Personality Disorders in Athletes

Personality Disorders in Athletes

Mental Illness in Athletes

  • Athletes struggle with mental illness at similar rates as their peers.

  • Biopsychosocial Approach: A holistic understanding of mental health that considers the interplay of biological, psychological, and social factors.

    • Changes in any of these areas can impact mental health.

  • Most common concerns in athletes:

    • Anxiety disorders

    • Mood disorders

    • Personality disorders

    • Attention Deficit Hyperactivity Disorder (ADHD)

    • Eating disorders

    • Body dysmorphic disorder

    • Adjustment disorders

    • Substance use disorders

    • Impulse control disorders

    • Psychosomatic illness

  • State vs. Trait: Many of these concerns are viewed as state-based (temporary) rather than trait-based (permanent), except for personality disorders, which require a longer developmental journey.

    • Personality disorders negatively affect athletes' ability to connect with others and their overall perspective, impacting teams, coaches, and the athletic environment.

Understanding Personality

  • An athlete's thinking, functioning, and behaviors provide insights into their mental health.

  • Personality can develop into behavioral patterns, becoming consistent during adolescence, often influenced by sport culture.

  • Responses to the environment solidify into these personality patterns.

  • Correlation with Performance: Research indicates a connection between personality traits and athletic performance (Hendawy & Awad, 2013).

  • Definition of Personality:

    • "Patterns of thinking, behaving, and beliefs that occur regularly within normal limits allowing for individual expression. Unhealthy and rigid patterns can lead to strain, conflict, tension, and problematic behaviors that may be classified as disorders."

  • Understanding an athlete's personality helps in assessing their responses to environments and emotional reactivity.

  • Theorists and researchers aim to categorize expected versus atypical personality types.

Historical Perspectives on Personality

  • Theories of personality date back to ancient Greek medicine.

    • Four Temperaments: Predictable behaviors based on imbalances of bodily humors.

  • Ancient Chinese medicine explored unusual temperaments, emphasizing the concept of Qi (psychological energy) and its balance affecting character.

  • Throughout history, character types have been identified, with ranges from adaptive to dysfunctional to pathological.

The Big Five Personality Model

  • Big 5 Personality Characteristics (Costa & McCrae, 1990): Includes five key domains that form the foundation of personality assessment.

  • Domains of Maladaptive Personality (Livesley & Larstone, 2018):

    • Negative affect

    • Detachment

    • Antagonism

    • Disinhibition

    • Psychoticism

Ten Item Personality Inventory

  • Developed by Gosling et al. (2003), this inventory allows individuals to assess their personality traits across various dimensions. Respondents rate statements on a scale from 1 (disagree strongly) to 7 (agree strongly) across pairs of traits.

    • Example Traits:

    • Extraverted, enthusiastic

    • Critical, quarrelsome

    • Dependable, self-disciplined

    • Anxious, easily upset

    • Open to new experiences

    • Reserved, quiet

    • Sympathetic, warm

    • Disorganized, careless

    • Calm, emotionally stable

    • Conventional, uncreative

Scoring the Inventory

  1. Take the inventory, rating each item from 1 to 7.

  2. Reverse score for even-numbered items (transform scales: 1 ↔ 7; 2 ↔ 6; …; 4 stays the same).

  3. Calculate scores for the five personality characteristics as follows:

    • Extraversion: (1 + 6R) / 2

    • Agreeableness: (2R + 7) / 2

    • Conscientiousness: (3 + 8R) / 2

    • Emotional Stability: (4R + 9) / 2

    • Openness to Experiences: (5 + 10R) / 2

Ethnicity and Personality Traits

  • Mean Scores for various ethnic groups in relation to the Big Five personality traits:

    • All ethnicities (N=1,813):

    • Extraversion Mean: 4.44

    • Agreeableness Mean: 5.23

    • Conscientiousness Mean: 5.40

    • Emotional Stability Mean: 4.83

    • Openness Mean: 5.38

    • Data broken down by ethnicity (White, Hispanic, Asian, Black, and others) showing respective means and standard deviations (SD).

Largest Personality Study to Date

  • Conducted by Ivanova et al. (2007):

    • Sample of 30,243 youth from 23 countries using the Youth Self-Report (Achenbach & Rescorla, 2001).

    • Developed an 8 syndrome taxonomic model based on the responses, identifying:

    • Anxious/depressed

    • Withdrawn/depressed

    • Somatic complaints

    • Social problems

    • Thought problems

    • Attention problems

    • Rule-breaking behaviors

    • Aggressive behavior

Personality in Athletes

  • Understanding athlete traits aids in training and performance:

    • Key personality traits:

    • Extraversion: Beneficial for athletes in public settings.

    • Perfectionism: Setting high standards and striving for excellence is valuable.

    • Narcissism: Can motivate athletes positively, but excessive levels lead to maladaptive behaviors (often linked to the "dark triad").

