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Chapter 5
THE PSYCHOLOGY OF INJURY
I. Personality Variables
A. Personality is defined as the “stable, enduring qualities of the individual.” Factors that
play a role in sports injuries include the athlete’s general personality make up, trait anxiety, locus of
control and self-concept.
1. A person’s general personality can be classified as aggressive, passive,
introverted, extroverted, etc.
2. Trait anxiety is defined as “a general disposition or tendency to perceive certain
situations as threatening and to react with an anxiety response.”
3. Locus of control refers to people’s belief, or lack thereof, that they are in control
of events that affect their lives. People with an external locus of control feel they have little control
over their lives; people with an internal locus of control feel they are responsible for what happens
to them.
4. Self-concept, particularly low self-concept, may be a factor in sports injury.
Athletes with low self-concepts are less able to deal effectively with the stress of competition. In the
extreme, being injured may become an attractive alternative to participation because it provides
attention for the athlete and gives him or her an excuse to avoid playing.
a. Low self-concept can be raised through a program of individualized
counseling provided by a trained specialist.
B. Seasonal Affective Disorder (SAD)
1. SAD is a psychiatric disorder that occurs primarily during the fall and winter
seasons.
2. Symptoms include loss of physical capacity and energy, increased appetite,
decreased libido, hypersomnia, anhedonia, and impaired social activity.
a. Research on ice hockey players (n = 68) found a total of 22 suffering from
either symptomatic SAD or subsyndromal SAD.
3. Accurate diagnostic tests are available and should be administered by a specialist.
4. Rosen, et al. reported that light therapy could be helpful in treating SAD.
II. Psychosocial Variables. Although correlations between personality traits and injury have been
weak, recent research has found strong relationships between psychosocial factors and injury.
Psychosocial factors develop through interaction between the individual and a changing social
environment.
A. Stressful life events have been defined as positive or negative episodes that usually evoke
some adaptive or coping behavior or significant change in the ongoing life of the individual.
B. A variety of life-events questionnaires have been developed including the SRRS,
SARRS, LESA, LEQ, LESCA and the ALES.
C. Evidence suggests a strong relationship between stressful life events, especially negative
events, and sports injury.
1. Athletes with a higher degree of coping skills were less likely to get injured.
D. Coaches should refer athletes to trained specialists for counseling and avoid “playing
psychologist.”
III. Competitive Stress and the Adolescent
A. As more adolescents participate in sports, professionals are growing concerned about the
psychological effects of sports activities on youths.
1. The intensity of competition has increased drastically in some sports, particularly
women’s gymnastics, tennis, figure skating, BMX cycling, and skate boarding, which routinely
produce champions under 16 years of age.
2. Pressure to win can come from parents, coaches, peers, sponsors, and the media. It
is assumed that youngsters do not have the coping skills that enable adults to handle such pressure.
3. Young athletes may be more prone to injury, psychosomatic illness, burnout, and
other stress-related afflictions.
4. Parents and coaches must take care not to force children beyond their ability to
cope with the activity.
IV. Psychology of the Injured Athlete. Injury is a psychological stressor for the athlete.
A. Weiss and Troxel reported that an injury results in a psychophysiological response that
follows the classic stress-response model.
1. Phase one of the injury serves as potent stressor as the athlete is forced to adapt to
restriction of normal activity.
2. Phase two involves the appraisal of the short- and long-term significance of the
injury.
3. Phase three involves the emotional response to the injury that can precipitate
psychological and physical reactions including anxiety, depression, anger, and elevated blood
pressure and heart rate.
a. Ermler and Thomas as well as Pedersen developed models of injury
response that fit into phase three. According to Ermler and Thomas, injury causes an athlete to
experience feelings of alienation. Pedersen compared the effects of injury to the grief response that
follows a death of a loved one (loss).
4. The final stage involves the long-term consequences of the emotional responses
that occur in phase three. If an athlete responds to an injury in a negative manner, various healthrelated problems can occur, such as sleep disorders, loss of appetite, and possibly decreased
motivation.
B. Recommendations. Recommended guidelines for helping athletes cope with injuries are
shown in Time Out 5.1 on page 60.
V. Eating Disorders
A. The majority of sports impose a narrow set of parameters for the appropriate body type
required for success. Reality dictates that specific sports require specific body types for competition.
Some sports demand leanness for success because of biomechanics and societal expectations.
Media exposure of top athletes focuses on physical appearance, especially for female athletes.
1. Emphasis on the ideal body has resulted in negative effects for the athletic
community, particularly the development of abnormal and dangerous eating behaviors.
