Obsessive Compulsive Disorder (OCD) can be an annoying thing to suffer from. It can force you into a behaviour/s that can alter the way a person operates. I am speaking from experience. I have certain tendencies that tend to rule how I want things to be sorted. I like order and can't stand messiness. Athletes can also suffer from it and it can alter the way they practice; train and play.
DSM-5 Diagnostic Criteria for Obsessive-Compulsive Disorder
A. Presence of obsessions, compulsions, or both:
Obsessions are defined by (1) and (2):
1. Recurrent and persistent thoughts, urges, or impulses that are experienced, at some time during the disturbance, as intrusive and unwanted, and that in most individuals cause marked anxiety or distress.
2.The individual attempts to ignore or suppress such thoughts, urges, or images, or to neutralise them with some other thought or action (i.e., by performing a compulsion).
Compulsions are defined by (1) and (2):
1. Repetitive behaviors (e.g., hand washing, ordering, checking) or mental acts (e.g., praying, counting, repeating words silently) that the individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly.
2 .The behaviours or mental acts are aimed at preventing or reducing anxiety or distress, or preventing some dreaded event or situation; however, these behaviours or mental acts are not connected in a realistic way with what they are designed to neutralize or prevent, or are clearly excessive.
Note: Young children may not be able to articulate the aims of these behaviours or mental acts.
B. The obsessions or compulsions are time-consuming (e.g., take more than 1 hour per day) or cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
C. The obsessive-compulsive symptoms are not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition.
D. The disturbance is not better explained by the symptoms of another mental disorder (e.g., excessive worries, as in generalized anxiety disorder; preoccupation with appearance, as in body dysmorphic disorder; difficulty discarding or parting with possessions, as in hoarding disorder; hair pulling, as in trichotillomania [hair-pulling disorder]; skin picking, as in excoriation [skin-picking] disorder; stereotypies, as in stereotypic movement disorder; ritualized eating behavior, as in eating disorders; preoccupation with substances or gambling, as in substance-related and addictive disorders; preoccupation with having an illness, as in illness anxiety disorder; sexual urges or fantasies, as in paraphilic disorders; impulses, as in disruptive, impulse-control, and conduct disorders; guilty ruminations, as in major depressive disorder; thought insertion or delusional preoccupations, as in schizophrenia spectrum and other psychotic disorders; or repetitive patterns of behavior, as in autism spectrum disorder).
Specify if:
With good or fair insight: The individual recognises that obsessive-compulsive disorder beliefs are definitely or probably not true or that they may or may not be true.
With poor insight: The individual thinks obsessive-compulsive disorder beliefs are probably true.
With absent insight/delusional beliefs: The individual is completely convinced that obsessive-compulsive disorder beliefs are true.
It can take the focus away from skill development and turn one’s attention towards alleviating their anxiety or distress. Given that repetition is a necessity in training, it isn’t always easy to recognise when OCD is impeding on an athlete’s performance. One way to differentiate is to consider what is the underlying motivator. If an athlete’s performance is more directed towards alleviating anxiety and less towards development, conditioning or achieving sport specific goals, then OCD is likely interfering with athletic performance (Farris, n.d.).
Here are a few examples of how obsessions and compulsions might inhibit athletic performance:
- Perfectionism and interrupting the "flow." Mastering a new skill requires a lot of time to develop. Gradual progression and repetition is part of mastery. However, OCD can stop the progression or slow down momentum. For example, a swimmer with OCD and perfectionistic tendencies may stop in the middle of the pool to start over because the timing of his breath in the previous stroke wasn’t exactly right.
- Delays. Compulsions can often take up a significant amount of time. An athlete with OCD may find it difficult to resist their compulsions while at practice or during a game, leading to delays.
- Distraction. OCD can make it hard to feel fully present and can take an athlete’s focus out of their performance.
- Tardiness. An athlete struggling to resist compulsions may show up late to practice or competitions.
- Overtraining and risk of injury. Repeating drills in order to alleviate intrusive thoughts can lead to excessive training and potential injury.
- Poor recovery. OCD can interfere with down time. Intrusive thoughts may surface when an athlete is planning on relaxation and self-care during post-training recovery. It can also disrupt sleep. As a result, recovery becomes more stressful than restorative.
- Loss of confidence. The more OCD interferes, the more doubting gets reinforced. An athlete may spend more time mentally reviewing, ruminating, or seeking reassurance on aspects of their training that they worry about.
- Isolation or loneliness. An athlete struggling with anxiety may feel alone in their experience or worry about how they are connecting with peers (Farris, n.d.).
Many coaches, athletic trainers and other support staff have made great efforts in gaining awareness of general mental health issues, as well as more specific mental illnesses such as eating disorders. However, few coaches or athletic trainers are aware of a disorder that has a prevalence rate of 3% in the general population (von Stietz, 2021).
What coaches and trainers can do:
- Check-in with one student-athlete a day about how their personal life is going. This builds trust and a healthy relationship.
- Be a sounding board. Validate their emotional experience. Be a safe space. Model health.
- Ask athletes if they ever experience disturbing repetitive thoughts.
- Ask athletes if they ever engage in repetitive rituals in order to reduce anxiety or feel safe.
- Recognise that eating disorders and OCD are frequently co-morbid. According to the IOCDF, people with eating disorders have an OCD prevalence rate of 11% to 69% and people with OCD have an eating disorder prevalence rate of 10% of 17%. If you suspect an athlete has an eating disorder, also check for OCD.
