Coaches, parents and trainers should be alert to behaviors like eating alone, trips to the bathroom during or after meals, and the use of laxatives. Other signs and symptoms of the female athlete triad may include fatigue, anemia, depression, cold intolerance, and eroded tooth enamel from frequent vomiting. Associated problems with extreme and prolonged weight loss include disturbances of the cardiovascular, endocrine, and gastrointestinal systems, disruption of temperature regulation, psychological sequelae, and irreversible bone loss. The bolemic athlete engages in binge eating and forces purging either with vomiting or with laxatives. These athletes may engage in excessive exercise or fasting due to a morbid fear of gaining weight.
Athletic performance tends to fluctuate dramatically.
Suicide attempts are common with this disorder. Menstruation can be delayed or disrupted as part of the female triad. Poor nutrition from eating disorders, and excessive exercise contribute to this problem. Decreased estrogen associated with amenorrhea, along with decreased calcium intake from eating disorders leads to decreased mineralization of bone. This can increase the risk of stress fractures in these athletes.