The Gray Area That's Not Quite an Eating Disorder, But Is Common Among Dancers

It doesn't have to be diagnosable by the DSM-5 to be dangerous to your health. Photo by Dominik Martin/Unsplash

When the cat food started smelling good, I knew I had a problem.

I'd always considered eating disorders to be extreme. Someone who never eats. Someone who weighs less than 100 pounds. Someone who gets hospitalized.

My behavior didn't fit the mental health definition of an eating disorder. I ignored it because I didn't know how to articulate it. It took me several years after the cat food smelled good to have the language to describe what was going on.


It Started as An Act of Teenage Rebellion That Had Nothing to Do With Weight

For the author (above), being vegetarian turned into an excuse to get out of eating. Photo courtesy Tenuto

I had decided to become a vegetarian at 17. It started in earnest as a way to protest my dad hunting birds and bringing them home for my family to eat. First, I wrote off the meat he hunted. Then (enjoying the rebellion of it), I wrote off all meat.

It was circa 2001 and at that time books like "Fast Food Nation" were on the rise. I read up on the inhumane practices of the meat industry. I morally got behind my choice to be a vegetarian.

As a bit of time passed, I began to use my vegetarianism as a way to write off eating a healthy amount of food. "Oh, I can't eat that" or "I'll meet up after dinner" were frequent responses that came out of my mouth in my early 20s. Vegetarianism had become my excuse. It was a socially acceptable way to get out of eating.

Don't get me wrong—to this day I love animals and have met some vegetarians who are informed and balanced about their nutrition. That was not my case.

Having rice and vegetables for every meal, I thought I was eating like an enlightened monk. I did no research on what I needed to eat as a substitute for meat. But I had a well-rehearsed (and well-researched) speech ready about the meat industry's treatment of animals to defend my choices. I was often light-headed, and not from being enlightened. It was because I was malnourished.

Also, I was a professional dancer. Somehow, I didn't connect the dots. I knew about how many dancers had eating disorders. But I've honestly never met one dancer who doesn't obsess over their body. Seeing my behavior as fairly normal, I thought it'd be weird to ask for help.

Just Because It's Not Classified as An Eating Disorder Doesn't Mean It's Safe

Thinking about food all the time is an early sign of disordered eating. Photo by Eszter Biro.

New York City-based dietician Kelly Hogan, MS, RD, recently explained to me that there is a difference between eating disorders and disordered eating. An eating disorder has a set of diagnostic criteria and is diagnosable by a doctor. Disordered eating encompasses various behaviors such as restricting food intake, restricting food groups, having rigid rules, bingeing, purging and over-exercising. Disordered eating can be really complicated, but it's technically not diagnosable by the mental health standards manual, the DSM-5.

"Disordered eating may be more likely to happen in those with certain personality traits, like perfectionism," Hogan said. "It's also more likely if you already have other emotional turmoil going on. Recent review studies and surveys on disordered eating have found that most women exhibit disordered eating behaviors at some point in their lives."

"Most women?" I asked. She confirmed: About 75 percent. "This is a newer finding that is currently being looked into in a deeper way now." Hogan told me that women in aesthetic-based sports such as dance, gymnastics, running, ice skating and diving are at the most risk.

"Early signals for disordered eating include thinking about food all the time, finding ways to cut out foods or food groups from your diet, if your relationship with food affects your social life, or if you have low energy, aches and pains," she said.

Hogan acknowledges that, for dancers, it can be to discern if low energy, aches and pains are from their activity or a lack of nourishment. "Losing your period is a clear sign that you may not be eating enough to fuel your activity and that your body is under a significant amount of stress because of this energy deficiency," she says. This can put you at risk of injury, especially bone injuries.

Dancers Are Three Times as Likely to Have Disordered Eating Patterns

Since she got healthier, the author has noticed how many other dancers struggle in the gray area of disordered eating. Photo courtesy Tenuto

I rationalized my own disordered eating as, "I am still eating. I eat healthy food. I eat three meals per day." I didn't know how much more I needed to eat because I was dancing six to eight hours a day. I also didn't try to learn. Instead, I was restricting an entire food group from my diet for a non-health-based reason.

I also became really into looking as thin and as long as I could—the idealized version of a dancer body. Hogan says that research shows dancers are as much as three times more likely than other people to exhibit disordered eating patterns.

