Psychopathology in Sports

Britton W. Brewer and Trent A.
Petrie
Psychopathology in Sport
and Exercise 14
Copyright American Psychological Association. Not for further distribution.
I
t may seem unusual to discuss psychopathology in associa-
tion with sport and exercise because sport success is related to
lower levels of psychopathology (Morgan, 1985) and exercise
may be used as therapy for depression and other disorders
(for a review, see Chapter 7, this volume). Yet, the reality is
that sport and exercise participants, as human beings, experi-
ence psychopathology and related concerns (Heyman, 1986),
and factors associated with sport and exercise may increase
the risk (Auerbach, 1994; Beisser, 1977; Heyman, 1986). For
example, the physical contact that exists in sports such as
football, rugby, and soccer, as well as the emphasis on physi-
cal appearance that may be found in the sport environments
of gymnastics, diving, and beach volleyball, may contribute
to the occurrence of cognitive impairments (Matser, Kessels,
Jordan, Lezak, & Troost, 1998) and eating disorders (Petrie
& Greenleaf, 2012), respectively, among athletes. For some
disorders (e.g., developmental coordination disorder, bulimia
nervosa), pathological symptoms may include sport and exer-
cise behaviors, such as poor sport performance and excessive
http://dx.doi.org/10.1037/14251-014
Exploring Sport and Exercise Psychology, Third Edition, J. Van Raalte and
B. Brewer (Editors)
Copyright © 2014 by the American Psychological Association.
All rights reserved.
311
312 B re w er a n d P etr i e
exercise (American Psychiatric Association, 2000). The existence of

the International Society for Sport Psychiatry (founded in 1994) and the
Journal of Clinical Sport Psychology (launched in 2007) bears witness to the
relevance of psychopathology to sport.
Case studies and anecdotal reports have documented the occurrence
of a wide variety of mental disorders in sport and exercise participants
(Beisser, 1977; Ogilvie & Tutko, 1966). Examples of disorders experienced
by top-level athletes include bipolar disorder (Berger, 2010; Visser, 2010),
borderline personality disorder (Marchant & Gibbs, 2004), dissociative

identity disorder (“Walker Reveals Struggles,” 2008), major depression
(Caplan, 2008; “Everything Was Negative. Dark,” 2004), obsessive–
compulsive disorder (Garber, 2007), panic disorder (Hales, 1993), seasonal
affective disorder (Rosen, Smokler, Carrier, Shafer, & McKeag, 1996),
schizoaffective disorder (“Maine Issue,” 1997), and Tourette’s syndrome
(Page, 1990), and such disorders have been linked directly to the suicides
of athletes from a wide range of sports (Torre, 2011). In nationwide sur-
veys of clinical and counseling psychologists (Petrie & Diehl, 1995; Petrie,
Diehl, & Watkins, 1995), the primary areas of psychopathology addressed
in individual therapy with athlete clients were reported to be anxiety/
stress, depressive disorders, eating disorders, and substance-related
disorders.
Athletes and exercisers do experience a wide range of psychopatho
logical conditions (for a review, see Reardon & Factor, 2010), so pro-
fessionals who work in sport and exercise settings need to have a basic
understanding and knowledge of mental health disorders and treatment.
Such a recommendation is supported by professional organizations’ cer-
tification criteria (e.g., Association for Applied Sport Psychology, n.d.)
and recent descriptions of integrated sport psychology training programs
(Petrie & Harmison, 2012) and underscored by research showing that per-
formance enhancement interventions are less effective for athletes experi-
encing psychological difficulties (Wolanin & Schwanhausser, 2010). Thus,
the main purposes of this chapter are to highlight areas of psychopathol-
ogy that are particularly relevant to sport and exercise, to review empirical
research on the epidemiology of psychopathology in sport and exercise
populations, and to provide recommendations for diagnosis and treat-
ment of psychopathology in the context of sport and exercise.
Psychopathology Relevant
to Sport and Exercise
Although sport and exercise participants may experience a variety of

mental disorders, certain ones may be exacerbated by the sport and
exercise contexts. In this section, we discuss the epidemiology and
Psychopathology in Sport and Exercise 313
treatment issues associated with eating disorders, substance-related dis-

orders, psychological factors affecting physical condition (i.e., psycho
social antecedents of sport injury), and adjustment reactions (e.g., to
sport injury). In addition, we highlight other disorders and subclinical
syndromes (i.e., conditions in which impairment of behavioral, cogni-
tive, or affective functioning is evident but insufficient to satisfy diagnos-
tic criteria) that may be associated with sport and exercise participation
but have been investigated less thoroughly.
Eating Disorders
For anorexia nervosa and bulimia nervosa, lifetime prevalence rates are
higher among adult women (0.5%–0.9% and 1%–3%, respectively)
than men (0.05%–0.3% and 0.1%–0.5%, respectively; American Psy-
chiatric Association, 2000; Hudson, Hiripi, Pope, & Kessler, 2007). For
both disorders, research in the United States and Europe has shown that
rates are higher among adolescents than among young to middle-aged
adults (Currin, Schmidt, Treasure, & Jick, 2005) and have remained sta-
ble across the 1990s (Currin et al., 2005) and into the 2000s (Crowther,
Armey, Luce, Dalton, & Leahey, 2008; Keel, Heatherton, Dorer, Joiner, &
Zalta, 2006). Rates of subclinical disorders are higher than clinical for both
men and women (Crowther et al., 2008; Isomaa, Tsomaa, Marttunen,
Kaltiala-Heino, & Bjorkqvist, 2009; Keel et al., 2006) and may exceed
35% with college student samples (Cohen & Petrie, 2005).
For collegiate and international elite athletes, prevalence rates
may be slightly higher than in the general population. For example,
rates of anorexia nervosa are estimated to be between 0% and 6.7%
(female athletes) and 0% (male athletes), bulimia nervosa between 0%
and 12.1% (women) and 0% to 7.5% (men), and eating disorder not
otherwise specified between 2% and 13.4% (female athletes) and 0%
to 9.7% (male athletes; Greenleaf, Petrie, Carter, & Reel, 2009; Johnson,
Powers, & Dick, 1999; Petrie, Greenleaf, Reel, & Carter, 2008; Sundgot-
Borgen & Torstveit, 2004); rates may be highest among athletes who
participate in sports in which weight, body size and shape, and appear-
ance are emphasized (e.g., gymnastics, cross-country). Subclinical eating
disorder rates are higher, ranging from 19% of male collegiate athletes
to almost 26% of female collegiate athletes (Greenleaf et al., 2009;
Johnson et al., 1999; Petrie et al., 2008). Furthermore, athletes primarily
use exercise (2 or more hours/day: 25.2% females and 37% males) and
dieting or fasting (two or more times/year: 15.6% females and 14.2%
males) to control or manage their weight; more extreme behaviors, such
as self-induced vomiting, diuretics, and laxatives, are used much less
frequently (e.g., Greenleaf et al., 2009; Petrie et al., 2008).
As a result of dietary restriction and reductions in energy availability,
some female athletes will experience three interrelated conditions—
disordered eating, amenorrhea, and osteoporosis—that constitute the
female athlete triad (American College of Sports Medicine, 2007). The

