Amelia Boone is an attorney and well-known obstacle racer and ultrarunner, with 86,000 Instagram followers. According to her website’s about page, she’s known as “The Queen of Pain.” She’s won multiple world obstacle racing championships.

What her followers didn’t know until recently is that Boone has a 20-year history of anorexia. She discusses her experiences and her decision to seek treatment in a recent blog post, which she also linked to her Instagram account. Her story is like the stories of many athletes. Being in the spotlight, doing activities that focus on body size and fitness, leads to vulnerability to eating disorders, particularly in young athletes.

We can learn a lot from Amelia’s story, including how to support and help athletes who show the signs and symptoms of bulimia nervosa, anorexia, binge eating disorder, and other eating disorders. We can also learn how to get help if we need it ourselves.

Amelia’s Story

Amelia’s decision to seek treatment for her eating disorder was prompted, in part, by her fourth stress fracture in three years. Stress fractures are a complication of a condition called Relative Energy Deficiency in Sport (RED-S). People with RED-S may have low bone mineral density, which can lead to stress fractures.

“I’m not dense,” Boone wrote. “I’ve known for a long time that I’m the living, walking example of RED-S.”

Boone said that she’s sought treatment many times over the years, and she was hoping she could resolve things on her own. She decided she needed help and took a leave of absence to get help.

Seeking help was difficult for Boone, she wrote, because she had spent much of her early life as “the sick girl.” Once she started getting attention for her racing accomplishments, she didn’t want to bring up her past. The past never really left her, though.

“I hung on to disordered thoughts and eating habits,” Boone wrote. “While I had been able to fool myself, the body doesn’t forget so easily.”

Boone had been diagnosed with osteopenia, often a precursor to full-blown osteoporosis, at age 16. As she started getting more frequent bone fractures, she recognized that she needed “plentiful food and nourishment” to heal.

Myths and Misconceptions About Athletes

Boone had bought into some of the myths and misconceptions many people have about athletes.

“It was ok to have a different diet or eating patterns because ‘I was an athlete,’” she wrote. “It was ok to compare my body to other female athletes on the start line and to covet their abs, because that’s just ‘what women do.’”

Although any athlete (and any person) can develop an eating disorder, athletes in sports that emphasize size, weight, and appearance are especially at risk, according to the National Eating Disorder Association. These sports include bodybuilding, gymnastics, swimming, figure skating, wrestling and more. In these types of sports, up to 33% of male athletes and up to 62% of female athletes show the signs of disordered eating.

One common misconception about athletes is that it’s normal for athletes to stop menstruating or have delayed menstruation. This is not normal, according to the Wisconsin Interscholastic Athletic Association. It’s a sign of malnourishment. It’s one of the signs of RED-S and can lead to a loss of bone density and fertility difficulties.

Another common misconception is that athletes with eating disorders will always experience weight loss. This is a part of the larger misconception that only people of a certain size have eating disorders. Athletes can have an eating disorder without losing weight. The body often compensates for a lower caloric intake by slowing down metabolism, which helps to stabilize weight.

The WIAA also points out the common myth that an athlete who is performing well and excelling in classes or at work is unlikely to have an eating disorder. In fact, these traits (perfectionism, over-compliance, denial of being in pain) are what makes athletes more vulnerable to eating disorders.

For example, Boone is a successful attorney as well as an elite athlete. An outside observer might not realize that she’s vulnerable to an eating disorder because of her success. Like all mental health issues, eating disorders are usually not obvious. People from all walks of life, at all sizes, can develop eating disorders.

Seeking Help

Boone found the courage to seek treatment and help.

“When I called up my parents to tell them I was checking into treatment, I wasn’t prepared for the flood of emotions that came with this decision, this time with the motivation coming solely from myself,” she wrote.

She battled the sense of shame many of us feel when we can’t overcome something on our own. She is also upfront about the fact that she is not “recovered” or “done” with her recovery. It’s a process, and she’s sharing her experiences while she’s in the midst of it.

“Disorder and shame thrive in the darkness and silence, so I’m thrusting my disorder and shame into the light where it has no place left to hide,” she wrote.

Seeking treatment came from her recognizing her disordered thoughts around food. Others might seek treatment because of other symptoms that can’t be ignored. There are physical symptoms of bulimia nervosa and other eating disorders, such as not menstruating for three months or more, experiencing dizziness, or experiencing heart palpitations.

Some may recognize mental and emotional symptoms, such as obsessive thought patterns around food or about body size.

Asking for help is difficult. It’s acknowledging that we can’t manage things on our own anymore. This is a particularly difficult realization for those of us who are perfectionists. Getting help doesn’t mean we are weak. It just means we can’t do everything on our own, and that’s okay.

Like Boone, once we start getting the help we need, we can find ourselves full of hope.

Melinda Sineriz is a freelance writer and fat acceptance advocate. Read more of her musings on Twitter or visit her website to learn more.