Sports & Mental Health
Although participating in athletics has many benefits, the competitive nature of sports can cause, aggravate, or expose psychological problems in athletes[1]. Certain personality traits can aid in athletic success, yet these same traits can also be associated with poor mental health.
Approximately 35% of elite athletes suffer from eating disorders, burnout, depression, or anxiety[12]. Stress levels and training schedules can cause athletes of all kinds to develop mental health disorders.
Sports Psychiatry
Since the early 1980s, sports psychiatry has become an emerging field within psychiatry and sports medicine[1]. Several national interest groups have been established, such as the International Society for Exercise Research. These groups are primarily within national psychiatric organizations and focus on topics like exercise treatment and mental disorders.
Sports psychiatrists and similar organizations review the medical literature on exercise, sport, psychiatry, mental health, mental disorders, and related topics. The number of publications in the field has greatly increased. Most topics remain on the agendas of head trauma, concussion, drug abuse, doping, performance enhancement, overtraining, ADHD, or eating disorders.
New Outlook on Sports & Mental Health
Nobody questions an athlete taking time to recover from a sprained ankle or broken wrist. Those injuries are easy to see and come with a clear understanding that they cannot be ignored. However, mental health issues are not as visible but athletes still can benefit from tending to their mental health.
Depression and anxiety are not diagnoses that can be found on an X-ray or MRI. Although, mental health disorders can be every bit as limiting or debilitating as a physical injury. Too often, however, these issues are ignored or purposefully overlooked.
Recently, an act of bravery and openness helped spark a national conversation on the issue of mental health[2]. In May 2021, four-time Grand Slam champion tennis player Naomi Osaka announced her withdrawal from the French Open over concerns for her mental health. Popular and social media quickly ignited, with Osaka facing both global admiration and admonishment.
Other prominent athletes quickly voiced their support, such as tennis player Serena Williams, sprinter Usain Bolt, and swimmer Michael Phelps. Not long after, gymnast Simone Biles willingly sat out several events at the Tokyo Olympics due to her mental health. Simone’s actions are adding to the growing global discussion about mental health in sports.
How Do Sports Affect Mental Health?
It’s evident that there is a strong relationship between physical activity and mental health[3]. Cross-sectional studies show that regular physical activity is associated with better mental health and emotional well-being. Studies also show a direct correlation between physical activity and reduced risk of developing a mental disorder.
But how is our mental health affected when this physical activity comes in the form of competitive sports? Athletes often carry a persona that is larger than life in the public eye. They’re regarded as brave competitors who overcome obstacles and adversity in the pursuit of victory.
Athletes struggle with complex issues just like the general population. Athletes are not immune to the stresses of life. A 2016 study found that college athletes reported symptoms of depression at a similar rate to the general student population[4].
The Stress of Competition
It’s not just athletics that experience stress, but the culture of sports can be like a pressure cooker[5]. The aggressive environment within locker rooms often preys on any perception of weakness. The perfectionist mindset of competitors can lead to dismay despite performance and drive.
Finding a healthy balance between competition and mental health can be difficult. While working up through the different levels of competition, risk factors for developing mental health disorders can become more pronounced.
Factors in sports that can lead to stress & mental health issues include:[6]
- Personality issues amid the athletic culture
- Sexuality & gender issues
- Bullying
- Sexual misconduct
- Transitioning away from sports
- Injuries & pain management
- Eating disorders
Psychiatric disorders can develop in athletes due to these risk factors.
Most common psychiatric disorders among athletes include:[7]
- Anxiety disorders
- Mood disorders
- Personality disorders
- ADHD
- Eating disorders
- Body dysmorphic disorder
- Adjustment disorder
- Substance use disorders
- Impulse control disorders
The Athletic Personality
The motivation of athletes competing at professional levels is greater. Professional athletes tend to seek different and new sensations more than those competing at lower levels[7]. Lower levels of self-esteem and sensation-seeking in athletes have been associated with greater risk for depression, anxiety, social anxiety, and negative physical symptoms, all of which may impede performance.
Extremes of athletic identity, either too much or too little, may limit performance and spur growth for mental unwellness. Externally driven perfectionism that is encouraged by parents, coaches, and teammates is likely to be more problematic. External perfectionism can cause problems with performance and mental well-being more than internally driven perfectionism.
