Trauma and PTSD Among Elite Athletes

Even our “toughest” athletes are impacted by traumatic experiences.

Key points

Athletes are exposed to trauma both within and outside of sports environments.
Trauma can have adverse impacts on psychological health, physical health, and performance.
Effective treatments are available for athletes who have experienced trauma.

Between 13 and 25 percent of athletes experience posttraumatic stress disorder (PTSD) and other trauma-related disorders, a rate that exceeds that of the general population (Aaron et al., 2019). These rates include experiences of both personal and sport-specific trauma. Some athletes enter their sports careers with histories of adverse childhood experiences (e.g., abuse, neglect), gender-based violence (e.g., sexual assault, domestic violence), or intergenerational and identity-based trauma, while others experience trauma during the course of their sports participation (e.g., sports-related injuries, abusive team dynamics). This post will review common trauma symptoms among athletes, impacts of trauma unique to athletes, and effective treatments for PTSD among athletes.

Common Trauma Symptoms

Traumatic experiences, both personal and sport-specific, can have adverse effects on athletes’ psychological health, physical health, and sports performance. However, many athletes have a tendency to mask or minimize mental health concerns, including symptoms of PTSD, limiting practitioners’ ability to identify symptoms early and minimize the impact on health and performance. In fact, Aaron et al. (2019)’s review of PTSD in elite athletes describes how characteristics that make athletes elite (e.g., perfectionism, compartmentalization, derealization) are often the same characteristics that inhibit trauma processing. Thus, it is important for all staff in sports organizations to have the ability to identify symptoms and refer to appropriate services.

Psychological Health: Trauma symptoms often manifest psychologically, including emotional dysregulation and the development of PTSD or other mood disorders. In efforts to cope with the aftermath of trauma, athletes may engage in health-compromising behaviors (e.g., substance misuse, self-harm, disordered eating). Psychological symptoms, in turn, may create interpersonal issues with teammates and coaching staff (e.g., irritability, social withdrawal). Athletes who have experienced family trauma may also request that communication between athletics personnel and family be minimal or ceased.
Physical Health: Short-term physical consequences of trauma among athletes may include chronic fatigue, frequent illnesses, or overtraining. These symptoms are often attributed to other causes and, over time, can result in cardiovascular issues and compromised immune systems.
Sports Performance: Inconsistencies in athletic performance or development of the “yips” may arise in response to trauma. For traumatic sports-related injuries (e.g., concussions, orthopedic injuries) in particular, hesitancy and re-injury anxiety are common. Depending on the nature of the trauma, athletes may present with a lack of adherence to injury rehabilitation or authority figures.

Referrals to Treatment

Those working in sports spaces are encouraged to refer athletes who have experienced trauma to treatment accordingly. Effective treatments for trauma and PTSD among athletes mirror those available for the general public. The Veterans Affairs/Department of Defense Clinical Practice Guidelines for Management of Posttraumatic Stress Disorder and Acute Stress Disorder (2023) recommends individual, manualized trauma-focused psychotherapies that have a primary component of exposure and/or cognitive restructuring.

Specifically, the American Psychological Association’s Clinical Practice Guidelines for the Treatment of Posttraumatic Stress Disorder strongly recommends cognitive behavior therapy, cognitive processing therapy, cognitive therapy, and prolonged exposure and conditionally recommends brief eclectic psychotherapy, eye movement desensitization therapy (EMDR), narrative exposure therapy, and medication.

I want to acknowledge Dr. Sheriece Sadberry for the ideas she contributed to this article.

References

Aron, C. M., Harvey, S., Hainline, B., Hitchcock, M. E., & Reardon, C. L. (2019). Post-traumatic stress disorder (PTSD) and other trauma-related mental disorders in elite athletes: A narrative review. British Journal of Sports Medicine, 53(12), 779–784.

American Psychological Association. (2020). Clinical practice guidelines for the treatment of posttraumatic stress disorder.

VA/DoD Clinical Practice Guideline. (2023). Management of posttraumatic stress disorder and acute stress disorder work group. Washington, DC: U.S. Government Printing Office.