Clinical disorders of the mind in student athletes
Athletic coaches and administrators from the "old school" viewed student athletes suffering from psychological or mental issues as being weak or without backbone. A "real" student-athlete was someone who had the ability to overcome any mental or emotional crisis if he or she would just be strong and tough it out. The truth is that college student-athletes are human beings, and as human beings they are subject to the same clinical disorders that face non-student-athletes. In fact, the college student-athlete may be more at risk for certain types of clinical disorders because of the added pressures that are inherent in being a performer in front of a national audience who is also expected to carry a full load of college courses. The student-athlete is asked to essentially hold two full time jobs! Added to this is the need of the student athlete to have a balanced social life, which requires additional energy and effort in order to acquire and maintain relationships both in and out of the athletic world.
It is estimated that between 5% and 25% of student-athletes in American colleges and universities suffer from psychosocial conditions that require counseling services (Bunker & McGuire, as cited in Hinkle, 2002). Unfortunately, only about 5% of these athletes seek professional help. One possible explanation as to why these athletes do not seek professional help is due to their ignorance of the need for that help (Petitpas and Champagne, 1988). This ignorance can be inadvertently promoted by athletic department coaches and administrators as many student-athletes are sheltered, hiding behind the curtain of athletics where others look out for them and cater to their needs. It is a life that is regulated, and to many of these student-athletes a regulated life is attractive and comfortable. Another reason student athletes may not seek outside help is the "old school" faulty belief that those needing mental or psychological help are weak and undeserving. In American society, athletes are viewed as icons, and as icons they are not to show any weakness, especially mental or psychological weakness. Even though student athletes are center stage in sold out stadiums and arenas, they experience loneliness and social isolation (Golden, as cited in Hinkle, 2002). In this case, there seems to be truth in the saying "it's lonely at the top." Also, because student athletes are in the spotlight, non-student athletes may exhibit a jealous or envious disposition toward them. Unless the student athlete demonstrates nerves of steel and is able to ignore attitudes of prejudice or discrimination, this experience can become quite burdensome. Finally, the pressure of succeeding in the classroom may be just as challenging as any other facet of the intercollegiate college experience, especially if the student athlete is not equipped with the academic skills necessary to comfortably function at the post-secondary level. Intercollegiate athletics is as much mental as it is physical. In fact, intercollegiate athletics may require more mental strength as the perceived expectations of family, friends, coaching staff, and the media along with a more than full-time schedule of academics and athletics can wear down the body and mind. The combination of all these factors can lead the student-athlete down a lonely path of helplessness and hopelessness resulting in clinical disorders such as depression, adjustment disorder, generalized anxiety, and substance abuse.
Clinical depression is a very real disease affecting an estimated 9% to 20% of the general population (Boyd & Weissman, 1981). Women are more prone to suffering from this disease than men. For the college student-athlete, the combination of academics, athletics, living away from home, and being put into a new social network is sometimes just too great a burden to bear, resulting in psychological distress and risky behavior. This is, no doubt, especially true in the high profile sports of football and basketball where demands and pressures are multiplied. The end result of these stressors can be the cause of both physical and emotional illness.
Today, the most common mental disorder resulting from psychological distress is clinical depression. Clinical depression is a condition affecting the feelings, thoughts, and actions of individuals over a minimum period of two continuous weeks. Those affected show little hope, display sadness, and are not motivated to participate in activities that were once fun and enjoyable. Seemingly, all aspects of the human condition are negatively affected by depression (University of California, Berkeley, n.d.). Other symptoms of depression include troubled sleep, significant weight loss or gain, trouble with movement, fatigue, feelings of guilt, loss of concentration, and suicidal tendencies (American Psychiatric Association, 2010).
The causes of depression are complex, but are thought to stem from "a combination of genetic, psychological, and environmental factors" (University of California, Berkeley, n.d., p. 1). Biological factors appear to be connected to depression as chemicals inside the brain called neurotransmitters differ in persons suffering from depression. Antidepressant drugs, drugs that work on chemical imbalances in the brain, have been successfully prescribed for many of these individuals. What scientists don't know though is what comes first, the depression or the chemical changes in the brain. Some people may be predisposed to depression as it has been known to run in families.
Environmental and psychological stressors have also been shown to lead to episodes of depression. Common stressors for college student-athletes include fulfilling academic requirements, moving to and living in a new "home away from home", trying to balance sports and academics, missing one's family or friends, the exposure to new people and ideas. The psychological and emotional make-up of some people may also trigger depression. Individuals who are pessimistic, have a low self esteem, or who are very sensitive to stress may be prone to this illness. Finally, a link has been noted between alcohol and drug use and depression. Research findings state that the alcohol and drug use may trigger depression or depression may trigger the use of alcohol and drugs (University of California, Berkeley, n.d.).
