Abstract

Background: Relative Energy Deficiency in Sport describes a syndrome of impaired health and performance caused by low energy availability (LEA). It has been proposed that psychological factors may precede or result from RED-S, but a continued reliance on objective and physiological markers of LEA has largely neglected the importance of psychological factors underlying recovery from RED-S.
Aim and methods: This integrated methods multiple case-study qualitatively explored female endurance athletes’ psychological experience of recovery from RED-S. Eight female endurance athletes (M age = 29.75 years, SD = 5.03) identifying as ‘in recovery’, or having ‘recovered’ from RED-S, participated in the following tasks: (i) topical life-history interview to elucidate psychological antecedents and consequences of RED-S; (ii) a three-week online diary and one-week PhotoVoice task to capture psychological stressors encountered when managing energy availability; and (iii) a follow-up stimulated recall interview encouraging further reflection on their RED-S ‘recovery’ journey and experience during the study.
Results: Thematic and cross- case analysis generated seven common sources of psychological conflict: body image or weight concerns; eating opportunities; exercise volume; media influences; physiological symptoms of RED-S; social situations; and professional education and advice. Subjective appraisals of, and responses to, these stressors were captured by four themes: in two minds (cognitive appraisals); an emotional rollercoaster (affective appraisals); the only way is through (adaptive behavioural responses); and giving in (maladaptive behavioural responses).
Conclusion: These findings contribute valuable insights into psychological mechanisms underlying efforts to overcome RED-S by highlighting the importance of psychological wellbeing in restoring and maintaining adequate energy availability.