Health & Body

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."

The Conversation
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Sin #2: Misaligning the spine. Photo by Erin Baiano

Throughout your dancing life, you've heard the same corrections over and over. The reason for the repetition? Dancers tend to make the same errors, sometimes with catastrophic results. Dance Magazine spoke to eight teachers about what they perceive to be the worst habits—the ones that will destroy a dancer's technique—and what can be done to reverse the damage.


Rolling In

To get a 180-degree first position, dancers will sometimes let their arches roll forward. But turnout is not about forcing your feet open; it's about opening up in the hips. “Turning out is an activity, not a position," says Irene Dowd, who teaches anatomy at the Juilliard School. “If we stop sustaining that movement, our feet will passively roll in." Rolling in places stress on the tendons of the feet and leads to injury because the rest of the body compensates for the imbalance when your knees can't line up over your toes.

Dowd warns against using only the arch to combat rolling in. “Dancers will try to lift up their arches and pull up on the inside of the ankle," she says. This can result in the inflammation of the tendons in the ankle and lead to tendinitis, a painful overuse injury that's common in dancers. What she feels are “Victorian furniture feet—feet that aren't fully in contact with the ground" should be solid in three areas: the heel, the ball of the big toe, and the ball of the little toe. Imagine how your weight is being transferred from above, through the body and down the legs, rather than gripping the foot and lifting from the arch.

Misaligning the Spine

Distorting the back, either by crunching the lumbar vertebrae and splaying the rib cage open or by hunching the shoulders forward and tucking the pelvis under, affects every other part of the body. Since the proper placement of the torso is the foundation of any movement, a dancer with a misaligned spine will develop other deadly technique sins. Problems can ripple all the way down to the extremities and upward to the neck and head. The core will be loose, unable to provide essential support. A pelvis that either tips back or tucks under will limit the range of motion in the hips.

Christine Spizzo's students at the North Carolina School of the Arts constantly work on their placement. “The one directive I give in class more than any other," she says, “is tailbone down, navel muscles lifted." She emphasizes that the tailbone lengthens downward without tucking under, and the navel muscles lift upward, not inward. This opposition allows the external rotator muscles to be actively engaged at the top of the thigh. Spizzo uses the expression the Four Ts—“no tucking, tipping, tilting, or twisting of the pelvis"—as a reminder for students.

Clenching the Toes

Clenching, curling, knuckling—no matter what it's called, this condition hampers a dancer's ability to articulate the feet. Clenched toes also make the feet an unstable platform to stand on, creating problems for the rest of the body. The muscles and tendons of the foot, knee, and ankle must work together to perform a relevé or jump, says Edward Ellison, director of Ellison Ballet Professional Training Program in New York. Clenched toes will place unwanted stress on the joints of the legs, leading to imbalance and overuse injuries. On pointe, knuckling over can damage the bones and tendons of the feet.

Master ballet teacher Sara Neece of Ballet Arts in New York says that when the first joint of the toe presses down into the floor too hard, the second joint of the toe jams into the metatarsal. For Neece, the key to remedying clenched toes lies in “bringing sensation to those unused tendons" beneath the second joint, and teaching the toes how to work in a careful and deliberate manner. While seated, a dancer should prick the back of each clenched toe with a fingernail about 20 times. Sitting on a chair with the foot on the ground, she should drag it back toward the body, slowly raising it to demi-pointe with a forced arch. Teachers must pay attention to the response of the feet to this localized work, since overstressing the tendons can damage them. Another way to teach the toes to stretch out is to weave a strip of cloth over the second toe and alternate below and above successive toes, leaving it there during barrework and nondance activities.

Giving In to Extreme Hyperextension

Hyperextended legs, in which the straightened knee naturally curves behind the thigh and calf muscles, are prized in the world of extreme ballet bodies. Christine Spizzo sings the praise of a moderately hyperextended leg line, as the leg fits snugly in fifth position, and the arabesque looks gorgeous, with that slight curve offsetting the arch of the foot. However, dancers with extreme hyperextension must take special care. “The hyperextended dancer tends to have weak external rotator muscles," she says, so the legs are more prone to collapse in on themselves when landing from a jump, letting the body weight fall on the knees. This can result in damage to the joints that maintain the alignment of the leg, including twisted knees and sprained ankles. Even if the dancer understands how to avoid giving in to her hyperextension, she has to learn how to express herself fully while restraining her legs.

