Can We Treat the Cheat?

“Deflategate” may be the word of the day in the sports world, but it is neither the first nor the last example of athletes cheating to gain an edge on competitors. Winning is everything to many athletes, no matter the cost to their integrity and health.

Cheating in sports falls into one of the four B’s: Betting, Bribery, Battery, and Banned substances, said Thomas Newmark, M.D., a professor of psychiatry at the Rowan School of Medicine, at APA’s 2015 annual meeting in Toronto today. He gave an overview of infamous sports scandals in cheating, ranging from cyclist Lance Armstrong’s use of performance enhancement drugs to the ice skater Tanya Harding’s planned assault on fellow competitor Nancy Kerrigan at the Olympic trials in 1991. Newmark discussed that underlying motives behind some cheating scenarios are the gaining of fame, extreme financial incentives, success, and acceptance, or, in the case of collegiate athletes, grades and maintaining eligibility.

Psychiatrists can step in and help athletes caught cheating by educating them about the error of their ways or helping them cope with the stress of dealing with a suspension or the end of a career, said Eric Morse, M.D., a sports psychiatrist who works with professional, college, and youth athletes and teams. Ironically, sometimes it’s the psychiatrist who is pressured to cheat—to provide a medical diagnosis that helps a college athlete drop a course he is failing or “legalize” a banned medication with a back-dated prescription.

Dan Begel, M.D., a cofounder of the International Society for Sport Psychiatry, said that athletes with personality disorders such as narcissistic, borderline, or antisocial personalities are at higher risk of cheating behaviors. “Understanding the deeper motivations of such athletes can drive treatment,” said Begel. “It is important to explore childhood and family and cultural dynamics to develop a treatment plan.”

Therapy tools highlighted during the session to treat athletes included cognitive-behavioral therapy, family therapy, dynamic therapy, and supporting therapy. The experts emphasized that the key role of psychiatrists in sports medicine is to educate athletes about cheating and help them not to cheat again and help them with the consequential stress of being caught and dealing with a suspension, ban, and career termination—which could result in a loss of identity for the player.

Ira Glick, M.D., professor emeritus of psychiatry and behavioral sciences at the Stanford University School of Medicine, said that a personal, family, and cultural history of the athlete are good starting points for therapy.

“Cognitive-behavioral therapy, family therapy, dynamic therapy, or supportive therapy can help,” said Glick. “Often the elite athlete may feel a sense of entitlement that needs to be addressed.”