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Clinical Sports Psychiatry: An International Perspective

ISBN: 9781118404881
ISBN: 9781118404881

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This book has it all – written by national and international experts and edited by world authorities, it is the first book on sport psychiatry in over a decade. Dealing with psychopathology, mental health problems and clinical management, it differs markedly from sports psychology books that focus on performance issues. Eating disorders, exercise addiction, drug abuse are all problems that are seen in everyday athletes, not just elite performers. This book shows how to help.

This text covers the most important topics in contemporary sports psychiatry/psychology from an international perspective. Chapter authors are experts in the field and global leaders in the related professional organizations, including current and past Presidents/Chairs of the International Society for Sports Psychiatry and of the World Psychiatric Association Section on Exercise and Sports Psychiatry. Authors are mainly psychiatrists: the rest are PhD sport psychologists.

The book comprises representative chapter authors from around the world, to an extent unprecedented in this topic. The authors and editors are well-informed in global perspectives, e.g., having served as consultants to numerous Olympic teams, in addition to service on the International Society for Sports Psychiatrys Board of Directors.

Specifically, this book covers four main categories of topics:

1) mental health challenges faced by athletes (including substance use disorders, exercise addiction, eating disorders, depression, suicide, and concussion),

2) treatment approaches and therapeutic issues with athletes (including different types of psychotherapy for psychiatric disorders, psychotherapeutic performance enhancement approaches, transference and countertransference issues, achievement by proxy, psychotherapeutic issues as applied to a couple of sports that are played around the world, and use of psychiatric medications in athletes),

3) psychosocial issues affecting athletes (including sexual harassment and abuse, cultural issues, and ethics issues), and

4) the field of sports psychiatry (including work within one common sports psychiatry practice setting, and current status of and challenges in the field of sports psychiatry).

There is a growing need for this book. Performance-enhancing drugs, use of psychotropics in impaired athletes, head trauma, sexual abuse, eating disorders, ethics, and depression and suicide in athletes, are just a few of the timely subjects addressed in this text. This is the only comprehensive reference available for those working in the field (or merely interested in it) to consult for current information on these topics. The existing sports psychology texts all focus on performance issues, with little, if any, attention paid to these areas of clinical significance. The book addresses the core differences between sports psychiatry and sports psychology, as well as the areas of overlap. Emphasis is placed on how the disciplines should work together in diagnosing and treating athletes dealing with emotional stress and psychopathology.

Chapters include case examples and specific goals listed at the beginning, along with tables and graphs to highlight key concepts.


Contributors xi

Foreword by Steve Peters xiv

Foreword by Thomas Newmark xvi

Acknowledgments xviii

Preface xix


1 Substance Use in Athletes 3
Eric D. Morse

Background and Scope of Problem 3

Reasons for Use 4

Traumatic Brain Injury 5

Recognizing Substance Use 6

Treatment 7

College versus Professional 8

Specific Substances 8

Conclusions 11

2 Addiction in Retired Athletes 13
Pavel A. Ponizovskiy

Background 13

Athletic Retirement ? Always Traumatic? 13

A Model of Adaptation to Athletic Retirement 14

Substance Abuse and Addiction in Retired Athletes 16

Preretirement Predispositions to Addictions 17

Painkillers Misuse 17

Smoking 17

Drinking 18

Conclusion 18

3 Doping in Sport 21
David A. Baron, Claudia L. Reardon, and Steven H. Baron

Introduction 21

History of Doping in Sport 22

The Current State of Doping in Sports 23

Controversies of Positive Drug Tests 26

Financial and Business Implications 26

Short- and Long-Term Effects of Doping 27

Gene Doping 29

Cultural Issues Associated with Doping 29

Case Studies 29

Summary 30

4 Exercise Addiction: The Dark Side of Sports and Exercise 33
Tam?s Kurimay, Mark D. Griffiths, Krisztina Berczik, and Zsolt Demetrovics

Definitions, Symptomology, and Classification 33

Assessment of Exercise Addiction 35

Epidemiology 35

Comorbidity 35

Etiology 37

Conclusion and Implications 40

Acknowledgments 40

5 Eating Disorders in Athletes 44
Antonia L. Baum

Introduction 44

Epidemiology 45

The Role of Sports in the Genesis of Eating Disorders and Sports-Specific Eating Disorders 46

