Bulimia In Athletes

By Chelsea Fielder-Jenks, M.A. | CFJCounseling.com

softball-372980_640Bulimia is a common eating disorder seen in both athletes and non-athletes; however, athletes may be at an increased risk of developing bulimia. Bulimia involves cycles of uncontrollable eating followed by periods of purging which may include self-induced vomiting, the use of laxatives and/or diuretics, and/or compulsive exercising to rid the body of the excess calories.

One behavior that differentiates non-athletes with bulimia from athletes with bulimia is the athlete’s use of exercise as the predominant purging method. Because excessive exercise is a normative behavior in competitive athletes, exercising as a compensatory behavior may go unrecognized, thus putting the athlete at physical and psychological risk.

Warning signs

Psychological and behavioral warning signs that have been identified in athletes with bulimia include:

  • Binge eating (eating that feels out-of-control and is rapid and excessive)
  • Evidence of binge eating (disappearance of large amounts of food in short period of time, empty food wrappers/containers)
  • Eating in secret
  • Fear of binging or purging behaviors being discovered
  • Agitation when bingeing is interrupted
  • Use of laxatives, diuretics, or both that are not prescribed by a physician
  • Stealing (food, laxatives)
  • Dieting
  • Evidence of vomiting
  • Excessive exercise (exercise that is: beyond that required for the athlete’s sport, continues despite illness or injury, interferes with balanced activities and relationships, rigid – must exercise in narrowly defined way or at a certain time, the primary and only means of coping with stress, and if reduced, leads to withdrawal symptoms such as: agitation, anxiety, anger, insomnia, appetite changes, feelings of guilt, etc.)
  • Excessive use of the restroom
  • Going to the restroom or “disappearing” after eating
  • Depression (loss of interest in enjoyable activities, self-harm behaviors, suicidal thoughts, increased feelings of loneliness, worthlessness, etc.)
  • Self-critical, especially concerning body, weight, and athletic performance
  • Feeling guilty after eating
  • Social isolation

Physical warning signs that have been identified in athletes with bulimia include:

  • Evidence of self-induced vomiting: Calluses or abrasions on the back of the hand, red eyes, swollen cheeks or glands in neck
  • Dehydration
  • Dental and gum problems
  • Edema, complaints of bloating
  • Electrolyte abnormalities
  • Muscle cramping associated with dehydration
  • Frequent weight fluctuations with associated mood changes including irritability
  • Gastrointestinal problems
  • Menstrual irregularity
  • Low weight despite eating large volumes of food
  • Physical weakness, fainting

How to Help an Athlete with Bulimia

girl-432675_640Early identification and intervention results in fewer and less severe complications, less resistance to treatment, and faster, easier, and more positive treatment outcomes. Here are steps you can take to help an athlete with bulimia:

    1. Prepare. Gather resources and have them available when you approach the athlete. Any literature about bulimia and athletes or where to go for help may help the athlete identify that they are struggling with bulimia. Also, in the case that they may have some awareness of their struggles, you are providing them with resources they may not know were available to them.


    1. Talk. Find a good time to talk to the athlete. Speak to the athlete privately and allow for adequate time to talk openly and honestly. Ask how the athlete feels, both physically and psychologically. Communicate to them that you are very concerned about him or her. Calmly tell the athlete the specific observations that you have noticed and that are a cause of your concern. Focus on eating or exercise behaviors that you have noticed or other problems (e.g., withdrawing or isolating from others).


    1. Listen. Allow the athlete time to respond to your concerns. Listen carefully and in a nonjudgmental and open manner. Listening is very important in this process. Face the athlete; maintain eye contact and an open posture.


    1. Respond. If the athlete refuses to acknowledge that there is a problem, or any reason for you to be concerned, restate your feelings and the reasons for them and leave yourself open and available as a supportive listener. If the athlete acknowledges there is a problem, you can summarize what you have heard, explain that you think these things may indicate that there could be a problem that needs professional attention. Ask the athlete to explore these concerns with a counselor, doctor, nutritionist, or other health professional who is knowledgeable about eating disorders. If you feel comfortable doing so, offer to help the athlete make an appointment or accompany them on their first visit.


  1. Get help. After talking with the person, if you are still concerned with their health and safety, find a trusted adult or professional to talk with (e.g., an eating disorder specialist, doctor, school counselor or nurse, coach, or minister). Problems that are particularly troubling and warrant seeking medical attention immediately include: if the athlete is binging and purging several times throughout the day, passes out or complains of chest pains, complains of severe stomachaches or vomiting blood, or has thoughts of harming themselves or suicide.


Beals, K.A. (2004). Disordered Eating Among Athletes: A Comprehensive Guide for Health Professionals. Human Kinetics: Champaign, IL.

Hudson J.I., Hiripi E., Pope H.G., & Kessler R.C. (2007). The Prevalence and Correlates of Eating Disorders in the National Comorbidity Survey Replication. Biological Psychiatry, 61, 348-358.

Johnson, C., Powers, P.S., & Dick, R. (1999). Athletes and Eating Disorders: The National Collegiate Athletic Association Study, International Journal of Eating Disorders, 6, 179.

National Eating Disorders Association. (2014). Learn, Special Issues, Athletes and Eating Disorders. Retrieved from https://www.nationaleatingdisorders.org/athletes-and-eating-disorders

Ray, R. & Wiese-Bjornstal, D.M. (1999). Counseling in Sports Medicine. Human Kinetics: Champaign, IL.

Thompson, R.A. & Trattner, S.R. (1993). Helping Athletes with Eating Disorders. Human Kinetics: Champaign, IL.

Vohs, K., Heatherton, T., & Herrin, M. (2001). Disordered eating and the transition to college: A longitudinal study. International Journal of Eating Disorders, 29, 280-288.

Chelsea Fielder-JenksChelsea Fielder-Jenks is a designated Expert Writer on Eating Disorder Hope.  Her well researched and thoughtful pieces have been helpful to many of our visitors.  We hope you will read through some of her other interesting pieces: Binge Eating Disorder & AnxietyBulimia in Athletes,  The Pressure to Compete.