Sports Medicine: Just the Facts

CHAPTER 74 • PSYCHOLOGIC CONSIDERATIONS IN EXERCISE AND SPORT 449

(e.g., diminished strength, power, and speed) and the

increased potential for risk of injury (Green and

Nattiv, 2003).

• According to the NCAA survey, 78% of college ath-
  letes reported they began drinking before entering col-
  lege. Prevention efforts should therefore target student
  athletes at high school, junior high, and even elemen-
  tary levels (Green and Nattiv, 2003).


• The use of other drugs by athletes (e.g., anabolic
  steroids) is of concern and is discussed in greater
  detail in other chapters. Worth a brief mention here is
  the use of smokeless tobacco products.
  1.The NCAA 2001 survey reported that 17% of all ath-
  letes had used smokeless tobacco. This is a decrease
  from 28% reported in 1989 (Green and Nattiv, 2003).
  2. According to the 2001 NCAA survey, 41% of
  baseball players and 29% of football players
  reported using smokeless tobacco in the past year.
  The NCAA does ban the use of smokeless tobacco
  products in NCAA sanctioned events. Minor
  league baseball has also banned the use of smoke-
  less tobacco products in games, but use is still per-
  mitted during games at the major league level
  (Green and Nattiv, 2003).
  3. Every athlete who uses tobacco products should at
  least be offered a minimal intervention. An inter-
  vention lasting less than 3 min can increase overall
  tobacco abstinence rates (U.S. Department of
  Health and Human Services, 2000). Intensive
  tobacco cessation programs are available to assist
  individuals in their quit efforts. The more effective

interventions are based on a dose-response rela-

tion, with four or more sessions yielding higher

abstinence rates (U.S. Department of Health and

Human Services, 2000).

DISORDERED EATING BEHAVIOR

• Most athletes experience the same types of mental
  health problems as that of the general population
  (Begel and Burton, 2000); however, disordered eating
  behavior has been identified as being more prevalent
  amongst athletes and more prevalent in female athletes
  than male athletes. While there has been variability in
  prevalence rates reported, a recent study revealed 20%
  of female and 8% of male athletes met DSM-IV criteria
  for anorexia nervosa, bulimia nervosa, and eating dis-
  orders not otherwise specified compared to 9 and 0.5%
  for female and male nonathletes (Sundgot-Borgen,
  Klungland, and Torstveit, 1999).


• The “female athlete triad” was coined by the
  American College of Sports Medicine in 1992 to
  describe three interrelated conditions of amenorrhea,
  osteoporosis, and disordered eating that often occur
  together in female athletes (Nattiv et al, 1994). This is
  important given the increase in sports participation by
  females. For example, in the 1997–1998 school year,
  2,570,333 girls participated in high school sports; a
  significant increase from the 294,015 girls participat-
  ing in high school sports in the 1971-1972 academic
  school year (NAGWS, 1999).


• Disordered eating behavior can range from that which
  meets clinical diagnostic criteria for anorexia nervosa
  or bulimia nervosa (see Table 74-4) as established in
  the DSM-IV-TR to subclinical levels of disordered
  eating behavior, which might include occasional purg-
  ing, and/or laxative use or diet pill use referred to as
  “eating disorder not otherwise specified” in the DSM-
  IV-TR. One subclinical form of anorexia has been
  referred to by researchers as anorexia athletica
  (Pugliese et al, 1983; Sundgot-Borgen, 1993).
  
  
  1. Symptoms of anorexia nervosa can include com-
     pulsive exercising, anxiety at mealtime, a preoc-
     cupation with food, calories, and weight,
     isolation from family and friends and avoiding
     food related social activities, cutting food into
     small pieces, extreme sensitivity to cold, sleep
     disturbances, high consumption of sugar free
     gum, constipation/bloating, lightheadedness, high
     intake of caffeine-containing beverages, and
     amenorrhea (Jacobson, 2003; Wilmore, 1991).
     Amenorrhea precedes other symptoms of
     anorexia nervosa in 16% of cases and coincides
     with the onset of anorexia nervosa in 55% of
  
  
  
  

TABLE 74-3 DSM-IV-TR (2000) Criteria for Alcohol
Withdrawal
A. Cessation of (or reduction in) alcohol use that has been heavy and
prolonged.
B. Two (or more) of the following, developing within several hours to a
few days after Criterion A:

1. autonomic hyperactivity (e.g., sweating or pulse rate greater than
   100)


2. increased hand tremor


3. insomnia


4. nausea or vomiting


5. transient visual, tactile, or auditory hallucinations or illusions


6. psychomotor agitation


7. anxiety


8. grand mal seizures
   C. The symptoms in Criterion B cause clinically significant distress or
   impairment in social, occupational, or other important areas of
   functioning.
   D. The symptoms are not due to a general medical condition and are
   not better accounted for by another mental disorder.
   Specify if:
   With Perceptual Disturbances

SOURCE: APA: Diagnostic and Statistical Manual of Mental Disorders,
4th ed. Text Revision, Washington, DC, American Psychiatric
Association, 2000.