Original Article

DISORDERED EATING ATTITUDES IN RELATION TO

ANXIETY LEVELS, SELF-ESTEEM AND BODY IMAGE
IN FEMALE BASKETBALL PLAYERS
Maria Michou, Vassiliki Costarelli
Human Ecology Laboratory, Department of Home Economics and Ecology, Harokopio University,
Kallithea, Athens, GREECE

The purpose of the current study was to explore the possible differences in disordered eating (DE) attitudes,
components of body image, self-esteem and anxiety levels in a group of female basketball players. A total of
154 women, 74 Greek basketball players (national and international level) and 80 women who were non-
athletes, were recruited. Participants completed the following questionnaires: the Eating Attitudes Test (EAT-
26), the Multidimensional Body–Self Relations Questionnaire (MBSRQ), the State-Trait Anxiety Inventory
(STAI), and Rosenberg’s Self-Esteem Scale (RSE). Analysis revealed that in the group of 154 young women
(athletes and non-athletes), the women with DE attitudes had higher levels of anxiety and scored significantly
more in components of the body image questionnaire (MBSRQ) such as appearance orientation (p = 0.002),
health evaluation (p = 0.026), health orientation (p < 0.001), and illness orientation (p = 0.003). In addition, 11%
of the basketball players and 15% of the non-athletes demonstrated DE attitudes. However, the differences
between the two groups were not significant. The analysis of specific components of the body image ques-
tionnaire (MBSRQ) revealed that athletes scored significantly higher in fitness orientation (p = 0.021) and fitness
evaluation (p = 0.019). There were no significant differences in the STAI and RSE results between athletes and
non-athletes. The prevalence of DE attitudes in female basketball players was slightly lower than that in non-
athletes, but the difference was not statistically significant. More studies specifically designed to investigate
DE attitudes in females involved in team sports, such as basketball, are needed. [ J Exerc Sci Fit • Vol 9 • No 2 •
109–115 • 2011]

Keywords: basketball, body image, eating attitudes

Introduction manifestations of abnormal eating attitudes. Milder

Disordered eating (DE) attitudes seem to have an impor-
tant impact on physical health, psychosocial health and
sports performance in athletes (Costarelli & Stamou
2009; Currie & Morse 2005; Filaire et al. 2001). Anorexia
nervosa and bulimia nervosa represent only the extreme
Corresponding Author
Vassiliki Costarelli, Department of Home
Economics and Ecology, Harokopio University of
Athens, 70, E. Venizelou Avenue, 17671 Kallithea,
Athens, GREECE.
E-mail: costarv@hua.gr
variables related to DE attitudes such as obsessive
thinking about food and dieting, body image dissatis-
faction, overweight preoccupation and fear of fatness
are also of paramount importance because their pres-
ence is strongly associated with an increased risk of
developing clinical eating disorders (Currie & Crosland
2009; Goldschmidt et al. 2008).
Studies suggest that for the majority of women,
participation in sport contributes to significant health
benefits, overall wellbeing, improved physical fitness,
positive attitudes towards health, higher self-esteem
and a healthier body image, in comparison to women

