Extreme sports - a hidden form of self-harm for some?

Ruth Phillips takes a look at endurance and extreme sports and asks, could they be a hidden form of self-harm for some.

Exercise and activity are vital to our wellbeing. Over the last 30 years, a substantial body of literature linking physical activity and reduced incidence of depression has accumulated (Gilbert 2000, Mental Health Foundation 2005). It is not just the exercise that is so beneficial, but also the connection with other people that it provides, and the stimulation of getting out and about.

However, some sports, or levels of activity, due to the extreme exertion, control or risk they demand, lend themselves particularly to becoming harmful. Activities such as ultra marathons, mountain running, Ironman competitions (for which competitors train at an extremely intensive level to swim 2.4 miles, cycle 112 miles and run 26.2 miles and winners finish in under nine hours), and extreme mountaineering, could be described as hidden forms of self-harm. 'Hidden', because they are put on a pedestal by society. One self-harm report describes "an Ironman phenomenon manifesting itself in the general population under various socially acceptable guises" (Conterio and Lader 1998).

What is self-harm?

The Mental Health Foundation states that "Self harm describes a wide range of things that people do to themselves in a deliberate and usually hidden way. In the vast majority of cases self harm remains a secretive behaviour that can go on for a long time without being discovered." (Mental Health Foundation, 2006). Most definitions include activities and lifestyles such as starving or compulsively exercising (Favazza 1996 in Long and Jenkins 2010). Because of the feelings of control and release they provide, they can also be addictive. When does hard sport become self-harm?

When does hard sport become self-harm?

On discussion forums on Ironman UK and similar sites, it seems some people inhabit a world bordering on obsession with punishing schedules. There are of course those who retain a healthy perspective on their sport, and appear to enjoy it. However, there are those whose words bear more resemblance to those in self-harm forums in how they glorify pain. These are perhaps the people who are crossing a line into an activity that has punishing and addictive qualities for them. They revel in discussions on restricted diets, weight control, demanding training regimes and even hallucinating during punishing runs.

This is not to say that one cannot enjoy high risk or high endurance and extreme sports. Athletes describe how there is something about the intensity of extreme endurance that causes them to feel very alive. Just as is recommended in treatment for self-harm, it is important not to judge solely from a practitioner's frame of reference. Indeed a sports psychologist might view a highly rigorous and punishing regime as normal.

How to recognise the signs and where to find help

Many become aware themselves that their chosen activity or lifestyle has crossed into something harmful and seek support from fellow athletes. Ironman.co.uk recognises 'Ironman blues' - sadness, loss of direction, depression - and provides remedies and support for this condition, advising competitors to concentrate on relationships and pleasurable activities, and not to feel guilty. If it has become more serious, affecting relationships and happiness, someone may choose to enter into counselling or psychotherapy, to explore why their chosen activity has become too punishing and possibly harmful.

As in so many aspects of mental health, it is good to be familiar with your own fears or vulnerabilities - you will be less likely to use extreme or endurance sports negatively, to a level that is harmful, or starts to take control of your life. To compete in activities at the levels described above does require one to be driven - let that not necessarily be, as the saying goes, 'driven by demons'.

References

Conterio, K. and Lader, W. 1998, Bodily harm, Hyperion: New York.
Department of Health, At least five a week: Evidence on the impact of physical activity and its relationship to health, A report from the Chief Medical Officer, April 2004, www.dh.gov.uk [accessed 27 July 2010].
Gilbert, P. 2000, Overcoming depression, 2nd ed, Constable and Robinson Ltd: London.
Long, M. and Jenkins, M. 2010, Counsellors' perspectives on self-harm and the role of the therapeutic relationship for working with clients who self-harm, Counselling and Psychotherapy Research, 10 (3), 192-200.
Macfarlane, R. 2003, Mountains of the mind, Granta Publications: London.
Mental Health Foundation, 2005, Up and running? Exercise therapy and the treatment of mild or moderate depression in primary care, Mental Health Foundation: London.
Mental Health Foundation, 2006, The truth hurts: report of the national enquiry into self-harm among young people, p5, Mental Health Foundation: London.
NICE Clinical guideline 23 Depression, Management of depression in primary and secondary care, December 2004, NICE, www.nice.org.uk [accessed 27 July 2010].
Royal College of Psychiatrists. Self-Harm [online leaflet], 2007, www.rpsych.ac.uk/mentalhealthinfoforall/problems/depression/self-harm.aspx [accessed 29 July 2010].

Useful websites

National Self-harm Network, http://www.nshn.co.uk
BEAT: National Eating Disorders Association. Includes information on compulsive exercising, http://www.b-eat.co.uk/Home
Information on compulsive exercise and overtraining syndrome, http://sportsmedicine.about.com/cs/eatingdisorders1/a/compulsive_ex.htm

First Psychology Centre, Edinburgh provides therapy to those who self harm. To find out more or book an initial session, please contact us on info@edinburghtherapy.co.uk or phone 0131-668-1440.