ED & Dance: Interview with a professional dancer and ED specialist

Why do eating disorders seem to go hand in hand with dance? It’s almost a cliche. You see it in movies and on TV all the time (I’m looking at you, Center Stage, Black Swan, and Flesh & Bone). And whether or not these productions portray ED in a helpful way (spoiler alert: they don’t), we all know that ED struggles are common in the dance community. A meta-analysis from 2013 found that the overall prevalence of ED among dancers is 12% (and 16.4% for ballet dancers). The study concluded that dancers are 3x more likely to develop an eating disorder than the general population. So yeah, there’s a reason the cliche exists. 

I really wanted to speak with someone who could offer a real-life account of how disordered eating develops among dancers. And I found the PERFECT person - Alexa Shank, LPC Intern. Alexa is a good friend of mine - but I didn’t learn until well after we met that she danced professionally.

Alexa has your standard perfectionist’s resume: she began dancing at the age of 3 and took everything from hip-hop to ballet. She trained and competed with both her dance studio AND her high school drill team. She was captain of the drill team her senior year, and after graduating danced for the Austin Toros and San Antonio Spurs. She only retired from dance to attend graduate school, and she’s now a therapist specializing in ED recovery. She told me that feeling the incredible pressure to be thin as a dancer encouraged her to specialize in ED treatment.

Alexa was kind enough to let me interview her and she has some incredible insights into the issue of ED and dance. We had the LONGEST conversation about this topic, and somehow I managed to condense her words of wisdom into 4  points. 

1. The dislike of your body begins YOUNG and before most kids know what eating disorders are:

Alexa told me she started to notice body image issues in middle school:

Alexa: Because you spend so much time looking at yourself in the mirror, people would body check a lot. You would see people touching their stomachs or putting their hands around their arms. I would hear people say things like, "I look really fat in this leotard." And the one thing I remember distinctly is when they would measure you for costumes. It would be written down on a piece of paper what your bust size was, your waist, your hips, etc. And I remember people starting to look at each other's measurements and make comments to each other like, "my chest is 2 inches bigger than last year," or "my hips were measured and they are so big!" 

She explained that dancers are not educated on ED prevention. Which means that when disordered eating begins, people don’t always notice.  

Alexa: One of my good friends who I grew up dancing with - she was always really small... And then I started spending more time with her outside of dance and I began to notice things. Like she would take an exceptionally long amount of time to eat. And she would cut food into little pieces and nibble on crackers. And I thought it was bizarre. But it wasn't until years later that I understood what she was doing. I remember realizing when I was 15 or 16 that something wasn't right and there was an eating problem going on. And I remember thinking, why doesn't anyone help her? Why doesn't anyone say anything? But I never did.

Alexa expressed that looking back, she wished she would have said something to her friend. But at that age, she didn’t know what to say. Almost no one ever does. When I asked Alexa about her own struggles with body image, she told me she did go through a phase of disordered eating:

Alexa: When I was a sophomore I auditioned to be a captain. It was super competitive and I didn't make it my first year. I got focused on why I didn't make it, what I could do better, and how I could fix myself in every way possible so I could make it next time. Through that, I felt like I became extra perfectionistic. I wanted to control everything. And it was too much. I thought, “if I can't be a good enough dancer to be captain, then I'm going to be the best in everything else I can be.”

got really depressed and lost some weight. And my dance coach commented on it saying, "wow you look really great! I wish I could do that!" and I remember thinking, "OK, well I guess I better not gain this back. I guess I didn't look as great before.” I did gain the weight back. But I remember looking at pictures and thinking, "what if they thought I looked better when I lost the weight? Or what if I looked bad before and they just never told me!" 

Alexa explained that learning self-compassion is what protected her from developing a full eating disorder. She discussed how her mom normalized food and encouraged her to not fear “fun” foods. Her mom also gave what I think is the best statement you could provide a perfectionistic dancer: “It’s OK. You don’t have to be perfect.”  Her parents also helped her find a good therapist who could support her.

2. Achievement won't take away the fear of failure

I was hugely interested in learning about dance competitions and auditions. When you audition or compete, you’re literally inviting judgment and criticism from others. That’s terrifying for anyone. But when you combine it with a dancer’s perfectionism, it creates an… intense environment. 
 
