Q & A: The Female Athlete Triad

Q: I’ve heard of the “Female Athlete Triad” of disordered eating, amenorrhea, and osteoporosis. Don’t all these women have anorexia nervosa? (B.E. Syracuse, N.Y.)

A: Although many of the core signs and symptoms of the Female Athlete Triad overlap with those of anorexia nervosa, not every female with the “athlete triad” technically qualifies for the diagnosis of anorexia nervosa. However, this may often be splitting hairs, since all these women would at least qualify for a diagnosis of “eating disorders not otherwise specified” if they didn’t make the exact criteria for anorexia nervosa. In most cases, the distinction might occur if the athlete has not lost enough weight to bring her below 85% of what would be her expected weight. It has been suggested that these diagnostic criteria should be applied more flexibly, since athletes often have increased lean body mass. Since the prevalence of eating disorders in some groups of female athletes has been estimated at between 15% to 62%, these syndromes are relatively common, particularly in sports that emphasize leanness such as gymnastics (Kazis and Iglesias, Adolescent Medicine 14: 87, 2003). Whenever the female athlete triad is noted, assessment for the severity of eating disorder and proper behavioral and dietary interventions are indicated to prevent further deterioration of health, particularly skeletal health.

—J.Y.