By
David Conant-Norville on August 3rd, 2011
Eating Disorders Often 'Overlooked' in Elite Athletes
July 8, 2011 (Brighton, United Kingdom) — Eating disorders, which are highly prevalent among both male and female athletes, is a largely ignored problem, an expert says.
In a presentation at the International Congress of the Royal College of Psychiatrists 2011, sports psychiatrist Alan Currie, MD, consultant psychiatrist and honorary clinical lecturer for the Assertive Outreach Team, Northumberland Tyne and Wear NHS Trust, Newcastle, United Kingdom, said athletes get a "raw deal" when they develop mental illness.
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| Dr. Alan Currie |
"If you rupture your ACL [anterior cruciate ligament], within about 10 minutes 6 guys have gathered around you, within 2 days you've had surgery and a treatment plan, and everybody helps you with your rehab."
"If you become depressed, or if you get an eating disorder, you pretty much get abandoned," Dr. Currie, himself a former athlete, said in an interview with Medscape Medical News. "It doesn’t get recognized, it doesn’t get picked up, there isn’t the same coordinated response to get people well again."
In his presentation, Dr. Currie highlighted
The researchers evaluated the entire population of Norwegian male and female elite athletes — 1620 in number — as well as 1696 controls, and found that 13.5% of athletes and 4.6% of controls had subclinical or clinical eating disorders (P < .001).
The overall prevalence of eating disorders among male athletes was 8% — 16 times the prevalence rate among nonathletic males. Among females, it was 20% — double that of female nonathletes.
Unusual vs Problem Eating
Dr. Currie, who competed in track while in high school and medical school and who now does triathlons, said that he did not develop an eating problem himself, but he did have to eat in an "unusual way" compared with his nonathletic counterparts.
"We do have to eat differently, watch our weight, and watch how our weight affects our performance. One of the points I wanted to get across to psychiatrists who perhaps may not know very much about sport is to help them distinguish what is unusual but not abnormal eating," he said.
For example, Dr. Currie noted that Tour de France cyclists have to eat an enormous amount of food every day to fuel their bodies so that they can race up and down the Alps.
"They do stages that require them to eat 7000 or 8000 calories a day. That would fill a table. And they have to eat that in a day. So they have pasta for breakfast, they eat baked potatoes without getting out of the saddle; they drink and drink and drink."
"That Tour cyclist is racing at 25 miles an hour for 6 hours. They have to be very careful. Their food is all measured, they take chefs with them, they bring all their own food, they’ve got personal nutritionists, they weigh their meals," he said.
This is an example of athletic eating. It seems unusual to nonathletes but is perfectly normal for high-performing cyclists. "The trick for the psychiatrist is to recognize the difference," Dr. Currie said.
Aesthetic Sports Riskier?
"I couldn’t agree more," said Antonia Baum, MD, a psychiatrist in private practice in Chevy Chase, Maryland, and vice president of the International Society of Sports Psychiatrists.
"Psychiatrists need to be able to distinguish between usual eating for sports and problem eating," she told Medscape Medical News.
Athletes who are most vulnerable to develop eating disorders are those whose sports emphasize aesthetics, such as gymnastics, figure skating, diving, tennis, and swimming.
"Women, especially in those sports, are probably more vulnerable," said Dr. Baum. "They’re out there on a court or the deck of a pool in clothing that is quite revealing," she said.
Rowing and wrestling are 2 other sports that emphasize weight.
"If you get someone who is in a sport that might predispose them to develop an eating disorder, and they also have a genetic predisposition to an eating disorder, you have a convergence of risk factors that could be problematic," Dr. Baum said.
High Index of Suspicion
Most psychiatrists are trained to ask about eating disorders, but they might need to ask about them in a different way for an athlete, Saul Marks, MD, a sports psychiatrist from the University of Toronto, Ontario, Canada, told Medscape Medical News.
"The athlete might need to be spoken to away from the team. There should be a high index of suspicion in acrobatic sports or where weight matters, such as weigh-in sports, or in sports that demand that someone be very fit and thin, like in long-distance running," Dr. Marks said.
"They need to be told that they need treatment and that they will no longer be part of the team until they receive the treatment they need and deserve and that it will be difficult for them in the future if they don’t get help for it now. It’s being very kind and compassionate, caring, but firm. No bargaining," he said.
Athletes deserve the same quality of psychiatric care that every other citizen receives, but sadly that is not the case, Dr. Marks added.
"There is still the stigma attached to mental health problems. However, that is beginning to change. There are more people who are starting to see psychiatric illness in sports."
Dr. Currie, Dr. Baum, and Dr. Marks have disclosed no relevant financial relationships.
International Congress of the Royal College of Psychiatrists 2011. Presented July 1, 2011.
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Authors and Disclosures
Journalist
Fran Lowry
is a freelance writer for Medscape.
