European Child & Adolescent Psychiatry

, Volume 17, Issue 2, pp 108–113 | Cite as

Psychopathology in elite rhythmic gymnasts and anorexia nervosa patients

  • Nora KlinkowskiEmail author
  • Alexander Korte
  • Ernst Pfeiffer
  • Ulrike Lehmkuhl
  • Harriet Salbach-Andrae


This study investigates current psychopathology and psychological distress in elite rhythmic gymnasts. Due to a strong emphasis on leanness in aesthetic sports and the controversial findings in literature regarding the role of anorexia nervosa (AN) in such sports, we compared elite rhythmic gymnasts (= 51) to inpatients with AN (= 55) as a disease control group and to high school students (= 53) as a “normal” control group. We assessed psychopathology using the Symptom Checklist (SCL-90-R). Moreover, body height, weight, Body Mass Index (BMI) and the presence of amenorrhea were assessed. Regarding physical aspects, the rhythmic gymnasts showed an intermediate position between the two other groups. In terms of psychopathology, significant differences were found between the gymnasts and the AN patients, while no differences were detected between the gymnasts and the “normal” control group. Depression discriminated best between the three groups. Elite rhythmic gymnasts may show a lean, almost anorexic-like physique. Nevertheless, no psychological distress comparable to that of AN patients was found. Therefore, even though analogies to AN might seem obvious in elite rhythmic gymnasts, this study is putting emphasis on the importance of a careful consideration of psychological distress and psychopathology.