J Exerc Sci Fit • Vol 9 • No 2 • 109–115 • 2011 109

who do not engage in physical activity (Costarelli et al.
2009; Putukian 1998). However, factors uniquely found
in athletes such as excessive training, non-conventional
eating patterns, extreme diets and restriction of food
intake, might increase the risk of eating disorders in
this population (Monthuy-Blanc et al. 2010; Fleming &
Costarelli 2007; Vardar et al. 2007).
There is good evidence that participation in com-
petitive sport is an important risk factor for developing
eating disorders (Sundgot-Borgen & Torstveit 2004),
particularly in the case of female athletes (Greenleaf
et al. 2009; Sundgot-Borgen & Torstveit 2004).
A well-designed study that evaluated the presence of
DE in Norwegian male and female elite athletes (n =
1,620) from 66 different sports and controls (n = 1,696)
found that among female athletes competing in aes-
thetic sports, the prevalence of DE was 42%, which was
higher than that observed in endurance (24%), techni-
cal (17%), and team sports (16%) (Sundgot-Borgen &
Torstveit 2004). In a smaller-scale study conducted in
Spain in 283 elite sportswomen competing in 20 dif-
ferent sports, the proportion of athletes suffering from
some kind of eating disorder was five times higher
than in the general population (22.6% vs. 4.1%) (Toro
et al. 2005).
It is important to clarify that athletes (male and
female) in endurance, aesthetic and weight classification
sports, where leanness or a specific weight are believed
to favor sports performance, have a higher risk of devel-
oping eating disorders than athletes in team sports and
than the general population (Cook & Hausenblas 2011;
Resch & Haasz 2009; Smolak et al. 2000; Sundgot-
Borgen 1994). As a result, most studies investigating the
prevalence of DE and its underlying factors in athletes,
to date, have focused either specifically on endurance,
aesthetic and weight classification sports or have inves-
tigated athletes in general, regardless of the type of
sport (Costarelli & Stamou 2009; Black et al. 2003;
Yannakoulia et al. 2002). A comprehensive search of the
literature has found no other study specifically designed
to adequately investigate the prevalence of DE attitudes
in female basketball players.
While a number of studies that aimed to determine
the prevalence of eating disorders and their risk fac-
tors in female athletes have been published, the nature
of the relationship between athletic involvement and
eating problems is unclear. Previous studies have shown
that psychological factors such as anxiety, self-esteem,
perfectionism, mood, emotion disregulation, and dis-
turbed body image are implicated in the multifactorial
etiology of eating disorders (Costarelli et al. 2009; Petrie
110
et al. 2009; Markey & Vander Wal 2007; Sassaroli &
Ruggiero 2005; Hewitt & Flett 1991). More specifically,
low self-esteem seems to be an important additional
factor associated with dieting, body image dissatisfac-
tion and alterations in eating patterns, although it is diffi-
cult to know whether this is actually a cause or an effect
(O’Dea 2009). The relationship between anxiety and
eating disorders has also attracted considerable atten-
tion (Davey & Chapman 2009; Godart et al. 2000).
Despite consistent findings suggesting links between
emotions such as anxiety and eating disorder sympto-
matology, the precise role of anxiety in the etiology of
eating disorders remains a subject of discussion (Davey &
Chapman 2009).
However, the role of self-esteem in relation to body
image, anxiety levels and DE in athletes of team sports
such as basketball has not yet been investigated. The
purpose of the current study was to explore the possible
differences in DE attitudes, components of body image,
self-esteem and anxiety levels in a group of female
basketball players and a group of non-athletes.
Methods
Participants
A total of 154 women, 74 Greek basketball players
(national and international level) and 80 women, non-
athletes, were recruited. The mean ages of the two
groups were 24.92 ± 3.81 years and 25.21 ± 3.42 years
for the athletes and non-athletes, respectively. All
women were of normal body weight [body mass index
< 25 kg·(m2)−1]. The basic characteristics of the partici-
pants are shown in Table 1. The athletes were recruited
from the following 10 Greek basketball clubs: Kronos
Agiou Dimitriou, Paianias Ktifison, Pagratiou, Astir
Exarchion, Niki Leukadas, Hrakleio Kritis, Panionios,
Esperides Kallitheas, Panathlitkos Sikeon, and Anagenisi
Neou Rusiou. The control group, which was recruited
from the student population of Harokopio University
of Athens and the general population, did not engage
in vigorous physical activity and did not engage in any
competitive sport.
Study design
All participants signed consent forms and received a
full verbal and written explanation of the purpose of
the study and its anonymous nature. Participants also
completed the following questionnaires: the Eating
Attitudes Test (EAT-26), the Multidimensional Body–
Self Relations Questionnaire (MBSRQ), the State-Trait
J Exerc Sci Fit • Vol 9 • No 2 • 109–115 • 2011

