Anxiety Disorders

For most atheletes, performance comes easy on and off the field. However there are some athletes do well in practice and once a game day approahes they tend “freeze up”. This is called performance anxiety, which is the most common form of Anxiety disorder that is found in sports world. However, they tend to find ways to avoid this anxiety, but what happens when they are diagnosed with other forms of anxiety such as Generalixed Anxiety disorder( GAD), panic disorder, social anxiety disorder, post tramutic stress disorder (PTSD) or obession complusion disorder (OCD). Approximately 40 million American adults ages 18 and older, or about 18.1 percent of people in this age group in a given year, have an anxiety disorder,a nd half of them have reacurrent anxiety disorders.(NIHM)

Generalized Anxiety Disorder (GAD): is characterized by extreme worry of apprehension. Uncomfortable muscle tension and sleep disturbances are also associated with GAD. Many athletes have a normal state of anxiety, but some have trait anxiety.
- Trait anxiety starts early in life. These athletes get stressed out before games and evaluations. They project catastrophic results such as not making the team or striking out. The best way to distinguish between GAD and normal anxiety is whether or not the person feels the anxiety is difficult to control. The athlete may present themselves to the trainer with headaches, upset stomach or diarrhea rather than anxiety. The athlete may also have difficulty concentrating or insomnia, but the most important symptom of GAD is the asking of what if questions, such as presenting with a headache saying what if I have a brain tumor.
- There is no percentage was to who, females or males athletes, are more prone to GAD. However, as a general population, women tend to show a more problems with this than men, with a 6.6 % to 3.6% (Medindia Health, 2010)

Panic Disorder: also known as panic attacks, are spontaneous and unexpected feelings of being out of control. They are characterized by trembling, shortness of breath, sweating, and choking.
- An example of this is a boxer who quits fighting in the middle of an important match. This boxer would panic and do illegal fouls on his opponent even while already ahead in the match. He had been disqualified for more than one match. Those in his corner wondered if he suffered from panic disorder and indeed he did.
- During a panic disorder an athlete’s abilities are greatly diminished and judgment is impaired. During such attacks, an athlete reverts back to basic flight or fight instinct. If the sport medical team thinks that an athlete is having a panic attack during competition, it is best to pull the athlete to the sidelines and narrow the athlete’s field of vision and or auditory input. . This can be done by cupping one’s hand on the side of the face. Then make eye contact with the athlete and tell them everything will be alright. Using a paper bag to revive correct breathing and a quick break to the locker room can also be beneficial.

Social Anxiety Disorder: also known as Social Phobia, is a fear of social or performance situations where an individual perceives being judged by others. Symptoms of social anxiety disorder are similar to that of panic attacks. Typically the individual will try to avoid these situations at all costs.
- Ricky Williams, a running back for the Miami Dolphins, is an example of an athlete with social anxiety disorder. Early in his career, Williams would give postgame interviews with the media while still wearing his helmet. His visor on his helmet would still be down. Williams always knew he was ‘Wired differently.” He would avoid social situations however, since he was a star athlete, his behavior would be shrugged off as the typical behavior of a coddled athlete. Williams said, “If I didn’t want to honor an obligation, I knew someone would cover for me. It was easy for me to hide.”
- During his second professional season, Williams was playing with the New Orleans Saints and broke his ankle. The stress from this injury heightened the anxiety, and no one from the sport medical staff was paying attention to his emotional needs. Williams went to the internet and self-diagnosed social anxiety disorder and sought out a therapist. When he told his coach about his condition, he was yelled at to stop being a baby. An emotional disorder is still seen as just a weakness by many sports organizations. After psychotherapy, Williams was able to move on to the Miami Dolphins and become one of the most productive running backs in the league.
- Another type of social anxiety disorder is performance anxiety.
  - Performance anxiety is a specific type of social anxiety disorder. An athlete who has performance anxiety “freezes up” during certain situations. It was present as the sudden inability to perform for no known reason what used to be a routine athletic task. An example of this is a pitcher who can throw well in practice, but freezes up during a game.
    - One example of someone who has this is Chuck Knoblauch, of the New York Yankees. His case was so bad that it actually ended his career. Rick Ankiel, a pitcher for the St. Louis Cardinals, went through a similar situation. Rick was the top prospect in the organization and had one great season on the mound. The next season, Rick couldn’t even throw a strike and eventually was removed from his position and sent down to he minors. He was no longer able to deal with the pressure of being a major league pitcher and hasn’t pitched since. He was able to recover and become a very good position player for the organization and currently plays outfield for the Kansas City Royals.
    - Another recent case is that of Vince Young, quarterback for the Tennessee Titans of the National Football League. This disorder caused him to vanish for a short period of time and brought up talks of suicide. Luckily, for Vince Young, he was able to bounce back from his disorder and became successful once again in the NFL.
Posttraumatic Stress Disorder (PTSD): An athlete with PTSD is someone who has seen or experienced a traumatic or life threatening event that caused them to have nightmares and intrusive memories. Athletes in high risk sports such as; football, auto racing, horse racing and boxing, possess a higher potential to develop PTSD.
- An example of an athlete with PTSD is Julie Krone, a jockey. However, being a woman in a man’s sport, Julie’s symptoms went unnoticed because of her reputation of toughness which almost led her to committed suicide. Julie won the Belmont Stakes in 1993 and became the first and only woman to win a leg of the Triple Crown of horse racing. That summer she had a terrible fall, off her horse, in Sarasota, falling under several horses and being trampled. She ended up with 14 screws and 2 plates. She recovered from this well, almost as if it was a challenge for her to do so. The PTSD actually started 2 years later after a horse pitched her off in a race. To protect herself during the fall, she covered her head with her hands causing her hands to break. Krone stated that “It fried me and I couldn’t talk.” It was not the severity of the fall that caused the PTSD. It was the fact that she had been sensitized and the life events during the second fall made it have great psychological meaning. Julie said, “The heart and he hands are the biggest organs a jockey has. The first spill got my heart; the second one got my hands, my trademark, the way I uniquely communicated with my mounts.”
- Krone started showing the symptoms of PTSD. She had flashbacks of the spill when approaching the starting gate, reoccurring nightmares of the spill, and experienced the event when someone swung a golf club near her, the feeling of the wind created by the club reminded her of the sensation of the horses passing over her. Krone sought help but no one diagnosed PTSD. She had blurred vision, which was caused by anxiety, but was told there was nothing wrong. One day she had another bad day at the track and was considering suicide. She spoke to a psychiatrist friend at the track and the psychiatrist suggested that they talk. Eventually this psychotherapy led to the prescribing of an SSRI which helped Krone return to normal
- When an athlete has a minor injury and takes longer to return than normal, PTSD also needs to be considered. It should also be considered for vague medical conditions such as headaches, stomachaches, and backaches. An example of this is a runner showing above symptoms months after an injury has healed.
- Women, as a general population, also tend to suffer with PTSD more often than men with a 10-14% to 5-6%. (Medindia, 2010)

