Woman standing over scale with an eating disorder

Eating Disorders in Ballet Dancers: Anorexia, Bulimia, and EDNOS

Growing up, I participated in ballet for a good eight years where body image and eating disorders such as anorexia, bulimia and eating disorder not otherwise specified (EDNOS) were present. My participation in class became more extensive the older I got, and I found myself being in class almost everyday of the week until I decided to quit.  The preoccupation with thinness, and being light and delicate were prominent.

The physical rigors of class were quite strenuous and I saw that many of the older dancers faced lots of pressure. The instructors were not always kind, and I remember a day when the head principal of my dance school walked down the hall and took a single-sized serving bag of chips out of someone’s grasp. Another thing that was apparent is that most of the dancers that received lead roles in the Nutcracker performances always happened to be thin girls that were not necessarily the most healthy in size sometimes. The women that had started developing breasts or embodied more of a filled out “woman’s body” were more neglected.

Additionally, in every classroom, a large mirror is present so students can watch themselves and check their form. However, some people would make comments that they “looked fat” or “thick.” It is common that ballerinas express their vulnerability and self-consciousness with the shape of their bodies and face an increased risk to succumbing to an eating disorder.

In The Sociocultural Effect of Diet Culture on Body Image Expectations becomes presented through the media and how body image becomes distorted by the mind. People in the same professions or environments share a “moral belief system and a behavioral code, which tells them how to behave and what usually written rules to obey” (Aalten 2005:57). Women especially are presented as thin, perfect, and unrepresentative of “normality.” However, I’d like to take the time to mention the psychosocial effects of the human mind and the anthropology connotations that exist within eating disorders.

In my most recent post “Medical Anthropology and Public Health: Endometriosis, Patient Care and Dehumanization” I mention that our bodies are constituted in human culture (Bordo, 165). According to Abraham (1996), dancers had high scores on an Eating Attitudes Test and were absolutely likely to have an eating disorder. In a study conducted in the late 1990s, the data showed that “1 dancer (1.6%) and no student had anorexia nervosa, 1 dancer (1.6%) and 3 students (1.3%) had bulimia nervosa and 5 dancers (8.3%) and 9 students (4.2%) had an unclassified eating disorder (Abraham 1996). While this study is quite outdated, this shows that even without social media, body image issues and eating disorders are still prevalent.

In this blog post, I will first define several eating disorders that are commonly intertwined but are also separate, such as anorexia, bulimia, and EDNOS (eating disorder not commonly specified). Anthropologists have created several ideas about how different cultures shape their eating practices, and how social structures and relationships become obscured in “clinical and population interpretations” (Eli and Warin 2018). Next, I will show how ballet dancers (both men and women) suffer from body image and eating disorders and how it is intertwined with the desire to control and perfect themselves.

Depiction of different eating disorders
Source: https://nedc.com.au/eating-disorders/eating-disorders-explained/types/bulimia-nervosa/

Eating Disorder: Anorexia

Anorexia is defined as “a multidimensional disorder,” with several factors (perceptual, cognitive, familial, and biological factors) that intermingle to produce a final common pathway (Bordo 164). Drawing from feminist research, anorexia “reveals a socio-politically constructed paradox of the feminine body,” one that wants to reach a state of self-actualization through fitness (Germillion 2002, Eli and Warin et al 2018).

Irina Kolesnikova, a prima ballerina at the famous Russian ballet company, the  Bolshoi, revealed how she would eat just one apple a day and 450g of porridge. At size 8, she was told by the Bolshoi that her body was too big. She believed her “body was the enemy and wished it was smaller. Overall, the less that she ate, the more she felt better about herself and more in control. Because pain is often ignored as well as hunger, dancers desire to prove themselves, especially when performing roles are given out (Aalten 2005).

In short, it is important to note that anorexia is very dangerous and can lead to the whole onset of new problems including gastrointestinal disorders, heart issues, and also loss of one’s menstrual cycle.

