Sport specificity of mental disorders: the issue of sport psychiatry

Review

Abstract

The prevalence of psychiatric conditions among elite athletes is still under debate. More and more evidence has accumulated that high-performance athletes are not protected from mental disorders as previously thought. The authors discuss the issue of the sport specificity of selected mental diseases in elite athletes. Specific aspects of eating disorders, exercise addiction, chronic traumatic encephalopathy and mood disorders in the context of overtraining syndrome are examined. In particular, the interrelationship between life and work characteristics unique to elite athletes and the development of mental disorders are reviewed. Differences of clinical presentation and some therapeutic consequences are discussed. The authors suggest that the physical and mental strains endured by elite athletes might influence the onset and severity of their psychiatric disorder. Beside the existing research strategies dealing with the amount of exercise, its intensity and lack of recreation experienced by athletes, further research on psycho-social factors is needed to better understand the sport-specific aetiology of mental disorders in high-performance athletes.

Keywords

Sport psychiatry Elite athlete High performance Mental disorder Psychiatric care 

References

  1. 1.
    Allegre B, Souville M, Therme P, Griffiths M (2006) Definitions and measures of exercise dependence. Addict Res Theory 14:631–644CrossRefGoogle Scholar
  2. 2.
    Armstrong LE, VanHeest JL (2002) The unknown mechanism of the overtraining syndrome: clues from depression and psychoneuroimmunology. Sports Med 32:185–209PubMedCrossRefGoogle Scholar
  3. 3.
    Babiss LA, Gangwisch JE (2009) Sports participation as a protective factor against depression and suicidal ideation in adolescents as mediated by self-esteem and social support. J Dev Behav Pediatr (JDBP) 30:376–384CrossRefGoogle Scholar
  4. 4.
    Barrack MT, Ackerman KE, Gibbs JC (2013) Update on the female athlete triad. Curr Rev Musculoskelet Med 6:195–204PubMedCrossRefGoogle Scholar
  5. 5.
    Beals KA, Manore MM (1994) The prevalence and consequences of subclinical eating disorders in female athletes. Int J Sport Nutr 4:175–195PubMedGoogle Scholar
  6. 6.
    Begel D (2000) Family systems-based treatment of the athlete family. W.W. Norton, New YorkGoogle Scholar
  7. 7.
    Begel D (1992) An overview of sport psychiatry. Am J Psychiatry 149:606–614PubMedGoogle Scholar
  8. 8.
    Berglund L, Sundgot-Borgen J, Berglund B (2011) Adipositas athletica: a group of neglected conditions associated with medical risks. Scand J Med Sci Sports 21:617–624PubMedCrossRefGoogle Scholar
  9. 9.
    Bonci CM, Bonci LJ, Granger LR, Johnson CL, Malina RM, Milne LW, Ryan RR, Vanderbunt EM (2008) National athletic trainers’ association position statement: preventing, detecting, and managing disordered eating in athletes. J Athl Train 43:80–108PubMedCrossRefGoogle Scholar
  10. 10.
    Byrne S, McLean N (2001) Eating disorders in athletes: a review of the literature. J Sci Med Sport 4:145–159PubMedCrossRefGoogle Scholar
  11. 11.
    Byrne S, McLean N (2002) Elite athletes: effects of the pressure to be thin. J Sci Med Sport/Sports Med Aust 5:80–94CrossRefGoogle Scholar
  12. 12.
    Calhoun JW, Ogilvie BC, Hendrickson TP, Fritz GK (1998) The psychiatric consultant in professional team sports. Child Adolesc Psychiatr Clin N Am 7:791–802PubMedGoogle Scholar
  13. 13.
    Corsellis JA, Bruton CJ, Freeman-Browne D (1973) The aftermath of boxing. Psychol Med 3:270–303PubMedCrossRefGoogle Scholar
  14. 14.
    Costanza A, Weber K, Gandy S, Bouras C, Hof PR, Giannakopoulos P, Canuto A (2011) Review: contact sport-related chronic traumatic encephalopathy in the elderly: clinical expression and structural substrates. Neuropathol Appl Neurobiol 37:570–584PubMedCrossRefGoogle Scholar
  15. 15.
    Davis JM (1995) Carbohydrates, branched-chain amino acids, and endurance: the central fatigue hypothesis. Int J Sport Nutr 5:S29–S38PubMedGoogle Scholar
  16. 16.
