8.Clinical Sports Psychiatry

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8.Clinical Sports Psychiatry



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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
Tamás 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 Tamás 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



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