Coffee Morning with sketching Ballet Dancers | Mall Galleries - Woman leaping
Source: https://www.mallgalleries.org.uk/whats-on/events/coffee-morning-with-sketching-ballet-dancers-november

Eating Disorder: Bulimia 

Bulimia is also a life-threatening disorder which starts after a period of “dieting.” Sometimes people will eat a large amount of food or normal amount of food in a short period of time and then feelings of guilt, shame and sadness will inspire them to engage in vomiting to prevent weight gain. Exercising for long periods of time, or drinking a ton of water in attempt to rid the body of the extra calories is also another form of purging. Diuretics and drug use are also used as well or the person just simply fasts for a long period of time. Usually, the person that is suffering is stuck in this cycle for a long period of time and it is hard to break it without some form of intervention. 

In Abraham’s study (1996), groups of dancers were revealed to binge eat after starving themselves and used many different methods, such as purging to control their overeating. It’s usually not about the food, but the emotions and psychological state someone may be experiencing at that time. Just like anorexia, the act of binge eating is a means of establishing a sense of control or a way of just plain coping with a harsh environment. The act of reaching a low weight feels like one has accomplished something.

Bulimia and Binge Eating

Binge eating is closely associated with bulimia, as sometimes men and women have both, and it is defined as eating excessive large amounts of food excessively during a very short amount of time while feeling out of control. Sometimes people will try to rid themselves of the extra calories using forced vomiting. Excessive eating would entail at least a dozen cookies in about 10-20 minutes.

A woman describes her endless cycle with binge eating; “I am good with my diet for a few days, but then I give in and stuff myself with pizza and ice cream and am filled with self-hate.” From this quote, it is clear that her emotions are causing her to associate eating habits with her perceived failures in life.

By: David Suarez Matthew Stormont. What is EDNOS The Diagnostic and Statistical manual only recognizes two distinct eating disorders (anorexia nervosa. - ppt download
Source: https://slideplayer.com/slide/2348301/

EDNOS also known as Eating Disorder Not Otherwise Specified

There is another eating disorder category called EDNOS and it is characterized by someone who fails to meet the other guidelines for eating disorders but they definitely have disordered attitudes towards food, body image and weight. Some of the criteria includes a person who combines “symptoms of anorexia and bulimia” but does not meet all the medical criteria. Signs of someone who has this criteria are changes in one’s immune system, damage from vomiting and large changes in weight.

However, all of these types of eating disorders listed are very alarming and difficult to treat. It is important to discuss why they manifest in ballet dancers next.

What Do Ballet Dancers Really Eat? Professionals Open Up On Diet, Gruelling Rehearsals And Eating Disorders | HuffPost UK Life
Source: https://www.huffingtonpost.co.uk/2014/11/06/ballet-dancers-food-eating-disorders_n_6105968.html

Eating Disorders: Ballerina Control and Perfectionism  

For most people in the performing arts, especially ballet dancers, having an eating disorder and fearing weight gain are a mechanism for control. According to Susan Bordo,  women are the most oppressed in a system of “tyranny of slenderness.” Women describe that the diet is a sector of their life, which they feel they have control over.  Bordo states that the image shapes and permeates her experience of her own hunger food as insatiable and out of control, that makes her feel that if she takes just one bite, she will not be able to stop (177).

One woman describes that the idea of control stems from rigid thinking and perfectionism. At a weigh-in at a doctor’s visit, she felt terrible after gaining even one kilogram. She said, “I went crazy: I was screaming, shouting, pulling out my hair. I kept shouting ‘I hate my life, I hate my life, I hate it’. I just wanted to die. Basically, I felt that I had nothing if I wasn’t 40 kgs.” This same women went home after the appointment and walked 30 km in order to undo what she thought she had destroyed.

Most dancers are so preoccupied with controlling their weight, since they are not able to have any type of influence on what people perceive of them. The teaching styles can be so insulting and degrading, and many people feel as if they are unable to achieve a “perfect body” as they are disappointed in themselves and their ability. As said before, people spend hours at these locations and are completely immersed in this type of unhealthy environment. Pain and hunger almost become absent in the mind of a dancer  and they relate to pain differently (Aalten 2005:67). With perseverance and practice, dancers think that they will improve toward a required “ideal”(67).

