Annual Sports Psychiatry Symposium at the APA Annual Meeting
“Contemporary Issues in Sports Psychiatry: A Global Perspective”
Tuesday May 21, 2013 9:00 am-12:00 noon
Moscone Convention Center West/ 3rd Floor Room 3009
San Francisco, California
Speakers: Tomas Kurimay MD - Exercise Addiction
             David Baron MD - Depression in Athletes
             Michael Larden MD - Performance Enhancement
                                                 and the Sports Psychiatrist
Also you will want to attend:

Annual ISSP Scientific Session
Monday May 20, 2013 2:30-5:00 pm
San Fransisco Marriott Marquis, Pacific Suite J, Fourth Floor.  Featured speakers will be chapter authors for the soon to be released Sports Psychiatry book.  This will be a great time for members to discuss common topics in sports psychiatry and a great opportunity to consult with other sports psychiatrists.

Check out this article on depression in professional golfers, Tears of a Clown, featuring comments by ISSP board member Michael Lardon M.D.  Click the link below to access the article.

http://www.golfdigest.com/golf-digest-woman/2012-12/christina-kim-profile-sternberg

Guest Editorial

This Issue: Sports Psychiatry

• Psychiatric Annals
• October 2012 - Volume 42 · Issue 10: 359-360
• DOI: 10.3928/00485713-20121003-02

In 1988, a quorum of three psychiatrists, Daniel Begel, MD, Dan Glick, MD, and myself, created the Society for Sports Psychiatry. Since then, the Society has grown in number and spans the globe, thus the name change to the International Society for Sports Psychiatry.

Our initial mission was to define the field of sports psychiatry.¹ This has been a humbling project, not only because we were starting from nothing, but also because of the closely held stigma associated with psychiatry – and mental health in general in the athletic arena. The “rub-dirt-on-it-and-get-back-up” ethos, particularly in professional contact sports, does not mesh well with an athlete having a sense of mental or emotional frailty.

 When, as a fledgling resident, I first gave a talk on the subject, my skeptical attending declared: “I cannot recall the last time I had a varsity athlete come through my door.”

It seemed important to define our niche as distinct from the already well-established field of sports psychology. We envisioned that, rather than focusing on performance enhancement, the sports psychiatrist’s work would ideally improve an athlete’s execution on the field, and would be about the evaluation and treatment of psychopathology in the athlete, whether it was a premorbid illness, a problem engendered by involvement in sport, or some combination of the two.

Ultimately, sports psychiatrists strive to educate, thus playing a role in prevention, and continue to gather data so that we might become more evidence-based in our approach.

In this issue of Psychiatric Annals, we examine several key areas of sports psychiatry. Jeff Victoroff, MD, and David Baron, DO, cover sports-related traumatic brain injury (TBI) (see page 365), an area which has received tremendous media attention, and even resulted in congressional hearings aimed at improving the problem.

Drs. Victoroff and Baron review the epidemiology and the clinical presentation of TBI, as well as describe the pathophysiology, the diagnostic process, and issues in treatment.³ The morbidity and mortality associated with the brain-injured athlete requires that we direct our attention to this troubling problem in the sports world.

Gen Kanayama, MD, PhD, and Harrison G. Pope Jr., MD, who collectively possess the greatest wealth of knowledge in the area of anabolic-androgenic steroid abuse, address the myths that have developed surrounding this serious and growing problem (see page 371). They delve into the epidemiology, testing, putative benefits, and dangers of these drugs.²

David Conant-Norville, MD, focuses on treatment considerations for the ubiquitous phenomenon of attention deficit-hyperactivity disorder (ADHD) in the athlete, from children to adults, covering the gamut from the effects of exercise on brain development to the use of psychostimulants (see page 376).⁴

The latter is illustrated through a case challenge, as is the area of TBI. In addition, to demonstrate the potential for the sports psychiatrist to assist an athlete in the enhancement of performance through behavioral techniques, Thomas Newmark, MD, illustrates three cases in which he uses relaxation and imagery to help athletes overcome anxiety and other limitations.

Although we have begun our ascent to the summit, so to speak, we have a long way to go as we define the field of sport psychiatry and work to minimize the negative associations tough-minded athletes might have about psychiatry. This can be accomplished through psychoeducation, frequently capitalizing on the willingness of successful athletes to come forward with their personal struggles.

