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Introduction
Eating disorders are some of the most common forms of mental illnesses, with over 30 million people suffering from one in the US alone. Patients often suffer from depression as well, causing eating disorders to have the highest mortality rate out any mental illness, with 1 out of 5 victims resorting to suicide. This problem is especially prevalent for athletes competing in leanness focused sports; participants in sports that emphasize thinness and muscularity tend to display high degrees of “body uneasiness and inappropriate eating attitudes and behaviors” (Ravaldi, Vannacci, Zucchi, Mannucci, Cabras, Boldrini, Murciano, Rotella, & Ricca, 2003). Studies have indicated that athletics requiring minimal body fat to enrich performance or aesthetic appearance such as gymnastics, wrestling, figure skating, diving, and ballet, put participants at a higher risk for eating disorders (Garner, Rosen Barry, 1998).
Dance, one of the most popular aesthetic sports, fosters a cultural appropriation around unhealthy dieting, making dancers more susceptible to develop detrimental eating habits. Therefore, in order to fully understand the underlying factors causing dancers to be more vulnerable to eating disorders, this paper specifically analyzes possible components that make dancers a high risk group and the deadly implications that are often bound to an eating disorder
Dancers’ Perspective
Because dance encourages extreme competitiveness and perfectionism, eating disorders in dancers, particularly ballet dancers, are said to be nearly 10 times more likely than non-dancers (Shoker, 2013). In a study done in 2013 on the prevalence of eating disorders amongst dancers, it was found that 16.4% of ballet dancers were diagnosed with an eating disorder; of those, 4% had anorexia, 2% had bulimia, and 14.9% had eating disorders not otherwise specified (EDNOS) (Arcelus, Witcomb, Mitchell, 2013). Even those who have not been medically diagnosed show numerous risk signs. Nearly all dancers had a low body weight and body fat, and were considerably more “preoccupied with thoughts of eating and body weight, felt they had greater difficulty controlling their body weight, used and abused laxatives for weight control,” and engage in unhealthy eating habits more than school students (Abraham, 1996). Calorie intake was found to be insufficient in nearly all age groups, especially when considering their intense physical activity. (Dotti, Fioravanti, Balotta, Tozzi, Cannella, & Lazzari, 2014).
Certain studies suggest that perfectionism is a large risk factor for eating disorders. Results from a study done in 2011 suggest that disordered eating symptoms are significantly influenced by “the interaction of perfectionism and learning (Penniment, Egan, 2011). These dancers often feel the need to model their bodies after the ideal “ballet body,” believing that weight loss will lead to a positive result in their dance career. Victoria Ferguson, an elite dancer in the United Kingdom, recalls that “the whole purpose of dance is to be self-critical and constantly pushing yourself, and you strive to be better. It was all self-imposed.” This statement is reinforced with reports showing significantly greater EDI, Drive for Thinness, and Perfectionism scores compared with recreational dancers or non-dancers. (Thomas, Keel, & Heartherton, 2005). Dancers’ incessant thirst for perfection in their practice makes them more likely to engage in dieting activities and potentially develop an eating disorder.
Environmental Perspective
While certain studies suggest that perfectionism in dancers is a major cause for eating disorders, many papers agree that environmental factors including teachers, parents, and dance culture in general, are the most toxic influences on dancers’ mental health. Typically, a prolonged length of time in a ballet environment often increases food, weight, and body image concerns (Dotti, Fioravanti, Balotta, Tozzi, Cannella, & Lazzari, 2014). There are five main contributing factors - teachers, peers, system (culture and rules of dance school), training, and schedules - that add additional pressure for weight loss in dancers (Francisco, Alarcao, Narcisco, 2012). However, at 31%, teachers appear to be the largest source of influence on dancers; 41.5% of students reported a negative relationship with their teacher, feeling as if their instructors are not accessible, intimidating, show favorites, and express hostility (Francisco, Alarcao, Narcisco, 2012). These claims are extremely likely to contribute to decreased confidence, and a lack of social support. In addition, over 60% of elite athletes in aesthetic sports reported “pressure from coaches concerning body shape” (Kong, Harris, 2013).
