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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]
In 1994, Begel founded the International Society for Sports Psychiatry (ISSP). 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]
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]
In professional sports more than others, seeking assistance to improve one's mental health is often stigmatized. [9] Athletes will most commonly seek help from psychologists first or not go for help at all, and serious mental health-related issues might go unrecognized. Hence, another role of sports psychiatrists is to help de-stigmatize and promote mental health among athletes. [1] [8]
Bipolar disorder, previously known as manic depression, is a mental disorder characterized by mood instability that flucatuates between periods of depression and periods of abnormally elevated mood that each last from days to weeks. If the elevated mood is severe or associated with psychosis, it is called mania; if it is less severe and does not significantly affect functioning, it is called hypomania. During mania, an individual behaves or feels abnormally energetic, happy or irritable, and they often make impulsive decisions with little regard for the consequences. There is usually also a reduced need for sleep during manic phases. During periods of depression, the individual may experience crying and have a negative outlook on life and poor eye contact with others. The risk of suicide is high; over a period of 20 years, 6% of those with bipolar disorder died by suicide, while 30–40% engaged in self-harm. Other mental health issues, such as anxiety disorders and substance use disorders, are commonly associated with bipolar disorder.
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.
A mental disorder, also referred to as a mental illness, a mental health condition, or a psychiatric disorder, 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.
Schizophrenia is a mental disorder characterized by reoccurring episodes of psychosis that are correlated with a general misperception of reality. Other common signs include hallucinations, delusions, disorganized thinking, social withdrawal, and flat affect. Symptoms develop gradually and typically begin during young adulthood and are never resolved. There is no objective diagnostic test; diagnosis is based on observed behavior, a psychiatric history that includes the person's reported experiences, and reports of others familiar with the person. For a diagnosis of schizophrenia, the described symptoms need to have been present for at least six months or one month. Many people with schizophrenia have other mental disorders, especially substance use disorders, depressive disorders, anxiety disorders, and obsessive–compulsive disorder.
A mood disorder, also known as an affective disorder, is any of a group of conditions of mental and behavioral disorder where a disturbance in the person's mood is the main underlying feature. The classification is in the Diagnostic and Statistical Manual of Mental Disorders (DSM) and International Classification of Diseases (ICD).
Anxiety disorders are a cluster 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.
Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterised by executive dysfunction occasioning symptoms of inattention, hyperactivity, impulsivity and emotional dysregulation that are excessive and pervasive, impairing in multiple contexts, and otherwise age-inappropriate.
Schizoaffective disorder is a mental disorder characterized by abnormal thought processes and an unstable mood. This diagnosis requires symptoms of both schizophrenia and a mood disorder: either bipolar disorder or depression. The main criterion is the presence of psychotic symptoms for at least two weeks without any mood symptoms. Schizoaffective disorder can often be misdiagnosed when the correct diagnosis may be psychotic depression, bipolar I disorder, schizophreniform disorder, or schizophrenia. This is a problem as treatment and prognosis differ greatly for most of these diagnoses.
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.
Orthomolecular psychiatry is the use of orthomolecular medicine for mental illness. The approach uses unorthodox forms of individualized testing and diagnosis to attempt to establish an etiology for each patient's specific symptoms, and claims to tailor the treatment accordingly, using a combination of nutrients, dietary changes and medications that are claimed to enhance quality of life and functionality as well as to reduce or eliminate symptoms and the use of xenobiotic drugs. Scientific studies have shown mixed results; although there are some promising results from nutritional psychiatry, some forms of orthomolecular psychiatry are ineffective.
Despite the scientifically well-established nature of attention deficit hyperactivity disorder (ADHD), its diagnosis, and its treatment, each of these has been controversial since the 1970s. The controversies involve clinicians, teachers, policymakers, parents, and the media. Positions range from the view that ADHD is within the normal range of behavior to the hypothesis that ADHD is a genetic condition. Other areas of controversy include the use of stimulant medications in children, the method of diagnosis, and the possibility of overdiagnosis. In 2009, the National Institute for Health and Care Excellence, while acknowledging the controversy, stated that the current treatments and methods of diagnosis are based on the dominant view of the academic literature.
The emphasis of the treatment of bipolar disorder is on effective management of the long-term course of the illness, which can involve treatment of emergent symptoms. Treatment methods include pharmacological and psychological techniques.
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.
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.
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.
Psychiatry is the medical specialty devoted to the diagnosis, prevention, and treatment of deleterious mental conditions. These include various matters related to mood, behaviour, cognition, perceptions, and emotions.
Management of depression is the treatment of depression that may involve a number of different therapies: medications, behavior therapy, psychotherapy, and medical devices.
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 was defined by the European Federation of Sport Psychology (FEPSAC) in 1996, as the study of the psychological basis, processes, and effects of sport. Otherwise, sport is considered 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 and physical factors. Sport psychologists teach cognitive and behavioral strategies to athletes in order to improve their experience and performance in sports.
Addiction psychiatry is a medical subspecialty within psychiatry that focuses on the evaluation, diagnosis, and treatment of people who have one or more disorders related to addiction. This may include disorders involving legal and illegal drugs, gambling, sex, food, and other impulse control disorders. Addiction psychiatrists are substance use disorder experts. Growing amounts of scientific knowledge, such as the health effects and treatments for substance use disorders, have led to advancements in the field of addiction psychiatry. These advancements in understanding the neurobiology of rewarding behavior, along with federal funding, has allowed for ample opportunity for research in the discipline of addiction psychiatry. Addiction psychiatry is an expanding field, and currently there is a high demand for substance use disorder experts in both the private and public sector.