triad is associated with increased risk of injury (e.g., stress fractures),
medical complications (e.g., infertility), and psychological problems
(e.g., anxiety, depression; American College of Sports Medicine, 2007).
Although prevalence rates of the triad are relatively low, ranging from
1.2% to 4.3% (e.g., Beals & Hill, 2006; Nichols, Rauh, Lawson, Ji, &
Barkai, 2006; Torstveit & Sundgot-Borgen, 2005), rates associated with
experiencing two of the three conditions, which still increase female
athletes’ risk of negative outcomes, can range from 5.4% to 27% (Beals
& Hill, 2006; Hoch, Stavrakos, & Schimke, 2007; Nichols et al., 2006;
Torstveit & Sundgot-Borgen, 2005).
Although the etiology of eating disorders is considered to be multi
dimensional, including familial, biological, personality, and genetic
factors, sociocultural or environmental factors play a prominent role.
Within sport, there are unique pressures that increase athletes’ focus
on how they look and how much they eat and thus their risk of devel-
oping a clinical eating disorder or engaging in a variety of disordered
eating behaviors (Petrie & Greenleaf, 2012; Thompson & Sherman,
2010). First, some coaches and athletes believe that weight loss auto-
matically leads to performance improvements. Although not supported
by research, this belief may lead to subtle pressures and/or direct mes-
sages about diet, weight, and body size and shape being present within
athletic teams. Second, in sports such as gymnastics, swimming and
diving, and beach volleyball (for women), athletes are required to wear
uniforms that are highly revealing and thus draw attention to their
bodies. Third, people generally believe athletes in certain sports should
have a specific body type and look. For example, gymnasts should be
“tiny,” runners “lanky,” and football players “big.” When athletes do
not conform to these stereotypical images, they may be considered odd
by teammates, judges, coaches, and/or fans. Fourth, on many teams
and in many organizations, athletes are valued primarily for their
performances; hence, health and well-being may become secondary
to winning. In such situations, athletes may experience pressures to
substantially increase training load and/or engage in other pathogenic
weight loss behaviors in hopes of achieving their performance ideal.
Fifth, within the sport environment, characteristics and traits such as
exercising excessively, denying pain and discomfort, complying com-
pletely with requests, and pursuing perfection are valued and reinforced.
Yet, these same characteristics may in reality be symptoms of disordered
eating. Thus, what helps athletes be successful in sport also may increase
their risk of developing an eating disorder. Whether singly or in com-
bination, these pressures may lead athletes to become more body con-
scious and uncomfortable with how they look and to engage in more
social comparison. Such scrutiny and evaluation and comparisons with
others may increase the pressures athletes feel to take extreme mea-
sures to change their body shape and appearance, be it through caloric
restriction or muscle enhancement. In fact, recent research (Anderson,
Petrie, & Neumann, 2011) has shown a strong relationship between
sport environment pressures and increases in dietary restraint and body
dissatisfaction.
Because of these unique pressures, special consideration needs to be
given to the prevention of eating disorders among athletes. Such preven-
tion efforts might occur at the system level (Petrie & Greenleaf, 2012) by
creating a “body-healthy” environment in which athletes’ physical and
psychological well-being are primary. To do so, coaches and other ath-
letic department personnel can (a) deemphasize weight as a salient fac-
tor for performance improvements; (b) eliminate weigh-ins and weight
requirements for athletes (if it is medically necessary to weigh athletes,
such as when monitoring water loss during hot and humid practice con-
ditions, medical personnel can do so privately); (c) become aware of and
then change the unhealthy norms that may exist on a team about body,
weight, eating, and appearance; (d) educate themselves about eating
disorders to better understand how their behaviors may inadvertently
have a negative influence and to recognize when some of their athletes
may be struggling; and (e) use other professionals, such as nutritionists
and sport psychologists, in training their athletes and thus not focus solely
on weight loss as the means for achieving performance success but, rather,
encourage healthy eating, developing mental toughness, and improving
speed and conditioning. Because the scope of this chapter does not allow
for a more detailed discussion of prevention and treatment issues, we refer
readers to Thompson and Sherman (2010), Petrie and Greenleaf (2012),
Petrie and Sherman (2000), and Stice, Shaw, and Marti (2007) for more
information.
Substance-Related Disorders
Although sport and exercise may connote images of clean living, health,
and well-being, drug use by athletes is a serious concern. The issue of
substance use is more complicated for sport and exercise participants
than for other individuals because athletes may use drugs for both rec-
reational and performance enhancement purposes (Martens, Dams-
O’Connor, & Kilmer, 2007; Martens, Kilmer, & Beck, 2009). In addition
to the legal and health (physical and mental) ramifications of drug use
experienced by the general population, competitive athletes may face
sanctions from their sports’ governing bodies. The disqualification of
athletes from sport events, such as the Olympic Games and Tour de
France, for using performance-enhancing drugs bears witness to the
potential negative sport-related consequences of substance use.
Alcohol and marijuana are the primary substances used recreation-

ally by athletes (Selby, Weinstein, & Bird, 1990; Spence & Gauvin, 1996),
and the prevalence of alcohol use for athletes, at least at the high school
and college levels, is greater than that for nonathletes (Lisha & Sussman,
2010; Mays, DePadilla, Thompson, Kushner, & Windle, 2010; Musselman
& Rutledge, 2010). For drugs other than alcohol, however, the avail-
able evidence suggests that the prevalence rates are lower for athletes
than for nonathletes (Martens et al., 2007, 2009). These lower preva-
lence rates may be attributable to increases in drug testing of athletes

and awareness of the health- and performance-compromising effects of
many recreational drugs (Martens et al., 2007). Although athletes may
curb their use of alcohol and recreational drugs during the competi-
tive season (Martens, Dams-O’Connor, & Duffy-Paiment, 2006; Selby
et al., 1990), athletes still binge drink and get drunk more often than
nonathletes (Rainey, McKeown, Sargent, & Valois, 1996; Wechsler,
Davenport, Dowdall, Grossman, & Zanakos, 1997).
In terms of anabolic steroid use, which is done to increase muscular
size and strength, lifetime prevalence estimates range from 1.4% for
eighth graders to 2.2% for high school seniors (National Institute on
Drug Abuse, 2006); steroid use among athletes may range from 1% to
6% (National Institute on Drug Abuse, 2006), with prevalence being
3 to 5 times higher for male athletes than for female athletes (Gaa,
Griffith, Cahill, & Tuttle, 1994; Kersey, 1996; Middleman & DuRant,
1996). Athletes also may use other banned substances to reduce pain
(e.g., morphine), to increase energy and arousal (e.g., amphetamines),
to promote relaxation or reduce arousal (e.g., beta blockers), or to con-
trol weight (e.g., diuretics) (Martens et al., 2007).
In summarizing the empirical and theoretical literature, Martens
et al. (2007) identified excessive stress, sport-specific cultural and
environmental factors, personality characteristics, and performance
considerations as potential contributors to the use of recreational and
performance enhancement drugs by athletes. Sport-specific cultural
and environmental factors include the elevated social status of athletes
(and the social opportunities accompanying that status), perceived
social norms of heavy drinking among athlete peers, and the seasonal
pattern of sport competition over the course of the year. Personality
characteristics thought to influence substance use by athletes include
impulsivity, sensation seeking, and competitiveness. Performance
considerations include enhancing sport performance (e.g., heighten-
ing alertness, relaxing), reducing pain, and accelerating recovery from
injury. Many of these reasons parallel explanations for drug use given
by members of the general population but take into account the unique
aspects of the sport environment.
Strategies for preventing drug use in sport have focused primarily

on education, but few drug education programs have been subjected
to controlled trials (Martens et al., 2009). Although comprehensive
substance abuse prevention programs for athletes have been imple-
mented (e.g., Goldberg et al., 1996; Grossman & Smiley, 1999), less well-
developed programs suffer from a number of limitations, including a
reliance on one-time lectures and a lack of follow-up (Petitpas & Van
Raalte, 1992). Among the promising preventive approaches that have
been tested experimentally, that do not rely exclusively on education,

and that have shown favorable results is an Internet-based interven-
tion in which athletes obtain personalized feedback on their drinking
behavior in relation to national peer norms and risk status for negative
alcohol-related consequences (Doumas & Haustveit, 2008; Doumas,
Haustveit, & Coll, 2010).
Treatment for athletes with an identified substance-related disorder
is likely to involve outpatient or inpatient modalities, depending on
the severity of the problem (Carr & Murphy, 1995; Stainback, 1997).
Although it is clear that scare tactics alone are not effective (Goldberg,
Bents, Bosworth, Trevisan, & Elliot, 1991), intervention evaluation
studies conducted with athletes are scarce, and there is not currently
an empirical basis for recommending the use of one particular type of
intervention over another (Martens et al., 2009).
Psychological Factors Affecting