Personality Disorders Defined

  • Definition:

    • "A way of thinking, feeling, and behaving that deviates from cultural expectations, causes distress or issues in functioning, and persists over time."

  • Main features of personality disorders (Hoermann et al., 2021):

    • Distorted thinking

    • Problems with emotional regulation

    • Problems with impulse control

    • Interpersonal difficulties

  • Coaches often tolerate some personality variances if they align with team goals, but significant issues may require diagnosis using DSM-5 criteria.

Factors Involved in the Development of Personality Disorders

Aetiology of Personality Disorders (according to the APA)

  • Genetics:

    • Linked to conditions like OCD, aggression, anxiety, and fear.

  • Diathesis-Stress Model:

    • Individuals with genetic predispositions develop disorders when combined with adverse experiences.

  • Emotional Dysregulation:

    • Tends to run in families.

  • Abuse:

    • Strong correlations exist between childhood trauma and later development of personality disorders (Gunderson et al, 2000).

    • Examples: Individuals with high rates of sexual trauma are more prone to borderline personality traits.

    • Verbal Abuse: Children exposed to verbal aggression from parents are three times more likely to develop certain personality disorders as adults (Johnson et al., 2001).

  • Environment: Individuals with inherently timid or anxious personalities may react intensely to external stimuli (e.g., light, noise).

  • Relationships: Parental psychopathology and family dynamics can contribute to personality development.

    • Positive relationships can mitigate negative influences.

Additional Influencing Factors

  • Individuals with personality disorders may struggle with:

    • Interpersonal difficulties

    • Impulse control problems

    • Misinterpretation of comments/situations

    • Affective instability

    • Maladaptive coping skills

  • Gender Differences in Diagnosis:

    • Antisocial disorders are more prevalent in men, while disorders like borderline and dependent personality disorders are common in women.

  • Diagnosing personality disorders requires evidence of a "pervasive pattern" over at least one year (APA guideline).

Athlete-Specific Factors Contributing to Personality Disorders

  • Athletes often encounter unique pressures during formative years:

    • High-stress environments (e.g., sports)

    • Frequent exposure to criticism from various sources (coaches, crowds, etc.)

  • Abuse in sports may be misconstrued as "good coaching," leading to emotional neglect.

  • Athletes often experience somatic, social, and interpersonal stresses.

  • According to the DSM, personality disorders are classified into three clusters:

    • If an individual does not fit neatly into a specific type, a cluster type can be described instead.

Characterization of Personality Disorders

  • Each disorder involves specific diagnostic criteria:

    • Long-term behavior patterns that develop in late adolescence or early adulthood

    • Must cause distress or functional difficulties

  • Clusters of Personality Disorders:

    • Cluster A (Odd, Eccentric): Characterized by social awkwardness and withdrawal.

    • Cluster B (Dramatic, Emotional, Erratic): Features dramatic, overly emotional, and unpredictable behaviors.

    • Cluster C (Anxious, Fearful): Encompasses anxious behavior and fearful thinking.

Detailed Characteristics of Personality Disorders

Cluster A (Odd, Eccentric)

  • Paranoid PD:

    • Suspiciousness and belief others aim to harm or deceive.

  • Schizoid PD:

    • Detachment from social relationships, little emotion, prefers solitude.

  • Schizotypal PD:

    • Discomfort in close relationships, distorted thinking, and eccentricity.

Cluster B (Dramatic, Emotional, Erratic)

  • Antisocial PD:

    • Disregard for others' rights, nonconformance, impulsive behavior.

  • Borderline PD:

    • Instability in relationships, emotions, and self-image; fear of abandonment.

  • Histrionic PD:

    • Excessive attention-seeking and emotional expressiveness.

  • Narcissistic PD:

    • Need for admiration, lack of empathy, and inflated self-importance.

Cluster C (Anxious, Fearful)

  • Avoidant PD:

    • Extreme shyness, feelings of inadequacy, sensitive to criticism.

  • Dependent PD:

    • Need for reassurance, submissive behavior, difficulty making decisions.

  • Obsessive-Compulsive PD:

    • Preoccupation with orderliness and perfectionism (distinct from OCD).

The Dark Triad Traits

  • Dark Triad Definition (Paulhus & Williams, 2002):

    • Three personality traits known for "callous, selfish, and malevolent interpersonal interactions":

    • Narcissism: Excessive self-focus and need for admiration.

    • Machiavellianism: Manipulative behavior for personal gain.

    • Psychopathy: Lack of empathy and remorse, often associated with aggression.

  • Competitive athletes tend to score higher on the Dark Triad traits, which correlate with:

    • Desire to win and fear of losing (related to narcissism).

    • Machiavellian tendencies during perceived competition/loss.

    • Psychopathic traits relating to fear of failure and inferiority.

Athlete Perspectives on Mental Health

  • Stories from athletes like Kevin Love and Brandon Marshall emphasize mental health and the necessity of vulnerability in discussing these topics.

