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Sports psychiatry is a medical specialty that aims to treat and prevent mental disorders in athletes and helps them use different techniques to enhance their performance. [1] First mentioned in literature in 1967, it is a developing area [2] that relies on other fields, like sports psychology. [3]
The first publication on sports psychiatry was written in 1967 by Arnold R Beisser, a doctor and tennis player. [4] It was brought up in literature again twenty years later by JH Rick Massimino, MD, and mentioned again in 1992 by California-based psychiatrist Daniel Begel, who is known for officially launching the specialty. As the field developed, the World Psychiatric Association eventually created a section on Exercise and Sports Psychiatry, giving way for interest in other countries, including Britain and Germany. [3]
Founded in 1994 by Dan Begel, the International Society for Sports Psychiatry (ISSP) is a global leader in promoting mental health and well-being in athletes of all ages, abilities and backgrounds. Through education, advocacy, and collaboration, the ISSP advances the field of sports psychiatry, ensuring athletes have the resources they need to thrive. Leaders of the ISSP have developed and continue to refine world-class courses and curricula for mental health in sports, author seminal papers/books, provide mentorship for developing sports psychiatrists, and continue to lead global coalitions in sports psychiatry. The organization aims to spread the benefits of the field to the entire athletic community and promote mental health in sports.
ISSP membership in 2020 is open to medical students, residents, psychiatrists, and other clinicians at times. [5] The ISSP collaborates with several national and international organizations to advance the field of sports psychiatry.
The ISSP has partnered with the Swiss Society for Sport Psychiatry and Psychology to advance the Journal of Sports and Exercise Psychiatry.
In 2023, seven sports psychiatrists founded the American Board of Sports & Performance Psychiatry: Brook Choulet, MD; Mark Allen, MD; Thomas Horn, DO; Amanda Klass, DO; Rolando Gonzalez, MD; Tia Konzer, DO; Ankur Desai, MD. Their mission is to credential sports and performance psychiatrists who demonstrate excellence in the comprehensive care of athletes and performers, fostering mental well-being and optimal performance. Through the certification of board-certified sports and performance psychiatrists, the ABSPP aim to enhance the mental health and well-being of athletes, performers, executives, and individuals striving for peak performance in their personal and professional lives. [6]
Sports psychiatry positions often require specific experience in sports medicine, as well as a master's degree in clinical psychology, counseling, or sports psychiatry especially. [7] However, in addition to that, they must be aware of individual and team culture as well as approach the prescription of medication with a perspective on doping in sports. [4]
Differences between sports psychologists and psychiatrists, according to Antonia Baum, are that although both areas aim to enhance athletes' performance, psychiatry also focuses on psychopathology and tries to uncover deeper issues than performance problems. Additionally, psychiatrists are able to prescribe psychotropic medication. [8]
Some of the most commonly found mental disorders in athletes that sports psychiatrists may come in contact with include mood disorders (such as major depressive disorder, bipolar disorder), anxiety disorders (including social anxiety disorder, obsessive-compulsive disorder, eating disorders, attention deficit hyperactivity disorder (ADHD), and substance abuse), and more sport-specific ones such as concussions, body dysmorphic disorder, traumatic brain injuries (TBI), and chronic traumatic encephalopathy (CTE). [1] [3]
Eating and body dysmorphic disorders have higher incidence in women in sports that emphasize appearance, like gymnastics or figure skating.[ medical citation needed ] Substance abuse is commonly found in the athletic community. College athletes have been reported to use alcohol at higher levels than the general public despite its detriment to performance. Anabolic steroids are also a widely abused substance among athletes. These aid athletes in faster training and recovery time, but may also have psychiatric side effects like irritability and mood swings. [1] Substance abuse is a concern among elite athletes. [9]
The treatments of choice for many mental illnesses experienced by athletes include psychotropic medication as well as, depending on the specific situation and life of the athlete, psychotherapy, psychoeducation, counseling, and family therapy. [3]
