Eating disorders (ED) are prevalent mental health conditions that significantly threaten the physical and psychological well-being of female athletes. The risk of ED is driven by the interplay of multiple factors, including sport-specific training environments, psychological vulnerabilities, and sociocultural pressures. Although existing research has identified several independent risk factors, a systematic understanding of the sport-related psychosocial mechanisms remains insufficient. This study aims to synthesize empirical evidence from the past five years to elucidate the multidimensional pathways of ED in female athletes, with a particular focus on intervention targets from a sport psychology perspective. A systematic literature review was conducted, retrieving English and Chinese articles published between 2017 and 2023 from databases such as PubMed, Web of Science, and CNKI. A total of 30 empirical and review studies exploring the influencing factors of ED in female athletes were included. Thematic analysis was employed to extract key evidence across five dimensions: sports training environment, dietary behavior patterns, self-body-image perception, psychosocial mechanisms, and exposure to online media. 1) Sport Training Environment: Athletes in lean sports exhibit higher ED risks. Elite athletes face coach-driven body image pressures and competitive comparisons, while adolescents are more vulnerable due to sport-related pressures and low body image. 2) Dietary Behavior Patterns: Excessive pursuit of "healthy eating" or strict dietary restrictions exacerbate nutritional imbalances and self-punitive eating. Skipping meals and insufficient supplementation further increase risks. 3) Self-Body Image Perception: Over 25% of female athletes display irrational body dissatisfaction, particularly in aesthetic sports like ballet and gymnastics. 4) Psychosocial Mechanisms: Negative emotions and externally driven motivations (e.g., pleasing coaches, competitive goals) correlate with ED risk, while intrinsic motivation (e.g., self-enjoyment) protects high-intensity athletes. Exercise addiction indirectly triggers ED through motivational biases. 5) Online Media Exposure: "Thin-idealized" social media content heightens body comparison anxiety, with adolescents more prone to ED risk cycles due to frequent online interactions and reduced self-esteem. Eating disorders in female athletes result from the interaction between sport-related psychosocial mechanisms and environmental pressures. Recommendations include screening motivation types to enhance intrinsic motivation and emotional management, standardizing coach evaluations of body weight, restricting harmful body image promotion on social media, and developing integrated sport medicine and psychology prevention guidelines for aesthetic sports. Future research should validate sport psychology intervention tools and explore digital health information regulation pathways.
Zhao et al. (Thu,) studied this question.