Medical Condition
Because psychosocial factors such as coping resources, life stress, and
social support may influence the occurrence of sport injury, it can be
argued that the psychosocial antecedents of sport injury constitute
“psychological factors affecting medical condition” (American Psychiat-
ric Association, 2000, p. 731). Although early research investigating the
relationship of psychological variables to sport injury was conducted
primarily with high school and college football players and focused
mainly on life stress as a predictor of injury, other sports and predic-
tor variables have been considered more extensively in recent efforts.
Empirical findings have provided consistent support for a theoretical
model in which life stress and other psychosocial factors (e.g., social
support, personality) exert direct and moderated effects on the occur-
rence of sport injury (for a review, see Petrie & Hamson-Utley, 2011),
which has been estimated at 7 million per year in the United States
(Conn, Annest, & Gilchrist, 2003).
Theoretically, psychological interventions can help reduce athletic
injury by (a) assisting athletes in adapting to and recovering from the
high-intensity training that is a typical part of sport and (b) reducing the
presence and impact of negative psychosocial factors (e.g., life stress);
increasing positive psychosocial factors (e.g., social support); changing
psychological appraisals; and learning to reduce anxiety, worry, and
stress responses that occur. Studies examining such interventions have
shown that cognitive–behavioral stress management programs can be
effective in reducing the rate of injuries in high-risk sports such as gym-
nastics, rugby, soccer, and rowing (for a review, see Petrie & Hamson-
Utley, 2011).
Adjustment Reactions
During the course of their involvement in sport and exercise, partici-
pants may have to adjust to a number of personally challenging tran-
sitions (Pearson & Petitpas, 1990). For example, competitive athletes
face the prospects of deselection (i.e., being cut from the team) and
sport career termination, and both competitive athletes and exercisers
may become injured and be unable to participate for a period of time.
Psychological adjustment to injury is a topic of interest among research-
ers, who have examined the prevalence and correlates of postinjury
emotional disturbance.
An estimated 5% to 24% of athletes report clinically meaningful lev-
els of psychological distress, at least in the short term (i.e., 1–2 months),
following injury (for a review, see Brewer, 2007). Research findings sup-
port a conceptualization in which personal and situational variables inter-
act to influence cognitive, emotional, and behavioral responses to injury
(Brewer, 2007). Thus, characteristics of the person (e.g., age, personality,
psychological investment in sport) and the situation (e.g., injury sever-
ity, injury duration, life stress, social support) affect how the individ-
ual appraises the injury, reacts emotionally, and responds behaviorally.
Managing affective responses to injury may be critical to physical reha-
bilitation because postinjury emotional disturbance has been associated
with both poor adherence to sport injury rehabilitation regimens (Daly,
Brewer, Van Raalte, Petitpas, & Sklar, 1995; Saez de Heredia, Ramirez,
& Artaza, 2004) and poor rehabilitation outcome following sport injury
(Brewer et al., 2000).
A variety of psychological treatments have been advocated for ath-
letes with injuries, ranging from relaxation and imagery to counseling
and psychotherapy (for a review, see Petitpas & Danish, 1995). Research
has documented the beneficial effects of biofeedback, imagery, relaxation,
and other cognitive–behavioral procedures on outcomes such as pain,
reinjury anxiety, and physical rehabilitation parameters (for a review,
see Brewer, 2010). Regardless of the particular intervention selected—
which, of course, depends on the nature of the client’s concerns and
resources—Petitpas and Danish (1995) emphasized the importance of

building rapport, educating injured athletes about their injury, helping
injured athletes to develop coping skills, providing injured athletes with
opportunities to practice their newly acquired coping skills, and evaluat-
ing the effectiveness of the intervention.
Various Disorders and

Subclinical Syndromes
Dose–Response Reactions
Sport and exercise participants engage in physical activity presumably
to prepare for competition or to enhance their fitness and well-being.
Sometimes, however, the amount or dose of physical training can be
excessive and counterproductive. Competitive athletes who engage
in high-volume training regimens are at risk of becoming overtrained,
a condition characterized by diminished performance and a variety of
symptoms, including disturbances in mood, sleep, and appetite (for a
review, see Kellman, 2010). Because the symptoms of overtraining may
mimic those of depressive disorders and chronic fatigue syndrome, care-
ful evaluation is needed to rule out alternative causes of the symptoms
(Puffer & McShane, 1991). Contemporary approaches to prevention and
treatment of overtraining focus on monitoring athletes’ states of recov-
ery and stress and initiating substantial recovery efforts for athletes who
become overtrained (Kellman, 2010).
Although many individuals struggle to establish a regular exercise
habit, some exercisers and recreational athletes have the opposite prob-
lem in that they become dependent on their involvement in physical
activity and persist in their participation past the point at which physi-
cal and mental health benefits are gained. Although research on exer-
cise dependence has been fraught with definitional and measurement
issues, commonly identified characteristics of the condition include
prioritizing exercise over other important activities and relationships,
engaging in exercise despite the presence of exercise-related physical
health problems (e.g., injury, pain), and experiencing withdrawal symp-
toms (e.g., mood disturbance) when restricted from participation in
physical activity (Hausenblas & Downs, 2002). Comorbidity with eat-
ing disorders (de Coverley Veale, 1987) and general psychopathology
(White-Welkley, Higbie, Fried, Koenig, & Price, 1998) is a strong pos-
sibility among individuals with exercise dependence. Although little
information is available regarding treatment, Morrow (1988) developed
a cognitive–behavioral intervention for exercise dependence in which
clients are reinforced for gradually relinquishing exercise time to other
activities after being assessed and trained in coping skills.
Anxiety Reactions
Anxiety is a central aspect of sport participation (Hackfort & Spielberger,
1989); in fact, some athletes experience precompetitive anxiety to an
extent that it interferes with performance (for a review, see Chap-
ter 4, this volume). For the most part, the anxiety associated with sport
involvement, even when it has an adverse effect on performance, is
subclinical and can be addressed through performance enhancement
interventions. In rare cases, however, the level of anxiety experienced

is more severe and warrants clinical attention (e.g., Farkas, 1989). Silva
(1994) identified a sport-specific condition in which anxiety is “isolated
on an element of a total performance” (p. 104). As examples of this
condition, termed sport performance phobia, Silva cited the behavior of a
tennis player who was afraid to come to the net and a baseball catcher
who developed an inability to throw the ball back to the pitcher despite
being able to throw the ball to second base. Phobias and other extreme
anxiety reactions should be addressed by sport and exercise psychology
practitioners with clinical training.
Another sport- and exercise-related phenomenon with an anxiety
component is muscle dysmorphia, a variant of body dysmorphic dis-
order. Muscle dysmorphia involves (a) a pathological preoccupation
with one’s body (viewing it as insufficiently lean, muscular, and large);
(b) obsessive–compulsive involvement with dieting, weight lifting, and
related activities; and (c) severe impairment of social and occupational
functioning (e.g., giving up other activities so that one can work out;
H. G. Pope, Gruber, Choi, Olivardia, & Phillips, 1997). In addition to anxi-
ety, muscle dysmorphia may be associated with depression, poor self-
concept, and suicidal ideology (McFarland & Kaminski, 2009; C. G. Pope
et al., 2005). Muscle dysmorphia is more prevalent among men than
women, and although there are no epidemiological studies regarding its
prevalence, Olivardia (2001) estimated that hundreds of thousands of
men experience some symptoms associated with the disorder. Among
athletes, bodybuilders and weight lifters appear to be most at risk (e.g.,
Baghurst & Lirgg, 2009). Etiological factors in muscle dysmorphia are
thought to include physical (i.e., body mass, anabolic androgenic ste-
roid use), perceptual (i.e., body distortion), cognitive–affective (i.e., self-
esteem, negative affect, ideal body internalization, body dissatisfaction),
dispositional (i.e., perfectionism, health locus of control), and social (i.e.,
media influences) variables (Grieve, 2007; Rohman, 2009).
Personality Disorders
A number of forces in competitive sport may contribute to the develop-
ment and maintenance of personality disorders in athletes. For example,
the coddling and adulation received by gifted athletes may help to fos-
ter narcissistic personality disorder (Andersen, Denson, Brewer, & Van