Eating Disorders in the Male Athlete 48

The Female Athlete Triad 49

Treatment 49

Future Research 51

6 Personality and Personality Disorders in Athletes 53
Heba M. Fakher M. Hendawy and Ezzat Abdelazeem A. Awad

Introduction 53

Personality Traits in Athletes 54

Perfectionism 56

Anger and Aggression 57

Athletic Identity 57

Personality Disorders in Athletes 58

Case Studies 60

Summary 62

7 Assessing and Treating Depression in Athletes 65
David A. Baron, Steven H. Baron, Joshua Tompkins, and Aslihan Polat

Introduction 65

Defining Depression 66

Symptoms and Presentation 66

Diagnostic Issues 67

Diagnostic Tools 68

Treatment 69

Special Considerations 71

Conclusion 76

8 Suicide in Athletes 79
Antonia L. Baum

Introduction 79

Etiology 80

Retirement 81

Psychological Traits 81

Substance Abuse/Anabolic Steroid Abuse 82

Axis I Psychopathology 83

Pressure to Win 84

Sexual Abuse 85

Homosexuality 85

Firearms 85

Cultural Influences 85

Prevention 86

Sports as Therapy 86

Future Research 86

9 Concussion in Sports 89
David A. Baron, Claudia L. Reardon, Jeremy DeFranco, and Steven H. Baron

Introduction 89

What is Concussion and Traumatic Brain Injury? 90

Pathophysiology of Concussion 91

Diagnosis of Concussion 91

Epidemiology and Etiology of Concussion 93

Prevention of Concussion 93

Post-concussion Syndrome 94

Second Impact Syndrome 94

Chronic Traumatic Encephalopathy 95

Future Research 98

10 Posttraumatic Stress in Athletes 102
Thomas Wenzel and Li Jing Zhu

General Aspects 102

Risk Factors 105

Other Research on Diagnosis of Posttraumatic Stress Symptoms in Athletes 107

Further Specific Reactions to Extreme Stress in Sport 107

Relevance 109

Clinical Considerations and Interventions 110

Conclusions 111


11 Psychotherapeutic Treatment of Athletes and Their Significant Others 117
Mark A. Stillman, Eva C. Ritvo, and Ira D. Glick

Introduction 117

The Athlete-Patient 118

Psychotherapy with the Athlete-Patient: Unique Challenges 121

Conclusion 122

12 Mindfulness, Attention, and Flow in the Treatment of Affective Disorders in Athletes 124
Brandon J. Cornejo

Introduction 124

Mindfulness 125

Flow 126

Attention in Sports 127

Mindfulness, Exercise, and Mental Health 128

Bridging the Gap between Flow and Mindfulness ? Developing a Treatment Approach 128

Conclusions 129

13 Performance Enhancement and the Sports Psychiatrist 132
Michael T. Lardon and Michael W. Fitzgerald

Introduction 132

Motivation and Goal Setting 133

Maximizing Cognition and Emotion in Competitive Environments 136

Attentional Focus and Mental Imagery 139

Positive Psychology, Peak Performance, and the Athletic Zone 140

Summary 145

14 Applied Sports Psychology in Worldwide Sport: Table Tennis and Tennis 147
Kathy Toon, Dora Kurimay, and Tam?s Kurimay

Introduction 147

Tennis and Table Tennis: Examples of Worldwide Sports 148

The Game Face Routine 149

The Game Face Pyramid 153

Recommendations and Conclusions 155

15 The Use of Psychiatric Medication by Athletes 157
Claudia L. Reardon and Robert M. Factor

Introduction 157

Antidepressants 158

Anxiolytics and Sedative-Hypnotics 159

Stimulants 161

Mood Stabilizers and Antipsychotics 162

Recommendations and Conclusions 162


16 Sexual Harassment and Abuse in Sport 169
Saul I. Marks

What is Sexual Harassment and Abuse in Sport? 169

Prevalence of Sexual Harassment and Abuse in Sport 170

Perpetrators of Sexual Harassment and Abuse in Sport 170

Risk Factors for Sexual Harassment and Abuse in Sport 170

Physical and Psychological Consequences of Sexual Harassment and Abuse in Sport 173

Physical Consequences and Medical Presentations of Sexual Harassment and Abuse in Sport 173

Psychological Consequences of SHA in Sport 174

Specific Psychological Consequences and Medical Presentations Seen in Sport in General 175

Prevention by Understanding the Coach?Athlete Relationship 175

The Team Doctor?s Role in Prevention of SHA 176

Leadership from the International Olympic Committee 176

Clinical Approach to Disclosure 176

Conclusion 177

17 The Role of Culture in Sport 179
Claudia L. Reardon, David A. Baron, Steven H. Baron, Bulent Coskun, and Ugur Cakir

Multiculturalism 181

Specific Examples of Important Cultural Issues in Sport 181

Stigma and Access to Psychiatric Treatment Around the World 182

Epidemiology of Mental Illness in Athletes Across Different Cultures 183

Women, Sport, and Culture 184

Conclusions 186

18 Ethical Issues in Sports Psychiatry 188
David A. Baron, Joshua Tompkins, Sally Mohamed, and Samir Abolmagd

Introduction: The Evolution of Medical Ethics 188

Modern Medical Ethics 189

Medical Ethics Around the World 190

Ethical Issues in Psychiatry 191

Mental Health in the Athletic Arena 192

Sports Psychiatry: A Newcomer to the Field 193

Ethics of other Sports Health-Care Professions 193

Ethical Challenges for the Sports Psychiatrist 195

Conclusion 197


19 Sports Psychiatrists Working in College Athletic Departments 203
Eric D. Morse

Background 203

Design 204

Budget 204

Who is Being Served 205

Confidentiality 205

Boundaries 205

Improving Utilization with a Team Assistance Program Model 206

Treatment Issues 209

Part of the Sports Medicine Team 211

Location 211

Conclusion 213

20 Sports Psychiatry: Current Status and Challenges 215
Ira D. Glick, Thomas Newmark, and Claudia L. Reardon Background 215

Evolution of the Field 216

Challenges for the Field 216

The Role of Professional Sports Psychiatry Organizations 217

Index 219