424 The Professional Counselor | Volume 11, Issue 4 research seeking to advance knowledge of the culture of performing institutions and how they relate to artists’ mental health experiences. Therefore, an exploration of ballet culture and identity and their impact on ballet dancers’ mental health experiences could help inform counselors and counselor educators about the counseling needs of this population. Mental Health Among Elite Athletes and Performing Artists Because of the scant literature focusing directly on professional ballet dancers’ mental health, we included research findings from articles examining mental health among athletes and performing artists. Although differences exist between professional ballet dancers, elite athletes, and performing artists, a professional ballet dancer straddles multiple environments. For example, an elite athlete trains to win a national title or medal, possesses more than two years of experience, and trains daily to develop talent (Swann et al., 2015). Rouse and Rouse (2004) suggested that performing artists’ goals or outcomes are to create art and achieve a high performance level with audience satisfaction. Similar to these groups, a professional ballet dancer trains almost every day, which requires extreme dedication. They must comply with high physical and mental demands to develop their ballet technique for performing and entertaining audiences. Scholars have discovered that elite athletes experience a high prevalence of anxiety, eating disorders, and depression compared to the general population (Åkesdotter et al., 2020; Gorczynski et al., 2017). At the same time, eating disorders are overrepresented in elite athlete studies because of the requirement that elite athletes maintain a specific stature for their profession (Åkesdotter et al., 2020). Interestingly, few elite athletes reported anxiety disorders even though they scored in the moderate range on the General Anxiety Disorder-7 (GAD-7; Åkesdotter et al., 2020). This could indicate that elite athletes normalize their anxiety and eating concerns, even at a clinical level. Likewise, performing artists display disproportionately high reporting rates for mental health disorders, such as depression, anxiety, and stress, when compared to the general population (Van den Eynde et al., 2016; van Rens & Heritage, 2021). Given professional ballet dancers’ emotionally demanding performance levels as performing artists and their physicality as athletes, they may share similar mental health experiences with elite athletes and performing artists, yet these experiences remain unknown. Ballet Culture and Professional Dancers’ Mental Health Literature exploring ballet dancers has focused on culture (Wulff, 2008), development (Pickard, 2012), emotional harm (Moola & Krahn, 2018), injury prevention (Biernacki et al., 2021), and disordered eating (Arcelus et al., 2014). Ballet, with origins in the Italian and French courts, is an age-old culture that fuses beauty and athleticism (Kirstein, 1970; Wulff, 2008). Influenced by social and cultural forces in the Western world (Kirstein, 1970), ballet culture is synonymous with tradition and hierarchy (Wulff, 2008). Ballet culture holds steadfast to idealistic tenets in which dispositions (e.g., tenacity), perceptions of an ideal body, and actions (e.g., constant rehearsals) provide dancers the ability to illustrate a story through movements (Wulff, 2008). Exquisite sets, costumes, and movements create a unique experience and can produce a visceral reaction in the audience (Moola & Krahn, 2018). Yet a strong commitment to the art form requires ballet dancers to work with their bodies for hours, sustain injuries, and work through chronic pain (Pickard, 2012), often leading to emotional distress (Moola & Krahn, 2018). Physical requirements also make dancers three times more vulnerable, compared to non-dancers, to suffer from eating disorders, particularly anorexia nervosa and those labeled by the Diagnostic and Statistical Manual of Mental Disorders as eating disorders not otherwise specified (Arcelus et al., 2014). van Staden et al. (2009) focused directly on ballet dancers’ mental health, finding that professional ballet dancers also experience mental health concerns due to
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