Disorders of the female athlete triad among collegiate athletes

Int J Sport Nutr Exerc Metab. 2002 Sep;12(3):281-93. doi: 10.1123/ijsnem.12.3.281.


This study examined the prevalence of and relationship between the disorders of the female athlete triad in collegiate athletes participating in aesthetic, endurance, or team/anaerobic sports. Participants were 425 female collegiate athletes from 7 universities across the United States. Disordered eating, menstrual dysfunction, and musculoskeletal injuries were assessed by a health/medical, dieting and menstrual history questionnaire, the Eating Attitudes Test (EAT-26), and the Eating Disorder Inventory Body Dissatisfaction Subscale (EDI-BD). The percentage of athletes reporting a clinical diagnosis of anorexia and bulimia nervosa was 3.3% and 2.3%, respectively; mean ( SD) EAT and EDI-BD scores were 10.6 9.6 and 9.8 7.6, respectively. The percentage of athletes with scores indicating "at-risk" behavior for an eating disorder were 15.2% using the EAT-26 and 32.4% using the EDI-BD. A similar percentage of athletes in aesthetic, endurance, and team/anaerobic sports reported a clinical diagnosis of anorexia or bulimia. However, athletes in aesthetic sports scored higher on the EAT-26 (13.5 10.9) than athletes in endurance (10.0 9.3) or team/anaerobic sports (9.9 9.0, p <.02); and more athletes in aesthetic versus endurance or team/anaerobic sports scored above the EAT-26 cut-off score of 20 (p <.01). Menstrual irregularity was reported by 31% of the athletes not using oral contraceptives, and there were no group differences in the prevalence of self-reported menstrual irregularity. Muscle and bone injuries sustained during the collegiate career were reported by 65.9% and 34.3% of athletes, respectively, and more athletes in aesthetic versus endurance and team/anaerobic sports reported muscle (p =.005) and/or bone injuries (p <.001). Athletes "at risk" for eating disorders more frequently reported menstrual irregularity (p =.004) and sustained more bone injuries (p =.003) during their collegiate career. These data indicate that while the prevalence of clinical eating disorders is low in female collegiate athletes, many are "at risk" for an eating disorder, which places them at increased risk for menstrual irregularity and bone injuries.

MeSH terms

  • Adult
  • Amenorrhea / epidemiology
  • Body Image
  • Feeding and Eating Disorders / complications
  • Feeding and Eating Disorders / epidemiology*
  • Feeding and Eating Disorders / psychology
  • Female
  • Humans
  • Menstruation Disturbances / complications
  • Menstruation Disturbances / epidemiology*
  • Musculoskeletal System / injuries*
  • Prevalence
  • Psychiatric Status Rating Scales
  • Risk Factors
  • Self Concept
  • Sports*
  • Students
  • Surveys and Questionnaires
  • United States / epidemiology
  • Universities