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chapter 4: co-occurring disorders and athletes

Athletes should not ignore or mask mental health issues because this often leads to substance abuse. This chapter will examine mental health in sports, signs of a co-occurring disorder and famous athletes with anxiety and depression who continue to push forward with their dreams without hiding their conditions.

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Chapter 4: Co-Occurring Disorders And Athletes

Co-occurring disorders describe the presence of both a mental health issue and a substance use disorder. In 2014, about 7.9 million American adults had co-occurring disorders. Athletes cope with a high level of stress, pressure and a need to succeed despite how they feel, making them especially vulnerable to co-occurring disorders.

An NCAA survey found that 30 percent of athletes reported feeling depressed and half said they experienced high levels of anxiety. Athletes may use drugs to self-medicate and relieve symptoms of anxiety, depression or other mental health issues. They may feel pressure to hide their pain, making their symptoms worse.

Athletes and Depression

Depression is common among Americans, including athletes. A recent national survey reported 8.1 percent of American adults over the age of 20 had depression in a given two-week period. About 80 percent of depressed adults experience some trouble with work, relationships or home activities due to depression.

Certain factors cause an individual to become depressed. These might include:

  • Childhood trauma
  • Medical conditions
  • Genetic factors
  • Stressful life events such as the death of a loved one, the loss of job, an illness or relationship issue
  • Seasonal affective disorder (SAD)
  • Certain medications
  • Temperament

Athletes are not immune to depression, though they may underreport depression to uphold an image of strength. For example, the rate of depression among college athletes ranges from 15.6 percent to 21 percent. Based on these findings, up to one in five athletes may be depressed.

There are many reasons an athlete may become depressed. For example, athletes coping with a sports injury have higher rates of depression. If they suffered a concussion, they might become depressed because concussions can lead to emotional changes that cause depression. Other possibilities that could lead to depression include:

  • Overtraining syndrome (OTS)
  • Decline in athletic performance
  • Career termination
  • Isolation resulting from an injury

As you can see, athletes face unique circumstances that the general population does not have to deal with. For this reason, athletes need to be encouraged by friends and family to speak about depression and the pressure they feel.

Athletes With Anxiety

Athletes have many concerns. They might feel anxious about future sports performances or games and worry they will lose or fail. Athletes who have been injured might fear another injury will occur when they perform. Those who have caused an injury might experience anxiety thinking they will unintentionally hurt someone again.

Research conducted by the NCAA shows that about 85 percent of certified athletic trainers believe anxiety disorders are an issue with student-athletes on their campus. Anxiety might express itself in the following ways:

  • Muscle tension
  • Gastrointestinal issues
  • Difficulty breathing
  • Headaches
  • Increased heart rate
  • Panic attacks

Considering that anxiety disorders are the most common mental health issue in the U.S., affecting 18.1 percent of the adult population, one can assume that there are athletes in this group. Also, many people with depression also have anxiety. In fact, almost half of those diagnosed with depression also have an anxiety disorder. Genetics, personality and life events can all cause an anxiety disorder.

Signs of a Co-Occurring Disorder

With anxiety and depression affecting many American adults, including athletes, it is no surprise that millions have a co-occurring disorder. Athletes might experience depression or anxiety first and turn to drugs or alcohol to relieve symptoms. A substance use disorder worsens the symptoms of a mental health disorder, despite the temporary relief it provides.

Some athletes may have a substance use disorder which leads to a mental health issue like depression. For example, depression is a serious withdrawal symptom of anabolic steroid misuse. Users might even turn to opioids to cope with steroid withdrawal, continuing the cycle.

Self-medicating with drugs or alcohol is common. It is hard to list symptoms of a co-occurring disorder because symptoms vary widely among individuals. However, they may include the following:

  • Withdrawal from loved ones
  • Using substances in dangerous situations
  • Feeling a need to use drugs
  • Experiencing withdrawal symptoms
  • Sudden behavioral changes
  • Loss of control over substance use
  • Engaging in risky behaviors
  • Building a tolerance to a drug

If you or an athlete in your life displays signs of depression or anxiety and have been turning to drugs or alcohol to escape, it’s important to seek professional help for a co-occurring disorder. Treatment is available for the presence of both a substance use disorder and a mental health issue, and it is very common for one to precede the other.

Famous Athletes With Mental Illness

When we think of an athlete, we might imagine someone who represents perfect health. We might think of a person who is always in complete control of their body and mind and who can endure all of life’s challenges.

The truth is, athletes are like anyone else and might be even more susceptible to mental health issues due to the competitive nature of playing sports and the effects of overtraining. It does not make them any less of an athlete, or a person.

On the contrary, many famous athletes continue to excel in their sport despite mental health disorders. Let the following list inspire you to get the help you need and not let a mental health problem or a co-occurring disorder stand in your way:

  • Imani Boyette: WNBA player who has severe clinical depression
  • Mardy Fish: Top-ranked tennis player with anxiety disorder
  • Rick Ankiel: MLB player who experiences severe anxiety
  • Royce White: NBA player diagnosed with obsessive-compulsive disorder and generalized anxiety disorder
  • Allison Schmitt: Olympic swimmer who has depression
  • Brandon Marshall: NFL player diagnosed with borderline personality disorder and has an anxiety disorder
  • Jerry West: Retired basketball star who has depression
  • Michael Phelps: Olympic swimmer who has depression
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