Recognizing Psychiatric Disorders in Athletes

Whether you are a dancer, swimmer, or basketball player, being involved in a sport is always physically demanding. The pressures of being a competitive athlete take an emotional toll as well, although may not be as evident because many athletes do not admit they have a mental illness nor do they take the appropriate steps to seeking help.  Professors Lynette Hughes and Gerard Leavey believe that athletes are “vulnerable to mental illness” because elite sports call for “investments of time and energy, often resulting in a loss of personal autonomy and disempowerment for athletes.” Oftentimes, athletes feel distress when their beloved pastime becomes a stressful occupation. When athletes consider their sport as a huge part of their identity, and this essential part of themselves begins to cause them stress, that’s when psychological disorders start to develop.  

Injury, competitive failure, ageing, retirement from sport, and other similar psychosocial stressors precipitate depression in athletes. Major depressive disorder (MDD) is as common in athletes as in the general population. A main challenge, however, is diagnosing an athlete with MDD, as many defining symptoms overlap with those of overtraining (fatigue, insomnia, appetite changes, weight loss, avolition, and lack of concentration). Personality disorders may also emerge from being intensely involved in a sport. Extraversion, perfectionism, and narcissism are typical, socially acceptable traits displayed by student athletes. They suffer from interpersonal difficulties, instability, and maladaptive coping skills. Impulse control problems may as well result and involves aggression, fighting, and risky sexual behavior.

Eating disorders are not a rarity in the sports world.  In sports where body mass, muscularity and physique are especially scrutinized, such as figure skating and gymnastics, running, and even wrestling, athletes tend to engage in reckless eating habits. Athletes develop a mindset where they believe doing whatever is necessary, although dangerous, will enhance their appearance, endurance, and performance. Interestingly, most of the athletes with eating disorders are those involved in sports that have competition between individuals rather than teams. The most common eating disorders within the athlete population are anorexia and bulimia. Anorexia nervosa occurs when a person attempts to consume little to no food due to an irrational fear of weight gain. While anorexia is more prevalent in females, many males suffer from the condition as well. Symptoms include extreme weight loss, amenorrhea, osteoporosis, and anxiety. Female athletes, because they do not have the proper nutrition, may experience amenorrhea, or the absence of menstruation. They are prone to stress fractures of bone because they lose calcium. Athletes with bulimia likewise have a fear of weight gain, but compensate for the weight in a different way. Bulimic individuals go through a cycle of binge eating and purging through vomiting, using diuretics, or using laxatives. People with bulimia have more of normal weight than those with anorexia but there are cases where they are underweight. There are several similarities between the two as they both have psychological symptoms such as low self-esteem, compulsive exercise, symptoms of depression, anxiety, or both.

There are treatments and steps to recovery for anorexia and bulimia. Anorexia may require hospitalization of the patient because significant weight loss can affect the functioning of important organs. Because people with bulimia often are within normal weight, hospitalization is not necessary. Doctors, dietitians, and psychiatrists are all helpful resources for recovery. Because symptoms of anorexia include depression and anxiety, antidepressants, and anti-anxiety medication are typical to prescribe. In an athletic setting is helpful that coaches, trainers and administrators become involved to ensure athletes are exercising and eating in a healthy manner. They can propose nutritional guidelines and educate their athletes on health effects of maladaptive behavior.

Substance use disorders are also fairly common in student athletes and are more prevalent in males. Athletes especially use alcohol and tobacco. Alcohol use by student athletes is associated with academic problems, vandalism, assault, injury, driving under the influence, sleep deprivation, and even sometime death. Chewing tobacco is often used among professional athletes for relaxation, improved, concentration, boredom, increased energy, pleasure and performance enhancement. Additional substances include anabolic-androgenic steroids, human growth hormone, creatine, erythropoietin and blood doping, amphetamines, and stimulants, and beta-hydroxy-beta-methylbutyrate. The NCAA (National Collegiate Athletic Association) aims to reduce intake on these drugs by enforcing standardized drug tests as well as penalties for evidence of drug intake.

The most crucial way to address these issues is for athletic departments to raise awareness of mental health problems eradicate the stigma mental health disorders have. The need for psychiatric intervention is imperative. A positive mental health and body image approach is beneficial to encourage positive body image and focus on safe nutrition and exercise by providing social support and coping strategies. Screening for and treatment of underlying mental illness such as depression that may contribute to self-treatment with drugs by athletes should be increased.

Rachanne Nabong