We have also made strides by increasing our accessibility to athletes and their coaches and trainers, sometimes planting ourselves directly in training rooms and on the athletic field, forming alliances with orthopedists, and using our own athletic experiences to heighten our empathy for and win the trust of this patient population.

References

1. Begel D. An overview of sport psychiatry. Am J Psychiatry. 1992;149(5):606–614.
2. Kanayama G, Brower KJ, Wood RI, Hudson JI, Pope HG Jr, . Issues for DSM-V: Clarifying the diagnostic criteria for anabolic-androgenic steroid dependence. Am J Psychiatry. 2009;166(6):642–645. doi:10.1176/appi.ajp.2009.08111699 [CrossRef] . doi:10.1176/appi.ajp.2009.08111699 [CrossRef]
3. CDC. Sports Related Concussions. Agency for Healthcare Research and Quality, HCUIP, 60, 2011.
4. Stabino M. The ADHD Affected Athlete. Victoria BC: Trafford; 2004.

Click the link below for access to the entire Sports Psychiatry Special Issue:

http://www.healio.com/psychiatry/journals/psycann/%7Be23732ff-27ec-47e5-91bd-e9fad0554c60%7D/this-issue-sports-psychiatry


AUTHORS

About the Guest Editor

Antonia L Baum, MD, DFAPA, received both her undergraduate degree in biology and her medical degree from Brown University in Providence, RI, where she was also a resident in psychiatry. Dr. Baum completed two research fellowships at the University of British Columbia, Vancouver, Canada: one in reproductive psychiatry at British Columbia Women’s Hospital and another in eating disorders at St. Paul’s Hospital. Her third fellowship was in consultation-liaison psychiatry in the Department of Psychiatry, Fairfax Hospital, Georgetown University.

Dr. Baum has worked as a consultation-liaison psychiatrist, most recently for the Walter Reed National Military Medical Center. She is a therapeutic drug use exemption consultant to the Professional Golf Association and to Major League Baseball, where she has served as a staff physician for the Rookie Career Development Program. Dr. Baum also served the US Olympic Committee Working Group Safety in Sport, and is an Assistant Clinical Professor of Psychiatry and Health Sciences at the George Washington University School of Medicine and Health Sciences.

A founding member of, Chair of Special Projects for, and Vice President of the International Society for Sports Psychiatry, Dr. Baum is a Distinguished Fellow of the American Psychiatric Association.

Dr. Baum is a triathlete and marathon runner who has also competed as a swimmer, Nordic skier, gymnast, and field hockey player. She has a private general adult and adolescent practice in Chevy Chase, MD, and also specializes in sports psychiatry.

doi: 10.3928/00485713-20121003-02

Sports of The Times

 With No One Looking, a Hurt Stays Hidden

 By WILLIAM C. RHODEN  (E-mail: wcr@nytimes.com)

A version of this article appeared in print on October 30, 2012, on page B8 of the New York edition with the headline: With No One Looking, a Hurt Stays Hidden.

 Published: October 29, 2012

 We’ve seen it hundreds of times. An athlete is injured and within seconds is surrounded by an armada of medical personnel: trainers, assistant trainers, team doctors. The athlete is helped off the field, given a diagnosis, treated and sent to physical therapy, often to return miraculously in a week or two.

But when that same athlete has a mental disorder, there is no armada of trainers, no team doctors. That athlete is often abandoned. For all of the current focus on traumatic brain injury as a result of concussions, mental illness, often overlooked, exists at every level of sports.

Sports too often is a masking agent that hides deeply rooted mental health issues. The better the athlete, the more desperate to reach the next level, the less likely he or she will reach out for help. The gladiator mentality remains a primary barrier.

“Mental health has a stigma that is tied into weakness and is absolutely the antithesis of what athletes want to portray,” said Dr. Thelma Dye Holmes, the executive director of the Northside Center for Child Development, one of New York’s oldest mental health agencies, serving more than 1,500 children and their families.

“Mental health is not something that you can easily know,” Holmes said. “You feel a pain in your side, you have discomfort. Mental illness is vague and makes us uneasy. Especially when it comes to athletes, there tends to be a stigma around coming forward.”

Holmes was among a group of health care professionals and former professional athletes who met recently at the Schomburg Center for Research in Black Culture in New York to discuss the problem of mental health and mental illness in athletes. The gathering was part of a series of salons initiated by Schomburg’s director, Khalil Muhammad, to explore the relationship between sports and the African-American community.   But mental illness knows neither race nor ethnicity, and at a time when brain trauma has become front and center of a national conversation about safety in sports, mental illness is the silent spike of the sports industry. Asking for help is looked upon as a weakness in a community in which coaches preach mental toughness.