Table 1. Basic characteristics of the participants*
Non-athletes (n = 80)
Age (yr) 25.21 ± 3.42
Height (m) 1.68 ± 0.06†
Weight (kg) 60.54 ± 7.60†
Body mass index [kg ⭈ (m2)−1] 21.37 ± 2.29
Years of playing basketball – > 10
No. of days practicing per week – >5
No. of hours practicing per week – 15
*Data presented as mean ± standard deviation; †p < 0.05.
Anxiety Inventory (STAI), and Rosenberg’s Self-Esteem
Scale (RSE). The RSE has been translated into Greek
and an independent translator performed a second
translation. The retranslated and original versions were
compared by one of the researchers and were found to
match closely. All the other questionnaires had already
been translated and successfully used in Greek in the
past (Costarelli et al. 2011, 2009; Fountoulakis et al.
2006).
Prior to the start of the study, in order to identify
possible ambiguous questions, the questionnaires were
piloted to a group of six volunteers. The mean time
taken to complete the questionnaires was 20 minutes.
The questionnaires were given to the study partici-
pants in the form of a single booklet, together with
specific completion instructions. They had a week to
complete and return them to the investigator. A total
of 100 questionnaires were distributed to the controls
and 80 to the athletes; 80 and 74 were returned respec-
tively, properly completed and on time.
General background and lifestyle questionnaire
A specially designed self-administered two-part ques-
tionnaire was used to collect background information
on age, weight, height, ethnicity, education, general nutri-
tional habits, weight loss diets used, physical activity
involvement, and frequency of measuring body weight
(Part A—completed by all participants), as well as the
nature and extent of athletic involvement, training reg-
imen, weight history, making weight and weight loss
methods used (Part B—completed by the athletes).
Participants were asked to rate their satisfaction with
their body weight and to state whether they wished to
lose or gain body weight.
The EAT-26
The Greek version of the EAT-26 (Yannakoulia et al.
2004; Garner & Garfinkel 1979) was used. To complete
the EAT-26, participants rate their agreement with 26
J Exerc Sci Fit • Vol 9 • No 2 • 109–115 • 2011
M. Michou, V. Costarelli
Athletes (n = 74) Total (n = 154)
24.92 ± 3.81 25.07 ± 3.60
1.75 ± 0.069† 1.71 ± 0.71
65.97 ± 8.69† 63.15 ± 8.55
21.61 ± 1.84 21.49 ± 2.08
–
–
–
statements about weight and food. The EAT-26 has
three individual scales: the Dieting Scale (preoccupa-
tion with being thin and avoidance of fattening foods),
the Bulimia and Food Preoccupation Scale, and the
Oral Control Scale (self-control of eating and perceived
pressure from others to gain weight). A total score ≥ 20 in
the questionnaire indicates abnormal eating behavior.
Cronbach’s alpha coefficient is 0.76.
The MBSRQ
The MBSRQ is an instrument for evaluating self-attitude
aspects of body image and is determined from the
69-item self-evaluation tool comprised of 10 subscales
(Cash 2004, 2000): Appearance Evaluation (AE),
Appearance Orientation (AO), Fitness Evaluation (FE),
Fitness Orientation (FO), Health Evaluation (HE), Health
Orientation (HO), Illness Orientation (IO), Body Areas
Satisfaction (BAS), Overweight Preoccupation (OP),
and Self-Classified Weight (SCW). In the present study,
only the first seven subscales were used. The MBSRQ
uses a 5-point, fully anchored Likert-type scale (1 =
definitely disagree, 2 = mostly disagree, 3 = neither agree
nor disagree, 4 = mostly agree, 5 = definitely agree).
High scores indicate positive feelings and satisfaction,
while low scores reflect a general dissatisfaction. The
Cronbach’s alpha coefficients of the subscales ranged
from 0.77 to 0.88 in the present study.
The STAI
The 40-item STAI state instrument was used to measure
anxiety symptoms (Spielberg 1983). Various reliability
and validity tests have been conducted on the STAI and
have provided sufficient evidence that the STAI is an
appropriate and adequate measure for studying anxiety
in research. It has been translated into 66 languages,
including Greek. The 40 items are divided into two
groups: 20 items record current anxiety symptoms
(state anxiety) and the other 20 items record usual
anxiety symptoms (trait anxiety). The STAI is scored
111
on four levels of anxiety intensity from 1 (not at all) to
4 (very much) for the first 20 items and from 1 (nearly
always) to 4 (nearly never) for the remaining 20 items.
Some of the questions are inverted for the purpose
of calculating the sum score, through a scoring key.
Higher scores indicate higher levels of anxiety. In the
present study, only the items that record usual anxiety
symptoms (trait anxiety) were used. The Cronbach’s
alpha coefficient is 0.81.
The RSE
The RSE is a 10-item self-report measure of global self-
esteem. It consists of 10 statements related to overall
feelings of self-worth or self-acceptance. The items are
answered on a 4-point scale ranging from “strongly
agree” to “strongly disagree” (Rosenberg 1965). The
scale ranges from 10 to 40. Scores between 20 and 30
are within the normal range, while scores below 20
suggest low self-esteem. The Cronbach’s alpha coeffi-
cient is 0.72.
Statistical analysis
Comparisons between the two groups were made
using the Mann-Whitney U test. Both the Pearson and
Spearman Rank Order coefficient were used to test for
possible correlations among the different variables
tested, depending on whether the data were normally
distributed or not. All statistical analyses were performed
using SPSS PC version 10.0 (SPSS Inc., Chicago, IL,
USA) statistical software.
Results
We found that 11% of the basketball players and 15%
of the non-athletes demonstrated DE attitudes (EAT-26
> 20); the difference between the two groups, however,
was not significant. In addition, 20.8% of all participants
(athletes and non-athletes) were currently trying to lose
weight either through diet or exercise, and 6.2% of
them were measuring their body weight on a daily
basis.
There were no significant differences in the STAI and
RSE between the athletes and non-athletes (Table 2).
Analysis of specific components of the body image
questionnaire (MBSRQ) revealed that athletes scored
significantly higher in fitness evaluation (p = 0.019) and
fitness orientation (p = 0.021) (Table 3). However, there
was no statistically significant difference in appearance
evaluation between the two groups.
Analysis also revealed that in the group of 154 young
women (athletes and non athletes), the women with DE