    Freimuth M, Moniz S, Kim SR (2011) Clarifying exercise addiction: differential diagnosis, co-occurring disorders, and phases of addiction. Int J Environ Res Public Health 8:4069–4081PubMedCrossRefGoogle Scholar
  17. 17.
    Glick ID, Horsfall JL (2009) Psychiatric conditions in sports: diagnosis, treatment, and quality of life. Physician Sportsmedicine 37:29–34PubMedCrossRefGoogle Scholar
  18. 18.
    Greiner E, Arndt KH (2004) Der erste sportärztliche kongress 1912—programm für ein jahrhundert. Deutsche Zeitschrift für Sportmedizin 55:314Google Scholar
  19. 19.
    Guskiewicz KM, Marshall SW, Bailes J, McCrea M, Harding HP Jr, Matthews A, Mihalik JR, Cantu RC (2007) Recurrent concussion and risk of depression in retired professional football players. Med Sci Sports Exerc 39:903–909PubMedCrossRefGoogle Scholar
  20. 20.
    Hammond T, Gialloreto C, Kubas H, Davis HH (2013) The prevalence of failure-based depression among elite athletes. Clin J Sport Med Off J Can Acad Sport Med 23:273–277CrossRefGoogle Scholar
  21. 21.
    Hausenblas HA, Giacobbi PR (2004) Relationship between exercise dependence symptoms and personality. Pers Individ Differ 36:1265–1273CrossRefGoogle Scholar
  22. 22.
    Herholz K, Buskies W, Rist M, Pawlik G, Hollmann W, Heiss WD (1987) Regional cerebral blood flow in man at rest and during exercise. J Neurol 234:9–13PubMedCrossRefGoogle Scholar
  23. 23.
    Hoyer J, Kleinert J (2010) Leistungssport und psychische Störungen. Psychotherapeutenjournal 3:252–260Google Scholar
  24. 24.
    Iverson GL, Gaetz M, Lovell MR, Collins MW (2004) Cumulative effects of concussion in amateur athletes. Brain Injury [BI] 18:433–443CrossRefGoogle Scholar
  25. 25.
    Johnson C, Powers PS, Dick R (1999) Athletes and eating disorders: the national collegiate athletic association study. Int J Eat Disord 26:179–188PubMedCrossRefGoogle Scholar
  26. 26.
    Jokl E, Guttmann E (1932) Psychiatrisch-neurologische kasuistik aus der sportärztlichen praxis. Zeitschrift für die gesamte Neurologie und Psychiatrie 141:153–161CrossRefGoogle Scholar
  27. 27.
    Jordan BD (1987) Neurologic aspects of boxing. Arch Neurol 44:453–459PubMedCrossRefGoogle Scholar
  28. 28.
    Kreider RB (1998) Central fatigue hypothesis and overtraining. In: Kreider RB, Fry AC, O’Toole ML (eds) Overtraining in sport. Human Kinetics, Champaign, IL, pp 309–334Google Scholar
  29. 29.
    Landolfi E (2013) Exercise addiction. Sports Med 43:111–119PubMedCrossRefGoogle Scholar
  30. 30.
    Markser VZ (2011) Sport psychiatry and psychotherapy. Mental strains and disorders in professional sports. Challenge and answer to societal changes. Eur Arch Psychiatry Clin Neurosci 261(Suppl 2):S182–S185PubMedCrossRefGoogle Scholar
  31. 31.
    Martland HS (1928) Punch drunk. J Am Med Assoc 19:1103–1107CrossRefGoogle Scholar
  32. 32.
    McCrory P (2013) Traumatic brain injury: revisiting the AAN guidelines on sport-related concussion. Nat Rev Neurol 9:361–362PubMedCrossRefGoogle Scholar
  33. 33.
    McCrory P, Meeuwisse WH, Kutcher JS, Jordan BD, Gardner A (2013) What is the evidence for chronic concussion-related changes in retired athletes: behavioural, pathological and clinical outcomes? Br J Sports Med 47:327–330PubMedCrossRefGoogle Scholar
  34. 34.
    McKee AC, Cantu RC, Nowinski CJ, Hedley-Whyte ET, Gavett BE, Budson AE, Santini VE, Lee HS, Kubilus CA, Stern RA (2009) Chronic traumatic encephalopathy in athletes: progressive tauopathy after repetitive head injury. J Neuropathol Exp Neurol 68:709–735PubMedCrossRefGoogle Scholar
  35. 35.
    Meeusen R, Watson P, Hasegawa H, Roelands B, Piacentini MF (2007) Brain neurotransmitters in fatigue and overtraining. Appl Physiol Nutr Metab 32:857–864PubMedCrossRefGoogle Scholar
  36. 36.
    Modolo VB, Antunes HK, Gimenez PR, Santiago ML, Tufik S, Mello MT (2011) Negative addiction to exercise: are there differences between genders? Clinics (Sao Paulo) 66:255–260CrossRefGoogle Scholar
  37. 37.
    Mónok K, Berczik K, Urbán R, Szabo A, Griffiths MD, Farkas J, Magi A, Eisinger A, Kurimay T, Kökönyei G, Kun B, Paksi B, Demetrovics Z (2012) Psychometric properties and concurrent validity of two exercise addiction measures: a population wide study. Psychol Sport Exerc 13:739–746CrossRefGoogle Scholar
  38. 38.