“They believe nothing can go wrong, they don’t need help, they can overcome,” Dr. Ira Glick, professor emeritus of psychiatry and behavioral sciences at Stanford University School of Medicine, said in a telephone interview.

He added: “And just for that alone, they don’t want to go to therapy either for psychotherapy or medication. You have to start to change the culture beginning in Little League, imbue in them from the time they are Little League players.”

There is, of course, a related issue: confidentiality. Whom can a player trust?

“Players want to have somebody to talk to, but they don’t want their teammates or the team to find out because of the stigma and they’re afraid of being dropped,” Glick said.

Luther Wright can attest to that. He was a high school star in New Jersey, attended Seton Hall, then was a first-round pick of the Utah Jazz.

Wright published an intriguing memoir — “A Perfect Fit” — that chronicled his journey from the celebrity of being the largest baby born in New Jersey that year to stardom in high school and college, to a season in the N.B.A., to drug and alcohol abuse and, finally, to a diagnosis of mental illness.

According to Wright, who attended the conference, an athlete desperate to provide for his family — and to reach the professional level — may not feel he has the luxury to divulge, much less explore, a mental health issue.

“You can’t get sick,” Wright said. “At the college level, that’s your proving ground. There’s no room for any type of diagnosis for mental health issues because that would put up a red flag and maybe block you from going to the next level.

 “I don’t think they would even recruit you if they knew you had some illness or some mental health issues, that you were mentally incapable of performing at the highest level.”

 A complicating factor is that coaches are often ill-equipped to recognize and deal with mental health issues. But the coach of the future, Holmes of the Northside Center suggested, may need to be better prepared.

Indeed, coaches could be required to have a certificate, if not an advanced degree, in mental health. Professional leagues and governing bodies at the high school and college levels could ensure coaches work with mental health practitioners who could train them to look for signs of trauma, bipolar disorder and depression, among other maladies.

“Coaches need to know they’ve got somebody to talk with if things get out of hand,” Holmes said.

Coaches aren’t the only ones who fail to recognize mental health problems. General managers and team executives may look the other way, or go into denial, when mental health problems emerge in an enormously talented athlete.

 Glick argued that owners by and large do not want to address the notion that athletes face mental illness. In fact, Glick said he felt some owners feel that disclosures could hurt business.

“They are not into this,” he said. “They are businessmen for the most part and almost none of them are interested in these mental health issues. They want their businesses to succeed. They’re also fans, so they carry the same biases that the public has about mental health.”

But are players and owners really adversaries when it comes to mental health and mental illness? Dr. Janet Taylor, a New York-based psychiatrist, who also attended the conference, said that she is not convinced they are.

“My impression is not that a team-furnished mental health professional is seen as the enemy, but the service/resource is either underutilized or inserted as punishment,” she said. “Getting help for mental health issues should be seen as healthy and a mature approach.”

It is not unusual for the public to be suspicious of athletes who were sidelined by mental health problems. But as the existence of these issues become more prominent in society, athletes’ emotional episodes may be viewed with greater understanding.

“Even though it’s ever so slowly, the stigma is being lessened around mental health,” Holmes said. “Mental health issues are being exacerbated in this environment, where you are highly stressed, you’re constantly at work or constantly performing all the time. People are under an inordinate amount of stress. Even though we have technology, in some ways it has increased the stress that we feel because there is this pressure to constantly respond. Therefore, we are finding perhaps a greater incidence of mental health issues.”

Athletes included.

The larger problem is the deep-seated sports ethos that embraces a tradition of mental toughness, emotional fortitude and inner resourcefulness that makes it difficult, if not impossible, to say, “Help.”

 “Professional athletes are used to seeing themselves as warriors able to withstand multiple physical challenges, and have battled to get to the next level because of their mental and physical toughness,” Taylor said. “Now they may be sidelined by an enemy they can’t even see: their mind.”

Olympic Sports: Bad for the Brain?
Andrew Leigh; Ira Glick, MD
Authors and Disclosures
Posted: 08/06/2012 Medscape

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.