The majority of people who use Complementary and Integrative Health Care (CIC) to enhance their athletic performance report positive results. The most commonly used technique is yoga, which a high percentage of users have found helpful. Other styles such as manipulation, spiritual healing, special diets, acupuncture, meditation, and homeopathy were also reported to be beneficial for athletic performance. With high percentages stating that hypnosis, herbal therapies, massage, yoga, and manipulation had helped with their performance. Additionally, spiritual healing, special diets, acupuncture, meditation, traditional healing, biofeedback, naturopathy, and energy healing therapies were also reported to be helpful. However, due to limited data, odds ratios on the effectiveness of these therapies could not be generated. Overall, the study shows that CIC therapies are widely used and perceived as beneficial for enhancing athletic performance. [10]
Athletes need enough sleep to recover from their rigorous training, especially young athletes who engage in intense activity. To ensure proper recovery, they should aim for 10 hours of sleep. It's important to follow a consistent sleep schedule and work on gradually increasing sleep duration while reducing the time it takes to fall asleep. By doing so, athletes can improve their overall recovery and alertness. Questionnaires like the Pittsburgh Competitive Exercise Questionnaire and the Pittsburgh Sleep Quality Index can help assess athletes' sleep before events. However, it's important to note that self-reporting techniques are subjective, and athletes might identify different issues. Additionally, some nutrients, such as carbohydrates, protein, alcohol, and caffeine, can affect sleep quality. Carbohydrates are particularly important for athletes to maintain energy levels during intense activities and help in their recovery between training sessions or competitions. [11]
Usually, sports psychiatrists choose non-sedating medications [12] because they are less likely to cause side effects such as an increase in weight and body fat, sedentary behavior, a decrease in insulin sensitivity, cardiac issues. [3] The effect on athletes' performance must also be taken into consideration, as well the anti-doping guidelines of different sports leagues. The World Anti-Doping Agency (WADA) provides a list of generally banned substances, and it is left to each leagues' discretion to add a more strict code. [1]
The interpretation of natural athletic performance is essential in determining acceptable and non-acceptable performance-enhancing means and justifying the ban on Performance Enhancing Drugs (PEDs). To illustrate this point, consider exposure to hypoxic conditions through technology, such as altitude tents and chambers, which utilizes the phenotypic plasticity of the human organism and is deemed to be acceptable as it falls within the natural range. In contrast, the use of EPO is unacceptable as it goes beyond the biological response and adaptation processes that are ideal for natural performance. By understanding the distinction between these two methods, natural performance can promote and continue to improve athletic achievements within acceptable and safe boundaries. [13]
According to a recent review, circumin has several biological activities, due to its antioxidant and antiinflammatory properties. It can have positive effects on the heart, immune system, nervous system, and liver. Furthermore, circumin has shown posstive effects on athletes and exercise practitioners. A clinical trial involving both men and women showed that taking 500mg of circumin after eccentric exercise significantly reduced exercise-induced muscle damage and creatine kinase concentrations, leading to better recovery after exercise. [14]
Widely used medications include antidepressants (e.g. bupropion), mood stabilizers, anticonvulsants (e.g. lithium), anxiolytics (e.g. benzodiazepines), Psychostimulants/ADHD medications (e.g. dextroamphetamine), and sometimes sedative hypnotics and antipsychotics. [1]
Mental health is a common problem, with three hundred and twenty-two million people living with depression worldwide, according to the World Health Organization in 2015. [15] Athletes appear to have similar levels of mental health problems to the rest of the population. [16] However, they often face certain barriers in seeking mental health care, which can make their mental health issues more severe. The most challenging barrier that athletes face is the mental health stigma prevalent in the sports community. [17] Professions such as sports psychiatry provide athletes with outlets and solutions to their mental health issues. Therefore, an important role for sports psychiatrists is to help de-stigmatize and promote mental health among athletes. [1] [8]
What is a stigma?
