Musicians and Eating Disorders

Vol. 31 / No. 1 — Eating Disorders Review

A recent study shows perfectionism is one underlying factor.

Karen Carpenter is one of the best-known pop singers to have been overcome by longtime anorexia nervosa, and her death at age 32, in 1983, shocked most fans worldwide. Other well-known actresses and singers, such as Jane Fonda, Britney Spears, Elton John, and Lady Gaga, are just a few of the many celebrities who report having dealt with bulimia nervosa.

A recent report from London has shown that eating disorders are surprisingly common among musicians. The key elements increasing risk could be: perfectionism, stress, anxiety, and depression—all components of performing before a live audience (Eat Weight Disord. 2019; 24:54).

Drs. Marianna E. Kapsetaki and Charlie Easmon of Imperial College London and University College London investigated eating disorders among 303 musicians.  The authors had noted that eating disorders are not uncommon among performing artists and hypothesized that eating disorders would have a high prevalence among musicians. The authors sought to pinpoint factors that might be involved, including the type of music, the musician’s income, the stage in his or her career, the time of year, their age, gender, and risk factors, such as parental or peer pressure, social isolation, and perfectionism. They wanted to see if musicians believed eating disorders affected performance and diet, and if the musicians used any particular foods or substances to enhance their performance.

The participants were females and males 18 years of age or older, at all stages in their musical careers. They were asked about any eating disorders in the past, and current eating disorders. General mental health was assessed with the Depression Anxiety Stress Scale(DASS-21).  Body mass index was calculated from self-reported height and weight. All the questions were uploaded on UCL Opinio 7.3online survey software in English, and the survey was then sent worldwide to the musicians.

Musicians in every type of music were affected

A total of 119 males and 182 females participated, and the median age was 27 years. All types of music were represented, from classical to pop, folk, and rock.  Of the participants, 83% were instrumentalists, 31% were singers, 5% were composers, 2% were musicologists, 2% were conductors; and 2% described themselves as “other.” The EDE-Q Global Score (EDE-QGS)showed pathological values in 19% of the musicians, and when asked about lifetime history of an eating disorder, 32% of the participants answered positively. EDE-Q subscale scores were in the pathologic range in 13% to 35% of participants, with the highest percentage being seen on the shape concern subscale.

The authors noted that most of the participants spent much time traveling within one country (85%) versus traveling overseas. Most reported that their eating habits did not affect either their career or their performance; however, some reported that their career affected their eating habits—many reported that they would change their diet if they had higher incomes and about 20% were dependent on or addicted to certain food or drinks, usually caffeine-containing drinks.                      

Pinpointing possible risk factors

Music students, professional musicians, soloists and musicians who traveled overseas had a higher percentage of pathological scores on the EDE-QGSand there was a positive correlation between scores on the EDE-QGSand risk factors of perfectionism, depression, anxiety, stress, peer pressure, and social isolation. There was added stress when an individual was a soloist compared to singing or playing in a small or large group.

The authors note that an increased prevalence of eating disorders among musicians could be due to increased levels of perfectionism (especially in classical or professional musicians) because their goal is to perform perfectly.  The authors also suggest that one reason singers report more eating disorders than do instrumentalists is that there is an ambivalent association with their primary instrument, that is, their bodies make the music.

It is common to think that certain groups are at high risk for eating disorders; endurance athletes or dancers come to mind.  This study suggests that musicians are at similarly elevated risk.