Raalte, 1994; House, 1989). Similarly, reinforcement of qualities such as
toughness and aggressiveness in the sport environment may increase
the likelihood of problem behavior among athletes with antisocial
personality disorder (Andersen et al., 1994). Another factor that may
exacerbate or contribute to the development of personality disorders
in athletes is the dysfunctional performance-contingent social support
that athletes receive in many circumstances (House, 1989). Although
there have been no empirical investigations on the prevalence and treat-

ment of personality disorders in athletic populations, anecdotal evidence
suggests that athletes with personality disorders may not respond well
to performance enhancement interventions and likely require clinical
attention (Andersen et al., 1994; Marchant & Gibbs, 2004).
Pathological Gambling
Along with substance abuse and violence, gambling is an athlete behavior
that has received considerable media attention. Athlete gambling behav-
ior has increasingly become a topic of interest to researchers over the
past two decades. Findings from epidemiological studies have suggested
that (a) a majority of athletes in National Collegiate Athletic Associa-
tion Division I football and basketball programs engage in some form of
gambling (e.g., casino gambling, slot machines, playing cards for money,
betting on sports) while in college (Cross & Vollano, 1999; Ellenbogen,
Jacobs, Derevensky, Gupta, & Paskus, 2008), (b) approximately 25% of
National Collegiate Athletic Association Division I football players bet
on college sporting events (Cullen & Latessa, 1996), and (c) the extent
of gambling behavior is at a problematic or pathological level for a con-
siderable percentage (4%–12% for males and 0.4%–3.5% for females)
of American intercollegiate athletes (Ellenbogen et al., 2008; Weinstock,
Whelan, Meyers, & Watson, 2007). Because pathological gambling can
exact tolls on the personal adjustment and sport participation eligibility
of athletes as well as adversely affect the integrity of sport, further research
is needed to identify the prevalence, causes, and concomitants of and
optimal treatments for pathological gambling among athletes.
Sport Concussion
Over the past three decades, recognition of the frequency and serious
aftereffects of mild head injury has grown dramatically (Moser, 2007),
spawning the field of sports neuropsychology (Echemendia, 2006).
Although some athletes who experience concussions have symptoms
that resolve quickly, athletes who incur postconcussion syndrome may
encounter persistent disruptions in cognitive (e.g., attention, concen-
tration, processing speed), affective (e.g., irritability, depression), and
physical (e.g., headaches, fatigue) domains that hinder academic or

occupational functioning and overall psychological adjustment. As
awareness of sport concussion has expanded, standard procedures for
preseason (baseline) and postconcussion neurocognitive testing, con-
cussion management, and return to play have been implemented in
many sport settings (for more information, see McCrory et al., 2009).
Attention-Deficit/Hyperactivity Disorder
The attentional, behavioral, and social difficulties faced by people with

attention-deficit/hyperactivity disorder (ADHD) can spill over into the
realm of sport. As noted in a review by Lullo and Van Puymbroeck
(2006), there is evidence that although children with ADHD perform
below average in gross motor skills and physical fitness, they can expe-
rience improvements in outcomes such as sportspersonlike behavior,
sport performance, interest in sport, and enjoyment of sport as result of
reinforcement-based behavioral intervention (with and in some cases
without medication). Recent research suggesting that physical activity
may in itself exert a favorable effect on executive functioning (Gapin &
Etnier, 2010b) and symptoms of inattention and hyperactivity (Gapin &
Etnier, 2010a) is consistent with anecdotal reports that the prevalence
of ADHD is higher among athletes than among nonathletes because
athletes may be attracted to physical activity as a means of coping with
their disorder (Burton, 2000). Because of their stimulant properties,
common medications used to treat ADHD have been banned by some
sport governing bodies, thereby necessitating a delicate process of deter-
mining when to use and not use prescribed medications to optimize
progress toward the therapeutic and athletic aims of child and adult
athletes with ADHD (Heil, Hartman, Robinson, & Teegarden, 2002).
Depression
Despite its high prevalence (for a mental disorder) in the general popu-
lation (American Psychiatric Association, 2000), depression has been
the subject of few epidemiological studies with athletes. Recent find-
ings on college students, however, suggest that female athletes experi-
ence higher levels of depression than male athletes (Storch, Storch,
Killiany, & Roberti, 2005; Yang et al., 2007) and both male and female
nonathletes (Storch et al., 2005). Male athletes appear to have levels of
depression that are similar to those of female nonathletes (Storch et al.,
2005) and similar to (Storch et al., 2005) or lower than those of male
nonathletes (Proctor & Boan-Lenzo, 2010; Yang et al., 2007). The
reasons for these gender-specific athlete–nonathlete differences are not
completely clear and warrant further exploration. Maniar and Sommers-
Flanagan (2009) identified the unforgiving nature of the sport culture,
injury, sport retirement, and performance-related stressors as unique

contributors to depression in athletes and noted that the array of poten-
tial treatments for depression generally applied to nonathletes can also
be applied to athletes, taking into account, of course, an athlete’s indi-
vidual circumstances.
Recommendations for
Diagnosis and Treatment
For sport and exercise participants with diagnosable psychopathology,

appropriate treatment can improve their quality of life and enhance their
sport performance or involvement in exercise. In the absence of empirical
data suggesting otherwise, diagnosis and treatment of psychopathology
in sport and exercise participants should be the same as with nonpartici-
pants. Circumstances specific to sport and exercise, however, should be
taken into consideration. Accordingly, the following recommendations
for diagnosis and treatment of psychopathology in the context of sport
and exercise are offered.
1. Practitioners should recognize that some athletes’ attitudes and
behaviors that may appear to be pathological actually have adap-
tive value in sport and may be considered normal in the sport
subculture. For example, detachment and lack of social conformity
might assist ultramarathon runners in training and competition,
which can be solitary activities (Folkins & Wieselberg-Bell, 1981),
whereas extreme levels of perfectionism can help athletes reach
the highest level in their sport. Thus, practitioners need to care-
fully monitor their own attitudes and reactions to ensure that
labeling and bias do not occur. In addition, they may need to edu-
cate themselves about the general sport culture as well as specific
competitive or exercise milieus prior to working with athletes and
exercisers.
2. Practitioners should be sensitive to forces outside of the indi-
vidual that may be particularly influential in producing appar-
ently pathological behavior. For example, the constant scrutiny
faced by athletes both on and off the field may produce feel-
ings of paranoia and anxiety (House, 1989) or may contribute
to disordered eating attitudes and behaviors (Petrie & Greenleaf,
2012). Likewise, a variety of sport-induced stressors such as pres-
sure from coaches, restriction of social interaction, travel, and
pain or injury (Petrie et al., 1997; Wrisberg, Johnson, & Brooks,
1997) may adversely affect athletes’ mental state. Furthermore,
characteristics such as aggressiveness and single-minded devotion

to sport may be reinforced by coaches and teammates (Heyman,
1986). Thus, it is important to consider both the athlete and the
sport environment when assessing the behavior of sport and exer-
cise participants. Both personal and situational factors should be
assessed thoroughly before concluding that a problem resides
within the individual.
3. Practitioners should be aware that athletes in particular may be
reluctant to seek treatment of a psychological nature. Research

has shown that relative to college student-nonathletes, college
student-athletes have underused university mental health ser-
vices (e.g., Bergandi & Wittig, 1984) and expressed less favorable
attitudes toward seeking psychological assistance (Watson, 2005).
Athletes may be hesitant to seek counseling for several reasons,
including personal attributes (e.g., self-reliance), limited time,
closed or protected sport environments, high visibility as an athlete,
and potential loss of status or negative evaluation by others
(Ferrante, Etzel, & Lantz, 1996). Although athletes may be recep-
tive to working with a sport psychologist for performance enhance-
ment (Van Raalte, Brewer, Brewer, & Linder, 1992), the idea of
consulting a mental health practitioner for psychotherapy may
be met with resistance. Because entering treatment for psycho-
pathology may have negative ramifications for athletes’ sport
participation, they may be especially concerned about confidenti-
ality. Practitioners should be attuned to this possibility and should
make every effort to alleviate athlete-clients’ concerns.
4. Practitioners should recognize that although sport may seem to
be “just a game,” many athletes are heavily invested in sport as
a source of self-identity and self-worth (Brewer, Van Raalte, &
Linder, 1993). Strong self-identification with sport involvement
may benefit athletes in terms of developing a sense of self and
enhancing motivation for training and competition but may
leave athletes vulnerable to psychological distress when they
experience transitions such as deselection, injury, and sport career
termination (Brewer, 1993; Pearson & Petitpas, 1990). In extreme
cases, threats to athletic self-identity may precipitate suicide
(Petitpas & Danish, 1995; Smith & Milliner, 1994). Accordingly,
the high degree of self-investment in sport participation pos-
sessed by some athletes should be acknowledged by practitioners
and not dismissed as preoccupation with a frivolous activity.
Furthermore, during transitional times when athletic identity
is disrupted, practitioners may work with athletes to establish
support networks among friends and teammates and to develop
other roles (e.g., student, worker, romantic partner) with which
the athletes may also identify.
5. Practitioners should be aware that although many athletic