She described competitions as stressful and overwhelming. She discussed the incredible amount of preparation it takes to get ready for a competition, as well as the behind the scenes strategery to place dancers in categories with the highest chances of winning. Backstage meltdowns were apparently commonplace. And girls grow up competing against the same dancers again and again. So it’s like you have some unspoken adversary you go up against every season. But these stressors aren’t really acknowledged. Sure, everyone is aware of them. But stress, criticism, and perfectionism are ingrained in dance culture. And as intense as these competitions seem, the audition process for the Spurs seems terrifying.

Alexa: For auditions, they would place you with someone who looked like you (or had a similar dancing style to you) to see if one of you was better than the other. Because they didn't think it was worth taking both of you if one was better than the other. And when you're accepted, it's only for one year. So everyone has to re-audition each year.

It (was) the scariest experience of my entire life. Like, my parents have watched me dance since I was a little kid. They've seen crappy dances and great dances. And when I auditioned for the Spurs, for the final round you perform at Cowboy's Dance Hall in front of whoever wants to come. And I asked my parents not to come. I told them, ”I don't want you to watch me in case I don't make it. I don't want to be seen." And I think that illustrates the pressure. I didn't want to have my performance viewed if I did not make it. I didn't tell anyone other than my friends and family I was auditioning. Because if you don't make it, all those people are going to know. I would rather withhold the possibility that I might make it than have to tell you I didn't. 

We discussed how the fear of failure contributes to both shame and black & white thinking. If you win the competition or get the spot on the team, you’re OK. You can share your experience with others. But if you don’t, it feels shameful. And no one wants to share their experience as the girl who got cut.

You may think this criticism, shame, and fear of failure would contribute to difficult relationships among dancers. (Full disclosure: I was really hoping Alexa would share insane stories of backstage sabotage), but she reported the exact opposite. She described her fellow dancers as supportive and kind. They took care of each other and were the only ones who fully understood how badly it hurts when your dance doesn’t work out the way you want it to. That judgment was always directed inwards on the self, not toward your fellow dancer.

3. ED behaviors are often covert among professional dancers

Alexa: I would say, at that level, because we were dancing so much, I didn't see a lot of starvation or overt behaviors. It was little-disordered behaviors. For example, people would often talk about what diuretic they would use before a performance or they would talk about how they were eating very clean before auditions or performances. They would eat as little as possible before the performance, and after the performance, you'd hear them talk about going out to eat or getting fast food. Almost binging because they were so hungry. 

These disordered eating practices make sense when you consider that anyone outside of the narrow range of acceptable body sizes will be scrutinized. 

Alexa: One time when I was [in college], I could tell my body was bigger than normal. I figured my body would return to its normal weight on its own. But I was told I needed to lose weight and get in shape, otherwise, I would be cut from the dances. I was told this at a performance! I was upset this didn't happen one-on-one. People were around and I wondered if my teammates overheard. And I think my initial thought was just terror. The opposite side of the coin is another time I had lost weight just by pure accident. And I was told I needed to be careful to not lose more weight because they didn't want me to look gross. 

I want to clarify that professional dancers can and do develop full eating disorders. However, covert behaviors like obsessive clean eating or diuretic use were more common in Alexa's experience.

4. Alexa’s advice for dancers struggling with ED

Alexa: If you are worried about what you're eating or struggling with the idea of dieting, having a dietitian or a meal plan is so helpful. Sometimes it's hard to know what to eat or how much you should eat. And there's not a lot of education about that (in the dance community). So there's this idea that you can't have the "fun stuff." But I think dancers should know that if you incorporate fun foods on a regular basis, you're less likely to binge. And there needs to be education around that. All of dance is so focused on fitness, but none of it actually gives you accurate information about nutrition. It's all myths, what you hear on TV, and what's popular. So you get a lot of mixed messages. 

I asked for Alexa’s thoughts on whether pro dancers with eating disorders can continue to dance while in recovery. Here’s what she had to say:

Alexa: If that person is dedicated to the idea of recovery and is putting as much effort into it as they can while dancing, you can consider letting them continue. They have to be constantly medically monitored by someone who is experienced in ED - not just a regular PCP. You need someone who can take blood work regularly and monitor their heart. And they need medical clearance from that person before dancing. 

My last question to Alexa was this: If you could change one thing about the dance community, what would it be? 

Alexa: There needs to be more education and resources available for all foods fit and intuitive eating so distorted beliefs about food and exercise can be challenged early on. I think this would help normalize a lot of distorted behaviors and eating patterns. I believe the dance world has started to be more accepting of different sizes, but I think there needs to be a bigger movement to accept a greater diversity of sizes, weights, heights, etc. in what a dancer can look like.

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