“When you start avoiding your emotions, you start avoiding a lot of life,” says Taher Chugh, a general practitioner psychotherapist and director of the Toronto Concussion Clinic, speaking to the impact of posttraumatic stress disorder (PTSD) on the lives of concussed individuals.

A concussion is a form of traumatic brain injury that can occur when a blow to the head or force that shakes your body is strong enough to cause your brain to hit the side of your skull. Myriad symptoms can occur, including headaches, decreases in cognitive function such as confusion or amnesia, sleep difficulties such as prolonged feelings of drowsiness, and emotional dysregulation such as irritability and mood swings.

Chugh specializes in managing concussion injuries and the subsequent development of post-traumatic stress disorder, and has observed a strong link between concussions and PTSD in his patients, identifying key characteristics of posttraumatic symptoms, including hyperarousal, avoidance, reliving the event, and mood changes. He says that avoidance is especially prevalent, with patients often steering clear of trauma reminders and even emotions that evoke feelings of weakness or vulnerability.

Athletes, a group particularly vulnerable to concussion-related challenges, often face the same mental health struggles, especially due to sport-related concussions. Since athletes are commonly seen as tough and unbreakable, there is a tendency for their mental health to be overlooked, a trend that extends to scientific literature on concussions and PTSD.

Cindy Miller Aron, a leading expert on trauma in sports, and her team found that up to 25% of athletes experience PTSD and other trauma-related disorders, nearly double the rate seen in the general population. Despite this, most concussion and PTSD research tends to focus on other at-risk groups, such as veterans or survivors of abuse, leaving athletes’ mental health needs under-explored.

Chugh explains, “Anything traumatic enough to disrupt the fear structure in your amygdala is enough to trigger PTSD.” While sports events themselves may not necessarily be traumatic, the occurrence of a concussion certainly can be. Athletes are under constant pressure to perform at their best, often pushing through injuries, including concussions which tend to be a common occurrence. As a result, there might be an expectation to minimize the severity of their injuries, either to themselves or others.

A recent 2024 study sheds light on the significance and long-lasting negative psychological effects of sports-related concussions. The study found that 36.5% of athletes who sustained concussions continued to experience symptoms of depression, anxiety, and heightened irritability nine months post-injury, highlighting their enduring impact, even when athletes appear physically ready to return to compete.

Of concern, athletes who suffer traumatic injuries like concussions are at increased risk of developing PTSD, especially if they have a history of prior trauma. Chugh explains this phenomenon, stating, “Even though previous trauma may not have caused PTSD, this concussion could trigger it,” highlighting how a concussion can bring underlying trauma to the surface and lead to PTSD.

While there is some research on the prevalence of PTSD in athletes, it does not account for the prevailing culture of silence surrounding mental health in sports, which can prevent athletes from seeking help or even acknowledging their symptoms.

Kevin Love, basketball forward for the Miami Heat and five-time All-Star, reflects on his own attitudes toward mental health before recognizing his need for help in his article for The Players Tribune, “I thought about mental health as someone else’s problem… To me, it was a form of weakness that could derail my success in sports or make me seem weird or different.”

Adding another layer of complexity to research on concussions and PTSD, Chugh points out that 25% of people who do develop PTSD after a concussion may not show signs until 3-6 months later. This delay can make it difficult for athletes to recognize or accept the severity of their symptoms, underscoring the urgent need for more research on PTSD in athletes following concussions.

Currently, treatment for athletes follows general PTSD treatment guidelines, including cognitive reprocessing therapy, prolonged exposure therapy, and eye movement desensitization and reprocessing therapy. However, it is unknown how effective these treatments are for PTSD in athletes or if specialized treatment guidelines are needed. This is again, due to the lack of research on PTSD in athletes post-concussion.

When it comes to seeking mental health treatment, athletes face many barriers that perpetuate the stigma associated with them receiving care. They often struggle with a perfectionist mindset and an aggressive and competitive culture in sports that encourages them to ignore psychological issues. Further, among athletes, there is frequently a lack of awareness of mental health disorders and their symptoms, coupled with doubt regarding the efficacy of mental health treatment, preventing them from seeking help.

– Divya Bhupal, Contributing Writer

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Feature: Victoria Prymak at Unsplash, Creative Commons

First: Buddhi Kumar Shrestha at Unsplash, Creative Commons

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