Table 2. Results from the Eating Attitudes Test (EAT-26) and its subscales, the State-Trait Anxiety Inventory (STAI) and
Rosenberg’s Self-Esteem scale (RSE)*
Non-athletes (n = 80) Athletes (n = 74) Total (n = 154)
EAT-26 10.72 ± 7.47 10.78 ± 7.98 10.75 ± 7.69
Dieting 0.42 ± 0.42 0.40 ± 0.39 0.41 ± 0.41
Bulimia and Food Preoccupation 0.41 ± 0.37 0.43 ± 0.42 0.42 ± 0.39
Oral Control 0.37 ± 0.41 0.44 ± 0.44 0.41 ± 0.42
STAI 40.48 ± 7.99 39.61 ± 7.59 40.06 ± 7.79
RSE 31.12 ± 4.36 31.70 ± 4.07 31.40 ± 4.22
*Data presented as mean ± standard deviation and comparisons between non-athletes and athletes using the Mann-Whitney U test.

Table 3. Results from the Multidimensional Body–Self Relations Questionnaire (MBSRQ) and the Collins Body Image Scale*
Non-athletes (n = 80) Athletes (n = 74) Total (n = 154)
MBSRQ
Appearance Evaluation 2.91 ± 0.31 2.88 ± 0.27 2.89 ± 0.29
Appearance Orientation 3.31 ± 0.32 3.32 ± 0.32 3.31 ± 0.32
Fitness Evaluation 2.92 ± 0.35 3.07 ± 0.34† 2.99 ± 0.36
Fitness Orientation 2.93 ± 0.35 3.05 ± 0.32† 2.99 ± 0.34
Health Evaluation 3.28 ± 0.38 3.30 ± 0.35 3.29 ± 0.37
Health Orientation 3.46 ± 0.59 3.60 ± 0.42 3.53 ± 0.52
Illness Orientation 2.89 ± 0.41 2.88 ± 0.52 2.88 ± 0.47
*Data presented as mean ± standard deviation and comparisons between non-athletes and athletes using the Mann-Whitney U test; †p < 0.05.

