Disentanglement: Healing from Overtraining and Undereating

By Ingrid Worth

Edited by Pat Melgares

Third in a three part series


"From my perspective, my disordered behaviors had pushed me to run faster than I'd ever imagined and helped me to garner medals and accolades. I was terrified that, by changing my behaviors, I would lose everything. All I could see was what my rigid behaviors had given me, not all the joy they'd stolen from me."


Editor's note: Ingrid Worth was a cross country and track and field standout for Shawnee Mission East from 2014-2018. In 2017, she was the Sunflower League and regional champion in the 3200 meter run, before placing third at the Kansas state meet. In this three-part series, Worth talks about her struggles with an eating disorder, eventually leading to a condition known as Relative Energy Deficit in Sport, RED-S. After a year running at Carleton College in 2018-19, Worth sat out the 2019-2020 season to seek treatment, aided by a registered dietician and a disorder specialist. The first article in the series published on June 3; and the second article published on June 10.


As a runner, I am accustomed to pain and hardship. I've endured excruciating workouts, raced in the heat and the snow, and dealt with painful injuries. Yet, nothing has been more difficult, complex, or demanding than recovering from an eating disorder.

When I went to therapy for the first time almost three years ago, I thought that recovering from my eating disorder would be like recovering from a minor injury -- quick and relatively straightforward. I thought that after a few therapy sessions and appointments with a dietician, everything would go back to normal.

I couldn't have been more wrong.

My first therapy sessions were disastrous, mostly because I thought I was perfectly fine, but also because -- as crazy as it sounds -- a small part of me didn't want to get better.

From my perspective, my disordered behaviors had pushed me to run faster than I'd ever imagined and helped me to garner medals and accolades. I was terrified that, by changing my behaviors, I would lose everything. All I could see was what my rigid behaviors had given me, not all the joy they'd stolen from me.

To some extent, I also thought that if I refused to acknowledge my eating disorder, then it would disappear. In reality, eating disorders thrive in the darkness of silence and isolation. When I stopped therapy after only a couple months, I quickly returned to my disordered behaviors.

It wasn't until I returned to therapy last year that I began to fully understand the process of recovery. There wouldn't be a speedy, straightforward fix for my eating disorder. In order to truly live a full life, I needed to begin the slow and arduous process of disentangling myself from my disordered behaviors, a task that initially seemed impossible.

I had been living with an eating disorder for so long that I wasn't even sure which parts of myself were driven by the eating disorder and which were my own, authentic personality traits. For example, I wasn't sure whether my love of running stemmed from the act of running itself or the number of calories I burned while running.

I knew that I would never be able to untangle and analyze my behaviors on my own, yet I was reluctant to start treatment. I mistakenly believed that asking for help was a sign of weakness, but I have since learned that asking for and accepting help takes immense strength and courage.

So, warily and with a lot of support from my family, I began an intensive outpatient (IOP) program that met three times a week. I also regularly met with a multidisciplinary "treatment team" composed of a therapist, dietician, and medical doctor which, according to a paper by Katherine A. Halmi, M.D., provides the most effective care for those with eating disorders.

I have always taken pride in my independence and ability to overcome obstacles on my own, so it was initially very difficult for me to accept help from so many people. However, recovering from an eating disorder isn't a task that can be undertaken alone, and I quickly realized that every member of my team was crucial to my recovery. Even the group therapy sessions, which I initially despised, became cathartic as I began voicing my true, unfiltered feelings for the first time in years.

When I left the IOP, my only regret was that I hadn't started treatment sooner. According to an article from psychologist Megan Jones, early intervention increases the speed and likelihood of eating disorder recovery.

I began to show signs of an eating disorder in middle school, but it would be another five years before I was officially diagnosed. Throughout high school, my weight stayed within the "normal" range according to the Body Mass Index (BMI) tables on which the medical community places so much emphasis. As a result, my pediatrician assumed I was healthy, even as my period remained absent and I regularly sought weight loss advice.

After a few years of suffering from amenorrhea, I visited an endocrinologist (a hormone specialist) who quickly dismissed my problem as "normal" for an endurance athlete, largely because my weight was "normal."

Both doctors, like many others in the medical community, primarily relied on the scale to measure my health. As a result, my eating disorder went undetected and I became even more certain that I was completely fine.

I do not fault the doctors I visited; the issue is systemic in the medical community. According to an article written by two doctors and published in the American Family Physician journal, more than one half of eating disorder cases go undetected, despite eating disorders being the most common psychiatric problem in young women.

In my opinion, a large part of the problem lies in the focus the medical community places on weight, rather than behaviors. Although I was routinely weighed, I was rarely asked about my rigid behaviors around food, my urges to exercise, my intense fear of weight gain, or my distorted body image, all of which can be used to diagnose an eating disorder, according to a paper published in the medical journal,Mayo Clinic Proceedings.

Rapid weight loss or weight gain may be part of the diagnosis for an eating disorder, but it shouldn't be relied upon to tell the whole story. Although I'm not sure if I would have been honest, I wish health professionals had asked me about my behaviors instead of focusing solely on my weight.

Coaches can also play a crucial role in the detection of eating disorders and RED-S. As outlined by the National Eating Disorder Association (NEDA) in an eating disorder prevention guide for coaches, providing athletes with information regarding these issues can prevent misinformation and challenge unhealthy practices. Although I do not think that my coaches could have prevented my eating disorder, I believe receiving information and openly discussing eating disorders and RED-S would have positively impacted the culture of the entire team.

Both coaches and athletes should also strive to develop a team culture that emphasizes health over performance. Throughout high school and college, I watched helplessly as several of my teammates fell victim to the same disordered behaviors I practiced. So many of them, like me, believed that thinner meant faster and that health was worth sacrificing for fast PRs.

The disordered behaviors and comments from senior and junior team members, myself included, were common. For the culture to become healthier, the self-deprecating comments need to stop.

Instead, teammates should strive to create an open, encouraging space where athletes are valued not for their performances, but for their unique value as individuals. I wish that when I saw other teammates struggling with RED-S or disordered eating, I had talked to them or a coach about my concerns, instead of ignoring the issue altogether.

The link between endurance sports and eating disorders is tight. Just as it took an entire multidisciplinary team to begin to disentangle my true self from my eating disorder, it will take a combination of doctors, coaches, parents, and athletes to unravel the bond between endurance sports and its disordered culture. I firmly believe that the more light that is shed on this issue, the better.

I initially wrote this three-part series as the message my high-school self never received. So, for those, like me, struggling with an eating disorder, know that you are not alone even if you feel like you are.

Please talk to someone -- coaches, parents, mentors, teammates, friends, doctors -- and seek help because from personal experience -- even if you feel invincible right now -- you will eventually crash.

Change is scary, but sometimes it's necessary. Recovery will not be linear; it will take patience and there will be setbacks. However, in the end, a full, healthy life will be more rewarding than any hard-won race or shiny medal.


If you are struggling with an eating disorder and are in need of support, please call the National Eating Disorders Association Helpline at 1-800-931-2237. For a 24-hour crisis line, text "NEDA" to 741741.


NOTE: Information for this article was taken in part from the following sources:

Katherine A. Halmi Treatment Team


Megan Jones Early Intervention


American Family Physician Journal


Mayo Clinic Proceedings


Eating Disorder Guide for Coaches