Post-traumatic stress disorder (PTSD) and other trauma-related mental disorders in elite athletes: a narrative review

Correspondence to Ms Cindy Miller Aron, Department of Psychiatry, Samaritan Health Services, Corvallis, OR 97330, USA; [email protected]

Introduction

Trauma-related mental health disorders in elite athletes may be common, with rates possibly higher in this population than in the general population.¹ Athletes may experience trauma prior to sport (in childhood), in sports participation, or outside of sport during their athletic careers.

Trauma-related symptoms and disorders may manifest in several ways. The Diagnostic and Statistical Manual of Mental Disorders (DSM)-5 divides symptoms into four categories: intrusion symptoms; negative mood and cognitions; dissociative symptoms; and alterations in arousal (table 1). Constellations of these symptoms are seen in both acute stress disorder (ASD) and post-traumatic stress disorder (PTSD), with ASD lasting 3 days to 1 month following trauma exposure. PTSD is defined as lasting more than 1 month following exposure to trauma and may represent a chronic condition (table 2).² Other stressor and trauma-related disorders include adjustment disorder, in which disruptive emotional symptoms (ranging from depression or anxiety to disturbance of conduct) occur within 3 months of an acute stressor, which may be a traumatic event (table 2).² All of these trauma-related disorders are characterised by impaired daily function and, among elite athletes, may significantly negatively impact athletic performance or recovery from injury.^{1 3–5} While the impact of trauma-related disorders carries considerable morbidity, early identification and treatment can mitigate those effects.⁶

Table 1

Symptom categories in DSM-5 trauma-related disorders²

	Intrusion	Negative mood/cognitions	Dissociative	Alterations in arousal/reactivity	Avoidance
Trauma-related symptoms	Recurrent, involuntary and intrusive memories of the trauma Traumatic nightmares Dissociation/flashbacks, which may range from brief responses to outright loss of consciousness Prolonged or intense distress after exposure to reminder of the trauma Physiological reactivity in response to trauma-related stimuli	Inability to recall event related to trauma (unrelated to head injury or substance use) Distorted beliefs about the world (eg, ‘I am a terrible person,’; ‘The world is unsafe’) Persistent distorted blame of self or others for causing the traumatic event Negative trauma-related emotions (eg, fear, horror, guilt, anger) Markedly decreased interest in pretrauma activities Feeling alienated from others (detached or estranged) Constricted affect/persistent inability to experience positive emotions	Numbing, detachment or decreased emotional responsiveness Decrease in awareness Derealisation (feeling that one’s surroundings are...