Teachers are seen as strong influences on risk factors for eating disorders, as they pressure dancers to be thin, and express negative comments regarding eating, weight, and body image. Teachers often encourage anorexic behaviors, telling dancers that they look nice, when they are clearly suffering from severe malnutrition. With all these factors considered, it’s clear that dance instructors can be one of the most toxic influences on dancers’ mental health, driving them into disorder eating habits and mental instability. In general however, ballet culture as a whole tends to justify and romance eating disorders, undervaluing health related to eating disorder symptoms. The classical dance world in particular, is related to the pressure for thinness “as well as to dependence on public approval” (Francisco, Alarcao, Narcisco, 2012). It was found that dancers who are struggling body image “avoided performing so as not to exhibiting their body in public, disliked comparing their body with their peers, and believed that audiences paid a great deal of attention to their bodies” (Toro, Guerrero, Sentis, Castro, Puertolas, 2008).
Physiological Perspective
Ballet culture’s unfeasible body image standards fail to take physiological ramifications into account. Eating disorders - particularly in athletes - can have irreversible effects on one’s health, causing lifelong issues including low bone density, amenorrhea, and somatic complications. Dancers on a low calorie diet risk early bone loss, osteopenia or osteoporosis, stress fractures, and scoliosis, and over 50% of dancers report a lifetime history of broken bones and tendonitis (IADMS, 2008; Thomas, Keel, Heatherton, 2011).Even after recovery, health deficits still persist. Women with a history of anorexia nervosa in their teenage years are “more likely to be osteopenic than age-matched women without this history, even after many years of weight and menstrual recovery” (Misra, 2008). Adult dancers who have not recovered their weight and amenorrhea even in their older years risk perpetual decreases in bone density, causing worsening symptoms of osteopenia and osteoporosis (Misra, 2008).
Somatic complications are also frequently seen in malnourished dancers. Anorexia has been labeled with one of the highest rates of mortality among all mental disorders, and somatic complications are typically the first cause of death (Gosseaume, Dicembre, Bemar, Melchior, Hanachi, 2019). Cardiac complications related to undernutrition complications with cardiac failure risk, pathological behavior consequences, and refeeding metabolic complications are frequent at nearly 60%. Unfortunately, despite these horrifying consequences, both dancers and teachers continue to push for extreme leanness, without considering severe health implications. Therefore, from a physiological perspective, teachers should be more careful when bashing students for their weight.
Limitations
When brainstorming resolutions for high rates of eating disorders in dancers, there are several limitations that should be taken into account. Eating disorders are extremely personal, meaning that they are unique to each person. Therefore, while it may be possible to alleviate the damage, it is difficult to propose a universal solution that would prevent all disordered eating habits in dancers. Additionally, because body shaming, physical appearance, and dieting are deeply ingrained into dance culture, the abolishment of eating disorders would require a complete dismantling and rebuilding of the entire dance structure. A fundamental mindset change would need to take place in order to end all negative perspectives regarding physical appearance. This change is currently unfeasible, and for this reason, reformations are limited.
Recommendations
While it is impractical to completely revise the entire art of dance, steps of improvement can still be made to lessen the number of eating disorder cases in young dancers. Both dancers and their instructor should be taught proper nutrition and potential consequences that can result from long-term malnutrition. Learning more about eating disorders and healthy nutrition can help in spotting warning signs and allow dancers to seek early treatment (NIMH » Eating Disorders: About More Than Food, 2020). Additionally, dance companies should reform their policies on derogatory remarks and cease romanticization of anorexic behaviors. Teachers and staff should be specially trained to be more strategic and empathetic when speaking to their students, without coming across as condescending or demeaning. Finally, dancers who are showing signs of disordered eating should be immediately provided with the necessary resources for a speedy recovery. Psychological and nutritional attention needs to be given right away in order to prevent any further developments.
