ign if ican t ly on dr ive for th inness , wh ich sugges ts tha t bo th fema le a th le tes and non- a th le tes exper ience s im i lar dr ive for th inness bu t tha t the fema le a th le tes engage in h igher ra tes of ea t ing pa tho logy in order to ach ieve the ir des ired th inness .

Smo lak , Murnen , and Rub le (2000) a lso comp le ted a me ta-ana lys is; however ,

these au thors inves t iga ted the inc idence of ea t ing pa tho logy in fema le a th le tes on ly . The

resu l ts of th is ana lys is ind ica ted tha t fema le a th le tes repor ted s ign if ican t ly h igher scores

on ind ices of ea t ing pa tho logy than fema le non-a th le tes and , cons is ten t w i th the resu l ts of

Hausenb laus and Carron (1999) the au thors repor ted a very sma l l effec t s ize . A lso

cons is ten t w i th the prev ious me ta-ana lys is , the au thors no ted he terogene i ty in the group d ifferences across s tud ies , wh ich ind ica ted tha t there was s ignif ican t var iab i l i ty in the resu l ts of the s tud ies ana lyzed . The observed he terogene i ty indica ted tha t the true effec t s ize cou ld be much larger or sma l ler than was repor ted . S im i lar trends were observed in the fema le a th le te da ta ana lyzed by Smo lak , Murnen , and Rub le ( 2000) ; These da ta sugges ted tha t cer ta in groups of fema le a th le tes ev idenced h igher scores on the ind ices of ea t ing pa tho logy than o thers ; fema le a th le tes who par t ic ipa ted in dance , lean spor ts (appearance or we igh t is in tegra l for success , e .g . , gymnas t ics) ev idenced h igher leve ls of ea t ing pa tho logy than those fema le a th le tes who compe ted in spo r ts o ther than dance or in spor ts wh ich d id no t emphas ize leanness (e .g . , baske tba l l) .

Perhaps mos t re levan t to the curren t research is the fac t tha t the s tud ies no ted

above prov ided one of the f irs t ind ica t ions tha t un ivers i ty s tuden t a th le tes m igh t

exper ience h igher r isk for ea ting pa tho logy than the ir non-a th le tes peers . In the me ta-

ana lys is by Smo lak , Murnen and Rub le (2000) , i t was repor ted tha t when these au thors

compared co l lege-aged fema le ath le tes to fema le co l lege-aged no n-a th le tes on ind ices of

ea t ing pa tho logy , the he terogene i ty across s tud ies decreased and the effec t s ize was more

than tw ice tha t observed ( d=.15) when compar ing a th le tes and non-a th le tes from the

overa l l samp le (d=.07) . Thus , no t on ly was there a gr ea ter d ifference in ea t ing pa tho logy

observed be tween fema le a th le tes and non-a th le tes from co l lege-aged samp les than non-

s tuden t samp les , bu t the fac t that the he terogene i ty decreased a lso ind ica ted tha t the

d ifference was more cons is ten t ly observed . Wh i le i t may no t have been cen tra l to the

research des igns , un ivers i ty s tuden t a th le tes were a subgroup tha t was be ing inc luded in