112 J Exerc Sci Fit • Vol 9 • No 2 • 109–115 • 2011

 M. Michou, V. Costarelli

Table 4. Results from the Eating Attitudes Test (EAT-26) and its subscales, the State-Trait Anxiety Inventory (STAI), Rosenberg’s
Self-Esteem Scale (RSE), and the Multidimensional Body–Self Relations Questionnaire (MBSRQ)*
Women without DE attitudes Women with DE attitudes Total
(n = 134) (n = 20) (n = 154)
EAT-26 8.43 ± 4.53 26.35 ± 6.24† 10.75 ± 7.69
Dieting 0.30 ± 0.27 1.14 ± 0.43† 0.41 ± 0.41
Bulimia and Food Preoccupation 0.35 ± 0.29 0.90 ± 0.60† 0.42 ± 0.39
Oral Control 0.33 ± 0.32 0.89 ± 0.68† 0.41 ± 0.42
STAI 39.69 ± 8.07 42.55 ± 4.98 40.06 ± 7.79
RSE 31.34 ± 4.18 31.85 ± 4.60 31.40 ± 4.22
MBSRQ
Appearance Evaluation 2.89 ± 0.30 2.93 ± 0.25 2.89 ± 0.29
Appearance Orientation 3.29 ± 0.31 3.51 ± 0.32‡ 3.31 ± 0.32
Fitness Evaluation 2.98 ± 0.35 3.06 ± 0.43 2.99 ± 0.36
Fitness Orientation 2.98 ± 0.34 3.04 ± 0.33 2.99 ± 0.34
Health Evaluation 3.26 ± 0.35 3.47 ± 0.46† 3.29 ± 0.37
Health Orientation 3.45 ± 0.47 4.05 ± 0.51¶ 3.53 ± 0.52
Illness Orientation 2.84 ± 0.46 3.16 ± 0.42‡ 2.88 ± 0.47
*Data presented as mean ± standard deviation and comparisons between women without and with DE attitudes using the Mann-Whitney U
test; †p < 0.05; ‡p < 0.01; ¶p < 0.001. DE = disordered eating.

Table 5. Spearman rank order correlation coefficients between
the Eating Attitudes Test and other parameters
Spearman’s rho
STAI 0.260*
Appearance Orientation 0.216*
Health Evaluation 0.177†
Health Orientation 0.261*
Illness Orientation 0.203†
*p < 0.01; †p < 0.05. STAI = State-Trait Anxiety Inventory.
attitudes (n = 20) had higher levels of anxiety (Table 4)
and scored significantly higher than women without
DE attitudes in components of the body image ques-
tionnaire (MBSRQ) such as appearance orientation (p =
0.002), health evaluation (p = 0.026), health orientation
(p < 0.001), and illness orientation (p = 0.003). All the
above parameters were also significantly positively cor-
related (Spearman Rank Order coefficient, n = 154) with
DE (EAT-26) (Table 5). The results also showed that anx-
iety levels (STAI) were significantly positively correlated
with DE (EAT-26) (Spearman rho = 0.260, p < 0.01) and
significantly negatively correlated with levels of self-
esteem (Spearman rho = −0.545, p < 0.001).
Discussion
In this study, we found no significant differences in DE
attitudes (EAT-26) between female basketball players
and non-athletes. The actual prevalence of DE attitudes
in the basketball players (11%) was lower than in the
non-athletes (15%), which is encouraging, given the fact
that elite female athletes are more likely to develop DE
than the general population (Torstveit & Sundgot-Borgen
2005; Sundgot-Borgen & Torstveit 2004). It is highly
likely that basketball, as a team sport that does not
emphasize a thin body and does not require making
weight regularly to increase performance, is a sport that
does not increase the risk of developing DE attitudes
in females; it is probable that female basketball players
adopt healthier eating attitudes compared to women
who do not engage in any sport activity. However, more
studies are needed to further explore the prevalence of
DE in females involved in team sports.
In the current study, there were no differences in
levels of anxiety and self-esteem between athletes and
non-athletes. However, correlation analysis for the whole
group of women (n = 154) revealed that DE attitudes
are significantly positively correlated with anxiety levels
and an unhealthy body image (Table 5). In addition, anx-
iety levels were negatively correlated with self-esteem.
These findings have been confirmed by a number of
previous studies (Costarelli et al. 2011, 2009; Costarelli &
Stamou 2009). It is important to investigate the preva-
lence of DE attitudes concurrently with psychosocial
parameters such as anxiety and self-esteem because
both factors can affect eating behavior, sports per-
formance and general health and wellbeing in athletes
and non-athletes (Haase 2011; Cook & Hausenblas 2008;
Nattiv et al. 2007; Currie & Morse 2005).

