Recognizing Psychopathology in the Athletic Training Room

A common area of weakness among undergraduate athletic training programs is education on recognizing and referring psychological disorders.  Recently, it does seem there’s an increase in the number of sport psychologists employed at the Division 1 setting, but due to budget reasons it is highly unlikely high schools, Division 2, and Division 3 schools will have ease of access to sport psychologists on campus.  This leads the athletic trainer to be the closest person in contact with athletes on a daily basis.  It is helpful for athletic trainers to know common psychological disorders and their signs and symptoms for proper referral. An athletic trainer should not take on the role of head psychologist, but be able to lead an individual in the right direction for treatment.

Anxiety Disorders:

Anxiety disorders typically include feelings of dread, fear, or worry and include panic attacks, social anxiety, obsessive-compulsive disorders, PTSD, and generalized anxiety disorder.

In the last two years working at a Division 1 school, I have encountered multiple panic attacks, social anxiety disorders, and generalized anxiety.  Panic attacks have typically happened post very stressful physical tests.  Signs and symptoms included rapid heart rate, hyperventilation, sweating, nausea, and light headedness, which in some cases lead to fainting. In all of these cases, I was aware the individual also had generalized anxiety disorder.  The main focus should be in calming down the breathing rate to avoid more serious issues such as shock.  Breathing into a paper bag or having the individual breath in through their nose and out their mouth are two ways to slow down the breathing rate. Typically it has taken between 5-10 minutes for individuals I have encountered to calm down, but each person has a range of response during a panic attack.

Social anxiety disorder seems to be a common place in the athletic world.  It often includes a fear of performance or social situations.  Fear of failure or embarrassment is a common symptom.  This is seen before an individual test that may determine where the athlete is placed on the team, before a big event in front of many fans, or could occur after several disappointing performances leading to increased social anxiety in the future. Coping mechanisms and talking through the stressors could help ease this anxiety.

Most people have probably experienced some form of generalized anxiety disorder in their lifetime.  Common symptoms include excessive worry, disturbed sleep, increased irritability, problems focusing, increased fatigue and muscle tension.  This is a concern since many of these symptoms leading to an increased chance of injury.  Coping mechanisms and treatments that may help include relaxation, imagery, massage therapy, heat modalities,and stretching.  I have found by chatting with individuals during their treatment time about anxiety issues they have, then re-focusing their attention on positive things in their lives, helps maintain adherence to a rehab program and decrease anxiety signs/symptoms.

Mood Disorders:

Mood disorders include depression, bipolar disorder, dysthymic disorder, and cylothymia.  The most common mental health issue I have come across is depression, but have had several individuals with bipolar disorder too.

Men have a 5-12% chance and women have a 10-25% chance of experiencing depression at some time in their life (Andersen & Kolt, 2004). Signs and symptoms include sadness, hopelessness, loss of interest, disordered eating, disordered sleep patterns, weight fluctuations, fatigue, increased agitation, suicidal thoughts, and difficulty concentrating.  Managing depression is important in the athletic training setting.  If an individual is depressed it can lead to decreased adherence to rehab programs, increased risk of injury due to fatigue and stress, and loss of interest in return to sport. Seeking therapy or consulting with a physician when these signs and symptoms are present is key.  A helpful survey used at the University of Minnesota athletic department is the patient health questionnaire (PHQ 9).  This survey is self reported by the individual and helps detect signs of major depressive disorder.

Eating Disorders:

Unfortunately, eating disorders are prevalent in the sports world.  Many times, this disorder increases with sports that have higher focus on body image; gymnastics, track & cross country, swimming and diving,  volleyball for both men and women to name a few with higher incidences.  Eating disorders are harder to detect since most people know it’s wrong and hide it very well.



Kolts, G.S., Anderson, M.B. Pscyhology in the Physical and Manual Therapies.  Churchill Livingstone, 2004.  Print.

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