Sport psychiatry: How to keep athletes in the game of life, on or off the field
Some athletes’ toughest opponents are depression, addictions, and eating disorders. Managing these patients’ mental illnesses is a new niche for psychiatry
Anxiety disorders
Obsessive-compulsive disorder may have unique manifestations on the baseball diamond, where the batter wears his “lucky socks” to every game, spits his tobacco juice in a particular pattern, or taps his bat on the ground a requisite number of times before approaching the plate. It is easy to imagine that the features of obsessive-compulsive personality disorder, present in a subset of those with obsessive-compulsive disorder, can contribute to athletic success.
Repetition and perfectionism are required for the athlete who aspires to succeed at the elite level. U.S. speed skater Eric Hayden wore grooves into a wooden board on which he tirelessly practiced the side-to-side motion that hypertrophied his quadriceps en route to the Olympic gold medal.
Social phobia. Some athletes with social phobia appear to express a counterphobic response on the field or find an escape from their anxiety in this forum. Perhaps Ricky Williams, who has acknowledged that he is being treated for social anxiety disorder, takes refuge behind the armor of his helmet and uniform as a running back for the NFL’s Miami Dolphins.10
Panic disorder. Earl Campbell, a former NFL running back, developed panic disorder after his retirement from professional football. The chest pain and palpitations he experienced caused him to seek help, but he told a newspaper reporter, “I didn’t realize I was going to a shrink, and when I found out, I almost slugged him.”11 After an initial prescription of alprazolam, Campbell’s panic symptoms were well managed through relaxation techniques and exercise.
Posttraumatic stress disorder (PTSD). Julie Krone, the celebrated female jockey, developed PTSD after two falls from her mount: a serious spill from which she recovered, and later a more minor fall that resulted in two broken wrists.12 Her anxiety symptoms were treated, and she went on to race horses again before her retirement. She now participates in the Women’s Sports Foundation-sponsored Minds in Motion Depression Campaign to remove the stigma of PTSD.
Other disorders in athletes
ADHD. Children and adolescents with attention-deficit/ hyperactivity disorder (ADHD) may find sports to be adaptive, even therapeutic. Though this theory is untested, anecdotal reports, as in Box 1, are suggestive.
Eating disorders. Certain athletic environments foster eating disorders, especially in athletes who are psychodynamically or genetically predisposed to disordered eating. Eating disorders appear to arise in three major sports categories:
- Where low body fat provides an advantage, including track and field, swimming, and distance running. Distance runner Mary Wazeter developed an eating disorder while attending Georgetown University on a track scholarship.13
- Where it is imperative to “make weight,” including wrestling, horse racing, and crew. Thoroughbred jockey Herb McCauley recalls his bulimia developing when he was a high school wrestler, running in rubber suits and vomiting to keep his weight down. Later he won more than 3,000 races at major horse tracks, using diuretics and laxatives on his way to less than 2% body fat.14
- Where scoring may be based in part on aesthetics, including gymnastics, figure skating, diving, synchronized swimming, and—though not a competitive sport—ballet.
In aesthetic sports, the onset of an athlete’s eating disorder often can be traced to a single, critical comment (Box 2).5
In Little Girls in Pretty Boxes—her book about the rigors of gymnastics training and competition—news columnist Joan Ryan reported that one morning coach Bela Karolyi caught gymnast Erica Stokes eating a peach after several hours in the gym. “You’re so lazy!” he bellowed. “You’re so fat! You just come in and pig out after workouts. All you think about is food.” He then made the entire team train an extra 2 hours.
According to Ryan, Stokes began purging after that tirade: “Like stress fractures and torn muscles, vomiting was simply another unavoidable insult her body would have to tolerate if she was going to survive in elite gymnastics.” Ultimately, Stokes’ bulimia became so severe that after 12 years she quit gymnastics, just 9 months before the 1992 Olympic games for which she had been expected to qualify.5
Psychotic disorders also arise in athletes, sometimes after abuse of anabolic steroids or other substances or in association with bipolar disorder or schizophrenia. There is nothing more poignant than treating a first episode of schizophrenia in an adolescent who dreams of becoming the high school’s next great quarterback. The illness itself and necessary drug interventions can pose insurmountable obstacles, although the newer antipsychotics offer reduced side effects compared with older medications.
Substance abuse
Anabolic steroids. At the start of the 2002 baseball season, former Atlanta Braves third baseman Ken Caminiti shocked the sports world with allegations that “at least 50 percent” of Major League Baseball players use anabolic steroids to enhance their performance. Use of anabolic steroids is illegal without a prescription; the National Football League requires screening for steroid use, but Major League Baseball does not.