Adjustment disorders are a type of mental illness related to stress (Mayo Clinic Staff (2009a). Signs and symptoms of this illness can vary, but the stressors may be isolated events or chains of events in one's life. The adjustment disorder usually develops within 3 months of the occurrence of the stressor (Seligman, 2004). The affected individual may feel anxious or depressed, have suicidal thoughts, display clouded judgment, show poor adjustment to change, and may have trouble carrying out ordinary routines like going to work or communicating with friends. Adjustment disorders seem to be quite common, but how common is difficult to ascertain as many of the affected individuals do not seek out treatment (Seligman, as cited in Hinkle, 2002). Men and women appear to be equally affected by adjustment disorders, and many of those affected manifest physiological or psychological problems (Marshall & Barbaree, as cited in Hinkle, 2002).
Symptoms of adjustment disorders may be exhibited in emotions or behaviors. Emotional symptoms include sadness, hopelessness, lack of enjoyment, crying spells, nervousness, thoughts of suicide, anxiety, worry, desperation, trouble sleeping, difficulty concentrating, and feeling overwhelmed. Behavioral symptoms include fighting, reckless driving, ignoring bills, avoiding family or friends, poor school or work performance, skipping school, and vandalism (Mayo Clinic Staff, 2009b).
If symptoms last 6 months or less the adjustment disorder is considered acute. In these cases, symptoms may disappear on their own, especially if the affected individual actively follows self-care measures. If symptoms persist for longer than 6 months the adjustment disorder is deemed chronic. In these cases, symptoms continue to bother the affected individual, significantly affecting his or her life. Professional treatment is recommended to help with symptoms and prevent the condition from worsening (Mayo Clinic Staff, 2009b).
Generalized anxiety disorder (GAD) is an illness in which the affected individual suffers from unrealistic thoughts and anxiety. This person views life negatively, the glass always being half full. A student-athlete with this disorder may worry about issues such as health or injury, school, and sports. When the individual worries excessively about perceived problems for at least 6 months, he or she is diagnosed with this disorder. The affected person does realize excessive worrying is a problem, but feels little control over it (National Institute of Mental Health, 2009).
The primary symptoms of GAD are similar to those of depression and include fatigue, restlessness, difficulty concentrating, troubled sleep, and muscle tension (The Merck Manuals, 2009). Other symptoms may include headaches, muscle aches, difficulty swallowing, trembling, twitching, sweating, nausea, lightheadedness, having to go to the bathroom frequently, feeling out of breath, and hot flashes. GAD affects twice as many women as men. College-aged individuals fall into the higher than normal risk category of contracting GAD. As is the case with many physical and mental illnesses, there is evidence that genes play a modest role in GAD (National Institute of Mental Health, 2009). Student-athletes can suffer from a form of GAD known as competition anxiety, especially as the time for competition nears (Swain, Jones and Cale, 1990). Left unchecked, competition anxiety can lead to more serious symptoms including uncontrolled anxiety along with drug and alcohol use and abuse (Hinkle, 2002).
In today's world of intercollegiate athletics, athletic administrators, coaches, trainers, and other support staff need to first get to know and understand their student-athlete population both individually and collectively. Athletic department coaches and staff ought to be active in working on building relationships with student-athletes that are open, honest, and trusting. If this can be accomplished, student-athletes will be more willing to discuss their thoughts and feelings thus helping to prevent more serious mental disorders from developing. In a near perfect world the setting above would be optimal, but not all student-athletes or athletic staff will be willing to work together at having open, honest, and trusting relationships. In all cases though, athletic staff need to be educated on the symptoms of these mental illnesses, understanding the stressors specific to their student-athlete population. They should be familiar with as many treatment options as possible including individual and group counseling, interpersonal and cognitive therapies, relaxation and stress management programs, and biofeedback and hypnosis. Along with this, athletic coaches and staff should be familiar with all possible human resources at their disposal, including psychologists, psychiatrists, and support groups. In this way they can be proactive in helping prevent the more at risk student-athletes from falling into the grips of these debilitating illnesses.
Alcohol is the number one drug abuse problem among college student-athletes (Gay, Minelli, Tripp, & Keilitz, 1990). Even though alcohol consumption is legal for those 21 years of age and older, its use and abuse is a major problem in towns, cities, schools, and institutions of higher learning across the United States. Alcohol is a depressant, affecting the central nervous system of the body. It leads to slowed reactions, slurred speech, and in some cases, unconsciousness. Inhibitions are affected so that the intoxicated individual may act foolishly. Alcohol is quick to move into the bloodstream from the stomach and small intestine. It takes awhile for the effects of alcohol to wear off, up to one hour for one drink (University of Miami Counseling Center, 1998).
