Mental Health in Athletes: Breaking the Stigma

Nobody questions an athlete taking time to recover from a sprained ankle or broken wrist. Those injuries are easy to see and come with a clear understanding that they can’t be ignored.

But what about when athletes need to step away to tend to mental health needs?

Depression and anxiety aren’t diagnoses evident on an X-ray or MRI, but they can be every bit as limiting or debilitating as a physical injury. But too often, these issues are ignored in the name of grit.

A worldwide conversation on mental health in athletes has begun, though — and rightfully so, says sports psychologist Matthew Sacco, PhD. Let’s talk about why.

Athletes and mental health

Athletes often carry a larger-than-life persona in the public eye. They’re regarded as modern-day warriors, competitors who bravely push past obstacles and adversity in the pursuit of victory.

But the unique culture within sports can also serve as a pressure cooker.

Athletes work in an aggressive environment, explains Dr. Sacco. Day-to-day activities revolve around separating winners from losers. Opponents often look for and prey on any sign of weakness.

And then, there’s the perfectionist mindset of many competitors. It’s a driving force toward achievement, but it can also leave athletes feeling unsatisfied no matter how well they perform.

Finding a healthy balance in this cauldron can be difficult. “As you work your way up the level of competition, it turns the heat up on some of these factors — and they can become a little bit more pronounced depending on the person,” notes Dr. Sacco.

Mental health issues affecting athletes

News flash: Athletes are people who wrestle with the same complex mental health issues as the rest of us.

But asking for help can carry a stigma for athletes, says Dr. Sacco. “Because if you’re tough, there’s a misconception that you should be able to just do it yourself. You don’t have to get help.”

That idea, he says, only creates bigger problems as time goes by.

The reality is that many athletes face mental health issues as they manage challenges to perform at top levels. Research shows that between 5% and 35% of elite athletes report a mental health disorder. Numbers are even higher among college athletes.

Conditions common in athletes include:

• Depression. Research shows that athletes experience depression at the same rate as the rest of us. But the concern is that they’re often less likely to seek support to address the issue.
• Anxiety. A survey of college athletes found that 50% experienced overwhelming anxiety during the previous year.
• Overtraining syndrome (OTS). The pursuit of excellence in sports can become all-consuming and eventually lead to OTS, opening the door to both mental and physical distress. Studies suggest burnout has become increasingly common among athletes.
• Eating disorders. Athletes are at higher risk of developing eating disorders like anorexia nervosa or bulimia nervosa. It’s more common among those competing in sports where a low body weight offers a competitive advantage.
• Traumatic stress disorders. Sports-related injuries — including concussions — can lead to post-traumatic stress disorder (PTSD) symptoms in athletes, studies show.
• Sleep disorders. Training and competitions can disrupt an athlete’s natural circadian rhythm and cost them much-needed ZZZs. Nervousness can keep eyes open at night, too. Insomnia can sometimes help fuel mental health conditions.

In any of these cases, Dr. Sacco says athletes deserve time to sort things out — even if that means sitting on the sidelines for a bit.

“As onlookers, people often see it from this kind of armchair standpoint and think the athlete should just be able to figure things out,” he adds. “That lacks any kind of real awareness of what’s really going on.”

How mental health affects athletic performance

There’s no question that a mental health matter can become a distraction as athletes compete, particularly as the stakes of competition rise.

That’s why a change in an athlete’s mental state may result in a poor score or performance. For example, a baseball player who suddenly can’t throw or a golfer who develops the “yips” while putting.

At times, however, a distracted mind can be dangerous — such as when a gymnast flipping through the air develops a case of the “twisties” and becomes disoriented. “A lack of focus in those cases can be catastrophic,” says Dr. Sacco.

Again, in these instances, he emphasizes that athletes might need to take time away from competition to address a mental health issue.

Signs of mental health changes in athletes

Many athletes won’t actively seek mental health help when they need it. Instead, somebody — maybe a coach or parent — might notice that “something seems off” and encourage them to talk about it.

Signs that an athlete may need an assessment of their mental health include:

• Sleeping problems.
• Irritability.
• Low energy.
• Changes in eating.

“How do we measure someone who might be struggling with depression in a way that people can see, like an X-ray for a broken bone?” asks Dr. Sacco. “We’re looking at things that seem like side issues, but that might be connected to a whole host of deeper matters.”

How to help athletes with mental health

For years, advice regarding mental health issues for athletes could essentially be boiled down to four words: Just push through it. That’s not guidance that resolves an issue.

Open conversation needs to be a priority to address mental health. It’s a critical step toward building a culture where it’s OK to acknowledge and talk about the mental health aspect of competition, says Dr. Sacco.

Thankfully, prominent athletes sharing their experiences has drawn more attention to the topic in recent years. The ongoing discussion started by these influential voices has broadened the understanding of mental health issues in sports.

If you’re a parent with a young athlete in the house, encourage them to talk about any of their stresses, anxiety and worries, advises Dr. Sacco. Then, make sure you listen with an open mind to understand their situation.

Avoid being an additional person critiquing and evaluating their performance, too. Let their coaches do that.

Bottom line? Focus on supporting your child and their well-being.

“Give them a voice,” emphasizes Dr. Sacco. “Make sure they feel heard so that we’re not continuing a cycle of ignoring these issues. Don’t be afraid to bring up the issue. The risk of not addressing this is far greater in the long run.”