But Spizzo points to dancers such as international star Sylvie Guillem, who has used her extreme hyperextension to her advantage. The dancer must think of lengthening rather than straightening or locking the knee, even if it feels slightly bent. She must develop a heightened awareness of the turnout muscles from the top of the thigh down to the calf. “The muscles must be activated to not allow the dancer to give in to the hyperextension," says Spizzo. She uses the image of the barbershop pole to encourage dancers to apply that feeling of an infinite spiral to their legs. Somatic practices such as Pilates can help to strengthen those stabilizing turnout muscles. Spizzo insists that dancers stand with the heels together in first position and never be allowed to press back into that knee joint. To do this, “the quadriceps must remain soft. As soon as you grip, it pulls that kneecap back dangerously."

Using Unnecessary Tension

“Tension," says Daniel Lewis, dean of dance at the New World School of the Arts, “pulls you off balance. It tightens the muscles and causes injury." Stiff muscles are injury-prone muscles, which make free and confident movement impossible.

Unwanted stiffness can also limit your versatility as a dancer. “Modern dance is concerned with trying to go into space off-center and off-balance," says Mary Cochran, chair of the dance department at Barnard College. “If you spend too much time holding your body stiffly, it's hard to make the transition from working in-balance to working off-balance."

Rhythmic breathing helps dissipate tension. Think of the lungs as another limb and pace the breath with the dynamics of the music. Sustain a sense of motion in the body, even when you are still, advises Cochran. Doing so will help reverse the muscle memory of using tension as a form of stability.

Pinching Your Shoulder Blades

Although used as a strategy to open the chest in front, pinching your shoulder blades together immobilizes the back. The serratus anterior on the sides of your rib cage is so overstretched that it can't work. Edward Ellison says that pinched shoulder blades impede the freedom of the arms and the support of the upper spine. He feels that they “cause your weight to fall behind your axis, and strain the trapezius and rhomboid muscles of the back."

Irene Dowd suggests thinking about widening the tips of the shoulders to the side, to allow plenty of room for the chest. “It helps to think about the chest—full of your lungs, your heart, all those organs—as a sphere," says Dowd. “We need to have enough room for all those precious organs to breathe." To relax shoulder blades, sometimes she will tell students to focus on the movement of the hands. “Is the hand really a lively part of my being?" Dowd has her students ask. “The shoulder blade should support that hand."

Getting Stuck in a Rut

While physical habits impede progress, the deadliest sin is losing the drive to improve technique at all. Franco De Vita, principal of American Ballet Theatre's Jacqueline Kennedy Onassis School, says good technique begins with a dancer's approach to class. Being present and focused enables the dancer to learn combinations quickly—and correctly. “Not listening and changing the exercise is unacceptable," says De Vita.

Michael Vernon, chair of the ballet department at Indiana University, feels the worst thing a dancer can do “is to get fixed into doing something a certain way, being safe. I love young dancers who understand that you have to dance for tomorrow, and not yesterday." Keeping an open mind means more than just trying a different preparation for a pirouette. “Being open to new styles of dance and new ways of moving the body is vital to keeping the art relevant."

Rant & Rave
Matthew Murphy

I write this letter knowing full well and first-hand the financial challenges of running an arts organization. I also write this letter on behalf of dancers auditioning for your companies. Lastly, I write this letter as a member of society at large and as someone who cares deeply about the culture we are leading and the climate we create in the performing arts.

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"When I started out, I wanted to be a Fred Astaire," he told us, "and after that a Jerome Robbins. But then I realized there was always somebody a dancer or choreographer had to take orders from. So I decided I wanted to become a director, namely a George Abbott. But as I got older I dropped the hero-worship thing. I didn't want to emulate anyone. Just wanted to do the things I was capable of doing—and have some fun doing them. By this time I'm glad I didn't turn out to be an Astaire, a Robbins or an Abbott." He would go on to become an Academy Award–winning director, indelibly changing musical theater in the process.

The Creative Process
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Dance Magazine recently asked him about how he got this career, and what it takes to thrive in it.

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Health & Body
Leon Liu/Unsplash

Let's say that today you're having a terrible time following your class's choreography and are feeling ashamed—you're always stumbling a few beats behind. Do you:

1. Admit it's your fault because you didn't study the steps last night? Tonight you'll nail them down.
2. Feel worthless and alone? You slump your shoulders, avoid eye contact with your teacher and fellow dancers, and wish to disappear.

Shame is a natural emotion that everyone occasionally feels. If you answered #1, it may be appropriate—you earned it by not studying—and positive if it motivates you to do better in the future.

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My hypermobility used to cause me a lot of trouble, but I've gained confidence and strength after reading about it in one of your columns. I now have a Pilates instructor who's retraining my body and helping me dance in a consistent way. Thank you!

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