Psychiatric disorders in Swedish elite athletes : Prevalence, comorbidity and life stories

Sammanfattning: The aim of this thesis is to explore psychiatric disorders in Swedish elite athletes.The first study investigates a) the prevalence of symptoms of psychiatric disorders, b) the prevalence of mental health problems, defined by psychological suffering and impairment>2 weeks, c) the usefulness of sport-specific instruments in indicating clinical levels of psychiatric symptoms, and d) the life history of psychiatric disorders.The second study describes psychiatric disorders and comorbidities in a clinical cohort of treatment-seeking elite athletes and high-performance coaches at two publicly funded outpatient psychiatric clinics in Stockholm and Malmö, Sweden.The third study uses a narrative approach to understand the reasons why elite athletes with established psychiatric disorders choose to seek support and treatment outside – rather than within – their own sport environment.The fourth study presents a poetic representation of one female elite athlete’s experiences of living with, and seeking treatment for, an eating disorder.In sum, 19.5% of Swedish elite athletes had symptoms of anxiety and/or depression, and 8.1% had previously received a psychiatric diagnosis. The lifetime prevalence of mental health problems was 51.7%, with 50% of onsets between ages 17 and 21. Sport-specific instruments generally reported fair diagnostic accuracy, but without sufficient sensitivity or specificity for practical use. Among elite athletes in psychiatric treatment, anxiety disorders were the most common (69%), followed by affective disorders (51%) and eating disorders (26%). Comorbidity was generally common between disorders.Regarding help-seeking, the performance narrative – defined as a single-minded focus on performance that justifies, and even demands, the exclusion of any form of psychological weakness – forced elite athletes to adopt various impression management strategies to hide their psychological suffering. In closing, being invited to witness the em-bodied experiences of a female elite athlete struggling with and seeking treatment for an eating disorder reminds us that behind every prevalence number there is a person.