Running on Empty: Understanding Eating Disorders in Competitive Runners
- Cara Kopicki, LPC
- 3 days ago
- 6 min read
By: Cara Kopicki, LPC.
Competitive running is often associated with discipline, resilience, and peak physical performance. For many athletes, distance running provides structure, purpose, and community. Beneath this culture of achievement lies a growing concern that continues to affect runners at every level: body image distress, eating disorders, and disordered eating behaviors.
Eating disorders in runners can include restrictive eating, compulsive exercise, binge eating, purging behaviors, or chronic under-fueling that negatively affects physical and mental health. Distance runners and endurance athletes may be especially vulnerable due to performance pressures, body image concerns, and sport cultures that associate thinness with success.
Research consistently shows that endurance athletes, especially runners, are at a significantly higher risk for developing eating disorders than the general population. The reasons are complex, though one harmful, inaccurate message continues to pop up in running culture: “thinner equals faster.” While leanness is often praised in endurance sports, the reality is that under-fueling and disordered eating can severely damage both athletic performance and long-term health.
Why Runners Are Vulnerable to Eating Disorders
Many runners experience pressure to maintain a certain body type while balancing intense training demands, academic stress, and performance expectations. Psychological factors like perfectionism, anxiety, and low self-esteem can increase vulnerability. Sociocultural influences, including team culture, social media, and comments from others, can reinforce harmful beliefs about food.
For some athletes, these behaviors may begin so gradually that they do not immediately feel dangerous. What starts as “eating cleaner,” avoiding certain foods, or trying to improve performance can slowly turn into rigid rules around food and exercise. Skipping meals after a tough workout, obsessively tracking calories burned, feeling guilty for taking a rest day, or fearing normal body changes may initially be praised as discipline within competitive environments. In running culture especially, overtraining and restriction can sometimes be normalized under the belief that sacrificing more will lead to better performance.
The concern is that these behaviors often blur the line between dedication and self-destruction. Athletes may receive praise for their performances while they are quietly struggling behind the scenes. Many runners struggle with the fear that gaining weight, resting, or eating more could make them less successful. Over time, these struggles can evolve into anxiety around food, compulsive exercise patterns, isolation, and a damaging relationship with both sport and self-worth.
Why Eating Disorders in Runners Often Go Unnoticed
Common Signs of Disordered Eating in Runners
One of the biggest challenges is that eating disorders in athletes are often overlooked or misunderstood. Many people still picture someone with an eating disorder as visibly underweight. That false stereotype leaves countless athletes struggling in silence.
The reality is that eating disorders can affect people of every body size, shape, and appearance. An athlete may look “healthy” from the outside, continue competing at a high level, or seem ok while their physical and mental health are quietly deteriorating. Because of this misconception, many runners do not feel “sick enough” to ask for help. The reality is that there is no such thing as “sick enough.”
What Is RED-S in Athletes?
Distance runners are also particularly vulnerable to conditions like Relative Energy Deficiency in Sport (RED-S), which occurs when the body does not receive enough energy to support both training and essential bodily functions. In a culture that may celebrate pushing through exhaustion, athletes might ignore symptoms that are actually signs their bodies are struggling.
RED-S can lead to chronic fatigue, frequent injuries, poor concentration, hormonal dysfunction, weakened immunity, stress fractures, and long-term cardiovascular complications. For female athletes specifically, missed or irregular menstrual cycles can be a serious sign that the body is under significant stress.
For more on RED-S: https://www.childrenshospital.org/conditions-treatments/reds
Building Trust in Therapy with an Athlete Specialist
Athletes who feel psychologically safe, respected, and valued beyond performance outcomes are more likely to seek help early. Ultimately, they are able to work toward healthier relationships with food and exercise. This is why working with an eating disorder therapist for athletes can make a critical difference.
A specialist who works specifically with athletes and eating disorders can recognize these patterns and help you build a healthier relationship with food. Athlete specialists understand the unique culture of sports. They recognize how competitive environments can contribute to eating disorder symptoms. Therapy becomes a space where athletes do not have to explain the pressure to perform, earn playing time, maintain scholarships, or meet unrealistic body expectations.
An athlete-informed eating disorder specialist understands the intersection of performance, identity, nutrition, and mental health. Rather than focusing on weight or appearance, they help athletes rebuild trust with their bodies while supporting both recovery and sustainable performance.