Obsessive-Compulsive Disorder (OCD): Athletes with OCD, experience intrusive or disturbing thoughts, impulses or images that cause anxiety or distress. Those with OCD try to suppress these thoughts, but no matter how hard they try, they cannot get these thoughts out of their mind. They may have compulsions as well such as hand washing or counting. These compulsions are done to alleviate the stress of the thoughts.
- An example of an athlete with OCD is Julian Swartz who was diagnosed with OCD in the ninth grade. His senior year, Julian was the Associated Press High School Basketball Player of the Year. Julian attended the University of Wisconsin, and during his freshman year helped them make the Final Four. However doubt plagued him as to whether he was good enough or working hard enough. He developed depression and attempted suicide. Finally Julian transferred to a NCAA division III school where there was less pressure to perform. His OCD became controllable again. Given his disorder, choosing the smaller school would have been the best knowing his condition and the possible outcomes or triggers of events. Another famous sport star affected by OCD is Los Angeles Galaxy and English soccer Star David Beckham. He has been quoted saying the things must be in straight lines or in pairs.
  - There is a common question that is asked among athletes and that is wherther or not they, an athlete, is more prone to OCD. This question came about because of the daily rituals a player goes through everyday while in practice.
    - OCD can be separated from superstitious rituals in sports but the OCD interferes with the athlete’s life. An example of this is obligatory running or exercise. The affected athlete will get into a “Have to do” attitude. The athlete will feel anxiety if he or she does not run or exercise to a certain level. These individuals will organize their lives around the activity and this can impact interpersonal relationships in a negative way. This athlete used the excuse that the running or exercise will help to maintain a certain weight or muscularity. They will even exercise when told not to by the sports medical team.
- Both, male and female athletes, are likely to suffer with OCD because of the daily ritals they go through. Those with a “pracitice makes perfect” attitude are twice as likley to suffer than regular athletes.

Attention Deficit Hyperactivity Disorder (ADHD): is characterized by hyperactivity or inattention or the combination of these two. This disorder is usually diagnosed in childhood. The athlete has difficulty finishing projects, often loses things, and is forgetful. ADHD is also more common in athletes then non-athletes because several things are happeing at once and people with ADHD are more energetic and spontaneous, which in some sports can be helpful. However, there are some negative side effects that may come along with an athletes.
- An example of ADHD negatively affecting an athlete is that of a goalie who is unable to have the patience to wait for the play to develop and tackles the striker or forward. However, AHDH can also work to a goalie’s advantage since they have to be aware and pay attention to everything that is happening on the field of play.
- Another negative example is that of a hockey player who had his performance affected by the people in the stands who might be yelling his name and distracting him while the other team slides the puck into the goal. ADHD athletes tend to do well in sports where there is constant chaos such as hockey or soccer where the play is unpredictable and the athlete has to be aware and react throughout the entire duration of the contest. They tend to excel less in those sports that are slow paced such as baseball and football where there is significantly more down time.
- ADHD can also interfee with the ability to focus on what the coach is wanting from the athlete, which in return, makes a coach frustrated.
- An athlete can see a sports psychiatrist and get a prescription for a stimulant medication, but must be careful in regards to banned substances of the sport.
- Treatment includes stimulats such as methylphenidate (Ritalin).

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