Stuhr says the personality traits that make for great athletes – perfectionism and the ability to endure physical pain – also make them most prone to eating disorders.

"They expect the perfect no matter what they think that is," says Stuhr. "And it doesn’t matter if what they are doing is not healthy."

Stuhr often finds a majority of these athletes develop bone fractures.

"Then we ask, ‘is this the result of abnormal stress on healthy bones, or is it the fact that the bone isn’t healthy?’ " she says.

photo: James Madison University

Women athletes who are judged partly on appearance are often prone to the triad.

Athletes most susceptible to the triad often take part in sports in which coaches or athletes think lightness is an advantage, such as long distance running; sports in which athletes are judged partly on appearance, like gymnastics; and sports with weight classifications, such as women’s rowing.

Stuhr says the pressure to be thin for women athletes is real.