Emotional abuse in sport: A case study of trichotillomania in a prepubescent female gymnast

Abstract

Despite improved legislation in most countries, child abuse in sport continues to exist but is a problem which is often under reported or ignored. In elite sport ‘suffering’ is not uncommon and hence sometimes child abuse is sometimes unrecognised, de-emphasised or easily dismissed as part of a collective experience that is perceived to be necessary to ‘create’ elite athletes. However, even swearing, anger, raised voices and negative comments directed at child athletes by coaches is considered abuse and can, when regular and routine, cause long term wellbeing and health issues. Self-harm can be a consequence and here self-harm in the form of trichotillomania, self hair-pulling, is reported for the first time as a secondary consequence of abuse. The 12 year old female gymnast, subject of this case study, presented with this impulse control disorder as defined by the American Psychiatric Association and was successfully treated using cognitive behavioural therapy. However, the training environment, including coach behaviour, did not change and so the gymnast remained at risk of recurrence of self-harm. Such environments in sport have many characteristics in common with and reminiscent of religious cults; sacrifice, isolation, shared obsession, a charismatic leader, and often in the presence of severe calorie restriction. As a consequence of ageing, growth, injury and an unchanging abusive environment, a year later the gymnast retired from the sport.