Ms Dallmann, you accompany the German Paralympics-Team as a psychiatrist and psychotherapist. What does your job involve in Paris?
For the first time, Team D has two welfare officers at this year’s Paralympics. Our job is to look after the mental health of the entire team.
How common are mental illnesses in competitive sports?
Overall, it can be said that competitive athletes do not differ from the rest of the population in terms of the frequency of mental illnesses. However, there are some changes in the prevalence of specific illnesses.
Which ones are they exactly?
The only illnesses that are more common among athletes are eating disorders. This is mainly because weight is a performance factor. In addition, in some sports, being slim is a certain aesthetic requirement that may also be expected by the judges.
Are there any diseases that occur less frequently among competitive athletes?
Yes, there are. Examples include bipolar disorders or psychoses. The impairment caused by these illnesses is usually so severe that competitive sport is not possible.
Does it make a difference with regard to mental illness whether people participate in para-sports or in sports for people without disabilities?
Overall, it must be said that mental illnesses in competitive sports in general, but especially in para-sports, have not yet been studied in detail. Because we are dealing with a very small population group, it is difficult to obtain large data sets. However, the studies that exist on this topic indicate that para-athletes do not differ from other competitive athletes in terms of the frequency of mental illnesses.
Which sport-specific factors can contribute to the development of mental illness?
Basically, everyone has a certain genetic risk of developing mental illness in their life. In addition to biological factors, biographical influences play a role, as do acute and chronic stress factors. In sport, well-known stressors include frequent or long-term injuries, as well as career transitions. It is also known that concussions increase the risk of depression. But overtraining is also a risk factor for depression.
Why is overtraining so harmful to the human psyche?
When you overtrain, training intensity and regeneration become unbalanced. This may be fine for a while, but at a certain point your energy reserves are exhausted. This also leads to changes at the metabolic level, some of which are similar to those that occur in depression. If you feel exhausted for days or weeks, sleep badly, can no longer train properly and perhaps have poor competition results and existential fears, it is certainly understandable from a psychological point of view that depressive symptoms can arise.
How can one recognize such a depression as a sufferer or as an outsider?
An important sign of depression is a change in mood. However, this does not always have to be sadness. Many people are more irritable than usual or feel empty inside. Motivation also usually decreases – there is a lack of energy, you can no longer enjoy things like you used to. What often occurs in athletes in particular and is sometimes not immediately attributed to depression is a predominantly physical exhaustion that cannot be explained by a physical cause, for example.
Suppose an athlete notices such symptoms in themselves. What would be the next steps?
As Welfare Officers, we introduced ourselves to the athletes and gave them our contact details. If they have any mental problems during the games, they can contact us at any time. After Paris, there is also the option of a telephone consultation and, if necessary, we can help arrange psychotherapists, doctors or sports psychologists near the affected person’s home.
Does the treatment of mental illnesses in competitive athletes differ from that of the general population?
In principle, not. However, therapists need to be a little more flexible because patients are often on the move and cannot always keep fixed appointments. Otherwise, I have the feeling that athletes are generally very motivated once they have decided to start therapy. They often ask what they can do right after the first session. In principle, that is a great thing, but sometimes you have to slow them down a little and explain to them that psychotherapy takes some time.
Psychotherapy is often still stigmatized in society. Do you also experience a reluctance among athletes to seek therapy?
Young people are often hesitant when it comes to psychotherapy. In competitive sports, most athletes are still young. That’s why it’s important that we act as a completely normal part of the team in our position – just like the other doctors or physiotherapists, in order to normalize psychological care. In the second step, we introduced ourselves to all athletes personally. Sometimes people still have strange ideas about what kind of people psychologists and psychiatrists are. Hopefully, we were able to show them that we are completely normal, which will make it easier to make contact in the future.
Does it often happen that people have to give up competitive sports due to mental health problems?
Mental illnesses are easy to treat. However, our goal is not to treat athletes so that they perform as well as possible, but rather to make them feel good. Of course, it can happen that some decide to end their careers because they feel better that way.
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Even better than treating mental illnesses is preventing them from occurring in the first place. What does the DBS do to take preventive action?
There was a scientific project that carried out health monitoring of athletes. This initially focused on physical complaints. In preparation for the Paralympic Games in Tokyo, a short questionnaire on psychological well-being was added. This was filled out weekly and asked about symptoms of anxiety disorders and depression. If an athlete showed abnormal values, we contacted them. There was also the option of indicating in the questionnaire that they needed help. This group of people was then also contacted.
Do these queries still exist today?
A decision is currently being made as to whether the project will continue. But as a consequence of the results of this work, para-athletes will now have the opportunity to receive quick, uncomplicated advice in the long term and that is a great step.
Was there any special psychological preparation for the athletes in the run-up to the Paralympics?
We offered a small preparatory workshop before departure. Topics included how to deal with the special situation of the games.
Where do you see room for improvement in dealing with mental well-being in competitive sports in the future?
I think that a lot has happened, but of course there is still a lot to be done. Research must continue to be driven forward. I also think it is important to educate those around people. What are the warning signs of a mental illness? And above all: what do I do then and who can I contact if in doubt? A Germany-wide network is needed for this. Destigmatization will also continue to be an issue. Just because we welfare officers are at the Paralympics for two weeks, not all stigmas will disappear. The topic of mental health must continue to be promoted.
