Prevalence and Experience of Clinical and Subclinical Eating Disorders in Elite Male Athletes

: (Alternative Format Thesis)

Abstract

Eating disorder risk among male performance athletes remains poorly understood, largely due to the historical focus on female athletes (Fatt et al., 2024) and the use of diagnostic tools developed for non athletic and predominantly female populations (Stanford & Lemberg, 2012a). Existing prevalence estimates are inconsistent, often reliant on self report measures that conflate performance functional behaviours with psychopathology and overlook male specific symptom profiles such as drive for muscularity or exercise based compensatory routines. Furthermore, research has paid limited attention to the organisational and cultural pressures that characterise male team sport environments and how these may interact with individual factors to influence risk. The overarching aim of this PhD was therefore to provide a more accurate, context sensitive understanding of eating disorder risk among male performance athletes by integrating methodological, empirical, theoretical, and applied analysis across three interlinked studies.

Following an introduction, Chapter Two synthesises the existing literature on eating disorders in sport, outlining the limitations of female derived diagnostic tools, the underrepresentation of male athletes in prevalence studies, and the need to consider broader psychosocial and cultural determinants of disordered eating risk. The chapter reviews Petrie’s (2020) Psychocultural Model as the primary conceptual framework, alongside Achievement Goal Theory and organisational stress models, highlighting gaps relating to measurement sensitivity, the role of structural stressors, and the lived experience of male team sport environments. These gaps informed the design and rationale for the subsequent empirical programme.

Chapter Three (Study One) reports a methodological and epidemiological study designed to generate a more accurate prevalence estimate for male performance athletes. A two stage diagnostic approach was implemented, combining the Eating Disorder Assessment for Men (EDAM) with a sport adapted, contextualised Eating Disorder Examination (EDE) interview. Results revealed low clinical prevalence (1%) but non trivial subclinical presentations (5.7%) among athletes, and higher EDAM global and muscularity related scores in ball sports, particularly rugby, than in traditionally defined “high risk” sports. Importantly, almost one quarter of athletes flagged via self report were reclassified as non concerning during interview, demonstrating the necessity of contextual interpretation in performance settings. This study provides one of the most rigorous assessments of eating disorder prevalence in male athletes and underscores the importance of male sensitive, context aware screening. Chapter Four (Study Two) examined the extent to which organisational stressors and motivational climate predict eating disorder symptoms. Survey data showed that stressors relating to goals and development, logistics and operations, team and culture, coaching practices, and selection processes were all positively associated with binge eating, body dissatisfaction, and muscle dysmorphia related concerns, collectively explaining 24% of the variance in EDAM scores. Ego involving climates (e.g., intrateam rivalry, punishment for mistakes, unequal recognition) also predicted greater symptomatology, whereas task involving climates showed weaker but protective associations. Notably, perceived personal control amplified the relationship between rivalry and disordered eating symptoms, identifying a boundary condition that challenges assumptions about perceived internal control serving solely as a buffer. Chapter Five (Study Three) provides qualitative depth to these patterns through an immersive case study of a hybrid amateur–professional rugby environment. Findings revealed normalised weight related dialogue, physique comparison, surveillance and measurement practices, and competitive gym cultures that intensified appearance and performance based pressures. Structural constraints such as limited fuelling opportunities, irregular schedules, and financial barriers exacerbated food related stress and contributed to compensatory behaviours. Crucially, protective factors included the presence of an embedded, relational nutritionist and performance framed body composition communication, which helped reduce appearance based internalisation.

Finally, Chapter Six synthesises the programme’s contributions. Methodologically, the thesis demonstrates the value of male specific, two stage assessment to improve measurement validity. Empirically, it identifies organisational stressors and ego climates as proximal predictors and clarifies how cultural mechanisms in team sports enact and sustain these pressures. Theoretically, it refines Petrie’s model by integrating structural and environment based determinants, articulating a muscularity driven risk pathway, and identifying contextual buffers and conditional processes. Practically, it offers actionable recommendations for screening, safeguarding, environment shaping, and structural support in male performance environments. Collectively, this programme provides a multidimensional, ecologically grounded account of eating disorder risk in male athletes and offers a foundation for future research and intervention across diverse sport contexts.

Date of Award	24 Jun 2026
Original language	English
Awarding Institution	University of Bath
Supervisor	Rachel Arnold (Supervisor), Melissa Atkinson (Supervisor) & Fiona Gillison (Supervisor)