The Female Athlete Triad and its Connection to Mental Health
Allison Osmer, Masters Level Clinician
In women's sports, the focus on performance, mental toughness, and aesthetics can sometimes lead to a condition known as the Female Athlete Triad. This condition combines three connected health issues: low energy availability, menstrual dysfunction (Amenorrhea), and low bone density (Osteoporosis). Additionally, if/when the triad impacts athletic performance, athletes may be at a higher risk of developing mental health issues, including eating disorders, body image issues, depression. anxiety, and other psychological struggles. These issues can lead to a vicious cycle of low energy, irregular menstruation, and low bone density.
What is the Female Athlete Triad?
The Female Athlete Triad is a complex condition that primarily affects women participating in sports that emphasize a lean body aesthetic. The three components of the triad are:
Low Energy Availability - the imbalance between food consumed and energy used during physical activity. When energy intake is insufficient to meet the body's needs, it can lead to various health issues, including menstrual irregularities and decreased bone density.
Menstrual Dysfunction (Amenorrhea) - the absence or irregularity of menstrual periods. Intense physical training combined with low energy availability can disrupt hormones in the body, leading to disruptions in the menstrual cycle.
Low Bone Density (Osteoporosis or Osteopenia) - this can occur when there is chronically low energy and hormonal imbalances. Low bone density can lead to decreased bone strength, resulting in bone fractures.
It's uncommon for female athletes to experience all three triad components simultaneously and instead athletes tend to have one or two conditions. Additionally, all triad components may manifest at different times in the athlete's life rather than all at once. Signs of the condition to look for include:
Long recovery time
Increased injuries, especially stress fracture
Loss of muscle
Weight loss
Abnormal menstrual period
The Female Athlete Triad and Connection to Mental Health
Female athletes may also be at risk of developing other mental health conditions, which can worsen symptoms of the triad. However, the connection between the Female Athlete Triad and mental health is a complex and an often-overlooked aspect of the condition. The relationship between the two involves several key points:
Psychological Stress: The traits that make an athlete successful, such as mental toughness, competitiveness, and perfectionism, can also be a source of psychological stress and prevent athletes from seeking the healthcare they need to prevent and treat the aspects of the triad.
Eating Disorders: Female athletes can also risk developing disordered eating/an eating disorder due to pressure to look a certain way or maintain a specific weight. The stress experienced by athletes to adhere to a particular body weight can result in adopting restrictive eating habits, engaging in excessive physical activity, and possibly even receiving a clinical diagnosis for eating disorders like anorexia and bulimia. When eating becomes disordered, this leads to low energy availability, which can affect hormonal balance and bone health.
Depression and Anxiety: Depression and anxiety often coexist with eating disorders, further emphasizing the interconnectedness of mental health and the triad. They may also be underlying conditions that emerge under pressure or with life transitions, including during a period of high stress, injury, or other stressors that athletes commonly encounter.
Body Image Issues: Athletes who feel compelled to conform to certain body standards for their sport may develop poor body image. Negative body image can fuel anxiety, depression, and other psychological struggles, which again may fuel symptoms of the triad.
Mental health struggles can contribute and worsen the components of the triad. For example, stress and anxiety can disrupt hormonal balance, contributing to menstrual irregularities and bone health issues, and disordered eating can lead to low energy. The connectedness of mental health disorders with components of the triad emphasizes the need to address mental wellbeing as a preventive measure against worsening physical consequences.
How to Treat Symptoms of the Female Athlete Triad?
The focus of treatment for the Female Athlete Triad is on prevention and early intervention. Without treatment, long term effects of the condition are risk of fractured bones, organ damage due to lack of nutrients, and in extreme cases, the condition can lead to fatal outcomes. Some strategies for prevention and treatment to decrease risk of possible long-term effects include:
Education: Athletes, along with parents and coaches, should be educated about the risks of the Female Athlete Triad, the importance of adequate nutrition, and the signs of disordered eating.
Nutrition: Athletes should receive proper guidance on balanced nutrition to fuel their training and performance and maintain overall health.
Regular Check-ups: Athletes' menstrual cycles, bone health, and overall wellbeing should be regularly monitored to detect any signs of imbalance early on.
Mental Health Treatment: Addressing the psychological aspects of body image, self-esteem, and perfectionism is essential to care. Athletes should have access to mental health resources to cope with stressors.
Collaboration: Healthcare providers, coaches, parents, and the athletes should be in communication and collaboration to ensure the athletes' health and wellbeing are adequately prioritized.
Overall, the Female Athlete Triad is complex and requires collaborative support from healthcare providers, coaches, and athletes' parents. While prevention and treatment are vital to treating the triad, as stated above, one of the most significant obstacles to care is stigma/ psychological barriers to treatment. Perfectionism, competitiveness, culture of the sport, and stigma can also make it challenging for athletes to seek psychological support, change mentality, and alter diet and exercise tendencies.
If you are a current or former athlete, reaching out for psychological support can be an important step to treatment and prevention for this condition. Therapist and Coach, Hannah Connor, LCPC has a specialization in Sport and Health Psychology, is an athlete, and has extensive experience working with athletes to cultivate better wellbeing. Read more Sport & Mental Performance Coaching here and schedule a consult call here.