B. Anorexia Nervosa and Bulimia Nervosa
1. Anorexia nervosa is characterized by self-starvation motivated by an obsession
with being thin and an overwhelming fear of being fat. People with this condition have grossly
distorted body images. They think of themselves as fat even though they are abnormally lean.
2. Bulimia nervosa is characterized by repeated bouts of binge eating followed by
some form of purging, i.e., vomiting, taking laxatives, fasting, or undertaking vigorous excessive
exercise.
3. Both conditions are serious psychological problems that are more common in
adolescent and young-adult females.
C. Research
1. A significant percentage of female collegiate athletes may practice pathogenic
(unhealthy) dietary habits, usually to improve their performance or appearance. In one study, 70%
of subjects who reported having pathogenic eating behaviors felt their dietary practices were
harmless.
2. Rosen et al. found that 32% of the athletes studied regularly practiced some form
of pathogenic eating behavior. In another study, 39.2% of the females and 14.3% of the males were
classified as bulimic, and 4.2% of the females and 1.6% of the males were classified as having
anorexia nervosa. In a more recent survey, Johnson et al. found that almost 11% of females and
about 13% of males binge-ate on a weekly, or more often, basis.
3. Little is known regarding pathogenic eating behaviors among male athletes;
wrestling has been plagued with strange eating behaviors and training practices to “make weight.”
Although males comprise around 10% of the diagnosed cases of eating disorders, male athletes
report relatively higher indices of the disorders when compared to male non-athletes than when
female athletes are compared to female non-athletes.
D. Sport Specificity and Eating Disorders
1. Certain sports have a higher risk that participants will develop eating disorders,
particularly women’s gymnastics, ballet, diving, and figure skating. In a study of 215 female
gymnasts attending college, over 60% reported a variety of disordered eating behaviors.
2. Female athletes in sports that place a premium on physical appearance have a
significantly higher prevalence of eating disorder symptoms than female non-athletes.
3. Eating disorders may be becoming a problem in sports that historically have not
been associated with these conditions, such as female field hockey, softball, volleyball, track, and
tennis.
4. People suffering from anorexia nervosa and bulimia nervosa are at risk of
esophageal inflammation, erosion of tooth enamel, hormone imbalances that can lead to
osteoporosis and amenorrhea, and electrolyte imbalances that can result in kidney and heart
problems.
Additionally, psychological problems such as depression and anxiety disorders often
affect people with eating disorders.
E. Prevention. Prevention of eating disorders must be the goal of those involved in
organized sports. Referring to weight in a negative manner, requiring mandatory weigh-ins, or
ostracizing an athlete publicly for being overweight are practices that should be condemned.
1. Coaches and parents need to be alert to the signs of eating disorders. A sample
disordered eating questionnaire is shown in Table 5.1 on page 62.
F. Treatment. Treatment ranges from simple counseling and education when eating disorders
are diagnosed early to hospitalization in severe cases. Eating disorders may be symptoms of a more
severe problem such as depression or anxiety disorder. According to experts, at least one-third of all
cases do not respond to therapy.
REVIEW QUESTIONS
1. Briefly define several of the personality variables described in the chapter.
Answer:
1.) General personality makeup can be classified in a variety of ways, for example, aggressive or
passive, introverted or extroverted.
2.) Trait anxiety has been defined as “a general disposition or tendency to perceive certain situations
as threatening and to react with an anxiety response.”
3.) Locus of control has to do with people’s belief, or lack thereof, that they are in control of events
occurring within their lives.
Page: 56
2. Discuss the relationship between an athlete’s self-concept and the risk of sports injury.
Answer: Self-concept may be a risk factor with regard to injury. Athletes with low self-concept
have been found to demonstrate a statistically significant relationship with sports injuries.
Page: 57
3. Describe briefly the relationship between psychosocial variables and the risk of sports injury.
Answer: Psychosocial variables develop through the interaction between the individual and a
changing social environment. Evidence suggests that when an athlete is experiencing significant
personal changes, especially those seen as negative, the chance of injury increases.
Page: 58
4. List several sports in which adolescent athletes routinely achieve national-championship status.
Discuss the possible relationship between this high level of competitive stress and the psychology
of the adolescent athlete.
Answer: Sports such as women’s gymnastics, tennis, figure skating, bicycle motocross cycling, and
professional skateboarding routinely produce regional and national champions under the age of 16.
The stress of the competition may result in significant problems for some kids. Young athletes may
be more prone to injury, psychosomatic illnesses, emotional burnout, and other stress-related
afflictions.
Page: 59
5. Discuss the psychological impact of a sports injury on an athlete in terms of the stress model
shown in the chapter.