J Exerc Sci Fit • Vol 9 • No 2 • 109–115 • 2011 113

 In the case of body image, a number of longitudinal
studies have shown that body image dissatisfaction
has consistently been identified as one of the most
robust risk factors for eating disturbances (Abraham
2003; Stice & Bearman 2001). In the present study,
athletes seemed to have a healthier body image than
non-athletes (MBSRQ), but only in two components of
the questionnaire: health evaluation and health orienta-
tion, which was anticipated. There were no other differ-
ences in terms of body image between the two groups,
which is in contrast to the results of other studies where
athletes reported a more positive body image than
non-athletes (Hausenblas & Symons Down 2001). It has
to be stressed that the relatively low prevalence of DE
attitudes in the control group of this study (15%), com-
pared to other studies in similar populations (> 20%),
could partly be attributed to the fact that all participants
were of normal weight and the majority appeared to
have a healthy body image (Monthuy-Blanc et al. 2010;
Costarelli et al. 2009; Gonidakis et al. 2009).
There is a distinct lack of good quality papers on
DE attitudes and their underlying causes in females
participating in specific team sports such as basket-
ball. There is evidence that eating behavior in athletes
differs among different sports. The current study high-
lights the need for more studies in this area in order to
facilitate the prevention and management of DE in this
population.
The prevalence of DE attitudes in female basketball
players is slightly lower than in non-athletes; however,
the difference was not statistically significant. More stud-
ies, specifically designed to investigate DE attitudes in
females involved in team sports, such as basketball,
are needed.
Acknowledgments
Special thanks go to all the athletes and their coaches
who helped us with recruitment, and all the other vol-
unteers who took part in the study.
References
Abraham SF (2003). Dieting, body weight, body image and self-esteem
in young women: doctors’ dilemmas. Med J Aust 178:607–11.
Black DR, Larkin LJ, Coster DC, Leverenz LJ, Abood DA (2003).
Physiologic screening test for eating disorders/disordered eating
among female collegiate athletes. J Athl Train 38:286–97.
Cash TF (2000). The MBSRQ Users’ Manual, 3rd ed. Old Dominion
University, Norfolk, VA.
114
Cash TF (2004). Body image: past, present, and future. Body Image 1:1–5.
Cook BJ, Hausenblas HA (2008). The role of exercise dependence for
the relationship between exercise behavior and eating pathology:
mediator or moderator? J Health Psychol 13:495–502.
Cook BJ, Hausenblas HA (2011). Eating disorder-specific health-related
quality of life and exercise in college females. Qual Life Res Mar 8.
[Epub ahead of print]
Costarelli V, Antonopoulou K, Mavrovounioti C (2011). Psychosocial
characteristics in relation to disordered eating attitudes in Greek
adolescents. Eur Eat Disord Rev 19:322–30.
Costarelli V, Demerzi M, Stamou D (2009). Disordered eating attitudes in
relation to body image and emotional intelligence in young women.
J Hum Nutr Diet 22:239–45.
Costarelli V, Stamou D (2009). Emotional intelligence, body image and
disordered eating attitudes in combat sports athlete. J Exerc Sci Fit
7:104–11.
Currie A, Crosland J (2009). Responding to eating disorders in sport—UK
guidelines. Nutr Food Sci 39:619–26.
Currie A, Morse ED (2005). Eating disorders in athletes: managing the
risks. Clin Sports Med 24:871–83, ix.
Davey GCL, Chapman L (2009). Disgust and eating disorder symptomatol-
ogy in a non-clinical population: the role of trait anxiety and anxiety
sensitivity. Clin Psychol Psychother 16:268–75.
Filaire E, Maso F, Degoutte F, Jouanel P, Lac G (2001). Food restriction,
performance, psychological state and lipid values in judo athletes.
Int J Sports Med 22:454–9.
Fleming S, Costarelli V (2007). Nutrient intake and body composition in
relation to making weight in male Taekwondo players. Nutr Food Sci
39:358–66.
Fountoulakis KN, Papadopoulou M, Kleanthous S, Papadopoulou A, Bizeli V,
Nimatoudis I, Iacovides A, Kaprinis GS (2006). Reliability and psycho-
metric properties of the Greek translation of the State-Trait Anxiety
Inventory form Y: preliminary data. Ann Gen Psychiatry 5:2.
Garner DM, Garfinkel PE (1979). The Eating Attitudes Test: an index of
the symptoms of anorexia nervosa. Psychol Med 9:273–9.
Godart NT, Flament MF, Lecrubier Y, Jeammet P (2000). Anxiety dis-
orders in anorexia nervosa and bulimia nervosa: co-morbidity and
chronology of appearance. Eur Psychiatr 15:38–45.
Goldschmidt AB, Aspen VP, Sinton MM, Tanofsky-Kraff M, Wilfley DE
(2008). Disordered eating attitudes and behaviors in overweight
youth. Obesity (Silver Spring) 16:257–64.
Gonidakis F, Sigala A, Varsou E, Papadimitriou G (2009). A study of eating
attitudes and related factors in a sample of first-year female Nutrition
and Dietetics students of Harokopion University in Athens, Greece.
Eat Weight Disord 14:e121–7.
Greenleaf C, Petrie TA, Carter J, Reel JJ (2009). Female collegiate athletes:
prevalence of eating disorders and disordered eating behaviors. J Am
Coll Health 57:489–95.
Haase AM (2011). Weight perception in female athletes: associations with
disordered eating correlates and behavior. Eat Behav 12:64–7.
Hausenblas HA, Symons Down D (2001). Comparison of body image
between athletes and non athletes: a meta-analytic review. J Appl
Sport Psychol 13:323–39.
Hewitt PL, Flett GL (1991). Perfectionism in the self and social contexts:
conceptualization, assessment, and association with psychopathology.
J Pers Soc Psychol 60:456–70.
Markey MA, Vander Wal JS (2007). The role of emotional intelligence
and negative affect in bulimic symptomatology. Compr Psychiatr
48:458–64.
Monthuy-Blanc J, Maïano C, Therme P (2010). Prevalence of eating disor-
ders symptoms in nonelite ballet dancers and basketball players:
an exploratory and controlled study among French adolescent girls.
Rev Epidemiol Sante Publique 58:415–24.
Nattiv A, Loucks AB, Manore MM, Sanborn CF, Sundgot-Borgen J, Warren
MP (2007). American College of Sports Medicine position stand. The
female athlete triad. Med Sci Sports Exerc 39:1867–82.
O’Dea JA (2009). Self perception score from zero to ten correlates well
with standardized scales of adolescent self esteem, body dissatisfaction,
J Exerc Sci Fit • Vol 9 • No 2 • 109–115 • 2011

