Body image and perfectionism of ballerinas: comparison and contrast with anorexia nervosa

Relationships Between Common Preseason Screening Measures and Dance-Related Injuries in Preprofessional Ballet Dancers

OBJECTIVE: To examine modifiable and nonmodifiable factors for associations with dance-related injury among preprofessional ballet dancers over 5 academic years. DESIGN: Prospective cohort study. METHODS: Full-time preprofessional ballet dancers (n = 452; 399 female; median age [range], 15 years [11-21]) participated across 5 academic years at a vocational school. Participants completed baseline screening and online weekly injury questionnaires including dance exposure (hours/week). Zero-inflated Poisson regression models were used to examine associations between potential risk factors measured at baseline and self-reported dance-related injury. RESULTS: In count model coefficients, left one leg standing score (log coefficient estimate, -0.249 [95% CI: -0.478, -0.02]; P = .033) and right unipedal dynamic balance time (log coefficient estimate, -0.0294 [95% CI: -0.048, -0.01]; P>.001) carried a protective effect with increased years of training when adjusted for Athletic Coping Skills Inventory (ACSI) score. A significant association was found for left unipedal dynamic balance time and dance-related injury (log coefficient estimate, 0.013 [95% CI: 0.000, 0.026]; P = .045) when adjusted for years of training and ACSI score. There were no significant associations between dance-related injury and ankle and hip range of motion, active straight leg raise, or Y Balance Test measures. CONCLUSION: When adjusted for years of previous dance training and psychological coping skills, there was a significant association between limb-specific lumbopelvic control and dynamic balance tasks, as well as self-reported dance-related injury in preprofessional ballet. J Orthop Sports Phys Ther 2023;53(11):703-711. Epub 3 October 2023. doi:10.2519/jospt.2023.11835.

Cardiometabolic health profile of young girls with aesthetic professions

Background

In the literature, professions that impose body standards for daily performance are designated as non-conventional professions (i.e. models, athletes, ballet dancers), with great emphasis on the female population. More than a job, it becomes a lifestyle to those inserted in this environment, thus, thousands of children and adolescents seek inclusion and success in these professions due to financial and media gains. Such professions are associated with several health-related risk factors. The purpose of this study was to identify and compare among physical fitness levels, cardiometabolic health markers, mental health and dietary habits in non-conventional professions.

Methods

The sample consisted of 41 female individuals aged between 14 and 24 years, allocated into four groups, control group composed by university students (UG = 11), models (MG = 11), ballet dancers (BG = 11), and athletes’ group (AG = 8). Physical fitness outcomes (cardiorespiratory fitness, flexibility, maximal dynamic strength, muscular endurance and body composition); biochemical outcomes (high-density lipoprotein [HDL], low-density lipoprotein [LDL], total cholesterol [TC], fasting glucose [FG], fasting insulin [FI], C-reactive protein [CRP]), diet quality and mental health were evaluated.

Results

No impairments were observed in the health markers evaluated among groups, both for health-related physical fitness and biochemical outcomes. However, low levels of bone mineral density (BMD) were observed. Even with statistically significant differences between the groups for chronological age (p = 0.002), menarche (p = 0.004), career length (p = 0.001), height (p = 0.001), body mass index (p = 0.018), waist-to-height ratio (p < 0.001), %Fat (p = 0.020), VO_2peak (p = 0.020), maximal dynamic strength of knee extensors (p = 0.031) and elbow flexors (p = 0,001) and flexibility (p < 0.001), all these values are within the normal range for health.

Conclusion

The professions analyzed do not seem to interfere in the physical fitness and cardiometabolic health of the girls assessed. However, we identified that exposure to these profession can impair mental health (depressive symptoms in 100% of participants) and body composition (BMD 63% of participants).

