What is sports psychiatry and what benefits does it offer?

The intense pressure of elite athletics, and its accompanying highs and lows, can frequently provoke mental health problems among athletes. Sports psychiatry is the best way of addressing these specific problems. In his latest article, highly-renowned psychiatrist Dr Samr Dawood explains the benefits of sports psychiatry, as well as how elite athletes may be at a higher risk of developing mental health problems.

What is the aim of sports psychiatry?

Mental health disorders (MHD) in elite athletes are a topic that has received increased attention in recent years. Mental health is a fundamental component of the well-being of athletes. Subsequently, the fields of sports psychology and sports psychiatry are rapidly developing to respond to the needs of athletes.  For example, a new FIFA-supported project aims to demonstrate the importance of mental health and offer advice on ways to promote mental well-being through physical activity and sports. This project is led by the World Health Organization and Qatar’s Ministry of Public Health. It aims to demonstrate the importance of mental health in sports.

The promotion of mental health through the prevention, diagnosis and treatment of mental health problems and illnesses requires interprofessional cooperation. For sports psychiatry, however, this essentially means adapting and tailoring the general recommendations, principles, and guidelines for mental illnesses in general adult psychiatry to the needs of athletes.

Are sportspeople and athletes more prone to mental health problems? Why is this?

Although the elite’s susceptibility to mental health concerns appears comparable to the general population, they experience widespread risks that are not applicable to the general public. Sport-specific situations such as injuries, periods of overtraining and career termination may put athletes at an increased risk of developing mental health problems. Other possible risk factors include: 

• Achievements and performance outcomes pressures, maladaptive perfectionism.
• Injuries
• Physical health problems 
• Receiving criticism
• Doubts about personal and social identity
• Stressful life circumstances, relationship difficulties, adverse life events
• Public scrutiny
• Watching an opponent performing very well
•  Distractions by other life stresses
• Criticism by the media
• Receiving a referee’s warning
• Watching over cheating behaviour
• Unfair treatment
• Racism and discrimination
• Group threats and social threats, financial uncertainty, or inadequate social support

How can sportspeople and athletes benefit from specialist psychiatric care?

Usually, generic psychiatric services are not organized to address the special needs of athletes. Athletes may also be less inclined to seek support from their local mental health services because of different barriers like stigma or even poor mental health literacy.

Cultural factors can also act as barriers to help-seeking for mental health concerns, such as gender role beliefs, religious beliefs, and dependence on economic benefits from sports participation.

Consequently, it has been postulated that a psychiatrist interested in sports psychiatry will be more capable of understanding mental health problems associated with sports and can help build models to prevent, discover, diagnose, and treat mental health problems in athletes. Sports psychiatrists can use their expertise in the detection, treatment, and prevention of mental health issues in competitive athletes

How are athletes and sportspeople evaluated to assess their mental well-being?

To date, there are no published frameworks regarding how best to support the mental health needs of elite athletes. However, there are different ways to assess the mental well-being of athletes. Sport providers and managers should consider the range of relevant risk factors across key career phases, to remove or reduce them to ensure the basic safety of athletes and others in the sports setting.

Many of the general and athlete-specific risk factors for mental ill-health are potentially modifiable. Sports physicians and other healthcare providers should be able to screen and detect mental health problems. Screening questionnaires can be used as well. Mental health literacy programs should be provided to athletes, coaches, and high-performance support staff to help to create a culture that values enhancing the mental health and well-being of all stakeholders. Sports physicians should not hesitate to seek help from psychiatrists if they would identify psychiatric signs and indications.  

Which aspects of psychiatry or forms of therapy can be helpful for sportspeople and athletes?

Sports psychiatrists are uniquely positioned to distinguish mental health issues early and intervene appropriately. They should be vigilant to detect the most common mental health problems athletes can face like:

Attention deficit hyperactivity disorder (ADHD): Exercise may decrease lack of attention or impulsive behaviour. Thus, competitive sports may attract and benefit those with ADHD. ADHD can manifest in many ways, including lack of focus and concentration, oppositional behaviour in team sports, argumentative attitude, inability to follow instructions, disorganization, lateness, excessive exercise frustration, poor self-esteem, and mood lability.

The treatment of ADHD in sports requires a combination of behavioural, psychosocial, and medication modalities. Sports psychiatrists can support athletes in these procedures and can offer treatment. Athletes who are suffering from ADHD require a formal diagnosis and must supply documentation of diagnosis and treatment. if a stimulant medication is prescribed; a clear plan for follow-up and monitoring should be in place to comply with the rules of the sport established by the governing bodies, according to the type of sport and the level of the competition. 

Eating disorder/disordered eating: The risk of developing EDs among athletes varies, depending on gender, sports discipline, personal background, and competitive level. This highlights the need for sports psychologists, physicians, coaches, and other sports professionals working with athletes to monitor early signs of eating disorders symptomatology like distorted body image or certain eating habits. Psychiatrists can help in detecting these problems and in designing interventions. 

Anxiety and Insomnia: Pharmacological and psychological intervention might be needed to treat these conditions. However, there is a concern that sleep medication overreliance is frequent among elite athletes. These medications might affect athletic performance. Psychological interventions are safer for the treatment of anxiety and sleep disturbance, but sedatives for insomnia and selective serotonin reuptake inhibitors (SSRIs) for athletic anxiety may be considered under specialized care from a psychiatrist.

Depression:  Athletes most probably suffer from depression at the same rate as the general population. However, they might be underreporting depression symptoms in an attempt to portray themselves in a favourable light. Early recognition and appropriate management of depression in athletes lead to improved clinical and performance outcomes and minimise their suffering. Assessment of mood symptoms in an athlete should include biopsychosocial formulation to identify risk factors that were outlined earlier. An experienced psychiatrist can develop the best treatment plan to ameliorate the illness with a focus on minimizing the impact on sports performance.

Substance abuse: Athletes use substances to produce pleasure, relieve pain and stress, improve socialization, recover from injury, and enhance performance. Substances such as anabolic androgenic steroids, amphetamines, human growth hormone, or erythropoietin. These substances can combat fatigue, relieve pain, enhance injury recovery, alter intensity and aggression, sharpen focus, increase strength and endurance, or reduce or add weight. Consequently, athletics can descend into full clinical addiction. Diego Maradona struggled with a twenty-year cocaine addiction, leading to three suspensions and multiple failed drug tests during his career. Alcohol and the athlete have been linked together since ancient times. It continues to be the most commonly consumed drug among the athletic population.

The more elite the athlete and the more financial gain that is involved, the greater the risk of doping and the use of performance-enhancing drugs, and the greater the need for sports psychiatrists working with athletes. Psychiatrists are well-trained in recognizing, preventing, and treating substance use disorders.

Dr Samr Dawood is a leading London-based psychiatrist with over 15 years of experience.  If you would like to book a consultation with Mr Dawood you can do so today via his Top Doctors profile.