Olympic Sports: Bad for the Brain?: A Coach, a Trainer, and...a Psychiatrist

Medscape: Can you elaborate on the mental health systems in place for young athletes? What improvements are needed to improve mental health outcomes in this population?
Dr. Glick: I think there's a lot of improvement needed. Everybody I've spoken to, the athletes and other sports psychiatrists say that youth athletic programs are slowly bringing mental health into the picture. But it's a very slow process and it's very difficult to get psychiatrists and psychologists involved, especially psychiatrists. Psychologists seem more socially acceptable because they're there presumably not because there's something wrong with the athletes but because they're helping them to do better in their sport. And some of the pro leagues, like the NBA, have very extensive programs for helping athletes. They work with the rookies. They have people in their office that they bring in to talk to them about life, relationships, and working with coaches. But they're really the exception. So, it's slowly changing, but very slowly. And what we're advocating is much greater use of professionals in both youth and adult programs -- the same way it would be unheard of now to have a program without a trainer or an internist or a general or family physician.
Medscape: Olympic athletes can compete at as young as 15 years of age. Does the fact that such a person is still developing, yet competing at the elite Olympic level, change the management approach?
Dr. Glick: They have incredible physical attributes, but mentally they're just kids and their brains are just developing. Their personalities are developing. And again, nobody is following this. Nobody has done a long-term, follow-up study to know for sure the science of this. Obviously, the media speculates that there might be longer-term problems with them. You can argue that these are people with terrific personalities; they're able to use their personality to become good at a sport. Or you can say that there are terrific stresses here. And a lot of these kids are going to end up with long-term problems. All you read about are those who have done well. Once a year there's a story on a gymnast who's now in her twenties and is doing okay. But nobody knows the systematic follow-up of those who you don't hear about. So it's certainly a real concern.

Medscape: In high-profile settings such as the Olympics, what beneficial interventions might sports psychologists or psychiatrists offer?
Dr. Glick: It would be useful to have a psychiatrist there to at least do supportive, brief therapy as problems come up in the course of competition. In terms of the future, what's the future going to hold for these athletes? It would help them to have some counseling or psychotherapy available as part and parcel of the Olympic experience, rather than have it be seen as a sign of weakness.
Medscape: You mentioned how athletes looked at going to a psychiatrist or psychologist as a means of gaining a performance edge, as opposed to as a way to cope. How do you think we change that perception to one about learning how to deal with the internal challenges that athletes might be struggling with?
Dr. Glick: I think the media can help by pointing out that seeking mental health is an old stigma (if you went, there was something wrong with you) and that teams have adapted from that. Second, it can be emphasized that working with a psychologist might help athletic performance. But that's a relatively recent phenomenon. And again, there's very little science behind it. It's all pop psychology. There are techniques like imaging and straight psychotherapy, but it's hard to know whether they really increase performance. There's never been a controlled study of, say, taking 100 wrestlers and giving 50 of them the pop psychology intervention and 50 of them no intervention to see which group does better. That's what would be needed. There's no question that if you're sick, going to a doctor usually helps rather than harms; at the very least, it doesn't hurt you. We want to instill the same thing in athletes about mental health: Just as having a physician available to treat your cold or bronchitis or sprained knee is helpful, so, too, is having a psychiatrist available to help you deal with the stress of having to succeed.
Medscape: What are the biggest risks that athletes run in regard to long-term mental health? What are the most potentially damaging issues that athletes face once their playing days are over?
Dr. Glick: One thing is that not everybody succeeds -- almost everybody fails. I was reading this book called The Art of Fielding -- a great book. One of the concepts in it is that what separates those who are successful from those who are not is the ability to cope with failure. Almost everybody in the Olympics is going to fail, so the ability to cope is number one. Number two is having to cope with physical injuries. And number three is being out of the spotlight; you have to have developed the balance to go on to the next part of your life. That is really the biggest issue: staying balanced. Sports are a means to a happy, successful life, but they're not the end.

Read a great article all about the 2012 ISSP Annual Symposium presented at the APA Annual Meeting in Philadelphia (published on Medscape)

Click the link below for photo with article:
ISSP 2012 symp. Medscape article.pdf


Early Guidance, Preventive Therapy Urged for Young Athletes

Deborah Brauser


May 16, 2012 (Philadelphia, Pennsylvania) — The recent death of former professional football player Junior Seau from apparent suicide once again highlights the need for elite athletes of all ages to receive early counselling and perhaps even mandatory prophylactic talk therapy to prevent psychiatric illness later in life in this high-risk population.

These were just some of the suggestions that emerged from a roundtable discussion between mental health professionals and several former and current athletes held here at the American Psychiatric Association's (APA's) 2012 Annual Meeting and hosted by the International Society for Sports Psychiatry (ISSP).