Mediating Mechanisms of Perfectionism: Clinical Comorbidity of OCD and ED

Obsessive-compulsive disorder (OCD) and eating disorders (ED) share common causal factors and often represent similar entities. Studies on obsessive-compulsive disorders and eating disorders reveal a significant correlation between maladaptive perfectionism. The objective of this study is to evaluate the predictive variables of perfectionism in patients diagnosed with Anorexia Nervosa (AN), Bulimia Nervosa (BN) and OCD using a structural equation model (SEM). The sample consisted of 187 participants (60.9% women, 39.1% men) with a mean age of 26.68 (SD = 10.97). The findings reveal that the model is the same in all the disorders evaluated, achieving an adequate fit: χ2 = 7.95 (p = 0.000), RMSEA = 0.087 (95% confidence interval: 0.00 to 0.02), CFI = 0.991, TLI = 0.951 and with an overall predictive capacity of around 30% (CD = 0.318). It is recommended that future studies address the subtypes of disorders evaluated using longitudinal designs.

Eating Disorders

More than 2 million female Americans have a clinically relevant eating disorder. Although the prevalence and seriousness of this problem has gained increasing attention in recent years, relatively little is known about eating disorder prevention. This article addresses a number of issues related to prevention efforts applied to eating disorders. An overview of putative risk factors that have been identified is presented. In particular, the article emphasizes the importance of understanding the psychological and physical developmental processes during adolescence and the sociocultural context in which eating disorders develop. A summary of empirical investigations of the efficacy of eating disorder prevention programs follows, including an illustration of one of the more promising strategies that has been reported to date. The role of counseling psychologists in further refining eating disorder prevention efforts is discussed.

Body Dissatisfaction Among Lesbian College Students: The Conflict of Straddling Mainstream and Lesbian Cultures

Research examining body dissatisfaction among lesbians has attempted to compare lesbians' and heterosexual women's attitudes toward their bodies. Studies have yielded mixed results, some indicating that lesbians, compared to heterosexual women, are more satisfied with their bodies, and some indicating that the two groups of women are equally dissatisfied. In an attempt to more closely explore lesbians' attitudes toward their bodies, we conducted interviews with 26 lesbian college students and inquired into how the following areas might be related to body-image concerns: (a) lesbian beauty ideals, (b) the sources through which lesbian beauty ideals are conveyed, (c) lesbian conflict about beauty, (d) negative stereotypes about lesbians' appearance, and (e) lesbian concerns about feminine identity. Results indicated that young adult lesbians embrace a beauty ideal that encompasses both thinness and fitness. Whereas mainstream sources, such as women's magazines and peer pressure seem to influence lesbian college students to value a thinner body ideal, sexual relationships with women encouraged acceptance of one's body. Conflict between mainstream and lesbian values about the importance of weight and overall appearance was repeatedly voiced by the respondents. The complexity of lesbians' feelings about their bodies is discussed, and future directions for research are suggested.

Comparative study of body image among dancers and anorexic girls

In order to examine the nature of body image distortions, we studied their perceptual and idealised components using a video distortion technique to create photographs of dancers, anorexics and controls that made their bodies look larger. Each subject was then asked to adjust the photograph until it reflected her estimated and desired body size. The results show that: 1) all three groups perceived themselves to be heavier than they actually are, but the dancers had a more realistic perception of their body weight; 2) the dancers would have liked to be thinner, whereas the controls and anorexics were satisfied with their body weight; 3) the scores of the anorexic subjects were characterised by a lack of correlation between their perceptual and idealised distortions, whereas those of the dancers--and even more so those of the controls--were characterised by consistency between the two types of distortion.

Stereotype accuracy of ballet and modern dancers

The authors recorded preprofessional ballet and modern dancers' perceptions of the personality traits of each type of dancer and self-reports of their own standing, to test the accuracy of the group stereotypes. Participants accurately stereotyped ballet dancers as scoring higher than modern dancers on Fear of Negative Evaluation and Personal Need for Structure and accurately viewed the groups as equal on Fitness Esteem. Participants inaccurately stereotyped ballet dancers as lower on Body Esteem; the groups actually scored the same. Sensitivity correlations across traits indicated that dancers were accurate about the relative magnitudes of trait differences in the two types of dancers. A group of nondancers reported stereotypes that were usually in the right direction although of inaccurate magnitude, and nondancers were sensitive to the relative sizes of group differences across traits.