A stigma is a negative perception that is associated with an individual, group of people, circumstance, or specific trait. [17] Erving Goffman, a well-known sociologist and social psychologist, explained that stigma occurs when what a person should be does not equate to what they perceive themselves to be. Goffman used stigma to describe the situations where one is not given respect due to them not fulfilling the role they are supposed to in whichever circumstance they are in. Goffman did this by creating two different groups of people: Those who attain what they ought to be are “normals”, and those who do not are the “stigmatized”. In the context of sports, those who do not have mental health issues would be the “normals”, and those who do experience mental health disorders would potentially be “stigmatized”. [16]
Mental health stigma in sports
In the sports world, it is often assumed athletes have the ideal mental toughness that allows them to be successful in their sport. Therefore, when an athlete has a mental health issue, they can see this as a contradiction to the mental fortitude they are supposed to maintain. [16] [17] This is where the mental health stigma arises: When what athletes feel internally contradicts what they are expected to portray externally. The concern for not being respected by coaches, teammates, and even family members can lead an athlete to not seek the mental health care that they need. Athletes often believe this lack of respect will come from them not fulfilling the role they are meant to fulfill when they have a mental health problem. [17]
Examples of mental health stigma
· Natasha Danvers is a retired, British track and field athlete who has won Olympic medals. She had consistent mental health issues and attempted to commit suicide in 2011. Later on, Natasha explained that the sport she played created an environment where she was supposed to be able to handle tough situations by herself. Due to this, it was hard for her to admit she had mental health issues, which she described as a “weakness”. [16]
· Michael Phelps is an American swimmer with the most Olympic medals of all time, winning a total of twenty-eight. Phelps struggled with mental health issues and experienced suicidal thoughts. Michael explained that he was under the impression it was a sign of weakness to ask for help. In the sports world, asking for help reduces the mentally strong image athletes are supposed to maintain. [16]
· American baseball player Rick Ankiel had anxiety issues which forced him to retire. He explained the stigma around mental health in athletics, and how it negatively affected him. Rick provided an example of this stigma when he mentioned people on social media accusing him of being weak and lacking mental toughness. [16]
· American professional tennis player Mardy Fish had a cardiac arrest which caused him to have a serious anxiety disorder. Mardy discussed that athletes are taught to have mental toughness and that showing weakness, such as anxiety issues, is unworthy behavior in the sports world. [16]
Major depressive disorder (MDD), also known as clinical depression, is a mental disorder characterized by at least two weeks of pervasive low mood, low self-esteem, and loss of interest or pleasure in normally enjoyable activities. Introduced by a group of US clinicians in the mid-1970s, the term was adopted by the American Psychiatric Association for this symptom cluster under mood disorders in the 1980 version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III), and has become widely used since. The disorder causes the second-most years lived with disability, after lower back pain.
A mental disorder, also referred to as a mental illness, a mental health condition, or a psychiatric disability, is a behavioral or mental pattern that causes significant distress or impairment of personal functioning. A mental disorder is also characterized by a clinically significant disturbance in an individual's cognition, emotional regulation, or behavior, often in a social context. Such disturbances may occur as single episodes, may be persistent, or may be relapsing–remitting. There are many different types of mental disorders, with signs and symptoms that vary widely between specific disorders. A mental disorder is one aspect of mental health.
Anxiety disorders are a group of mental disorders characterized by significant and uncontrollable feelings of anxiety and fear such that a person's social, occupational, and personal functions are significantly impaired. Anxiety may cause physical and cognitive symptoms, such as restlessness, irritability, easy fatigue, difficulty concentrating, increased heart rate, chest pain, abdominal pain, and a variety of other symptoms that may vary based on the individual.
Generalized anxiety disorder (GAD) is a mental and behavioral disorder, specifically an anxiety disorder characterized by excessive, uncontrollable and often irrational worry about events or activities. Worry often interferes with daily functioning, and individuals with GAD are often overly concerned about everyday matters such as health, finances, death, family, relationship concerns, or work difficulties. Symptoms may include excessive worry, restlessness, trouble sleeping, exhaustion, irritability, sweating, and trembling.
