by MaKenna McGough
MaKenna is a rising junior at UNC Chapel Hill and a Morehead-Cain Scholar. She is majoring in Nutrition Health and Society and Medical Anthropology. MaKenna was a 2021 CEED Summer Intern.
At first you might wonder why even ask whether there is an association between eating disorders and concussions? But when you think about the frequency with which athletes experience concussions coupled with the increased risk of eating disorders in athletes, it may make more sense. UNC is world renown for both its eating disorders research and its research on traumatic brain injuries (TBI), so we’re in an excellent environment to explore the question.
When searching the literature that reported on eating disorders (EDs) or disordered eating behaviors after concussions and/or traumatic brain injury (TBI), it was clear that this topic has not received much attention from researchers. Only a few studies were identified. In one pilot study that assessed the prevalence of EDs in patients presenting to a multidisciplinary concussion clinic, results showed that a significant number of females were judged to be at risk for an eating disorder. The study evaluated clinic patients using three questionnaires: the SCOFF ED Screening Tool, the Patient Health Questionnaire (PHQ-9 or PHQ-A for adolescents), and the Generalized Anxiety Disorder 7 (GAD-7). These questionnaires assess disordered eating, depression, and anxiety, respectively. Patients were between 12 and 52 years old and ED behavior was defined as answering “yes” to 1 question on the SCOFF and/or reported poor appetite, weight loss, or overeating on the PHQ.
A total of 22 patients completed the questionnaires and 55% of them were female. The mean age was 20.2 ± 10.4 years. Of these 22 patients, the time elapsed from their concussion ranged from 3 days to less than a year. The causes of their concussion varied from categories of “sport,” “struck,” and “other.” A full 45% of the patients screened positive for ED behavior based on their screening algorithm. They also reported significant associations between positive ED screens and total PHQ-9 scores, GAD-7 scores, and time since injury. No associations with positive screens and age or gender were observed. Although their definition of a positive screen was very broad, the fact that 45% of respondents screened positive suggests that presentation to a concussion clinic might be a reasonable opportunity to screen for EDs, especially in athletes.
Another approach to the question focused on the effect of TBIs on eating behaviors. Overall, the review identified appetite and eating behavior symptoms to be associated with damage to the right frontal and temporal lobe. Also mentioned was a study of 120 TBI patients who were assessed broadly for neuropsychiatric symptoms. These patients showed a wide range of neuropsychiatric symptoms including apathy, irritability, dysphoria/depression, and disinhibition. Notably, 27% of the patients presented with eating disturbances. This review also highlights the importance of screening for changes in appetite and eating behaviors after a TBI. Whether observed changes are directly due to damage to the brain or secondary to depression or psychological effects of the TBI is simply unknown.
Overall, there are limited studies on the correlation between concussions and eating disorders, but further research on this topic is warranted. Due to the significant proportion of females who present to concussion clinics, clinicians should be encouraged to regularly screen for eating disturbances. Not doing so could miss an important opportunity for detection and referral. Especially for female athletes who may hesitate or feel uncomfortable discussing their eating disorders with coaches, an encounter with healthcare professionals who are working with them toward recovery from a TBI may be well-positioned to assist with referring them for specialist care for eating disorders.
References:
Das, A., Elwadhi, D., & Gupta, M. (2017). Secondary eating disorder: A reality? Case report of post brain injury sequelae. Indian Journal of Psychological Medicine, 39(2), 205–208. https://doi.org/10.4103/0253-7176.203112
Emily Sweeney, David R Howell, Corrine N Seehusen, David Tilley & Ellen Casey (2020) Health outcomes among former female collegiate gymnasts: the influence of sport specialization, concussion, and disordered eating. The Physician and Sportsmedicine, DOI: 10.1080/00913847.2020.1850150
Gavi, N., Pearson, R., Bickart, K., Choe, M., Babikian, T., Giza, C. (2020). Eating disorder risk among patients presenting to a specialty concussion clinic. Neurology, S9-S10. DOI: 10.1212/01.wnl.0000719952.81181.73