organizations may not ordinarily be receptive to psychological
interventions, psychologists may be sought in crisis situations
such as a player death or a suicide attempt or threat (Vernacchia,
Reardon, & Templin, 1997). In such situations, sport psycholo-
gists with crisis intervention skills can provide counseling and
consultation to help athletes, coaches, and administrators deal
with the immediate and long-term consequences of the crisis
(Buchko, 2005) and perhaps increase receptiveness to additional

assistance in the future.
6. In keeping with ethical guidelines, practitioners should provide
referrals for their sport and exercise participant-clients who have
presenting problems that are outside their realm of competence.
Referral is clearly needed when the client’s problem is centered
on a technical aspect of sport performance or when the client
requests a performance enhancement intervention and the
practitioner lacks sport- or exercise-specific knowledge. Refer-
ral also may be necessary when the client presents with psycho
pathology for which the practitioner has not received training
or when supervision or consultation is not available. Thus, dur-
ing the intake and early sessions, practitioners must thoroughly
assess all areas of the athlete’s life and functioning to determine
the extent to which the problem is clinical in nature or perfor-
mance related (Taylor & Schneider, 1992). For a review of referral
processes in sport and exercise psychology, see Chapter 12, this
volume.
Summary and Conclusions
In this chapter, we reviewed the major categories of psychopathology

that have been identified and studied with sport and exercise partici-
pants. In addition, we provided recommendations for treatment and
prevention as warranted by current research. Several points become
clear from this review. First, athletes do experience psychopathology,
such as eating disorders and substance abuse, at rates equal to and some-
times greater than the general population. Second, psychopathology
specific to or exacerbated by sport or exercise involvement also exists.
Third, although empirical reports have appeared in the literature with
increasing frequency, research examining psychopathology in sport and
exercise participants has been lacking, and, thus, comments concern-
ing this area are tentative. Additional epidemiological, longitudinal, and
well-controlled studies need to be conducted to expand the knowledge
base. Finally, when treating psychopathology, it is essential that circum-

stances specific to sport and exercise be taken into consideration.
References
American College of Sports Medicine. (2007). The female athlete triad.

Medicine and Science in Sports and Exercise, 39, 1867–1882. doi:10.1249/
mss.0b013e318149f111
American Psychiatric Association. (2000). Diagnostic and statistical manual
of mental disorders (4th ed., text revision). Washington, DC: Author.
Andersen, M. B., Denson, E. L., Brewer, B. W., & Van Raalte, J. L.
(1994). Disorders of personality and mood in athletes: Recogni-
tion and referral. Journal of Applied Sport Psychology, 6, 168–184. doi:
10.1080/10413209408406292
Anderson, C. M., Petrie, T., & Neumann, C. (2011). Psychosocial cor-
relates of bulimic symptomatology among NCAA Division I female
collegiate gymnasts and swimmers/divers. Journal of Sport & Exercise
Psychology, 33, 483–505.
Association for Applied Sport Psychology. (n.d.). Become a certified con-
sultant. Retrieved from http://appliedsportpsych.org/Consultants/
become-certified
Auerbach, J. (1994). Psychopathology in the world of men’s sports. Unpub-
lished doctoral dissertation, Institute for Graduate Clinical Psychol-
ogy, Widener University, Chester, PA.
Baghurst, T., & Lirgg, C. (2009). Characteristics of muscle dysmorphia
in male football, weight training, and competitive natural and non-
natural bodybuilding samples. Body Image, 6, 221–227. doi:10.1016/j.
bodyim.2009.03.002
Beals, K. A., & Hill, A. K. (2006). The prevalence of disordered eat-
ing, menstrual dysfunction, and low bone mineral density among US
collegiate athletes. International Journal of Sport Nutrition and Exercise
Metabolism, 16, 1–23.
Beisser, A. R. (1977). The madness in sports (2nd ed.). Bowie, MD:
Charles Press.
Bergandi, T., & Wittig, A. (1984). Availability of and attitudes toward
counseling services for the collegiate athlete. Journal of College Student
Personnel, 25, 557–558.
Berger, K. (2010, November 22). West deals with bipolar disorder, gets
back on track. CBS Sports.com. Retrieved from http://www.cbssports.
com/print/nba/story/14337635/west-deals-with-bipolar-gets-back
on track
Brewer, B. W. (1993). Self-identity and specific vulnerability to depressed

mood. Journal of Personality, 61, 343–364. doi:10.1111/j.1467-6494.1993.
tb00284.x
Brewer, B. W. (2007). Psychology of sport injury rehabilitation. In
G. Tenenbaum & R. C. Eklund (Eds.), Handbook of sport psychology
(3rd ed., pp. 404–424). New York, NY: Wiley.
Brewer, B. W. (2010). The role of psychological factors in sport injury
rehabilitation. International Review of Sport and Exercise Psychology, 3,
40–61. doi:10.1080/17509840903301207
Brewer, B. W., Van Raalte, J. L., Cornelius, A. E., Petitpas, A. J., Sklar,
J. H., Pohlman, M. H., . . . Ditmar, T. D. (2000). Psychological factors,
rehabilitation adherence, and rehabilitation outcome following anterior
cruciate ligament reconstruction. Rehabilitation Psychology, 45, 20–37.
doi:10.1037/0090-5550.45.1.20
Brewer, B. W., Van Raalte, J. L., & Linder, D. E. (1993). Athletic iden-
tity: Hercules’ muscles or Achilles heel? International Journal of Sport
Psychology, 24, 237–254.
Buchko, K. J. (2005). Team consultation following an athlete’s suicide:
A crisis intervention model. The Sport Psychologist, 19, 288–302.
Burton, R. W. (2000). Mental illness in athletes. In D. Begel & R. W.
Burton (Eds.), Sport psychiatry (pp. 61–81). New York, NY: Norton.
Caplan, A. (2008, August 7). Mentally ill still subject to contempt:
When an Eagle admitted he suffers from depression, the bashing
began. Philly.com. Retrieved from http://articles.philly.com/2008-08-
07/news/25258066_1_mental-illness-training-camp-mental-health-
treatment
Carr, C. M., & Murphy, S. M. (1995). Alcohol and drugs in sport. In
S. M. Murphy (Ed.), Sport psychology interventions (pp. 283–306).
Champaign, IL: Human Kinetics.
Cohen, D. L., & Petrie, T. A. (2005). An examination of psychosocial
correlates of disordered eating among undergraduate women. Sex
Roles, 52, 29–42. doi:10.1007/s11199-005-1191-x
Conn, J. M., Annest, J. L., & Gilchrist, J. (2003). Sports and recreation
related injury episodes in the US population 1997-1999. Injury Pre-
vention, 9, 117–123. doi:10.1136/ip.9.2.117
Cross, M. E., & Vollano, A. G. (1999). The extent and nature and gambling
among college student athletes. Ann Arbor, MI: University of Michigan,
Department of Athletics.
Crowther, J. H., Armey, M., Luce, K., Dalton, G., & Leahey, T. (2008).
The point prevalence of bulimic disorders from 1990 to 2004. The Inter-
national Journal of Eating Disorders, 41, 491–497. doi:10.1002/eat.20537
Cullen, F. T., & Latessa, E. J. (1996). The extent and sources of NCAA rule
infractions: A national self-report study of student-athletes. Cincinnati, OH:
University of Cincinnati, Division of Criminal Justice.
Currin, L., Schmidt, U., Treasure, J., & Jick, H. (2005). Time trends in
eating disorder incidence. The British Journal of Psychiatry, 186, 132–135.
doi:10.1192/bjp.186.2.132
Daly, J. M., Brewer, B. W., Van Raalte, J. L., Petitpas, A. J., & Sklar, J. H.
(1995). Cognitive appraisal, emotional adjustment, and adherence to
sport injury rehabilitation. Journal of Sport Rehabilitation, 4, 23–30.
de Coverley Veale, D. M. W. (1987). Exercise dependence. British Journal
of Addiction, 82, 735–740. doi:10.1111/j.1360-0443.1987.tb01539.x
Doumas, D. M., & Haustveit, T. (2008). Reducing heavy drinking among