Mental health encompasses emotional, psychological, and social well-being, influencing cognition, perception, and behavior. According to the World Health Organization (WHO), it is a "state of well-being in which the individual realizes his or her abilities, can cope with the normal stresses of life, can work productively and fruitfully, and can contribute to his or her community". It likewise determines how an individual handles stress, interpersonal relationships, and decision-making. Mental health includes subjective well-being, perceived self-efficacy, autonomy, competence, intergenerational dependence, and self-actualization of one's intellectual and emotional potential, among others.
Biological psychiatry or biopsychiatry is an approach to psychiatry that aims to understand mental disorder in terms of the biological function of the nervous system. It is interdisciplinary in its approach and draws on sciences such as neuroscience, psychopharmacology, biochemistry, genetics, epigenetics and physiology to investigate the biological bases of behavior and psychopathology. Biopsychiatry is the branch of medicine which deals with the study of the biological function of the nervous system in mental disorders.
Social psychiatry is a branch of psychiatry that studies how the social environment impacts mental health and mental illness. It applies a cultural and societal lens on mental health by focusing on mental illness prevention, community-based care, mental health policy, and societal impact of mental health. It is closely related to cultural psychiatry and community psychiatry.
Stigma, originally referring to the visible marking of people considered inferior, has evolved in modern society into a social concept that applies to different groups or individuals based on certain characteristics such as socioeconomic status, culture, gender, race, religion or health status. Social stigma can take different forms and depends on the specific time and place in which it arises. Once a person is stigmatized, they are often associated with stereotypes that lead to discrimination, marginalization, and psychological problems.
Emergency psychiatry is the clinical application of psychiatry in emergency settings. Conditions requiring psychiatric interventions may include attempted suicide, substance abuse, depression, psychosis, violence or other rapid changes in behavior.
Mental disorders are classified as a psychological condition marked primarily by sufficient disorganization of personality, mind, and emotions to seriously impair the normal psychological and often social functioning of the individual. Individuals diagnosed with certain mental disorders can be unable to function normally in society. Mental disorders may consist of several affective, behavioral, cognitive and perceptual components. The acknowledgement and understanding of mental health conditions has changed over time and across cultures. There are still variations in the definition, classification, and treatment of mental disorders.
College health is a desired outcome created by a constellation of services, programs and policies directed at advancing the health and wellbeing of individuals enrolled in an institution of higher education, while also addressing and improving both population health and community health. Many colleges and universities worldwide apply both health promotion and health care as processes to achieve key performance indicators in college health. The variety of healthcare services provided by any one institution range from first aid stations employing a single nurse to large, accredited, multi-specialty ambulatory healthcare clinics with hundreds of employees. These services, programs and policies require a multidisciplinary team, the healthcare services alone include physicians, physician assistants, administrators, nurses, nurse practitioners, mental health professionals, health educators, athletic trainers, dietitians and nutritionists, and pharmacists. Some of the healthcare services extend to include massage therapists and other holistic health care professionals. While currently changing, the vast majority of college health services are set up as cost centers or service units rather than as parts of academic departments or health care delivery enterprises.
In applied psychology, interventions are actions performed to bring about change in people. A wide range of intervention strategies exist and they are directed towards various types of issues. Most generally, it means any activities used to modify behavior, emotional state, or feelings. Psychological interventions have many different applications and the most common use is for the treatment of mental disorders, most commonly using psychotherapy. The ultimate goal behind these interventions is not only to alleviate symptoms but also to target the root cause of mental disorders.
