some cases benzodiazepines to help in alleviating severe distress at mealtimes. psychological treatment although relative energy deficiency in sport is often regarded as a physiological issue, it can have psychological impacts in the process of treatment and psychological stress may contribute to the development of red-s, as athletes may use excessive exercise and decreased energy consumption as a means to manage stress levels. many athletes strive for perfection and this can exacerbate mental stress as well as put athletes at a greater risk for developing an eating disorder. the main reasons why athletes would be resistant to treatment for red-s is due to psychological factors. a mental health counselor who is experienced in eating disorders should provide treatment. if there are other comorbid psychological disorders, such as depression and anxiety, a risk of self harm, medical complications and lack of progress in an outpatient level of care, the person struggling with red-s may need more intensive care at an inpatient, residential, partial hospitalization or intensive outpatient level. at each level of care, treatment modalities include cognitive-behavioral therapy, dialectical behavioral therapy or family-based therapy. prognosis sustained low energy availability, with or without disordered eating, can impair health. psychological problems associated with eating disorders include low self-esteem, depression, and anxiety disorders. medical complications involve the cardiovascular, endocrine, reproductive, skeletal, gastrointestinal, renal, and central nervous systems. the prognosis for anorexia nervosa is grave with a six-fold increase in standard mortality rates compared to the general population. in one study, 5.4% of athletes with eating disorders reported suicide attempts. although 83% of anorexia nervosa patients partially recover, the rate of sustained recovery of weight, menstrual function and eating behavior is only 33%. amenorrheic women can be infertile, due to the absence of ovarian follicular development, ovulation, and luteal function. consequences of hypoestrogenism seen in amenorrheic athletes include impaired endothelium-dependent arterial vasodilation, which reduces the perfusion of working muscle, impaired skeletal muscle oxidative metabolism, elevated low-density lipoprotein cholesterol levels, and vaginal dryness. due to low bone mineral density that declines as the number of missed menstrual cycles accumulates, and the loss of bmd may not be fully reversible. stress fractures occur more commonly in physically active women with menstrual irregularities and/or low bmd with a relative risk for stress fracture two to four times greater in amenorrheic than eumenorrheic athletes. fractures also occur in the setting of nutritional deficits and low bmd. society and culture the american academy of pediatrics and the aafp contend that exercise is important and should be promoted in girls for health and enjoyment; however, pediatricians should be wary of health problems that may occur in female athletes. the health related issues concerning this topic are grave and can lead to numerous health issues as previously demonstrated. the treatment plan will depend on the severity of the disorder, however some form of treatment has been shown as helpful to produce successful progress towards a better health condition. clearly, many health problems arise due to disordered eating. coaches are discouraged from active participation in the treatment of eating disorders. in addition to conflicts of interest, coaches may be perceived to pressure athletes and potentially perpetuate components of red-s. for example, in maintaining a place on the team or continued scholarship support, a female athlete may feel compelled to overtrain or restrict eating. male athletes relative energy deficiency in sport is also common among male athletes, espcially those in sports that encourage a certain weight. risk of relative energy deficiency in sport is heightened in "road cyclists, rowers (lightweight and open weight), athletes in combat sports, distance runners, and jockeys."