- Recognise OCD and other mental health issues and refer the athlete to a mental health professional.
- Remember that issues such as anxiety and depression are mental health issues that need treatment. Mental health issues are not “choices” (von Stietz, 2021).
What coaches and trainers should avoid:
- Avoid shaming the student-athlete or judging them as "weak" due to emotional issues.
- Avoid minimising the problem. The problem is likely larger than the student-athlete is acknowledging (von Stietz, 2021).
There seems to be a difference between routines, rituals and OCD related behaviour (Thompson, 2019).
Sports routines: Athletes across all sports benefit from routines - in training and competition. Routines, as the term suggests, helps us to be more routine, to do things again, to become more consistent. If every time we turned up to train and chose to do something different for a warm-up and for our session, progression is likely to be a bit random - maybe we'd progress, maybe we wouldn't. Having a warm-up routine, a pre-performance routine for training (or practice) and for competition, can lay a great foundation for performance and for being consistent. Likewise, having a routine for our nutrition can help us to fuel well, to keep on top of our energy stores, to reduce the chance of gut issues (Thompson, 2019).
Sports superstitions or rituals: These are things that we do because we believe that they will help things go well, or the opposite, to avoid something bad happening. Examples can include eating some particular food before an event. It could be the need to wear certain clothing. It could be to communicate something to someone - perhaps by speaking to them or by text message. The thing which separates sports superstitions or rituals from the sports routines is that:
- The majority of other athletes don't do them
- Most coaches would not recommend them
Its really difficult to see how they can actually lead to a better performance
How do these behaviours get established? They start because a sportsperson wants to do well. When things go well, they try to work out why. Or, when things don't go well, they want to work out why. Often, an athlete isn't able to work out why. Athletes then have 2 options: to move on to something else or to think of less obvious things. These less obvious things include anything that was done differently that could, perhaps, be linked to the good or bad performance. This is how athletes start to consider what brought them good luck or good performance, or bad luck and poor performance (Thompson, 2019).
They then decide to go out of their way to either repeat or avoid doing those things next time. Over time, it's difficult for most athletes to ditch any of these superstitions or rituals - "just in case" it makes a difference. What is more likely, is that if there is one superstition or ritual, soon later there will be another added or that the superstition or ritual will become more elaborate and convoluted (Thompson, 2019).
What is better and recommended then for athletes? Routines are good, they help provide consistency in prep and performance. With them consider: do, or would, other athletes or coaches agree that these are good for you and other athletes to do? Are your routines and your approach flexible to cope with different circumstances, without generating excessive anxiety or distress?
Finally, do you conduct a performance analysis after competition which is balanced and helpful, with opportunities to extract links between what you do and how things went?
Don't be a slave to superstitions or rituals. Develop flexibility in your approach, with an effort to include the important things. Ditch the behaviours that are a sideshow (Thompson, 2019).
Rituals and superstitions may jokingly or offhandedly refer to these behaviours as OCD-like. However, they are not the same as OCD, a potentially debilitating mental health disorder. People with OCD have recurring, unwanted thoughts, ideas or sensations (obsessions) that make them feel driven to do something repetitively (compulsions). The repetitive behaviours, such as hand washing, checking on things or cleaning, can significantly interfere with a person’s daily activities and social interactions. OCD involves a person engaging in rigid thoughts and behaviors that take up significant time, usually at least one hour a day, that also interfere or cause problems in person’s daily life. In addition, the person will begin to feel increasingly anxious if he or she cannot complete these rituals (Reardon & Tran, 2019).
OCD can be treated. Psychotherapy, such as cognitive behavioural therapy, can be helpful for people with OCD. In addition, there are medications, such as selective serotonin reuptake inhibitors, a type of antidepressant, that can be helpful (Reardon & Tran, 2019).
Rituals and superstitions are common in athletics and can help athletes perform better by helping them gain the confidence they need before competition. However, if an athlete (or anyone) has rigid rituals or other repetitive behaviors that are affecting their ability to function and causing emotional distress, talking with a doctor or mental health professional may be helpful (Reardon & Tran, 2019).
OCD can definitely be a problem for athletes. However, it's good that there are ways to treat the condition. It can never be cured. It's a way of life for certain people. It's something that needs to be trained and to control, if made possible.
Reference List
Farris, S. (no date). How OCD Interferes with Athletic Performance [online]. Available from: https://anxietyinathletes.org/coach-team-staff/learn-more/how-ocd-interferes-with-athletic-performance/#:~:text=An%20athlete%20with%20OCD%20may,focus%20out%20of%20their%20performance [accessed: 21 January 2025].
Reardon, C.L. & Tran, H. (2019). Athletes’ Superstitions and Rituals [online]. Available from: https://www.psychiatry.org/news-room/apa-blogs/athletes-superstitions-and-rituals [accessed: 21 January 2025].
Thompson, V. (2019). Sports routines, superstitions, rituals or could it be OCD? [online]. Available from: https://www.sportspsychologist.com/post/2017/07/22/sports-routines-superstitions-rituals-or-could-it-be-ocd [accessed: 21 January 2025].
von Stietz, J. (2021). What coaches and athletic trainers should know about OCD [online]. Available from: https://cbtsocal.com/what-coaches-and-athletic-trainers-should-know-about-ocd/ [accessed: 21 January 2025].