That afternoon when I fed my cat wet food, I actually started to drool. I was about seven years into being a vegetarian. In that moment, I knew I had to eat meat again. I called my family and coordinated a barbecue with some "organic, grass fed-only" hamburgers. I plowed through my first hamburger and felt a surge of energy. My body was like "Finally! Thank you."

That first barbecue was more than 8 years ago. Since then, I've noticed a ton of other dancers whose relationships to food aren't extreme disorders, but they live in the gray area. Maybe it's over exercising. Maybe it's no food after 7 pm. Coffee after every meal to stimulate digestion. Hopping on the most recent fad diets. Or eliminating gluten when it's not a health concern.

Whatever it is, know that there are so many people with you.

If you're ready to seek help, Hogan warns that not all physicians understand disordered eating or know how to treat patients exhibiting symptoms. She suggests seeing a registered dietitian and/or a therapist. "A specialized professional can help you get to the root of why these behaviors are happening," she says, "and eventually, understand how to better nourish your body."

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The human head weighs somewhere between 8 and 12 pounds. For many of us, our youngest students included, that comparatively large weight spends on average at least a couple hours a day hunched over a screen. While you may not consider your students as average, there is no denying we spend more hours than ever looking down at handheld mobile devices. "I think of it as 'tech posture,'" says Blossom Leilani Crawford of Bridge Pilates, "when the head is forward and the shoulders are forward. People don't know where their heads are anymore, and you certainly can't turn well with the weight of your head forward."

Forward head posture seems to be the very antithesis of the open chest, lifted spine and presentational sensibility of most classical dance training. But beyond the aesthetics, this misalignment can affect balance and coordination in developing dancers and, at the extreme end, can be associated with nerve damage and pain down the arm.

According to Dr. Marshall Hagins, physical therapist for the Mark Morris Dance Group, there are really two things going on when you see forward head posture. First, the skull is projected forward in front of the body (as in when we look down at a phone). But then, because we are social creatures who want to see and interact with the world in front of us, the head rotates backward on the spine, thrusting the chin up and out. "The muscles in the front of the neck are short and relaxed," he explains, "while the muscles in the back, which are keeping the head from falling further, are lengthened and overworking." The neck muscles have a very high density of proprioceptors and the nervous system feedback is working to fight gravity all of the time, all of which can result in a levator scapulae that is overused and painful.

Hagins offers a tent analogy for balancing the head in three dimensions without simply resorting to a military posture. "All the surrounding neck muscles need to have just the right amount of tension to keep a heavy object, such as the head, balanced atop the tent pole of your spine," he says. "When it leans one way, the corresponding wire becomes loose and the other wires have to pull harder." He notes that it can still be possible for dancers to move in and out of the proper positions even if the resting posture is slouched. However, assuming such a posture for most of the day can lead to injury.

The phenomenon has caused Crawford to modify the abdominal exercises in her mat class. "I sometimes ask for the head to stay on the floor for the single-leg stretch or double-leg stretch," she says. "I call it 'angry turtle' when you work to draw the back of your head into the floor. Once that is understood, it is easier to transfer into lifting the head off the ground properly."

However, both Hagins and Crawford caution that dancers are often hypermobile and prone to overcorrecting, so it is important to focus on good postural habits and incremental changes so they don't move from one misalignment of the head and neck to another. Here are three simple exercises Crawford uses to help students find and feel where proper head alignment is in different planes of movement. They are great on their own, in any warm-up, or can be easily sprinkled into a Pilates mat routine.

Supine Head Float​

Elena Prisco, age 17, student at Lake Tahoe Dance Collective. Photos courtesy of Thompson

1. Lie on your back, knees bent and feet planted, with a yoga block, or prop of similar height, under the shoulder blades. Let your head rest back into this big, chest-opening stretch, with your fingers interlaced, hands behind your neck so that your pinky fingers are against the base of your skull.

2. Float your head up to spine level, chin tucked in, hands helping to
traction your neck long. Use exhales to activate the abdominals and keep ribs heavy and soft while your head is up. Hold for a few counts and then rest back into the stretch.

3. Repeat several times, being careful not to let the chin jut forward.

*If you are ready for more, float the pelvis up to spine level along with the head. Keep the pelvis in a neutral, untucked position.

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