- Negative mood
- Anxiety
- Anger
- Hostility
Management of Personality Issues
By definition, personality traits and disorders are long-standing issues. If deemed problematic for athletes, they may be addressed through psychotherapy[7]. Psychiatric disorders should be treated with medication, psychotherapy, or a combination. Unique challenges related to personality issues have been described when undertaking psychotherapy with high-level athletes in particular.
Sexuality & Gender Issues
Athletes may be adversely affected by discrimination and other environmental factors in sports related to sexuality and gender. The LGBTQ community, for example, may be subject to discrimination. A sexual minority is a group whose members are lesbian, gay, bisexual, transgender, and questioning (LGBTQ) identifying people. The masculine “culture of toughness” can also contribute to the stigma that prevents athletes from seeking mental health treatment[7].
Stigma regarding mental illness occurs facing athletes of all sexes, gender identities, and sexual orientations. The stigma around mental health in athletes arises partly from the culture of toughness that surrounds them. This tough culture can make it difficult for athletes to seek and accept treatment for psychiatric symptoms[8].
Athletes attempt to avoid displaying emotions on the playing field making it hard to transition to admit vulnerability and accept help when off the field. Moreover, athletes perceive that they risk playing time, starting roles, or endorsements if discovered seeking treatment for mental illness.
Support for All Athletes
Health care providers, coaches, and families can benefit from asking athletes about any concerns related to gender and sexuality. Education can be provided to athletes about the role of sexuality and gender issues in sports. Creating a supportive and welcoming environment can be key to the health of the athlete and team[7].
Students and coaches need to be taught empathy, stereotypes must be debunked, and proper wording should be encouraged. Policies and laws can have a role; for example, anti-discrimination policies in university settings can protect against homophobic actions.
Bullying in Sports
Bullying in athletics is another topic that can benefit from more research [7]. Defining bullying among athletes can be challenging due to athletes having different motivators. One athlete can respond positively to negative feedback while another could perceive the same response as bullying.
Bullying has been defined as “abuse and mistreatment of someone vulnerable by someone stronger, more powerful.” Coaches or teammates can exhibit bullying behaviors, which include shouting, physically overpowering someone, or threatening the athlete with body language. Bullying can also involve a coach making an athlete feel worthless, despised, inadequate, or valued only as a result of athletic performance.
Young athletes need to be taught that bullying is inappropriate and should be reported to an uninvolved, trusted adult. Athletes should be encouraged to defend their teammates who are experiencing bullying or help remove them from the situation.
Pain & Injuries
Individuals with pain are at increased risk for depression, post-traumatic stress disorder, substance use problems, and adjustment reactions[5]. A serious injury that leads to chronic functional impairment in a student athlete may trigger or cause mental health disorders[5].
In addition to all of these, pain presents another challenge to today’s student athletes. There may be pressure to play through the pain for fear of loss of a position or status. An athlete who is injured may experience a loss of identity and a loss of opportunity.
Signs of Mental Health Changes
Athletes tend to not seek mental health support when needed. Instead, a coach or parent might notice that “something seems off” and encourage them to talk about it.
Signs that an athlete may need an assessment of their mental health include[5]:
- Sleeping difficulties
- Irritability
- Low energy levels
- Changes in eating habits
Mental Health in Specific Sports
Discussing the myriad of conditions and environmental factors that athletes of all sports endure is important. In addition, athletes can be at different risks depending on the specific sport played. Below are just a few sports that may have higher rates of mental health issues.
Football
Besides mental health problems, football players also face some unique challenges. Chronic traumatic brain injuries sustained in football can lead to confusion, depression, aggression, dementia, and other symptoms[9].
Gymnastics
College gymnasts say they have a lot to juggle, including school, practice, friends, and their family. These gymnasts practice 20 hours a week, plus take time for strength training. Many gymnasts say they are mentally exhausted with these hours added to the school. Eating disorders are also more common in gymnastics as participants are judged on aesthetics[5].
Wrestling
Wrestlers have often been targeted as high-risk athletes for developing eating disorders. Wrestlers are needing to maintain a certain weight to belong to their specific weight class. Research has found that wrestlers practice extreme weight loss and disordered eating behaviors consistent with eating disorders[10].