Eating behavior of ballet dancers

Ballet dancers are frequently regarded as having a higher risk of developing eating disorders (ED). This paper describes the eating habits and prevalence of ED in a group of female students from a dance academy in Rome, Italy. Participants were assessed with an array of measures conventionally employed (usually singly) in epidemiological studies of ED, namely: an anthropometrical-nutritional evaluation, the EAT, EDI, and BUT questionnaires, and the EDE interview. The 160 students who agreed to participate were evaluated anthropometrically, nutritionally and psychometrically and 83 underwent the EDE structured interview. Their calorie intake was insufficient in all age groups in terms of the nutritional standards required by their daily physical activity. EAT, EDI and BUT enhanced concerns about dieting, food intake control and body image. The significance of the correlations between calorie intake and the EAT Dieting and the EDI Perfectionism and Interceptive Awareness scores increased in function of age. Food, weight and body image concerns increased with age and length of time in the ballet environment The reduced calorie intake was not necessarily linked to the presence of psychopathological signs.

Body image and self-esteem in adolescent ballet dancers

Body-image disturbances and low self-esteem have been implicated in the pathogenesis of eating disorders. This study investigated self-perception of body and personality among adolescent ballet dancers in a cross-sectional survey. Two questionnaires assessing "my body right now" and "my personality right now," using semantic differentials were completed by 90 ballet school students and 156 controls. Adolescent female dancers (ages 13 to 17 years) scored higher than age-matched controls and 11- to 12-yr. old peers on Undesirability and Sensitivity for personality and Unattractiveness for body. For both subscales of personality, differences were also found between male and female dancers; female ballet students scored higher. Within the control group a difference could be found only for Sensitivity on which girls scored higher than boys. Male dancers did not differ from controls except for a lower score on the Body mass measure. Adolescent female dancers showed a distinct answering profile for 7 of 16 semantic differentials in each questionnaire implicating less favorable body image and self-esteem. Interventions focused particularly on enhancing self-esteem may be useful in the prevention of psychopathology in adolescent ballet dancers.

Methodological issues regarding eating behavior of high-risk adolescents

Teens exist in multiple environments that offer a variety of foods and a range in nutrient intakes. Currently used dietary data-collection methods may not be contemporary and encompass the real world of today's youth. If we consider respondent capability when we design our dietary assessment methods, then we can increase accuracy and reduce errors in our data. Our methodological challenge is to improve collection methods and to: Focus on the teen and his or her respective environments, Develop environment-specific probes within food records, recalls, checklists, and frequencies, Inbed safeguards to assure impartial reporting when surrogate respondents-for example, parents or school food service staff-are queried, Differentiate between foods "as offered or available at the home or school" versus foods as actually selected and eaten, Tease out the influence of peers and older siblings on food choices versus selections based on personal choice or cost, Employ cooperative education in the classroom so teens will feel comfortable with spontaneous interviews by unfamiliar people, Train students in dietary recordkeeping procedures by incorporating assessment activities into the classroom instruction. In conclusion, the teen lives in multiple environments that influence his or her food and nutrient intake. To increase validity, reliability, and our confidence in the dietary data about teens, we must acknowledge these microenvironments and evolve our methods. The process must be evolutionary not revolutionary like the lives of many teens. The result will be an increased accuracy in both defining actual nutrient intakes and exploring the role foods and nutrients have in the overall health or nutrient deficit teens face.

Eating problems and interpersonal functioning among several groups of women

This paper examines the relationship between eating disorders and problems in interpersonal functioning. Questionnaires that measure eating problems, interpersonal adjustment, and general neuroticism were completed by several groups of women: anorexic patients, persons whose interests or occupations involved a concern about bodily shape or condition (dancers, models, and athletes), and members of the general public. A substantial and significant relationship was found between eating symptomatology and interpersonal functioning in all groups. However, this association survived only in the anorexic patient group when general neuroticism was partialled out. We take this to imply that psychosocial difficulties are unlikely to play a strong role in the initial development of eating problems.

