Olympic Sports: Bad for the Brain?

Andrew Leigh; Ira Glick, MD

Disclosures

August 06, 2012

Editor's Note:

With the London Summer Olympics under way, Medscape interviewed Dr. Ira Glick, Professor Emeritus of Psychiatry at the Stanford University School of Medicine, Stanford, California, and founder of the International Society for Sport Psychiatry, to discuss the potential mental health effects of athletics and athletic training regimens.

Athletics and Mental Health: Introduction

Medscape: Could you give an overview of what psychiatric illnesses, effects, and/or mental health issues might be of concern in young Olympic athletes? And which sports pose the biggest risks of athletes developing these kinds of problems?

Dr. Glick: In young athletes, the major problems are in the "thin" sports like gymnastics, running, and dancing, where you get eating disorders. The other big thing with Olympic athletes is the issue of overtraining and burnout. We've looked at this issue of athletes versus nonathletes, and although no one has studied this scientifically, the incidence of major psychiatric illness is either less than or equal to that of the general population. That's because most of the stuff we treat is genetic. We know NIMH [National Institute of Mental Health] studies have shown that there's a 15% incidence of mental illness in the general population. And you have to figure that that's going to be in athletes also. No one has ever systematically studied 100 gymnasts and seen what percentage have eating disorders; the best we can figure is that it's a low incidence.

Medscape: Even if there's not a big split in terms of incidence compared with the general population, what's unique about treating a high-level athlete for mental health issues?

Dr. Glick: There are 2 major issues. One is the gladiator mentality: There's narcissism; they believe nothing can go wrong; they don't need help; they can overcome it. And just for that alone, they don't want to go to therapy, either for psychotherapy or medication. The medication issue becomes a little more complicated because they're afraid that it's going to impair their performance. The other part of this is that there's a stigma to going to see psychologists or psychiatrists -- or even nonpsychiatrists, internists, or general practitioners. If they go for help, it's a sign of weakness. The stigma of mental illness becomes a very important issue.

Another issue is that when it's over, it's over. Their whole life is focused around this. And then suddenly they're left without it. Unless they've lived a balanced life and have other things going in their lives, it's very difficult for them to adjust to being a regular guy or gal.

Medscape: How might the stigma of mental illness in athletes be addressed? Does it need to start with the athletes or with the institutions that they are involved with?

Dr. Glick: The institutions that they're involved with are gradually -- but very, very slowly -- beginning to get mental health components into their programs. But the focus has been on performance enhancement. It's only been when there's a focus not only on performance enhancement, but solving problems of the sport, the stresses of a particular sport, and recognizing that athletes, like non-athletes, are subject to the same illnesses. Another thing that you can do is have athletes come out with their struggles. Actors and other famous people with mental and physical illnesses are coming out and saying that they've been treated. And that's helped. All of this has worked toward breaking down the stigma of working with athletes.

Contact vs Noncontact Sports

Medscape: We've talked mostly about noncontact sports. How do you compare the mental health ramifications of noncontact vs contact sports? Head injuries, for example, must present different issues versus excessive weight loss or overtraining.

Dr. Glick: Contact sports such as football or soccer have the additional burden of traumatic brain injuries, which cause both brain damage and subsequent psychiatric symptoms like depression, difficulty getting along, and difficulty thinking clearly. There's an association with early-onset dementia because there's real brain damage as well as personality effects. It's harder to cope with the normal stresses of life. In Olympic sports, there's obviously some contact in soccer and basketball. In addition, with these sports there are associated injuries that would show up 20-30 years later, such as traumatic arthritis and other residua of orthopedic injuries, which cause a lot of physical pain and emotional pain associated with depression and decreased function.

Medscape: Do you think that going through so many years of grueling physical activity makes athletes more prone to psychiatric side effects, such as trying to cope with long-term physical ailments that develop because of their careers?

Dr. Glick: Being less able to cope is a problem, also the fact that their orthopedic injuries are more severe. But in addition, they could also be working with a less functional brain, which is causing significant problems in socializing and in relationships. Now not everybody gets this. But it certainly increases the risk for having long-term problems.

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