first year intercollegiate athletes: Evaluation of a web-based personal-
ized feedback program. The Sport Psychologist, 22, 212–228.
Doumas, D. M., Haustveit, T., & Coll, K. M. (2010). Reducing heavy
drinking among first year intercollegiate athletes: A randomized con-
trolled trial of web-based normative feedback. Journal of Applied Sport
Psychology, 22, 247–261. doi:10.1080/10413201003666454
Echemendia, R. (Ed.). (2006). Sports neuropsychology: Assessment and
management of traumatic brain injury. New York, NY: Guilford Press.
Ellenbogen, S., Jacobs, D., Derevensky, J., Gupta, R., & Paskus, T. (2008).
Gambling behavior among college student-athletes. Journal of Applied
Sport Psychology, 20, 349–362. doi:10.1080/10413200802056685
Everything was negative. Dark. (2004, October 28). ESPN.com: WNBA.
Retrieved from http://sports.espn.go.com/espn/print?id=1911836&
type=news
Farkas, G. (1989). Exposure and response prevention in the treatment
of an okeanophobic triathlete. The Sport Psychologist, 3, 189–195.
Ferrante, A. P., Etzel, E., & Lantz, C. (1996). Counseling college student-
athletes: The problem, the need 1996. In E. Etzel, A. P. Ferrante, &
J. W. Pinkney (Eds.), Counseling college student-athletes: Issues and inter-
ventions (2nd ed., pp. 3–26). Morgantown, WV: Fitness Information
Technology.
Folkins, C. H., & Wieselberg-Bell, N. (1981). A personality profile of
ultramarathon runners: A little deviance may go a long way. Journal
of Sport Behavior, 4, 119–127.
Gaa, G. L., Griffith, E. H., Cahill, B. R., & Tuttle, L. D. (1994). Prevalence
of anabolic steroid use among Illinois high school students. Journal of
Athletic Training, 29, 216–222.
Gapin, J., & Etnier, J. L. (2010a). Parental perceptions of the effects
of exercise on behavior in children and adolescents with AD/HD
[Abstract]. Journal of Sport & Exercise Psychology, 32(suppl.), S165.
Gapin, J., & Etnier, J. L. (2010b). The relationship between physical activ-
ity and executive function performance in children with attention-
deficit hyperactivity disorder. Journal of Sport & Exercise Psychology, 32,
753–763.
Garber, G. (2007, February 26). Draper’s tale of two sports is one for the
movies. ESPN.com: Golf. Retrieved from http://sports.espn.go.com/
espn/print?id=2780719&type=story
Goldberg, L., Bents, R., Bosworth, E., Trevisan, L., & Elliot, D. L. (1991).
Anabolic steroid education and adolescents: Do scare tactics work?
Pediatrics, 87, 283–286.
Goldberg, L., Elliot, D., Clarke, G. N., MacKinnon, D., P., Moe, E.,
Zoref, L., . . . Lapin, A. (1996). Effects of a multidimensional ana-
bolic steroid prevention intervention: The adolescents training and

learning to avoid steroids (ATLAS) program. JAMA, 276, 1555–1562.
doi:10.1001/jama.1996.03540190027025
Greenleaf, C., Petrie, T. A., Carter, R., & Reel, J. J. (2009). Female
collegiate athletes: Prevalence of eating disorders and disordered
eating behaviors. Journal of American College Health, 57, 489–496.
doi:10.3200/JACH.57.5.489-496
Grieve, F. G. (2007). A conceptual model of factors contributing to the
development of muscle dysmorphia. Eating Disorders: The Journal of
Treatment & Prevention, 15, 63–80. doi:10.1080/10640260601044535
Grossman, S. J., & Smiley, E. B. (1999). APPLE: Description and evalu-
ation of a substance abuse education and prevention program for
collegiate athletics. The Journal of Primary Prevention, 20, 51–59.
doi:10.1023/A:1021354318923
Hackfort, D., & Spielberger, C. D. (Eds.). (1989). Anxiety in sports: An
international perspective. New York, NY: Hemisphere.
Hales, D. (1993, December 19). When panic strikes. Parade Magazine,
pp. 12–13.
Hausenblas, H. A., & Downs, D. S. (2002). Exercise dependence: A sys-
tematic review. Psychology of Sport and Exercise, 3, 89–123. doi:10.1016/
S1469-0292(00)00015-7
Heil, J., Hartman, D., Robinson, G., & Teegarden, L. (2002). Attention-
deficit hyperactivity disorder in athletes. Olympic Coach, 12(2), 5–7.
Heyman, S. R. (1986). Psychological problem patterns found with
athletes. Clinical Psychologist, 39, 68–71.
Hoch, A. Z., Stavrakos, D. E., & Schimke, J. E. (2007). Prevalence of
female athlete triad characteristics in a club triathlon team. Archives
of Physical Medicine and Rehabilitation, 88, 681–682. doi:10.1016/
j.apmr.2007.02.035
House, T. (1989). The jock’s itch: The fast-track private world of the profes-
sional ballplayer. Chicago, IL: Contemporary Books.
Hudson, J. I., Hiripi, E., Pope, H. G., & Kessler, R. C. (2007). The preva-
lence and correlates of eating disorders in the National Comorbidity
Survey replication. Biological Psychiatry, 61, 348–358. doi:10.1016/
j.biopsych.2006.03.040
Isomaa, R., Tsomaa, A., Marttunen, M., Kaltiala-Heino, R., & Bjorkqvist,
K. (2009). The prevalence, incidence and development of eating dis-
orders in Finnish adolescents—A two-step 3-year follow-up study.
European Eating Disorders Review, 17, 199–207. doi:10.1002/erv.919
Johnson, C., Powers, P. S., & Dick, R. (1999). Athletes and eating dis
orders: The National Collegiate Athletic Association study. International
Journal of Eating Disorders, 26, 179–188. doi:10.1002/(SICI)1098-
108X(199909)26:2<179::AID-EAT7>3.0.CO;2-Z
Keel, P. K., Heatherton, T., Dorer, D., Joiner, T., & Zalta, A. (2006).
Point prevalence of bulimia nervosa in 1982, 1992, and 2002. Psycho-
logical Medicine, 36, 119–127. doi:10.1017/S0033291705006148
Kellman, M. (2010). Overtraining and recovery. In S. J. Hanrahan &
M. B. Andersen (Eds.), Routledge handbook of applied sport psychology:
A comprehensive guide for students and practitioners (pp. 292–302). New
York, NY: Routledge.
Kersey, R. D. (1996). Anabolic-androgenic steroid use among Califor-
nia community college student-athletes. Journal of Athletic Training,
31, 237–241.
Lisha, N. E., & Sussman, S. (2010). Relationship of high school and
college sports participation with alcohol, tobacco, and illicit drug
use: A review. Addictive Behaviors, 35, 399–407. doi:10.1016/j.addbeh.
2009.12.032
Lullo, C., & Van Puymbroeck, M. (2006). Research update: Sports for
children with ADHD. Parks & Recreation, 41(12), 20–23.
Maine issue is health. (1997, August 20). Union-News, p. D16.
Maniar, S., & Sommers-Flanagan, J. (2009). Clinical depression and
college student-athletes. In E. Etzel (Ed.), Counseling and psychological
services for college student-athletes (pp. 323–348). Morgantown, WV: Fit-
ness Information Technology.
Marchant, D., & Gibbs, P. (2004). Ethical considerations in treating
borderline personality in sport: A case example. The Sport Psychologist,
18, 317–323.
Martens, M. P., Dams-O’Connor, K., & Duffy-Paiment, C. (2006). Com-
paring off-season with in-season alcohol consumption among inter-
collegiate athletes. Journal of Sport & Exercise Psychology, 28, 502–510.
Martens, M. P., Dams-O’Connor, K., & Kilmer, J. R. (2007). Alcohol
and drug use among athletes: Prevalence, etiology, and interventions.
In G. Tenenbaum & R. C. Eklund (Eds.), Handbook of sport psychology
(3rd ed., pp. 859–878). New York, NY: Wiley. doi:10.1002/978111
8270011.ch39
Martens, M. P., Kilmer, J. R., & Beck, N. (2009). Alcohol and drug use
among college athletes. In E. F. Etzel (Ed.), Counseling and psychologi-
cal services for college student-athletes (pp. 451–475). Morgantown, WV:
Fitness Information Technology.
Matser, J. T., Kessels, A. G. H., Jordan, B. D., Lezak, M. D., & Troost, J.
(1998). Chronic traumatic brain injury in professional soccer players.
Neurology, 51, 791–796. doi:10.1212/WNL.51.3.791
Mays, D., DePadilla, L., Thompson, N. J., Kushner, H., & Windle, M.
(2010). Sports participation and problem alcohol use: A multi-wave
national sample of adolescents. American Journal of Preventive Medicine,
38, 491–498. doi:10.1016/j.amepre.2010.01.023
McCrory, P., Meeuwisse, W., Johnston, K., Dvorak, J., Aubry, M., Molloy,
M., & Cantu, R. (2009) Consensus statement on concussion in sport

