Disordered Eating in Athletes: From Psychological Vulnerability to Relative Energy Deficiency in Sport - A Narrative Review

Abstract

Background: Disordered eating (DE) and eating disorders (EDs) are increasingly recognized among athletes, particularly in sports that emphasise leanness, aesthetics, endurance, or weight categories. Sport-specific pressures, body image concerns, and psychological vulnerability may contribute to unhealthy eating behaviours and eating disorders.

Aim: This narrative review summarized current evidence concerning the prevalence, psychological and sport-specific risk factors, physiological consequences, and prevention strategies related to DE and EDs in athletes.

Materials and Methods: A narrative review was conducted using literature from PubMed, Scopus, Web of Science, and SPORTDiscus. Relevant reviews, consensus statements, and clinical studies addressing eating disorders, risk factors, consequences, and prevention in athletes were included.

Results: Recent evidence suggests that athletes may have higher rates of DE and EDs than non-athletes, particularly in lean and aesthetic sports. Psychological factors such as perfectionism, anxiety, emotional dysregulation and compulsive exercise appear to increase risk of eating disorders. Chronic low energy availability may cause Relative Energy Deficiency in sport (RED-S), menstrual dysfunction, impaired bone health, an increased risk of injury, and reduced athletic performance. The literature also highlights the importance of early screening, multidisciplinary treatment, and the education of coaches and athletes.

Conclusions: Athletes are a high-risk population for DE and EDs due to the interaction between psychological traits and sport-specific environmental pressures. Early identification and prevention strategies are really important to reduce long-term health and performance consequences.