Weightlifting
Studies suggest that bodybuilders are particularly likely to experience muscle dysmorphia. Muscle dysmorphia refers to obsessive thoughts about the body being too small, despite being of a typical build or even quite muscular[11]. Muscle dysmorphia has been linked to serious mental health consequences, including anxiety, depression, suicide attempts, and substance abuse.
Get Help for Mental Health
While exercise is generally good for mental health, participating in sports can sometimes have negative effects. Knowing the inherent dangers of a specific sport is important for physical and mental health.
Considering the environmental factors and stressors exposed to athletes in team and individual sports can help with bettering mental health. If you or a loved one are struggling with mental health, please call today. Our providers can answer any questions you may have and give you a better understanding of treatment options.
- Strohle, A. (2018, March 21). Sports psychiatry: mental health and mental disorders in athletes and exercise treatment of mental disorders. Retrieved May 12th, 2022 from https://pubmed.ncbi.nlm.nih.gov/29564546/
- Meister, A., Lavaunchy, M. (2021, September 24). Athletes Are Shifting the Narrative Around Mental Health at Work. Retrieved May 12th, 2022 from https://hbr.org/2021/09/athletes-are-shifting-the-narrative-around-mental-health-at-work
- Breistol, S. (2017). Association Between Participating in Noncompetitive or CompetitiveSports and Mental Health among Adolescents. Retrieved May 12th, 2022 from
https://www.academia.edu/51373942/Association_Between_Participating_in_Noncompetitive_or_Competitive_Sports_and_Mental_Health_among_Adolescents_a_Norwegian_Population_based_Cross_sectional_Study - Wolanin, A., Hong, E., Marks, D., Panchoo, K., & Gross, M. (2016, January 18). Prevalence of clinically elevated depressive symptoms in college athletes and differences by gender and sport. Retrieved May 12th, 2022 from https://bjsm.bmj.com/content/50/3/167.abstract
- Stull, T. (2022). Mind, Body and Sport: The psychiatrist perspective. Retrieved May 12th, 2022 from https://www.ncaa.org/sports/2014/11/3/mind-body-and-sport-the-psychiatrist-perspective.aspx
- Cleveland Clinic (2021, August 10). Athletes and Mental Health: Breaking the Stigma. Retrieved May 12th, 2022 from https://health.clevelandclinic.org/mental-health-in-athletes/
- Chang, C. M.D. (2020, March). Mental Health Issues and Psychological Factors in Athletes: Detection, Management, Effect on Performance, and Prevention: American Medical Society for Sports Medicine Position Statement. Retrieved May 12th, 2022 from https://journals.lww.com/cjsportsmed/fulltext/2020/03000/mental_health_issues_and_psychological_factors_in.8.aspx
- Pierce, N. Ph.D., Lester, C. Ph.D., Seth A. Ph.D., & Turner, P. Ph.D. (2018, May). The Role of Physical Activity and Sport in Mental Health. Sport and Exercise Medicine UK. Retrieved May 12th, 2022 from
https://www.fsem.ac.uk/position_statement/the-role-of-physical-activity-and-sport-in-mental-health/ - Clay, R. (2017, January). A new NFL playbook: Enhancing mental health. Retrieved May 12th, 2022 from https://www.apa.org/monitor/2017/01/nfl-playbook
- Mayer, J. (2012). Disordered eating habits and extreme weight loss techniques in
collegiate wrestlers: A qualitative analysis. Retrieved May 12th, 2022 from https://scholarworks.uni.edu/cgi/viewcontent.cgi?article=1514&context=etd - Ellwood, B. (2020, August 7). Study links frustrated psychological needs to muscle dysmorphia in male bodybuilders. Retrieved May 12th, 2022 from https://www.psypost.org/2020/08/study-links-frustrated-psychological-needs-to-muscle-dysmorphia-in-male-bodybuilders-57596
- American College of Sports Medicine. (2021, August 9). The American College of Sports Medicine Statement on Mental Health Challenges for Athletes. ACSM. Retrieved May 18, 2022, from https://www.acsm.org/news-detail/2021/08/09/the-american-college-of-sports-medicine-statement-on-mental-health-challenges-for-athletes