3rd International Conference on Concussion in Sport held in Zurich,
November 2008. Clinical Journal of Sports Medicine, 19, 185–200.
McFarland, M. B., & Kaminski, P. L. (2009). Men, muscles, and mood:
The relationship between self-concept, dysphoria, and body image
disturbances. Eating Behaviors, 10, 68–70. doi:10.1016/j.eatbeh.
2008.10.007
Middleman, A. B., & DuRant, R. H. (1996). Anabolic steroid use and asso-
ciated health risk behaviors. Sports Medicine, 21, 251–255. doi:10.2165/
00007256-199621040-00001
Morgan, W. P. (1985). Selected psychological factors limiting performance:
A mental health model. In D. H. Clarke & H. M. Eckert (Eds.), Limits of
human performance (pp. 70–80). Champaign, IL: Human Kinetics.
Morrow, J. (1988, October). A cognitive-behavioral interaction for reducing
exercise addiction. Paper presented at the meeting of the Association for
the Advancement of Applied Sport Psychology, Nashua, NH.
Moser, R. S. (2007). The growing public health concern of sports con-
cussion: The new psychology practice frontier. Professional Psychol-
ogy: Research and Practice, 38, 699–704. doi:10.1037/0735-7028.
38.6.699
Musselman, J. R. B., & Rutledge, P. C. (2010). The incongruous alcohol–
activity association: Physical activity and alcohol consumption in col-
lege students. Psychology of Sport and Exercise, 11, 609–618. doi:10.1016/
j.psychsport.2010.07.005
National Institute on Drug Abuse. (2006). Anabolic steroid abuse.
Bethesda, MD: National Institutes of Health. Retrieved from http://
www.nida.nih.gov/researchreports/steroids/anabolicsteroids2.
html#scope
Nichols, J. F., Rauh, M. J., Lawson, M. J., Ji, M., & Barkai, H. S. (2006).
Prevalence of the female athlete triad syndrome among high school
athletes. Archives of Pediatrics & Adolescent Medicine, 160, 137–142. doi:
10.1001/archpedi.160.2.137
Ogilvie, B. C., & Tutko, T. A. (1966). Problem athletes and how to handle
them. London, England: Pelham.
Olivardia, R. (2001). Mirror, mirror on the wall, who’s the largest of
them all? The features and phenomenology of muscle dysmorphia.
Harvard Review of Psychiatry, 9, 254–259.
Page, P. (1990). Tourette syndrome in athletics: A case study and review.

Athletic Training, 25, 254–259.
Pearson, R. E., & Petitpas, A. J. (1990). Transitions of athletes: Pit-
falls and prevention. Journal of Counseling & Development, 69, 7–10.
doi:10.1002/j.1556-6676.1990.tb01445.x
Petitpas, A., & Danish, S. J. (1995). Caring for injured athletes. In
S. M. Murphy (Ed.), Sport psychology interventions (pp. 255–281).
Champaign, IL: Human Kinetics.
Petitpas, A. J., & Van Raalte, J. L. (1992, Spring). Planning alcohol
education programs for intercollegiate student-athletes. The Academic
Athletic Journal, 12–25.
Petrie, T. A., & Diehl, N. S. (1995). Sport psychology in the profession of
psychology. Professional Psychology: Research and Practice, 26, 288–291.
doi:10.1037/0735-7028.26.3.288
Petrie, T. A., Diehl, N. S., & Watkins, C. E., Jr. (1995). Sport psychology:
An emerging domain in the counseling psychology profession? The
Counseling Psychologist, 23, 535–545. doi:10.1177/0011000095233010
Petrie, T. A., Falkstein, D. L., Varnado, J. L., Austin, L. J., Harmison,
R. J., Jenkins, M., & Harvey, P. (1997). The occurrence of negative
life events in male and female college-student athletes [Abstract].
Journal of Applied Sport Psychology, 9(Suppl.), S144.
Petrie, T. A., & Greenleaf, C. (2012). Eating disorders in sport. In S. Murphy
(Ed.), Oxford handbook of sport and performance psychology (pp. 635–659).
New York, NY: Oxford University Press. doi:10.1002/9781118270011.
ch16
Petrie, T. A., Greenleaf, C., Reel, J., & Carter, J. (2008). Prevalence of
eating disorders and disordered eating behaviors among male colle-
giate athletes. Psychology of Men & Masculinity, 9, 267–277. doi:10.1037/
a0013178
Petrie, T. A., & Hamson-Utley, J. (2011). Psychosocial antecedents of
and responses to athletic injury. In T. Morris & P. Terry (Eds.), The
new sport and exercise psychology companion (pp. 531–552). Morgantown,
WV: Fitness Information Technology.
Petrie, T. A., & Harmison, R. (2012). Sport psychology in the field of
counseling psychology. In E. Altmaier & J. I. Hanson (Eds.), Oxford
handbook of counseling psychology (pp. 780–806). New York, NY: Oxford
University Press.
Petrie, T. A., & Sherman, R. (2000). Counseling athletes with eating
disorders: A case example. In M. Andersen (Ed.), Doing sport psychol-
ogy (pp. 121–137). Champaign, IL: Human Kinetics.
Pope, C. G., Pope, H. G., Menard, W., Fay, C., Olivardia, R., & Phillips,
K. A. (2005). Clinical features of muscle dysmorphia among males
with body dysmorphic disorder. Body Image, 2, 395–400. doi:10.1016/
j.bodyim.2005.09.001
Pope, H. G., Gruber, A. J., Choi, P., Olivardia, R., & Phillips, K. A.
(1997). Muscle dysmorphia: An underrecognized form of body dys-
morphic disorder. Psychosomatics, 38, 548–557. doi:10.1016/S0033-
3182(97)71400-2
Proctor, S. L., & Boan-Lenzo, C. (2010). Prevalence of depressive symp-
toms in male intercollegiate student-athletes and nonathletes. Jour-
nal of Clinical Sport Psychology, 4, 204–220.
Puffer, J. C., & McShane, J. M. (1991). Depression and chronic fatigue
in the college student-athlete. Primary Care, 18, 297–308.