Junior Seau's death closely follows 2 other recent suicides by former National Football League (NFL) players Ray Easterling and Dave Duerson. All 3 players suffered multiple concussions during their careers, and Easterling, who was the eldest of the 3, had been diagnosed with dementia.

Retired NFL player Duerson, who reportedly believed he was suffering from the effects of chronic traumatic encephalopathy (CTE), shot himself in the chest and requested that his brain be donated to science. A degenerative condition, CTE can lead to depression, uncontrolled impulses, and dementia.

In Seau's case, the former San Diego Chargers linebacker reportedly experienced serious problems after retiring in 2009. He was jailed after a domestic violence arrest and drove his vehicle off a cliff in California soon after. Although Seau said at the time that he fell asleep at the wheel, the incident was widely suspected to be a suicide attempt. Seau's family is still considering whether to donate his brain for research purposes.

In the roundtable discussion between clinician attendees and several former and current professional athletes, former San Diego Charger Carlos Bradley noted that he had been with Seau last December.

"You couldn't physically look at him and tell anything was going on, other than that he looked a little heavier than he had been. But then I hit myself a bit because if you really looked in his eyes, something seemed a little unsteady," said Bradley.

"The psychological makeup of being an athlete is very interesting because it starts when you're very young. Once talent is recognized, it's cultivated. But I think what is needed is more personal development," he added.

An Ounce of Prevention

Parents and coaches, said Bradley, need to "look at developing the whole person. If you don't have balance, then further down the line, there are going to be problems and other issues."

Ronald L. Kamm, MD, a psychiatrist in private practice in New Jersey who specializes in sports psychiatry, explained that as individuals reach their athletic potential, they are also "reaching maximum vulnerability" for developing a number of psychiatric illnesses, including depression, schizophrenia, and bipolar disorder.

Ira D. Glick, MD, professor of psychiatry and behavioral sciences at Stanford University Medical Center in California and a board member of the ISSP, reported that he has seen early symptoms of bipolar disorder in a number of young athletes.

"But because of their athletic skills, they're pushed along, and it never gets properly treated. And there are some barriers to early treatment. Number 1 is stigma and number 2 is that teenagers don't want to hear about this," said Dr. Glick.

Bradley said he believes that any child who shows strong athletic prowess should see some type of counselor, whether they have psychiatric symptoms or not. He noted that just talking with young athletes about what is happening not only on the field but also in their home life would help.

"We as professionals have tried to make inroads in that way. And I think it would be great if we could turn this into a positive, that this would be extremely helpful for someone with talent. But that's a tough sell," said ISSP vice-president Antonia Baum, MD.

"I think what needs to happen is that in the schools, they need to have not just an orthopaedist but also a psychiatric sports physician on board early on," added Dr. Glick.

Bradley noted that sports psychologists are often available to new NFL players, but that may be too late because "it's hard to get their attention if they're thinking: 'I'm the man. I'll be okay because I'm going to be rich and famous.' "

"So help needs to start at the high school level. Many kids don't go on to professional careers. There are only around 59 positions [on an NFL team roster], but each year there are thousands upon thousands of people trying to get the same job you are," said Bradley.

Pushy Parents

"Parents also can be a problem if they keep pushing. But good ones talk to their children and show that they care about them as human beings and not just for their athleticism. Tell kids that if they fall short, it's still okay," he said.

Athletes cited other pressures, including the common burden of being the main breadwinner in a family and playing while injured.

They also noted the struggle to make peace once they are no longer able to play professionally and the frustration and confusion that often occurs when they retire at a relatively young age.

Bradley, who is now a personal trainer, played 6 years in the NFL, which he said is double the average NFL career.

"Your career is short. You're exalted up and up and up all the time, and then you're just let go with no support and told to deal with life. But often you haven't been given those tools," he said.

He noted that at the time he retired, there was even greater stigma associated with consulting a mental health professional.

"I think athletes are now becoming more open to that. With the news of today and talk of concussions and head injury, athletes are becoming more open and realizing that we need help," said Bradley.

Mandatory Therapy?

Nyere Aumaitre, a star football player in high school and an All-American at the University of Iowa, said he was shocked when he was not drafted by a professional team.

"Not getting drafted led to such depression. And to this day I still dread being seen as 'regular' because I got used to being treated so well. I wanted to be seen as successful. And when that stopped, I didn't know what to do. I didn't feel complete anymore," he said.