Bipolar disorder in children, or pediatric bipolar disorder (PBD), is a rare mental disorder in children and adolescents. The diagnosis of bipolar disorder in children has been heavily debated for many reasons including the potential harmful effects of adult bipolar medication use for children. PBD is similar to bipolar disorder (BD) in adults, and has been proposed as an explanation for periods of extreme shifts in mood called mood episodes. These shifts alternate between periods of depressed or irritable moods and periods of abnormally elevated moods called manic or hypomanic episodes. Mixed mood episodes can occur when a child or adolescent with PBD experiences depressive and manic symptoms simultaneously. Mood episodes of children and adolescents with PBD are different from general shifts in mood experienced by children and adolescents because mood episodes last for long periods of time and cause severe disruptions to an individual's life. There are three known forms of PBD: Bipolar I, Bipolar II, and Bipolar Not Otherwise Specified (NOS). The average age of onset of PBD remains unclear, but reported age of onset ranges from 5 years of age to 19 years of age. PBD is typically more severe and has a poorer prognosis than bipolar disorder with onset in late-adolescence or adulthood.
Child and adolescent psychiatry is a branch of psychiatry that focuses on the diagnosis, treatment, and prevention of mental disorders in children, adolescents, and their families. It investigates the biopsychosocial factors that influence the development and course of psychiatric disorders and treatment responses to various interventions. Child and adolescent psychiatrists primarily use psychotherapy and/or medication to treat mental disorders in the pediatric population.
Major depressive disorder, often simply referred to as depression, is a mental disorder characterized by prolonged unhappiness or irritability. It is accompanied by a constellation of somatic and cognitive signs and symptoms such as fatigue, apathy, sleep problems, loss of appetite, loss of engagement, low self-regard/worthlessness, difficulty concentrating or indecisiveness, or recurrent thoughts of death or suicide.
Sport psychology is defined as the study of the psychological basis, processes, and effects of sport. Sport is defined as any physical activity where the individuals engage for competition and health. Sport psychology is recognized as an interdisciplinary science that draws on knowledge from many related fields including biomechanics, physiology, kinesiology and psychology. It involves the study of how psychological factors affect performance and how participation in sport and exercise affect psychological, social, and physical factors. Sport psychologists teach cognitive and behavioral strategies to athletes in order to improve their experience and performance in sports.
Panic disorder is a mental and behavioral disorder, specifically an anxiety disorder characterized by reoccurring unexpected panic attacks. Panic attacks are sudden periods of intense fear that may include palpitations, sweating, shaking, shortness of breath, numbness, or a feeling that something terrible is going to happen. The maximum degree of symptoms occurs within minutes. There may be ongoing worries about having further attacks and avoidance of places where attacks have occurred in the past.
The health issues of athletics concern their physical and mental well-being in organized sport. If athletes are physically and mentally underdeveloped, they are susceptible to mental or physical problems. Efforts to improve performance can lead to harm from overtraining, adopting eating habits that damage them physically or psychologically, like using steroids or supplements.
Mental health refers to a person's mental state, well-being, and ability to cope with the daily stresses of life. Good mental health also means that one has the ability to be mentally resilient, have a good life balance, having an absence of mental disorders and the ability to enjoy life. Elite athletes such as those competing in the Australian Football League(AFL), are at higher risk of developing a mental health disorders such as depression, anxiety, social anxiety, panic attacks and eating disorders. 16–34 years olds are also in the high risk category, which is the average age of a football player and extends to those who are being drafted, this puts AFL players in both high risk categories. A study conducted by Amelia Gulliver and Helen Christensen showed that 1 in 5 elite athletes suffered depressive symptoms. Playing elite sports is a great challenge emotionally, mentally as well as physically, some players can cope with all of these pressures while others cannot handle it and therefore suffer from a lack of mental health.
Paternal depression is a psychological disorder derived from parental depression. Paternal depression affects the mood of men; fathers and caregivers in particular. 'Father' may refer to the biological father, foster parent, social parent, step-parent or simply the carer of the child. This mood disorder exhibits symptoms similar to postpartum depression (PPD) including anxiety, insomnia, irritability, consistent breakdown and crying episodes, and low energy. This may negatively impact family relationships and the upbringing of children. Parents diagnosed with parental depression often experience increased stress and anxiety levels during early pregnancy, labor and postpartum. Those with parental depression may have developed it early on but some are diagnosed later on from when the child is a toddler up until a young adult.