According to the National Institute on Drug Abuse (2007), anabolic-androgenic steroids are synthetic or man-made substances derived from the male sex hormones. The word anabolic refers to the muscle building qualities that these chemicals induce. Androgenic refers to the masculine characteristics that these chemicals promote. Anabolic steroid use among high school students has become a problem in recent years. Feinberg and Meldrum (2002) estimate anabolic steroid use among college student-athletes to range between 1% and 12% (p. 1). Today's student-athletes use anabolic steroids to get bigger and stronger, thus enhancing performance on the playing field. Not only is steroid use illegal and unfair, but it has the potential to do damage to one's emotional and physical health. Side effects of steroid use include liver tumors and cancer, jaundice, fluid retention, high bold pressure, increases of bad cholesterol and decrease of good cholesterol, kidney tumors, severe acne, and trembling. Gender specific side effects such as infertility and baldness in men and growth of facial hair and deepening voice for women are common. Side effects affecting one's mental and emotional health include aggression, mood swings, depression, paranoid jealousy, extreme irritability, delusions, and impaired judgment (National Institute on Drug Abuse, 2007).
Amphetamines stimulate the central nervous system, acting to increase heart and respiration rates, increase blood pressure, dilate the pupils of the eyes, and decrease appetite. This can lessen sleepiness and decrease fatigue, effects that can be viewed as an asset to both students and student-athletes alike (Amphetamines, n.d.). Amphetamine abuse can also affect one's mental state by bringing about delusions, hallucinations, and feelings of paranoia leading to strange and often violent behaviors (Missouri Department of Mental Health, n.d.).
According to data from the 2007 National Household Survey on Drug Use and Health (as cited in Bureau of Justice Statistics, 2009), approximately 28% of college-aged individuals used marijuana during 2006. Heavy marijuana use can affect one's physical and mental health by causing poor coordination, difficulty in critical thinking and problem solving, and trouble with learning and memory. Repeated usage of this drug can affect one's mental state for a few days to several weeks, the time it takes for the effects of the drug wear off. Long-term marijuana use can lead to addiction and withdrawal symptom such as irritability, sleeplessness, decreased appetite, and anxiety. One's heart and lungs are also negatively affected by marijuana usage. Finally, increased rates of anxiety, depression, suicidal tendencies, and schizophrenia have been associated with chronic marijuana use (The National Institute on Drug Abuse, 2009).
The use of drugs and alcohol can be categorized as either substance dependence or substance abuse. Substance dependence is more severe than substance abuse. Both include patterns of substance use which lead to significant impairment or distress (Diagnostic and Statistical Manual of Mental Disorders, as cited in Hinkle, 2002).
It is imperative that athletic administrators, coaches, and other athletic staff be trained in recognizing the symptoms of and consequences of drug and alcohol abuse. This will bring about an understanding of the primary drugs abused and a proactive awareness of what to look for in the drug and alcohol user. They should also realize that student-athletes are at risk for using and abusing drugs more so than the general student population primarily because of the many stressors these student-athletes encounter. The athletic staff needs to be ready to assess and intervene for substance abuse as soon as it is suspected for the good of the student-athlete, the athletic program, and the institution.
There are a variety of treatment options for student-athletes suffering from substance abuse including individual and group counseling. Organizations such as The Association Against Steroid Abuse, Alcoholics Anonymous, and Narcotics Anonymous can be a tremendous asset in helping those suffering from substance addiction. Depending on the severity of the dependence, day treatment, residential treatment, or inpatient hospitalization may be necessary. Today traditional drug education programs are being replaced by more holistic programs that incorporate social skills training, verbal and nonverbal communication skills training, and techniques for coping with stress and anxiety (Koll & Pearman, as cited in Hinkle, 2002).
College student-athletes, like their non-athlete peers, suffer from clinical disorders including depression, adjustment disorders, generalized anxiety, and substance abuse. The reality is, because they are in the spotlight and exposed to great pressures both on and off the playing field, student-athletes are at greater risk of having to deal with clinical disorders as compared to other students on the college campus. All athletic department personnel including athletic administrators, coaches, trainers, and counselors must be keenly aware of symptoms that student-athletes with clinical disorders may exhibit. It is important that athletic department personnel collaborate with expert clinicians when the situation calls for action.
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