eating disorders risk, depression, and anxiety. Int J Adolesc Med Health
21:509–17.
Petrie TA, Greenleaf C, Reel JJ, Carter JE (2009). An examination of
psychosocial correlates of eating disorders among female collegiate
athletes. Res Q Exerc Sport 80:621–32.
Putukian M (1998). The female athlete triad. Clin Sports Med 17:675–96, v.
Resch M, Haasz P (2009). The first epidemiologic survey among
Hungarian elite athletes: eating disorders, depression and risk factors.
Orv Hetil 150:35–40.
Rosenberg M (1965). Society and the Adolescent Self-image. Princeton
University Press, Princeton, NJ.
Sassaroli S, Ruggiero GM (2005). The role of stress in the association
between low self-esteem, perfectionism, and worry, and eating
disorders. Int J Eat Disord 37:135–41.
Smolak L, Murnen SK, Ruble AE (2000). Female athletes and eating
problems: a meta-analysis. Int J Eat Disord 27:371–80.
Spielberg CD (1983). Manual for the State-Trait Anxiety Inventory (STAI).
Consulting Psychologists Press, Palo Alto, CA.
Stice E, Bearman SK (2001). Body-image and eating disturbances prospec-
tively predict increases in depressive symptoms in adolescent girls:
a growth curve analysis. Dev Psychol 37:597–607.
J Exerc Sci Fit • Vol 9 • No 2 • 109–115 • 2011
M. Michou, V. Costarelli
Sundgot-Borgen J (1994). Eating disorders in female athletes. Sports Med
17:176–88.
Sundgot-Borgen J, Torstveit MK (2004). Prevalence of eating disorders in
elite athletes is higher than in the general population. Clin J Sport
Med 14:25–32.
Toro J, Galilea B, Martinez-Mallen E, Salamero M, Capdevila L, Mari J,
Mayolas J, Toro E (2005). Eating disorders in Spanish female athletes.
Int J Sports Med 26:693–700.
Torstveit MK, Sundgot-Borgen J (2005). The female athlete triad exists
in both elite athletes and controls. Med Sci Sports Exerc 37:
1449–59.
Vardar E, Vardar SA, Kurt C (2007). Anxiety of young female athletes with
disordered eating behaviors. Eat Behav 8:143–7.
Yannakoulia M, Matalas AL, Yiannakouris N, Papoutsakis C, Passos M,
Klimis-Zacas D (2004). Disordered eating attitudes: an emerging
health problem among Mediterranean adolescents. Eat Weight
Disord 9:126–33.
Yannakoulia M, Sitara M, Matalas AL (2002). Reported eating behavior
and attitudes improvement after a nutrition intervention program
in a group of young female dancers. Int J Sport Nutr Exerc Metab
12:24–32.
115