Eating disorders and associated mental symptoms in Swedish elite athletes and a comparison group

This cross-sectional two-step study aimed to investigate the prevalence of eating disorder (ED) symptoms and associated mental health difficulties among elite athletes and an age-and sex matched comparison group.

National team athletes were recruited through national sport federations, while participants in the comparison group were recruited via social media. A total of 408 participants (athletes n = 256; comparison group n = 152) (72.1% female), completed an anonymous online survey comprising validated psychometric measures of ED symptoms, exercise addiction, depression and psychological flexibility. Participants who screened positive for ED symptoms and providing contact details were invited to undergo a clinical assessment using the ED Examination Interview (EDE 17.0D).

Overall, 25.0% (n = 102) reported ED symptoms, with a higher prevalence in the comparison group than among athletes (37.5% vs. 17.6%, p < 0.001). Interviews were completed by 78.0% (n = 18) of athletes and 47.0% (n = 16) of comparison group participants who screened positive for ED symptoms, confirming an ED diagnosis in all but one athlete. Furthermore, 18.6% (n = 76) reported clinically relevant symptoms of depression, and 22.8% (n = 93) of exercise addiction. Associations were observed between ED symptoms and symptoms of exercise addiction, depression, and psychological inflexibility in the total sample, among athletes and in the comparison group.

ED symptoms were common among athletes and the comparison group and were associated with depressive symptoms, problematic exercise behaviour, and psychological inflexibility. To safeguard athlete health and optimise performance, national sports organisations should implement systematic preventive strategies, promote early identification, establish clear referral pathways, and ensure access to coordinated multidisciplinary care.