Four reasons why we should screen for dissociation in competitive sports

Open AccessFour reasons why we should screen for dissociation in competitive sportsRalph Erich Schmidt, Andres Ricardo Schneeberger, and Malte Christian ClaussenRalph SchmidtRalph E. PhD, Department of Psychiatry, Psychotherapy, Psychosomatics, Psychiatric University Hospital Zurich, Lenggstrasse 31, 8032 [email protected] Psychology, Geneva, Switzerland Search more papers by this author, Schneebergerhttps://orcid.org/0000-0001-8176-9126 California San Diego, USA Claussenhttps://orcid.org/0000-0002-8415-3076 Clinic Depression Anxiety, PZM Psychiatry Center Münsingen AG, authorPublished Online:February 09, 2023https://doi.org/10.1024/2674-0052/a000040PDF ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinkedInReddit SectionsMoreThis article discusses the current literature on definition, prevalence, consequences sports. In light available evidence, it is argued that there are four deserves particular attention context: (i) Dissociation seems be prevalent among athletes when compared with general population; (ii) potentially performance-enhancing aspects may contribute its chronic use; (iii) dysfunctional entail underperformance; (iv) use mask exacerbate mental disorders, such as Post-traumatic Stress Disorder, delay recovery from injury. conclusion, advocated standardized measures included medical sports examinations.What dissociation?The fifth edition Diagnostic Statistical Manual Mental Disorders (DSM-5) [1] defines a disruption, interruption, and/or discontinuity normal, subjective integration behavior, memory, identity, consciousness, emotion, perception, body representation, motor control.Under umbrella DSM-5 distinguishes five different types dissociative disorders: Dissociative Identity Disorder; Amnesia; Depersonalization/Derealization Other Specified Disorders; (v) Unspecified Disorder.However, symptoms also other DSM-5-defined disorders. For example, diagnostic criteria Disorder (PTSD) explicitly feature subtype. Criteria subtype reminders traumatic stressor (PTSD Criterion A) lead depersonalization or derealization symptoms. Moreover, amnesia figures possible symptom Acute (ASD) PTSD.Dissociative symptoms, derealization, experienced large percentage people response events but generally decline over time [2]. Following vehicle accidents, instance, no fewer than 79% survivors reported at least one [3]. The number, intensity, persistence peritraumatic – including depersonalization, tunnel vision, confusion, temporal spatial disorientation, trance-like experiences, have been found predict development PTSD (for review, see [4]). A mediating mechanism leads inaccessible fragmented memories experience, thereby precluding information into autobiographical memory system [4, 5].Current conceptualizations suggest psychobiological state trait serves protective function overwhelming experiences [6]. thought mitigate impact sequestering about them through activation altered states consciousness. As consequence, segregates full meaning awareness [7]. Several lines evidence indicate might human equivalent “freeze” “feigning death” reaction (“thanatosis”) animals elicited fight flight life-threatening danger has failed would dangerous [7, 8].Athletes exposed prior their career (in childhood), course (during training competition, private life) [9]. Such include physical violence, sexual injury, vicarious witnessed trauma [9, 10]. Numerous studies clinical population samples revealed cumulative dose-dependent effect post-traumatic symptomatology, particularly strong associations if occur early life 11]. accord pattern, study sample elite those history multiple adverse childhood (ACE) physical, sexual, emotional neglect, domestic parental substance had an increased risk somatization problematic alcohol use, prescription medication [12].How dissociation?Dissociative disorders wide variety can any point life. industrialized countries prevalence varies between estimates 2.4% [13] 11.4% college students [14]. need differentiated up 75% healthy adults [15]. often develop context special focus [16]. recent meta-analysis estimated 38.1% across all [17].While continues sparse, clearer population. Thomson Jaque [18] demonstrated 13.3% met some specific subgroups (dancers) reaching rates 25.4%. Adverse athlete populations: 30.8% endorse ACE, average ACE score 2.1 (SD=1.5) [12].As mentioned, paucity focusing specifically athletes. comparison rhythmic gymnasts female dancers showed high levels non-pathological pathological within both groups [19]. athletes, adaptive skill used enhance performance high-stress situations However, inherent ignoring because presence psychiatric overlooked. culture supports athletes’ inclination downplay underreport fear stigma discrimination. presents preexisting trauma, additional stress likely numbing, avoidance dissociation. combination these tendency minimize them, preclude accurate assessment health disorders.Why important sports?Two factors presumably higher First, partly And second, suggests frequently interpersonal violence psychological [10]).Athletic performanceTo achieve optimal performance, able fully task-relevant ignore personal, situational, organizational distractors stressors [20]. sport psychology, two attentional strategies described associative strategies, where bodily sensations (e.g., breath, muscle tension) performance-related cues stroke rate rowing), task-unrelated contents daydreams, music, landscape) distract themselves pain, fatigue, negative affect [21].Research shown voluntarily shift toward task demands intensify [19, 22, 23], whereas less well performing tend adopt maintain manage stressful tasks [24].Mental trauma-related disordersAs coping short run 25]. especially histories abuse, reactions overgeneralize situation settings, impeding 26].Independently exposure very common reach When control group, obtained significantly scores item Experience Scale-II [27] assesses (“Some experience feeling does not seem belong them.”) gymnasts’ was close dancers. scored assessing ability pain find they sometimes pain.”) dancers’ were comparatively controls. Of note, duration professional practice statistically predicted gymnasts, suggesting “success” increase [19].In similar vein, injuries intrusion subscale Impact Event Scale [28] range who natural disasters, even avoidance/denial [29]. This includes items cognitive behavioral avoidance, numbing (“I felt hadn’t happened wasn’t real.”). Regarding gender, chronically injured scale did male counterparts [29], agreement previous investigation [30].What dissociation?As detailed earlier, inflexible associated number consequences, underperformance, underdiagnosis undertreatment self-injury suicidality, delayed injury 9]. overuse endured [26], during [10], suffered sense complex [11].Regarding undermine too rigidly, impairing flexible adaptation me gathered research showing [22, [24]. Athletes necessarily recognize dysfunctional, so report encounter do realize dissociation, hide mentioned earlier problems stigmatized high-performance settings sign vulnerability jeopardize 19, 31].Be consciously not, way If latter remain undetected, undiagnosed, untreated, progression disorder Independently potential undertreatment, acute prolonged factor later [4]. risks [32, 33], suicidality 34], 35]. addition, habitual renders individuals blind future situations, heightening revictimization retraumatization [29, 36].ConclusionAlthough normal athletic must principle distinguished overlap terms processes functions. forms self-induced deliberate [37, 38], preliminary resort “emotion regulation” [39].In view array advocate screening routine examinations [40]. conducted qualified care professionals psychiatrists psychotherapists trauma- dissociation-specific expertise.Sports physicians, psychologists, sensitized enabled refer affected professionals. 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