It’s not like Courtney Schrey wanted to go to the hospital — again.

But since 1999, complications from anorexia nervosa have sent the Northwestern cheerleader to in-patient care five times. Since then she’s seen more of the country than she would have liked, transferring from Boston University to Illinois-Chicago before finally settling in at NU two years ago.

Settling in, that is, until she was hospitalized once more last year.

‘ULTRA-COMPETITIVE BY NATURE’

All college students can relate to the pressure of a packed class schedule, but few students have the added pressure of facing thousands of fans while flying through the air clad in little more than a form-fitting top and pleated mini-skirt. Although Schrey spends hours lifting weights, getting tossed around and tumbling, these are relatively minor strains. The real stress comes with every home men’s basketball and football game.

To a degree every student athlete faces Schrey’s twin burdens of raised expectations and increased visibility. While some collegiate athletes thrive in the spotlight, the constant drive to succeed can prove overwhelming.

“Athletes are constantly expected to perform at a high level, and that makes them vulnerable to many things,” said Dr. Robyn Ross, Chairman of the Board and President of the Chicago chapter of the National Association of Anorexia Nervosa and Associated Disorders.

Chief among these vulnerabilities are hidden feelings of inadequacy, which student-athletes combat with a variety of healthy and unhealthy coping mechanisms, Ross said. Some of the most unhealthy methods are eating disorders — like anorexia, which is characterized by a severe and unhealthy restriction of caloric intake, as well as bulimia, a cycle of binges and purges.

Those familiar with eating disorders say they are, by their very nature, competitive. The desire to be the skinniest or to lose the most weight in the shortest period of time, is a huge psychological factor that can predispose athletes to develop anorexia or bulimia.

“Often an athlete’s competitive make-up challenges them to be the best — at everything,” said Tory Lindley, Northwestern Director of Sports Medicine.

The push to win at all costs and the pressure that goes with it puts collegiate athletes at a greater risk of acquiring an eating disorder, Ross said. Schrey added that she sees a link between the fire that drives her to achieve cheerleading glory, yet simultaneously fuels her crusade to shed pounds.

“I definitely think my mentality made me more susceptible to it,” Schrey said. “I am ultra-competitive by nature.”

That competitive make-up can prove deadly when the athletes feel a need to lose weight, especially if they think it can push them to greater excellence in competition. Coaches, who are often perfectionists themselves and are paid to get the most out of their athletes, can exacerbate the problem.

While Schrey cites her own exacting standards as the primary origin of the eating disorder that took over her life five years ago, she recalls that her high school gymnastics coach constantly pushed girls on the team to lose weight. After an injury sidelined Schrey during her junior year, that innocent suggestion to lose a little weight became her fixation and her quest.

The most at-risk sports are those that favor an athlete who maintains a certain weight or body type. The need to “make weight” often places an inordinate focus on food and body image, the type of undue focus that can lead to an obsession. Gymnastics, along with wrestling, cross-country, track and cheerleading are the sports with the highest rates of “disordered” eating among its participants. But Ross said she also has treated football players from Northwestern.

“It happens,” said Ross, who has treated about 20 NU athletes during the past decade. “The incidence is not quite as high (as in other sports), but it’s rising for sports in which speed is a factor.”

HELP TOWARD RECOVERY

NU has done its part to try and combat the higher incidence of eating disorders in college athletics. Lindley referred to the problem as “an issue that exists for student-athletes,” and noted NU’s lack of weight limits for its cheerleading squad, which is in stark contrast to most elite programs. Although weigh-ins in wrestling remain necessary because of strict NCAA weight classes, a member of the NU training staff is present at every weigh-in, and coaches are not allowed to participate, Lindley said.

Besides shifting the emphasis of such sports away from weight, the university also requires all incoming female athletes to attend an annual presentation on eating disorders that features a dietician and survivors. NU’s policies put the athletes’ health above competition.

Despite clearly showing the necessary skills to make the cheerleading team two years ago, NU doctors refused to clear Schrey to participate, citing her poor bone-density as well as her low weight. Now, in conjunction with a private therapist who can “yank” her off the squad any time he believes cheerleading might jeopardize her health, NU’s scrutiny pushes Schrey to maintain healthy behaviors.

In some respects, sports have aided her recovery as much as they contributed to the initial onset of the disease.

“I guess cheerleading is a motivation for me, I knew that if I lost weight I wouldn’t be allowed on the team,” Schrey said.

Mara Schieber, an eating disorder specialist with 25 years of experience treating mental health patients, said she agrees that sports have the power to encourage an athlete with an eating disorder to achieve some sort of recovery and prevent relapses.

“I’ve often seen people who use sports as a motivation for recovery,” said Schieber, a clinical psychologist at Highland Park (Ill.) Hospital.

Recovery, however, is hardly a black-and-white process. Relapses are comMonday, and patients usually continue out-patient therapy for years after physical recovery is complete. None of the NU athletes whom Ross currently treats would release their names.

Although most experts in the field acknowledge the rise in eating disorders among elite collegiate athletes, others have rejected the idea that student-athletes are at greater risk than the average undergraduate. Researchers at Toronto General Hospital and York University in Toronto have published a study indicating that “there is little valid support for the theory that athletes with eating disorders are psychologically different from their non-athlete counterparts.”

While no consensus has emerged, sports-medicine professionals like Lindley and Ross have had to accomodate a rising number of patients with eating disorders.

For athletes like Schrey, statistics don’t count for much. She practices four days a week, goes to class five days a week and struggles with anorexia every single day. No, make that every single meal.