By
Ian Norville on June 18th, 2011
By SHERRY BOSCHERT
Elsevier Global Medical News
EXPERT ANALYSIS FROM THE ANNUAL MEETING OF THE AMERICAN PSYCHIATRIC ASSOCIATION
HONOLULU – They’re not sports psychologists. And they’re not neurologists. Sports psychiatrists have their own position to play in the care of athletes.
A neurologist deals with memory and function after concussion, for example, but a sports psychiatrist also diagnoses and treats the short- and long-term psychiatric sequelae of traumatic brain injury (TBI) or other injuries, Dr. Ira D. Glick said at the meeting.
A sports psychiatrist in general might diagnose and treat psychopathology, symptoms, or disorders within an athlete or problems related to the athlete’s family, significant other, team, or the sport.
Just as a private-practice psychiatrist’s job is to help bring patients to their highest quality of life, “our job as sports psychiatrists is to bring athletes to optimal mental health and athletic performance,” said Dr. Glick, professor of psychiatry and behavioral sciences at Stanford (Calif.) University, who coauthored a paper with Dr. Claudia L. Reardon on the subject.
Treatment might target attention-deficit/hyperactivity disorder, anxiety disorders, depression, psychotic disorders (rarely), or substance abuse problems (frequently). Symptoms can interfere with performance, as in the athlete who develops so many obsessive-compulsive rituals before a game that he can’t get on the field in time. Aggression, cheating and gambling, and suicidal ideation and behavior all might occur less frequently in athletes than in the general population. However, there are always some who will engage in these behaviors.
In fact, Dr. Glick recently traveled to Germany to consult with psychiatrists in that country on the suicide of Robert Enke, the goalkeeper for Germany’s national team who took his life in 2009 after concealing many years of depression.
Female athletes in particular face family problems that don’t get enough attention. “It’s almost impossible to have a life if you’re a professional woman athlete. You’re always on the move; you can’t raise kids; you have to have your husband around to have a relationship,” said Dr. Glick, who is on the board of directors of the International Society for Sports Psychiatry. “These are tremendous family problems that have hardly been addressed. If somebody wants to make a career, focus on sports psychiatry now and carve out a niche” specializing in helping female athletes, he suggested.
Sports psychiatrists also look at systemic issues, such as the impact on athletes from the “posse” of people surrounding them, including agents, coaches, trainers, and others. Sports psychiatrists also might focus on problems in a particular sport, such as TBI in football, doping in cycling, or brain damage in boxing.
Once psychopathology is identified, the sports psychiatrist helps set goals. “One of the special characteristics of our field is deciding: goals for whom? The athlete? The team? Their significant others? Set the goals first, and then treat,” Dr. Glick said.
“That world is a very different world than the average patient who visits a psychiatrist’s office with depression, anxiety, or family problems. Sports psychiatry requires special skills and special treatments,” he said.
Treatment might involve individual psychotherapy for the athlete or someone close to the athlete – as in marital therapy – pharmacotherapy, or prescribing self-help groups such as Alcoholics Anonymous.
All professional sports leagues now have psychiatrists working with them specifically on substance abuse. “Steroid use is a huge issue, but that’s just the tip of the iceberg of what’s going on out there. What team physicians will tell you is that athletes will do anything and take anything to get a competitive advantage,” he said.
Substance abuse might even contribute to the long-term sequelae of TBI. “We don’t know what the confounders are,” he noted. “Steroids, for all we know, may be rotting out these brains. We know that in boxing, it’s from the hits, but we’re not that sure yet about the etiology of many of the brain-damage problems in other sports.”
Dr. Glick currently is attempting to work with professional sports leagues, unions, and the retired players’ associations around retirement issues for athletes. The average career in the National Football League lasts 4 years. In the National Basketball Association, it might be 5 years. Professional athletes may have neglected an education to compete and find themselves in retirement by age 23 with dim prospects and physical and psychiatric sequelae from their athletic years.
Athletes commonly are loathe to see a psychiatrist, in part because of the stigma and fear that they will be considered “crazy.” This gradually is changing, but some psychiatrists try to avoid stigma by speaking in terms of mental health instead of labeling these as psychiatric issues or disorders, he said.
Even when the problem is physical, such as a concussion, athletes often don’t admit it or seek help out of fear that the physician will prevent them from playing.
A wide variety of alternative-care “gurus,” as well as psychologists, counselors, and trainers, compete with psychiatrists to offer care for athletes. The efficacy of alternative interventions is unknown, as there are no outcome data.
Sports psychologists established a practice niche long before sports psychiatrists, and are much better organized, he said. Sports psychiatrists need to develop subspecialty requirements and training programs, a code of ethics, guidelines, and curricula to make the field more scientific. “We’re the new kids on the block,” he said.
Dr. Glick has been a consultant or speaker or received research grants from Bristol-Myers Squibb, AstraZeneca, Janssen, Pfizer, Shire, Solvay, GlaxoSmithKline, Merck, and Novartis. He holds stock in Johnson & Johnson
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