Answer:
1.) In phase one the injury serves as a potent stressor and requires the athlete to adapt to a restriction
of normal activity.
2.) Phase two involves an appraisal of the significance of the injury, both in a short and long-term
sense.
3.) Phase three of the stress model involves an emotional response that can precipitate a host of
physical and psychological reactions, ranging from severe anxiety, depression, and anger to
increased muscle tension, blood pressure, and heart rate.
4.) The fourth stage involves the long-term consequences of the emotional response in phase three.
If an athlete fails to respond to an injury in a positive manner, he or she may suffer from a wide
variety of problems, including sleep disorders, loss of appetite, and perhaps decreased motivation.
Pages: 59-60
6. List the recommended guidelines for dealing with an injured athlete.
Answer:
1.) Treat the person, not just the injury.
2.) Treat the athlete as an individual.
3.) Keep in mind that communication skills are critical to an open coach-athlete relationship.
4.) Remember the relationship between physical and psychological skills.
5.) Seek the help of a sports psychologist for further ideas and strategies.
Page: 60
7. Define both anorexia nervosa and bulimia nervosa.
Answer: Anorexia nervosa is characterized by a pattern of self-starvation motivated by an obsession
with being thin and an overwhelming fear of being fat. Anorexic individuals typically have a
grossly distorted body image; they think of themselves as fat when they are, in fact, abnormally
lean.
Bulimia nervosa is characterized by repeated bouts of binge eating followed by some form of
purging—for example, vomiting, taking laxatives, fasting, or undertaking vigorous, excessive
exercise.
Both anorexia and bulimia are considered to be serious psychological problems that are most
common among adolescent and young-adult females.
Pages: 59-60
8. True or False: Recent research found that 70% of those reporting pathogenic eating behaviors felt
such practices were harmless.
Answer: True. One study found that 70% of those reporting pathogenic eating behaviors felt such
practices were harmless.
Page: 61
9. List several common forms of pathogenic eating behaviors found to be practiced by athletes.
Answer:
1.) Binges
2.) Self-induced vomiting
3.) Laxatives
4.) Diet pills
5.) Diuretics
6.) Anorexia
7.) Fasting
8.) Restriction of fluids
9.) Sweating weight off by wearing a rubber suit in a sauna
Page: 61
10. List five common signs or behaviors that may indicate the development of an eating disorder.
Answer: Distorted body image, fasting, restriction of fluids, use of laxatives, vomiting, binging,
frequent weight checks.
Pages: 61-62
11. Define the acronym SAD and discuss its implications for competitive athletes.
Answer: Seasonal Affective Disorder is a psychiatric disorder that affects the general population,
including athletes, primarily in the fall and winter seasons. Considering the fact that many of the
symptoms of this disorder may negatively affect performance or, worse, predispose some to injury,
it seems prudent for parents, coaches, and sports medicine personnel to become familiar with the
signs and symptoms of SAD.
Page: 57
12. True of False: High levels of stress in athletes can result in physical fatigue as well as reduced
peripheral vision.
Answer: True. These results of stress can conceivably increase the chances of an injury.
Page: 56
13. What is a stressor?
Answer: A stressor is anything that affects the body’s physiological or psychological condition and
upsets the homeostatic balance.
Page: 59
14. True or False: An athlete that is experiencing significant personal changes, especially those seen
as negative, is thought to have a decreased chance of injury.
Answer: False. The chance of injury increases with significant personal changes.
Page: 58
15. Are bulimia nervosa and anorexia nervosa on the increase or decrease in the athletic
community? Which is more prevalent?
Answer: The eating disorders listed are on the increase in athletes with bulimia nervosa being the
more prevalent.
Page: 60
16. Which sport receives the most attention with regard to pathogenic eating in male athletes?
Answer: Wrestling.
Page: 61
17. What percentage of diagnosed eating disorder cases do males comprise?
Answer: 10%
Page: 61
18. What are some of the physical and psychological problems associated with both anorexia and
bulimia?
Answer: Esophageal inflammation, erosion of tooth enamel, hormonal imbalances that can lead to
osteoporosis and amenorrhea, kidney and heart problems related to electrolyte imbalances,
depression, and anxiety disorders.
Page: 62
19. How can coaches assist in the prevention of eating disorders?
Answer: Place less emphasis on body weight and fat, minimize referring to weight in a negative
manner, and eliminate mandatory weight checks and ostracizing an athlete for being overweight.
Page: 63
20. How are eating disorders treated?
Answer: Through simple counseling and education (for early stage disorders) to hospitalization in
severe cases. At least 1/3 of the cases will not respond to therapy.
Page: 63