LOS ANGELES — Alyssa Kitasoe studied herself in the mirror, and the image was shocking.
She had been standing near the bathroom sink, vomiting into a plastic container. When she looked up, through eyes blurred with tears, she was disgusted by what she saw.
"It was like seeing a ghost of yourself, or a monster," Kitasoe recalled. "I remember just staring at myself."
A year earlier, Kitasoe viewed herself very differently. A striking young woman with long black hair and a radiant smile, she was strong and proud — the UCLA gymnastics logo on her clothes providing instant respect around campus. She even felt confident wearing a tiny leotard in front of the piercing eyes of judges during her routines.
That all changed when she quit her sport. Since the age of 7 she had devoted her life to gymnastics, and without it she felt a loss of identity.
She tried coaching as an undergraduate assistant, but shuffling mats and floorboards didn't fill the void.
So she developed a new fixation.
Since she was no longer working out 25 hours a week, the pounds crept onto what had been her fit 5-foot-1, 115-pound frame — a frightening prospect for a girl who for nearly 10 years had endured weekly weigh-ins.
"You still have the mind-set that you need to be tiny," said Kitasoe, now 24 and four years removed from the most dramatic of her struggles. "You compare yourself to the way you were."
It was the start of a destructive cycle. As soon as she awoke each morning, her thoughts were consumed by food. But she resisted eating until the evening, when she would gorge, at times devouring an entire pizza and large bag of chips.
Then, overcome with guilt, she'd induce vomiting.
She knew she was hurting her body, but she didn't care.
"If someone would have told me if I did it one more time I would die," Kitasoe said, "I don't think that would have stopped me."
It's a common problem. At least one-third of female college athletes have some type of eating disorder, according to studies published in 1999 and 2002 by experts Craig Johnson and Katherine Beals, who together examined nearly 1,000 female student-athletes participating in various sports.
As Kitasoe knows, the struggle doesn't conclude at the end of an athletic career. Sometimes, that's where it starts.
"There's a competitive drive in that successful personality that's going to manifest itself somewhere," said Becci Twombley, director of sports nutrition at UCLA. "Eating fixations can happen."
Kitasoe continued to binge and purge — often up to four times in a day — for about a year after quitting gymnastics. Her family and friends had no idea she was suffering from an eating disorder because she looked relatively healthy.
Researcher Johnson, chief clinical officer of Eating Recovery Center in Denver, said one reason former athletes are at risk is that schools and coaches lose track of them once they retire. "The NCAA is focused on the athletes that are immediately in their purview," he said. "Once the athletes have moved out of their oversight, they don't really have the resources to follow them."
Beals, an associate professor at the University of Utah, suggested universities offer programs for athletes "to help them transition into the real world."
At UCLA, Twombley says she receives 15 to 20 calls a year from former athletes seeking nutritional advice, including some who are struggling with clinical eating disorders such as anorexia nervosa and bulimia nervosa.
In the absence of any formal program, she and several associates created a manual for graduating athletes hoping to prepare them psychologically, physically and mentally for life without their sport.
"A gymnast needs to know she doesn't always have to be so lean to function in society. Swimmers need to know they're not always going to burn 10,000 calories a day in the pool. That's how we came up with the idea for the manual."
Kitasoe wishes she had been offered some guidance when her career as a gymnast abruptly ended. She didn't receive help until she told one of her former teammates that she was bulimic and received an unexpected ultimatum:
She had one week to tell her former coach or the girl would tell the coach herself.
"At first, I was really upset," Kitasoe said. "But I needed that nudge."
Kitasoe reluctantly told her former coach, Valorie Kondos Field, who identified with the struggle. She had been a ballet dancer in her youth.
Kondos Field suggested that Kitasoe see a psychologist. She did, and in their first meeting, she remembered hearing eight words that changed her life:
"It sounds like you've suffered a great loss."
"It was a lightbulb moment," Kitasoe said.
She had never allowed herself to mourn. Kitasoe cried the day she retired from gymnastics but suppressed her emotions after that.
Now she was finally allowing herself to grieve. She sobbed in the psychologist's office, the tears continuing to flow as she wrote a paper for a sociology class.
"Reflecting back since I have retired, I have been so unhappy and lost," Kitasoe wrote.
At that point, she began to reclaim her life.
She started exercising again — initially at midnight so she wouldn't run into anyone — and slowly reintegrated herself into her old social circle. She even clued in her parents to her problems.
"I wanted to be happy again," Kitasoe said.