Aumaitre went on to become a lineman for the Philadelphia Soul, a team in the Arena Football League, and he now plays for the Cleveland Gladiators.

Several of the athletes stated that seeing a psychiatrist to deal with any stressors should become a mandatory part of every professional athlete's job.

When one of the psychiatrists at the session asked whether individuals would fight back against being forced into this, former semiprofessional football player Aaron Underwood said that a mandatory designation would remove the stigma often associated with seeking mental health care.

"If it was known starting out that this is required, than it would just have to be accepted," added Underwood, whose brother Dimitrius is a former NFL player who has been diagnosed with bipolar disorder.

Dr. Glick noted that an athlete in the National Basketball Association with bipolar disorder has it written in his contract that he must see a psychiatrist and take his medications if he wants to practice and to play.

"So perhaps a contract for everyone in all sports should note that a psychiatrist needs to be seen just for the everyday stresses of the sport," said Dr. Glick.

Trust Is Key

"Frankly, it's about developing a relationship where the players trust you," said David Baron, DO, executive vice-chair and psychiatrist-in-chief at the Keck School of Medicine at the University of Southern California, Los Angeles.

It's making sure they know: 'That person is here for me.' And it's letting them know that we're going to interact as two human beings," said Dr. Baron.

Overall, the participants agreed that it is important to talk with athletes of all ages as early as possible about balancing life, work, and play. However, there are still questions about the best ways to go about that.

"How do we get across that bruising your brain isn't the same as bruising your thigh? People get their bell rung and go right back in," said Dr. Baron.

"Our research has demonstrated that it's more problematic getting a slight ding in practice every day. And that builds up over time. Then we're seeing not only the dizziness, the headaches, the 'can't sleep,' but now we're also seeing effects on mood. How do we begin to change that culture with players and with coaches?" he asked.

"Football is a gladiator sport, and the day-to-day pounding is the nature of the game. Changing that is going to have to come from higher up. But I always say the only way to stop serious head collisions is to take away the helmet," said Bradley.

Dr. Glick said he is hopeful that "we're on the cusp of change" for leagues, high schools, and colleges.

"We just need to figure out how to change the culture so that the needs of people in the long run can be met — and we don't have more situations like the one with Junior Seau."

The American Psychiatric Association's 2012 Annual Meeting. Presented May 5, 2012.


Medscape Medical News © 2012 WebMD, LLC
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ISSP Annual Scientific Session
Saturday, May 5, 2012
9:00 am - 12:00 pm

Philadelphia Marriott

Grand Ballroom Salon G (this is a late room change)

1201 Market Street

Philadelphia, PA

Admission Free

Schedule
9-10 am: Overview of Sports
 Psychiatry Symposium
10-12 noon: Panel discussion with professional athletes discussing various roles of the sport psychiatrist

2012 ISSP Annual Symposium
on Sports Psychiatry at the Annual APA meeting


Saturday, May 5, 2012 from 2:00 P.M. to 5:00 P.M., in Room 103C Level 1 in the Pennsylvania Convention Center.

This year the ISSP is sponsoring a symposium at the APA annual meeting in Philidephia, PA  entitled "Rebound and Recovery in the Athlete"(session ID number 31651), Saturday, May 5, 2012 from 2:00 P.M. to 5:00 P.M., in Room 103CLevel 1 in the Pennsylvania Convention Center.  The annual ISSP Business meeting will be held in the same room immediately after the symposium.  Both the symposium and business meeting are free of charge and open to all APA meeting registrants.

Speakers and Topics to be discussed for

S12. Rebound and Recovery in the Athlete
International Society for Sport Psychiatry

1. Doping in Sports: What‘s on the Horizon? David A. Baron, D.O.

2. Sexual Harassment and Abuse in Sports: What It Is, How to Prevent It.  Saul I. Marks, M.D.

3. Psychological Impact of Injury on the Athlete Thomas S. Newmark, M.D., Ira Glick M.D.

4. Doping in Elite Cycling: A Psychiatric Perspective on Causes, Consequences, Recovery, and Rehabilitation Alan Currie, M.B.B.S.

Dr Saul Marks, board member of the ISSP, and his Canadian colleagues present there thoughts about this significant but under reported problem is competitive sport.  Read the article by clicking the citation: Br J Sports Med-2011-Marks-bjsports-2011-090345.pdf

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.

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.