Post-traumatic stress disorder among athletes

World map representing the presence of Post traumatic stress disorder within different countries

Post Traumatic Stress Disorder (PTSD) is a cognitive disorder, which comes about after overcoming a traumatic event.^[1] It is a disease, which is extremely common to those participating in a sport at an elite level.^[2] When these athletes feel like they have come to the end of their journey as an athlete, and then try and slot themselves back into mainstream society, or after they have had to overcome a large hurdle within their chosen sport. These athletes develop feelings of alienation, depression, flashbacks or hyperarousal, and generally become evident after a couple of months after stopping or after the specific event has concluded.^[1]

There is a common sense of confusion between the difference of PTSD and a normal response to trauma. If an athlete injures himself or herself in a horrific way, it is normal for them to go through some adversity before overcoming the injury.^[3] They may develop small flashbacks, have bad dreams, or feel like they can't get the traumatic experience out of their mind, however, depending on the athlete’s mental ability, or how determined they are within their chosen sport, these symptoms can be lifted in time.^[2] Along with this, those athletes who are weaker mentally are the ones who tend to not be able to recover themselves and fall into the category of PTSD.^[1]

There are many therapies which can help reduce ones deterioration of PTSD, some including, psychologist sessions, various medications, art therapy or social engagement etc.^[3]

History

There are many sports which are fairly dangerous and involve threatening activities, especially during competition. There is always the chance of athletes getting injured while competing or during training which is exactly the reason why a psychologist would eventually encounter a patient who is a serious athlete and is in need of their assistance to rehabilitate their PTSD.^[4] Psychology as a general occupation has dated back to times of 1878, and around 1897 the first psychologist specialising in sport was established, by the name of Dr. Norman Triplett. Ever since, sport psychologists were helping different athletes, in the mental aspect of their game, in order for them to reach their optimum potential.^[4]

PTSD became first evident due to those individuals who suffered extremely horrible experiences from war. Society noticed that those who took part in war, or had family members who took part in war, became distant from themselves and suffered terribly and found it very difficult to cope with the tragedies. Researchers took note of this and aimed to evaluate the situation and come to a conclusion with how to rehabilitate these victims, and while doing this they determined that these people had post-traumatic stress disorder.^[5]

Soon after this new found disorder was established it made it far more clearer for those sport psychologists to treat their clients, as prior to the discovery of PTSD, sports psychologists, had to come up with alternative options to rehabilitate their clients who were experiencing PTSD. These psychologists often took their clients to play different sports, completely different from their own in aim to treat them in the most comfortable way possible.^[4]

Signs and symptoms

There are many extreme and less extreme symptoms for PTSD, some which need medication to calm them down and others which can be solved in easier ways.^[6]

some of these include:

- The athlete reliving traumatic events, or reliving peeks of their career - these events are relived through memories taking over through strong images within nightmares. these nightmares have such strong effects that they can cause athletes to have many physical and emotional reactions, like sweating, hot and cold flushes, racing heart, tightening of the chest, snowballing worries, obsessive thinking, compulsive behaviour, panic, or heart palpitations.^[7]

- The athlete being more alert or annoyed - as athletes are experiencing these flashbacks, this can cause them to miss vital sleeping hours, which in turn, results in them having a lack of concentration and be irritated. Along with this athletes could also become startled easier and always be on the lookout for signs of danger.^[6]

- Avoiding reminders of the event: the athlete, if is encountered with an injury to trigger their PTSD, they involuntary ignore and block off certain reminders of the event. These reminders could be people, activities, feelings associated with the event, or places which remind them of their accident; they do this to ensure no painful memories become stronger.^[7]

- The athlete becomes emotionally numb: Once an athlete either retires from their sport or has a major injury, they can develop a lethargic lifestyle and lose interest in day-to-day activities, become cut off and detached from family and friends and become emotionally flat and numb.

Also, alongside these symptoms it is also very common for these specific symptoms to lead to other mental disorder such as depression, alcohol and drug use and anxiety disorders. Once an athlete reaches this stage it is then vital for them to seek assistance if they are not already doing so.^[8]]

- The athlete could also suffer from Chronic traumatic encephalopathy too much head trauma from practice and the games just like Kansas City Chiefs player Jovan Belcher who killed himself and girlfriend on December 1, 2012

Treatment

There are many available ways to treat people with PTSD, with most people resulting to psychologists as a preferred option, this is mainly because this is the most comfortable solution. Psychologists offer the option for an individual to open up, in an environment filled with positive vibes in order for them to determine the roots of their issues.^[9] There is also the option of art therapy, this was created by a man called Adrian Hill, in 1942 and is one of the earliest forms of treatment. This treatment is very beneficial to those with an open mind, it involves individuals to speak to a psychologist specialising in art, and the two both either paint, sculpt or any other forms of art. Another form of treatment, is treatment through medications; these medications aim to enhance their moments of happiness and reduce their moments of stress and anxiety.^[10] Some of these medications include fluoxetine, paroxetine, selective serotonin reuptake inhibitors (SSRIs), benzodiazepines and glucocorticoids. Obviously resulting to medications is a last resort, but unfortunately this type of therapy can be the matter of rehabilitating someone, meaning that the don’t have to live with these PTSD symptoms for the remainder of their life which is not a preferred way of life.^[9]

There are obviously many other treatment options, with cognitive behavioral therapy, interpersonal psychotherapy and Eye movement desensitization and reprocessing being some of the more popular options, all these involve an individual changing the way they think about their disease and experiences in life.^[7]

Etiology

Athletes may sometimes hide the severity of an injury in order to continue participating in their sport.^[11][12] This denial of the severity of an injury could lead to an early retirement in order for the athlete to refrain from sustaining permanent physical damage. Retirement at an earlier time than expected could lead an athlete to experience feelings such as alienation, distress or uselessness.^[13] The degree to which an athlete identifies with their sport may have an impact on their emotional response to a traumatic injury. ^[12] Individuals who identify strongly as athletes may be at increased risk for psychopathology such as depression or PTSD after sustaining an injury.^[12]

Tiaina Baul "Junior" Seau Jr

Junior Seau with his fellow Patriots

An example of an athlete who experienced this is Tiaina Baul "Junior" Seau Jr.^[13] Junior Seau was an American NFL player, and is a typical example of an individual with PTSD. He was born on January 19, 1969 and died on May 2, 2012. Seau was a very beneficial asset to the teams that he played for; throughout his career he played for San Diego Chargers from 1990 to 2002, Miami Dolphins from 2003–2005 and New England Patriots from 2006–2009.^[14] He played linebacker for all three teams and had extensive experience in this role, despite many injuries throughout his career.^[15] After his career at the NFL he developed differences in his personality, due to brain injury; these changes consisted of impaired self-control and regulation, sensitive emotionally and also he was not able to socialise as he once was able to, which then led to alienation, something which was a strong opposite to his original personality. From there he developed insomnia and committed suicide via a self-inflicted gunshot to his heart.^[15]

References