These specialists can help runners:
Identify early signs of disordered eating or RED-S
Develop healthier fueling habits for training and recovery
Address perfectionism, anxiety, and body image concerns
Separate self-worth from performance metrics
Navigate pressure from sport culture and social media
Create balanced relationships with exercise and competition
Lastly, an eating disorder therapist for athletes understands that long-term recovery does not mean giving up sport. With proper treatment and support, many athletes are able to continue competing safely while improving both mental and physical health.
As awareness grows, there is an opportunity to reshape running culture into one that prioritizes sustainable health alongside achievement. The goal should not be faster athletes, but healthier ones.
References
Anderson, L., et al. (2016). Running to win or to be thin? An evaluation of body dissatisfaction and eating disorder symptoms among adult runners. Body Image, 17, 43–47.
DiLodovico, L., Dubertret, C., & Ameller, A. (2018). Vulnerability to exercise addiction, socio-demographic, behavioral, and psychological characteristics of runners at risk for eating disorders. Comprehensive Psychiatry, 81, 48–52.
Halbeisen, G., Brandt, G., & Paslakis, G. (2022). A plea for diversity in eating disorders research. Frontiers in Psychiatry, 13.
Hulley, A. J., & Hill, A. J. (2001). Eating disorders and health in elite women distance runners. International Journal of Eating Disorders, 30(3), 312–317.
Other Mental Health Services Offered in PA, NJ, DE, SC, MD, CT, VT, and FL
We offer a wide variety of services related to eating disorder recovery including trauma therapy! We offer Weekly Support Groups, Nutrition Services, and Family and Parent Therapy as well as Coaching, all tailored to meet the specific needs of the individual. We offer our services for Anorexia, Bulimia, Binge Eating, and Orthorexia as well as Maternal Mental Health, and eating disorder therapy for athletes online in New Jersey, Delaware, South Carolina, Maryland, Florida, Vermont, and Connecticut! We are here to offer our support and understanding in a safe and non-judgmental environment.
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Recovered and Restored is an eating disorder therapy center founded by Gabrielle Morreale, LPC. We specialize in helping teens and young women heal from eating disorders such as anorexia, bulimia, orthorexia, and binge eating disorder and treat disordered eating, anxiety, depression, and PTSD. We provide eating disorder therapy in PA in the towns of Horsham, Upper Gwynedd, Lower Gwynedd, North Wales, Lansdale, Hatfield, Blue Bell, Doylestown, and nearby towns with eating disorder therapy. Also providing virtual eating disorder therapy in New Jersey, Delaware, and Florida. Some towns served virtually include but are not limited to Pittsburgh, Lancaster, Harrisburg, Center City, Cherry Hill, Haddonfield, Mount Laurel, Cape May, Avalon, Brick, Dover, New Castle, Bethany Beach, Marydel, and Oceanview
About the Author
Eating Disorder, OCD, and Anxiety Therapist, Athlete Specialist
Cara is a HAES-aligned (Health At Every Size) provider and utilizes cognitive-behavioral, existential, gestalt, and person-centered theoretical models in therapy. She believes in exploring the deeper meaning in people’s lives and helping clients foster purpose-filled lives that are aligned with their values and goals. She believes in meeting clients where they are and walking alongside them in their journeys with unconditional positive regard, authenticity, empathy, and a touch of humor!
Cara’s interests are spread equally between both mental health and athletics. She has a deep love for sports and has worked with athletes from all walks of life as a therapist, student-athlete coordinator, and lacrosse coach. She also is and ice-skater and has grown a passion for it as an adult. She has extensive experience working as an eating disorder therapist in a partial hospitalization facility treating anxiety, depression, trauma, attachment concerns, and relational disconnection. She is a graduate of the University of Pennsylvania’s counseling dual master’s program. She is a licensed professional counselor and nationally certified counselor. To combine her love for both sports and well-being, she completed a degree in Sports Administration this spring through Boston College!
Cara enjoys any and all sports, especially lacrosse, swimming, and ice skating. You can find her reading, crafting, visiting National Parks, creating curated Spotify playlists, or doing outdoor activities like kayaking/hiking. Additionally, she recently picked up Italian lessons!
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