Cultured notions of “gendered selfhood, relationality and moral subjectivity” are truly central in the ways that these eating disorders are experienced and treated in ballet culture (Eli and Warin 2018: 447). In the last decade, women have received more independence, and wish to assert themselves politically and socially in contemporary times. More research has shown how individuals feel about themselves.

Girls have been shown to voice their worries about their own weight and being “fat” as early as age six. Some dancers start training as young as age seven and many would love to become true professional dancers. They have voiced the need to be lean even at an elementary school age. Overall, proper education on nutrition is imperative as these issues are psychologically and physically damaging.

Chronic Pain and Eating Disorders: What is the Connection? Picture of girl with phone and feeling bad about herself
Source: https://www.eatingdisorderhope.com/blog/the-connection-between-chronic-pain-and-eating-disorders

 Significance in Anthropology

Why are we as a culture so obsessed with slenderness, thinness and being fit?  Like any condition, no single discipline provides all the answers or perspectives in fields such as anthropology or psychology to these disorders. However, anthropology highlights insights into certain cultural aspects that are embedded in eating disorders. According to Warin and Eli (2018), anthropological research shows how cultural meanings that underlie body ideals, media messages, and health and well-being (449). Men even suffer from body dysmorphia, eating disorders, and varying cultural perceptions on fitness from time to time.

In this blog and according to Nami, people with eating disorders are most likely coping with overwhelming feelings and “painful” emotions. The characteristics presented in this blog are indicative of the pressures and environmental issues that come with rigorous art forms such as ballet.To address the eating disorders in the ballet community, the whole school has to be present in combatting these issues. In these walls, fatness and thickness are still detested. The word “educate” is imperative in helping students understand how much they should be eating to sustain such a vigorous lifestyle.

A study in the dance world participant observation, interviews, and focus groups as well as controlling for “age and type of dance should be able to reveal the presentation of eating disorders in dancers differs from non-dancers” (Arcelus and Witcomb et al 2014). The question becomes what types of bodies should we be encouraging women to strive for, especially the ones who are physically active every day? Why do dancers not care for their bodies better? What moral codes signify “pain signals to the brain” to stop pushing oneself?

I strongly encourage researchers, health providers, anthropologists to engage in new research and conversations about eating disorders and how to best interfere when someone is suffering from them. An eating disorder is an illness. It is truly not a choice, and it is possible to recover from one with the right decisions and a bit of help.

Picture of four girls dancing
Source: https://mediaeating.wordpress.com/2013/10/01/ballet-disorder/

Further Resources for Sufferers:

  • Academy for Eating Disorders (AED): aedweb.org
  • National Association of Anorexia Nervosa and Associated Disorders: anad.org
  • Families Empowered and Supporting Treatment of Eating Disorders (F.E.A.S.T.): feast-ed.org
  • The International Association of Eating Disorders Professionals Foundation (IAEDP): iaedp.com
  • National Eating Disorders Association (NEDA): nationaleatingdisorders.org
  • Overeaters Anonymous (OA): oa.org

 References:

Arcelus J, Witcomb GL, Mitchell A. Prevalence of eating disorders amongst dancers: a systemic review and meta-analysis. European Eating Disorders Review : the Journal of the Eating Disorders Association. 2014 Mar;22(2):92-101. DOI: 10.1002/erv.2271.

 Abraham S. Characteristics of eating disorders among young ballet dancers. Psychopathology. 1996;29(4):223-9. doi: 10.1159/000284997. PMID: 8865353.

Bordo, Susan. “Anorexia Nervosa: Psychopathology as the Crystallization of Culture.” In Food and Culture: A Reader. Edited by Carole Counihan and Penny Van Esterik. 2nd ed. Routledge, 1997 (1991).

Gremillion, H.(2002). In fitness and in health: Crafting bodies in the treatment of anorexia nervosa. Signs, 27(2), 381-414.

Eli, K., & Warin, M. (2018). Anthropological Perspectives on Eating Disorders: Deciphering Cultural Logics. Transcultural Psychiatry55(4), 443–453. https://doi.org/10.1177/1363461518784385

Warin, M. (2005). Transformations of intimacy and socality in anorexia: Bedrooms in public institutions. Body & Society, 11, 97–113

Leave a Reply