Nutritional intake in adolescent athletes

Nutrition plays a critical role in the success of the competitive adolescent athlete. Some groups have stricter nutrition requirements than others. The authors summarize nutrition intake data on serious female gymnasts, ballet dancers, and high-school cross-country runners. This article also discusses the nutritional needs of young male wrestlers and weightlifters.

Eating attitudes and taste responses in young ballerinas

The Eating Attitude Test 40 (EAT 40) was administered to 23 ballerinas (mean age 18.3 +/- 0.9 years). The scores were high, as they are in anorexic patients. The EAT 40 revealed anorexic-like attitudes in dancers: selective food restrictions, severe dieting, constant preoccupations with food. However, dancers scored low at items screening bulimia, vomiting or laxative abuse. The dancers' perceptions and preferences for sweetness and fat food content were examined and compared to those of 14 sedentary controls. Taste stimuli were 20 semiliquid mixtures of soft-white cheese (0, 3 or 7 grams of fat per 100 grams) or heavy cream (30% fat), and sweetened with 1, 5, 10, 20 or 40% sucrose. The subjects used a 9-point category scale to rate the perceived sweetness, fat content, and hedonic value of the stimuli. There were no significant differences in the perceived sweetness intensity between groups, but the perception of fat appeared to be better in dancers, in particular in very sweet stimuli. Dancers showed a clear aversion for the fattest stimuli. In young female dancers, enhanced sensitivity for alimentary fats is associated with decreased preferred levels.

Nutrition beliefs, practices, and perceptions of young dancers

Forty-nine dancers from 21 states and Mexico ages 13-20 years participated in a study designed to further explore nutrition beliefs and dietary practices of young dancers. Subjects completed a previously used questionnaire that identifies nutrition beliefs and practices. The correlation between actual height and weight and subjects' perceived height and weight was significantly different (p = less than or equal to 0.5). Subjects requested that additional nutrition education be included in their training programs.

Anorexia nervosa and related conditions in schoolchildren

The clinical features of anorexia nervosa and the prevalence of the eating orders in different societies is described. The role of physiological, cultural and biological factors in the aetiology of eating are reviewed. Finally ways of preventing eating disorders are considered.

Inadequate Nutrition and Chronic Calorie Restriction in Adolescent Ballerinas

In brief: Studies show that adult ballerinas practice poor nutrition habits, but little research has been done on adolescent dancers. The authors analyzed the diet composition of 92 female ballet dancers aged 12 to 17 enrolled in six professional schools. Three- day diet histories were used to compile data, and a dietitian worked with the dancers to ensure accuracy in record keeping. The results showed poor nutrition habits and low calorie and nutrition intake. Sixty percent routinely took vitamin or mineral supplements, but not properly. Unfortunately, the dancers' desire to maintain a sylphlike, willowy body makes them unwilling to consume the number of calories required for a healthy diet. A nutrition class in the dance school curriculum would help increase their knowledge and improve their dietary habits.

The discriminative value of psychological characteristics in anorexia nervosa. Clinical and psychometric comparison between anorexia nervosa patients, ballet dancers and controls

The present controlled study examined anorexic and psychological characteristics of female ballet dancers, who by career choice must focus on thinness, and anorexia nervosa patients. Anorexia nervosa (AN) patients, female ballet (BA) students as well as asymptomatic female controls (AF) were compared with respect to the psychological characteristics: the Drive to Achieve, the Motive to Avoid Failure (Negative Fear of Failure) and the Motive to Achieve (Positive Fear of Failure). The results confirmed previous empirical and clinical findings that the AN group and the BA group can be differentiated from a control group with respect to a heightened Drive to Achieve. However, the Drive to Achieve of AN patients was found to originate in an avoidance of failure (the Negative Fear of Failure), while in BA students this drive was found to stem from a motive to achieve (the Positive Fear of Failure). The findings underline the importance of an evaluation of psychological characteristics in subjects with anorexic symptoms.