    • Brandon Marshall openly discussed his borderline personality disorder diagnosis, advocating for mental health awareness.

Biopsychosocial Model Review

  • Integrates biological, psychological, and social environmental factors for a comprehensive understanding of personality disorder development.

    • No single factor explains personality disorders' emergence.

Diagnosing Personality Disorders

  • Diagnosis is conducted by licensed mental health practitioners.

  • Evaluation should occur across multiple environments and data points.

  • Important to assess the athlete when sober and not in acute emotional distress.

  • Collaborative treatment teams enhance understanding and interventions addressing behaviors like mood swings and impulsivity.

  • Comprehensive assessment gathers observed behavioral data from various sources (coaches, family, etc.) and employs DSM-5 diagnostic criteria.

  • Commonly diagnosed personality disorders in athletes include:

    • Obsessive-Compulsive Personality Disorder (OCPD)

    • Borderline Personality Disorder

    • Narcissistic Personality Disorder

    • Mixed personality disorders (exhibiting traits of various disorders without fitting neatly into one).

Prevalence of Personality Disorders

  • Cluster A: 5.7%

  • Cluster B: 1.5%

  • Cluster C: 6.0%

  • Any Personality Disorder: 9.1%

  • Additional statistics from the National Epidemiological Survey on Alcohol and Related Conditions:

    • Approximately 15% of U.S. adults have at least one personality disorder.

    • Prevalence rates by specific disorders (e.g., Antisocial PD: 1-4%)

Impact on Social-Emotional Functioning

  • Personality disorders (PD) create disruptions in personal lives, affecting relationships and interactions within schools, workplaces, and sports environments.

    • This leads to isolation, risk-taking behaviors, and substance abuse.

  • Healthy emotional functioning is vital for personal development, encompassing:

    • Self-control, emotional expression, attentiveness, pride in accomplishments, positive self-image, and empathy.

  • Factors like genetics and abuse can hinder this development, especially when PDs co-occur with mood disorders (e.g., depression).

    • Athletes with borderline personality disorders report lower social support and increased social conflicts, making them socially disadvantaged.

Impact on Athletes

  • Involvement in sports can enhance emotional well-being, offering numerous psychological and social benefits:

    • Camaraderie, resilience, patience, teamwork, and improved self-esteem.

  • Team participation fosters essential social skills, improving cooperation and sense of belonging.

  • Intense training may support maladaptive patterns if not monitored for emotional limits.

  • Data suggests mental health disorders in elite athletes can range:

    • 19% report alcohol misuse

    • 34% experience anxiety and depression

  • Lifetime prevalence of symptoms indicates significant occurrences of depressive disorders, eating disorders, and stress-related conditions.

  • Personality disorders significantly hinder athletes' abilities to function cohesively in sports environments and manage daily challenges.

Recognizing Personality Extremes

  • Athletes may not recognize when their patterns of behavior become disordered.

  • Traits such as extraversion, perfectionism, and narcissism may initially align with sports culture and performance expectations.

  • At extreme levels, such traits can become liabilities requiring intervention.

Treatment Approaches

  • No specific medications are designated for treating personality disorders.

  • Some mood stabilizers might be considered for managing symptoms.

  • Psychotherapeutic Interventions: Various therapies effective in treatment include:

    • Psychoanalytic therapy: Focuses on self-limiting patterns and behavioral insights.

    • Dialectical Behavior Therapy: Addresses coping, regulation, and relationships.

    • Cognitive Behavioral Therapy: Targets cognitive distortions.

    • Group Therapy: Fosters social support and shared experiences.

    • Psychoeducation: Educates patients about their illness and coping strategies.

  • Differentiating maladaptive behaviors into state-based (temporary) and trait-based (pervasive) can inform treatment.

Practical Applications of Knowledge

  • Understanding personality disorders and mental health issues facilitate awareness and prompt appropriate referrals.

  • Many mental health issues can resolve with intervention, whereas personality disorders may need management rather than resolution, improving relationship dynamics.

  • Early detection is crucial to mitigate impacts on performance (implementing behavioral health surveys pre-performance).

  • Screening for mood disorders and assessing athletic identity can provide critical insights; data should be collected collaboratively.

  • Avoid labeling athletes and assuming they cannot change; additional information on age and behavioral patterns should be gathered meticulously to inform diagnosis.

  • Tailor treatment to specific disorders and refer athletes to qualified mental health practitioners for comprehensive care.

Case Study Discussion

  • Example of a student athlete pursuing therapy:

    • Experiences of strained relationships and sensitivity/reactivity to feedback noted.

    • Reported problem behaviors in team environments, including threats of self-harm and manipulative tendencies.

    • Expresses feelings of worthlessness and avoidance of clinical questions.

  • Discussion prompts:

    • How should one approach handling this situation?

    • What diagnostic impressions can be drawn?

    • What treatment suggestions are appropriate?