Key words

elite rhythmic gymnasts psychopathology anorexia nervosa eating disorders 


  1. 1.
    American Psychiatric Association (1994) Diagnostic and statistical manual of mental disorders, 4th edn. Washington DCGoogle Scholar
  2. 2.
    Bachner-Melman R, Zohar AH, Ebstein RP, Elizur Y, Constantini N (2006) How anorexic-like are the symptom and personality profiles of aesthetic athletes? Med Sci Sport Exerc 38:628–636CrossRefGoogle Scholar
  3. 3.
    Brownell K, Rodin J, Wilmore J (1992) Prevalence of eating disorders in athletes. In: Brownell K, Rodin J, Wilmore J (eds) Eating, body weight and performance in athletes: disorders of modern society. Lea & Febiger, Philadelphia, pp 128–145Google Scholar
  4. 4.
    Byrne S, McLean N (2002) Elite athletes: effects of the pressure to be thin. J Sport Sci Med 5:80–94CrossRefGoogle Scholar
  5. 5.
    Davis C, Kennedy SH, Ravelski E, Dionne M (1994) The role of physical activity in the development and maintenance of eating disorders. Psychol Med 24:957–967PubMedCrossRefGoogle Scholar
  6. 6.
    Ekeroth K, Broberg AG, Nevonen L (2004) Eating disorders and general psychopathology: a comparison between and adult patients and normal controls with and without self-reported eating problems. Eur Eat Disord Rev 12:208–216CrossRefGoogle Scholar
  7. 7.
    Exner C, Hebebrand J, Remschmidt H, Wewetzer C, Ziegler A, Herpertz S, Schweiger U, Blum WF, Preibisch G, Heldmaier G, Klingenspor M (2000) Leptin suppresses semi-starvation induced hyperactivity in rats: implications for anorexia nervosa. Mol Psychiatr 5:476–481CrossRefGoogle Scholar
  8. 8.
    Fichter M, Quadflieg N (1999) Strukturiertes Inventar für Anorektische und Bulimische Essstörungen nach DSM-IV und ICD-10. Göttingen, HogrefeGoogle Scholar
  9. 9.
    Franke GH (2002) SCL-90-R. Symptomcheckliste von L. R. Derogatis. Göttingen, HogrefeGoogle Scholar
  10. 10.
    Georgopoulos N, Markou KB, Theodoropoulou A, Paraskevopoulou P, Varaki L, Kazantzi Z, Leglise M, Vagenakis AG (1999) Growth and pubertal development in elite female rhythmic gymnasts. J Clin Endocrinol Metab 84:4524–4530CrossRefGoogle Scholar
  11. 11.
    Georgopoulos N, Markou KB, Theodoropoulou A, Vagenakis GA, Benardot D, Leglise M, Dimopoulos JCA, Vagenakis AG (2001) Height velocity and skeletal maturation in elite female rhythmic gymnasts. J Clin Endocrinol Metab 86:5159–5164PubMedCrossRefGoogle Scholar
  12. 12.
    Herpertz-Dahlmann B, Müller B (2000) Leistungssport und Essstörungen aus kindes- und jugendpsychiatrischer Sicht. Monatsschrift für Kinderheilkunde 148:462–468CrossRefGoogle Scholar
  13. 13.
    Hessel A, Schumacher J, Geyer M, Brähler E (2001) Symptom-Checkliste SCL-90-R: Testtheoretische Überprüfung und Normierung an einer bevölkerungs-repräsentativen Stichprobe. Diagnostica 47:27–39CrossRefGoogle Scholar
  14. 14.
    Holtkamp K, Herpertz-Dahlmann B, Mika C, Heer M, Heusse N, Fichter M, Herpertz S, Senf W, Blum WF, Schweiger U, Warnke A, Ballauff A, Remschmidt H, Hebebrand J (2003) Elevated physical activity and low leptin levels co-occur in patients with anorexia nervosa. J Clin Endocrinol Metab 88:5169–5174PubMedCrossRefGoogle Scholar
  15. 15.
    Klentrou P, Plyley M (2003) Onset of puberty, menstrual frequency, and body fat in elite rhythmic gymnasts compared with normal controls. Br J Sport Med 37:490–494CrossRefGoogle Scholar
  16. 16.
    Peñas-Lledó E, Vaz Leal FJ, Waller G (2002) Excessive exercise in anorexia nervosa and bulimia nervosa: relation to eating characteristics and general psychopathology. Int J Eat Disord 31:370–375PubMedCrossRefGoogle Scholar
  17. 17.
    Smolak L, Murnen SK, Ruble AE (2000) Female athletes and eating problems: A meta-analysis. Int J Eat Disord 27:371–380PubMedCrossRefGoogle Scholar
  18. 18.
    Sungot-Borgen J (1996) Eating disorders, energy intake, training volume, and menstrual function in high-level modern rhythmic gymnasts. Int J Sport Nut 6:100–109Google Scholar
  19. 19.
    Sundgot-Borgen J (1994) Eating disorders in female athletes. Int J Sport Med 17:176–188CrossRefGoogle Scholar
  20. 20.
    Sundgot-Borgen J, Torstveit MK (2004) Prevalence of eating disorders in elite athletes is higher than in the general population. J Sport Med 14:25–32Google Scholar
  21. 21.
    Theintz G, Ladame F, Kehrer E, Plichta C, Howald H, Sizonenko PC (1994) Prospective study of psychological development of adolescent female athletes: initial assessment. J Adolesc Health 15:258–262PubMedCrossRefGoogle Scholar
  22. 22.
    Thompson RA, Trattner Sherman R (1999) “Good Athlete” Traits and Characteristics of Anorexia Nervosa: Are They Similar? Eat Disord 7:181–190CrossRefGoogle Scholar

Copyright information

© Steinkopff Verlag 2007

Authors and Affiliations

  • Nora Klinkowski
    • 1
    Email author
  • Alexander Korte
    • 1
  • Ernst Pfeiffer
    • 1
  • Ulrike Lehmkuhl
    • 1
  • Harriet Salbach-Andrae
    • 1
  1. 1.Dept. of Child and Adolescent Psychiatry, Psychosomatics and PsychotherapyCharité - Universitätsmedizin BerlinBerlinGermany

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