While addictive disorders involving substances are well researched, the field of behavioral addictions, including exercise addiction, is in its infancy. Although exercise addiction is not yet recognized as a psychiatric disorder, evidence for the burden it imposes has gained attention in the last decade. Characterised by a rigid exercise schedule, the prioritization of exercise over one’s own health, family and professional life, and mental wellbeing, and extreme distress when exercise is halted, the phenomenon shares many feature with substance use disorders.
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For nearly a century it has been hypothesized, that repetitive head trauma can lead to adverse neurological and psychiatric conditions [1]. Still, it took the discovery of Chronic Traumatic Encephalopathy (CTE) in a player of the National Football League to bring widespread public and scientific attention to this important topic on the intersection of neurology, psychiatry and sports medicine [2,3].
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Suicidal ideation and behaviours are still a highly stigmatized and neglected health problems in athletes. The suicides of well-known athletes have repeatedly brought the subject of mental health problems of top athletes into the public discourse. However, there is still a lack in psychiatric and psychotherapeutic care in high-performance sports.
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lite athletes may use psychotropic substances for recreational reasons, (perceived) performance enhancement or self-medication. Causes can hereby overlap. In substance use, recreational consumption aiming primarily at psychotropic effects is distinguished from performance-enhancing use (doping).
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Pharmacological interventions play a substantial role in the treatment of psychological complaints. However, while psychosocial and psychotherapeutic strategies are preferred for the treatment of mild to moderately severe symptoms, the use of drugs is often indicated for severe clinical manifestations [1,2].
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Major depressive Disorder (MDD) is a widespread and burdensome disease. People with MDD suffer from loss of interest and pleasure in activities that they would usually enjoy. In addition, they report anxiety, complex somatic pain syndromes, cognitive restrictions, loss of sexual interest, impaired sleep and social withdrawal. MDD is the leading cause for years lived with disability (YLD) in women and men and has a lifetime prevalence of 10-20 %.
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Changes in public life, isolation, quarantine, and associated constraints within usual routine, as well as anxieties and concerns, are just some of many examples of psychiatric burdens caused by the COVID-19 pandemic (1). Not only the general population, but professional athletes in particular, are exposed to these challenges, as professional sports came to an abrupt halt upon occurrence of COVID-19.
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Anxiety is in principle a normal and (often) helpful emotion in humans and animals. However, anxiety can get excessive and be impairing and disabling. If anxiety is excessive in intensity and duration, occurs in actually non-dangerous situations, uncontrollable, and impairs actions, an anxiety disorder is typically diagnosed [2].
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Attention Deficit Hyperactivity Disorder (ADHD) is a common neurodevelopmental disorder which is characterized by symptoms of inattention, hyperactivity, and impulsivity. The estimated prevalence of ADHD in the general population is 7,2% in children, with persistence into adulthood of approximately 35%. [1,2]
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Mental disorders are common in competitive sports. They can influence performance, increase the risk of physical injuries and prolong rehabilitation. A specialized discipline for mental health has not (yet) been established. This position paper will emphasize the connection between the special requirements in competitive sports and the need of psychiatric specialization.
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