Works Cited
Ravaldi, C., Vannacci, A., Zucchi, T., Mannucci, E., Cabras, P. L., Boldrini, M., … Ricca, V. (2003). Eating Disorders and Body Image Disturbances among Ballet Dancers, Gymnasium Users and Body Builders. Psychopathology, 36(5), 247–254. https://doi.org/10.1159/000073450
Garner DM;Rosen LW;Barry D. (2017). Eating disorders among athletes. Research and recommendations. Child and Adolescent Psychiatric Clinics of North America, 7(4). https://pubmed.ncbi.nlm.nih.gov/9894045/
Sandish Shoker. (2013, June 27). Ballet and eating disorders: “Unspoken competitiveness” adds pressure to be thin. BBC News. https://www.bbc.com/news/uk-england-22985310
Arcelus, J., Witcomb, G. L., & Mitchell, A. (2013). Prevalence of Eating Disorders amongst Dancers: A Systemic Review and Meta-Analysis. European Eating Disorders Review, 22(2), 92–101. https://doi.org/10.1002/erv.2271
Abraham, S. (1996). Eating and Weight Controlling Behaviours of Young Ballet Dancers. Psychopathology, 29(4), 218–222. https://doi.org/10.1159/000284996
Dotti, A., Fioravanti, M., Balotta, M., Tozzi, F., Cannella, C., & Lazzari, R. (2002). Eating behavior of ballet dancers. Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity, 7(1), 60–67. https://doi.org/10.1007/bf03354431
Penniment, K. J., & Egan, S. J. (2011). Perfectionism and learning experiences in dance class as risk factors for eating disorders in dancers. European Eating Disorders Review, 20(1), 13–22. https://doi.org/10.1002/erv.1089
Thomas, J. J., Keel, P. K., & Heatherton, T. F. (2005). Disordered eating attitudes and behaviors in ballet students: Examination of environmental and individual risk factors. International Journal of Eating Disorders, 38(3), 263–268. https://doi.org/10.1002/eat.20185
Francisco, R., Alarcão, M., & Narciso, I. (2012). Aesthetic Sports as High-Risk Contexts for Eating Disorders — Young Elite Dancers and Gymnasts Perspectives. The Spanish Journal of Psychology, 15(1), 265–274. https://doi.org/10.5209/rev_sjop.2012.v15.n1.37333
The Sporting Body: Body Image and Eating Disorder Symptomatology Among Female Athletes from Leanness Focused and Nonleanness Focused Sports. (2015). The Journal of Psychology. https://www.tandfonline.com/doi/abs/10.1080/00223980.2013.846291
Toro, J., Guerrero, M., Sentis, J., Castro, J., & Puértolas, C. (2009). Eating disorders in ballet dancing students: Problems and risk factors. European Eating Disorders Review, 17(1), 40–49. https://doi.org/10.1002/erv.888
Resource Paper: Bone Health and Female Dancers - Physical and Nutritional Guidelines - International Association for Dance Medicine & Science. (2020). Iadms.Org. https://www.iadms.org/page/212
Misra, M. (2008). Long-Term Skeletal Effects of Eating Disorders with Onset in Adolescence. Annals of the New York Academy of Sciences, 1135(1), 212–218. https://doi.org/10.1196/annals.1429.002
Gosseaume, C., Dicembre, M., Bemer, P., Melchior, J.-C., & Hanachi, M. (2019). Somatic complications and nutritional management of anorexia nervosa. Clinical Nutrition Experimental, 28, 2–10. https://doi.org/10.1016/j.yclnex.2019.09.001
NIMH » Eating Disorders: About More Than Food. (2020, July 18). Nih.Gov. https://www.nimh.nih.gov/health/publications/eating-disorders/index.shtml
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