Rainey, C. J., McKeown, R. E., Sargent, R. G., & Valois, R. F. (1996).
Patterns of tobacco and alcohol use among sedentary, exercising,
nonathletic, and athletic youth. The Journal of School Health, 66, 27–32.
doi:10.1111/j.1746-1561.1996.tb06254.x
Reardon, C. L., & Factor, R. M. (2010). Sport psychiatry: A systematic
review of diagnosis and medical treatment of mental illness in athletes.
Sports Medicine, 40, 961–980. doi:10.2165/11536580-000000000-
00000
Rohman, L. (2009). The relationship between anabolic androgenic ste-
roids and muscle dysmorphia. Eating Disorders: The Journal of Treat-
ment & Prevention, 17, 187–199. doi:10.1080/10640260902848477
Rosen, L. W., Smokler, C., Carrier, D., Shafer, C. L., & McKeag, D. B.
(1996). Seasonal mood disturbances in collegiate hockey players.
Journal of Athletic Training, 31, 225–228.
Saez de Heredia, A. R., Ramirez, A., & Artaza, J. (2004). The effect of
psychological response on recovery of sport injury. Research in Sports
Medicine, 12, 15–31. doi:10.1080/15438620490280567
Selby, R., Weinstein, H. M., & Bird, T. S. (1990). The health of univer-
sity athletes: Attitudes, behaviors, and stressors. Journal of American
College Health, 39, 11–18. doi:10.1080/07448481.1990.9936208
Silva, J. M., III. (1994). Sport performance phobias. International Journal
of Sport Psychology, 25, 100–118.
Smith, A. M., & Milliner, E. K. (1994). Injured athletes and the risk of
suicide. Journal of Athletic Training, 29, 337–341.
Spence, J. C., & Gauvin, L. (1996). Drug and alcohol use by Canadian
university athletes: A national survey. Journal of Drug Education, 26,
275–287.
Stainback, R. D. (1997). Alcohol and sport. Champaign, IL: Human Kinetics.
Stice, E., Shaw, H., & Marti, C. (2007). A meta-analytic review of eat-
ing disorder prevention programs: Encouraging findings. Annual
Review of Clinical Psychology, 3, 207–231. doi:10.1146/annurev.clinpsy.
3.022806.091447
Storch, E. A., Storch, J. B., Killiany, E. M., & Roberti, J. W. (2005). Self-
reported psychopathology in athletes: A comparison of intercollegiate
student-athletes and non-athletes. Journal of Sport Behavior, 28, 86–98.
Sundgot-Borgen, J., & Torstveit, M. K. (2004). Prevalence of eating

disorders in elite athletes is higher than in the general population.
Clinical Journal of Sport Medicine, 14, 25–32. doi:10.1097/00042752-
200401000-00005
Taylor, J., & Schneider, B. A. (1992). The sport-clinical intake pro-
tocol: A comprehensive interviewing instrument for applied sport
psychology. Professional Psychology: Research and Practice, 23, 318–325.
doi:10.1037/0735-7028.23.4.318
Thompson, R., & Sherman, R. (2010). Eating disorders in sport. New York,
NY: Routledge.
Torre, P. S. (2011, August 15). Dangerous minds. Sports Illustrated, 12–13.
Torstveit, M. K., & Sundgot-Borgen, J. (2005). The female athlete
triad exists in both elite athletes and controls. Medicine and Science in
Sports and Exercise, 37, 1449–1459. doi:10.1249/01.mss.0000177678.
73041.38
Van Raalte, J. L., Brewer, B. W., Brewer, D. D., & Linder, D. E. (1992).
NCAA Division II college football players’ perceptions of an athlete
who consults a sport psychologist. Journal of Sport & Exercise Psychol-
ogy, 14, 273–282.
Vernacchia, R. A., Reardon, J. P., & Templin, D. P. (1997). Sudden death
in sport: Managing the aftermath. The Sport Psychologist, 11, 223–235.
Visser, L. (2010, May 12). Ten years after leaving field, Haley on more
solid ground. CBS Sports.com. Retrieved from http://www.cbssports.
com/columns/story/12777033
Walker reveals struggles with mental disorder in just-released book.
(2008, April 14). ESPN.com: NFL. Retrieved from http://sports.espn.
go.com/espn/print?id=3346240&type=story
Watson, J. C. (2005). College student-athletes’ attitudes toward help-
seeking behavior and expectations of counseling services. Journal of
College Student Development, 46, 442–449. doi:10.1353/csd.2005.0044
Wechsler, H., Davenport, A. E., Dowdall, G. W., Grossman, S. J., &
Zanakos, S. I. (1997). Binge drinking, tobacco, and illicit drug use and
involvement in college athletics: A survey of students at 140 American
colleges. Journal of American College Health, 45, 195–200. doi:10.1080/
07448481.1997.9936884
Weinstock, J., Whelan, J. P., Meyers, A. W., & Watson, J. M. (2007).
Gambling behavior of student-athletes and a student cohort: What
are the odds? Journal of Gambling Studies, 23, 13–24.
White-Welkley, J. E., Higbie, E. J., Fried, A. L., Koenig, L. J., & Price, L. R.
(1998). Exercise patterns, injury incidence, eating habits, aerobic fit-
ness and psychopathology among non-competitive females [Abstract].
Medicine and Science in Sports and Exercise, 30(Suppl.), S118. doi:10.1097/
00005768-199805001-00670
Wolanin, A. T., & Schwanhausser, L. A. (2010). Psychological function-

ing as a moderator of the MAC approach to performance enhance-
ment. Journal of Clinical Sport Psychology, 4, 312–322.
Wrisberg, C. A., Johnson, M. S., & Brooks, G. (1997). The life experience
of collegiate athletes: A phenomenological investigation [Abstract].
Journal of Applied Sport Psychology, 9(Suppl.), S76.
Yang, J., Peek-Asa, C., Corlette, J. D., Cheng, G., Foster, D. T., & Albright, J.
(2007). Prevalence of and risk factors associated with symptoms of
depression in competitive collegiate student-athletes. Clinical Journal

of Sport Medicine, 17, 481–487. doi:10.1097/JSM.0b013e31815aed6b

Psychopathology in Sports

Uploaded by

Copyright:

Available Formats

Psychopathology in Sports

Uploaded by

Document Information

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Psychopathology in Sports

Uploaded by

Copyright:

Available Formats

Britton W. Brewer and Trent A.

exercise (American Psychiatric Association, 2000). The existence of

borderline personality disorder (Marchant & Gibbs, 2004), dissociative

Although sport and exercise participants may experience a variety of

treatment issues associated with eating disorders, substance-related dis-

female athlete triad (American College of Sports Medicine, 2007). The

Alcohol and marijuana are the primary substances used recreation-

lence rates may be attributable to increases in drug testing of athletes

Strategies for preventing drug use in sport have focused primarily

been tested experimentally, that do not rely exclusively on education,

Psychological Factors Affecting

resources—Petitpas and Danish (1995) emphasized the importance of

Various Disorders and

interventions. In rare cases, however, the level of anxiety experienced

ter narcissistic personality disorder (Andersen, Denson, Brewer, & Van

there have been no empirical investigations on the prevalence and treat-

physical (e.g., headaches, fatigue) domains that hinder academic or

The attentional, behavioral, and social difficulties faced by people with

injury, sport retirement, and performance-related stressors as unique

Diagnosis and Treatment

For sport and exercise participants with diagnosable psychopathology,

characteristics such as aggressiveness and single-minded devotion

reluctant to seek treatment of a psychological nature. Research

5. Practitioners should be aware that although many athletic

(Buchko, 2005) and perhaps increase receptiveness to additional

Summary and Conclusions

In this chapter, we reviewed the major categories of psychopathology

base. Finally, when treating psychopathology, it is essential that circum-

American College of Sports Medicine. (2007). The female athlete triad.

Brewer, B. W. (1993). Self-identity and specific vulnerability to depressed

Doumas, D. M., & Haustveit, T. (2008). Reducing heavy drinking among

bolic steroid prevention intervention: The adolescents training and

M., & Cantu, R. (2009) Consensus statement on concussion in sport

Page, P. (1990). Tourette syndrome in athletics: A case study and review.

in the college student-athlete. Primary Care, 18, 297–308.

Sundgot-Borgen, J., & Torstveit, M. K. (2004). Prevalence of eating

Wolanin, A. T., & Schwanhausser, L. A. (2010). Psychological function-

depression in competitive collegiate student-athletes. Clinical Journal

You might also like

5. Practitioners should be aware that although many athletic