    Nattiv A, Loucks AB, Manore MM, Sanborn CF, Sundgot-Borgen J, Warren MP (2007) American college of sports medicine position stand. The female athlete triad. Med Sci Sports Exerc 39:1867–1882PubMedCrossRefGoogle Scholar
  39. 39.
    Newsholme EA, Parry-Billings M, McAndrew N, Budgett R (1991) A biochemical mechanism to explain some characteristics of overtraining. In: Brouns F (ed) Advances in nutrition and top sport. Basel, Karger, pp 79–83Google Scholar
  40. 40.
    Petibois C, Cazorla G, Poortmans JR, Deleris G (2002) Biochemical aspects of overtraining in endurance sports: a review. Sports Med 32:867–878PubMedCrossRefGoogle Scholar
  41. 41.
    Pugliese MT, Lifshitz F, Grad G, Fort P, Marks-Katz M (1983) Fear of obesity. A cause of short stature and delayed puberty. N Engl J Med 309:513–518PubMedCrossRefGoogle Scholar
  42. 42.
    Reardon CL, Factor RM (2010) Sport psychiatry: a systematic review of diagnosis and medical treatment of mental illness in athletes. Sports Med 40:961–980PubMedCrossRefGoogle Scholar
  43. 43.
    Resch M (2007) Eating disorders in sports–sport in eating disorders. Orv Hetil 148:1899–1902PubMedCrossRefGoogle Scholar
  44. 44.
    Resch M, Haasz P (2009) The first epidemiologic survey among Hungarian elite athletes: eating disorders, depression and risk factors. Orv Hetil 150:35–40PubMedCrossRefGoogle Scholar
  45. 45.
    Schmolzer B, Muller W (2002) The importance of being light: aerodynamic forces and weight in ski jumping. J Biomech 35:1059–1069PubMedCrossRefGoogle Scholar
  46. 46.
    Simma B, Lutschg J, Callahan JM (2013) Mild head injury in pediatrics: algorithms for management in the ED and in young athletes. Am J Emerg Med 31:1133–1138PubMedCrossRefGoogle Scholar
  47. 47.
    Snyder AC (1998) Overtraining and glycogen depletion hypothesis. Med Sci Sports Exerc 30:1146–1150PubMedCrossRefGoogle Scholar
  48. 48.
    Sudi K, Ottl K, Payerl D, Baumgartl P, Tauschmann K, Muller W (2004) Anorexia athletica. Nutrition 20:657–661PubMedCrossRefGoogle Scholar
  49. 49.
    Sundgot-Borgen J (1993) Prevalence of eating disorders in elite female athletes. Int J Sport Nutr 3:29–40PubMedGoogle Scholar
  50. 50.
    Sundgot-Borgen J (1996) Eating disorders, energy intake, training volume, and menstrual function in high-level modern rhythmic gymnasts. Int J Sport Nutr 6:100–109PubMedGoogle Scholar
  51. 51.
    Sundgot-Borgen J, Torstveit MK (2004) Prevalence of eating disorders in elite athletes is higher than in the general population. Clin J Sport Med Off J Can Acad Sport Med 14:25–32CrossRefGoogle Scholar
  52. 52.
    Sundgot-Borgen J, Torstveit MK (2010) Aspects of disordered eating continuum in elite high-intensity sports. Scand J Med Sci Sports 20(Suppl 2):112–121PubMedCrossRefGoogle Scholar
  53. 53.
    Veale D (1995) Does primary exercise dependence really exist? In: Annett J, Cripps B, Steinberg H (eds) Exercise addiction: motivation for participation in sport and exercise. The British Psychological Society, Leicester, pp 1–5Google Scholar
  54. 54.
    Wanke EM, Petruschke A, Korsten-Reck U (2004) Eating disorders in athletes—an inventory. Deutsche Zeitschrift für Sportmedizin 55:286–294Google Scholar
  55. 55.
    Weinstein A, Weinstein Y (2013) Exercise addiction- diagnosis, bio-psychological mechanisms and treatment issues. Curr Pharm DesGoogle Scholar
  56. 56.
    Whiting HTA (1994) Exercise addiction: motivation for participation in sport and exercise’. In: Submission for a satellite professional development workshop. The British Psychological Society, Sport and Exercise Psychology SectionGoogle Scholar
  57. 57.
    Wilson WM, Maughan RJ (1992) Evidence for a possible role of 5-hydroxytryptamine in the genesis of fatigue in man: administration of paroxetine, a 5-ht re-uptake inhibitor, reduces the capacity to perform prolonged exercise. Exp Physiol 77:921–924PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  1. 1.Pain & Autonomic Integrative Research (PAIR), Department of Psychiatry and PsychotherapyUniversity Hospital JenaJenaGermany
  2. 2.Practice for Psychiatry, Psychotherapy and Sport PsychiatryCologneGermany

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