Depression and chronic fatigue in the high school student and athlete.

By presenting the salient aspects of a case study of a high school student athlete, we have attempted to show how participation in sports can negatively impact on self-concept, self-esteem, physical acceptance, and self-efficacy, thereby contributing to an overall feeling of inadequacy, helplessness, hopelessness, and ultimately leading to depression and chronic fatigue. An early maturer, this student experienced early success in several sports without a great deal of effort and investment, and derived much of his sense of being from the recognition and reinforcement accorded him by significant others, most notably from a father who placed a higher premium on success in athletics than on other equally worthwhile pursuits. When continued success was not forthcoming, and as later-maturing peers caught up to and surpassed his athletic accomplishments, the student sought to protect his sense of self-esteem by rationalizing that his lack of success was due to a physical problem. He became obsessed with the thought that he was gradually losing his athletic identity and he lapsed deeper and deeper into a depressed state. His compulsive overtraining and starvation diet failed to produce his image of the "ideal body" that, of course, was unachievable because of his distorted view of reality. Ultimately, this behavior resulted in hospitalization for treatment of an eating disorder and clinical depression. Even a successful senior football season after his psychiatric care could not filter through his distorted perceptions and he could not cope with the thought of participating in another track and field season and having his performance bested by others whom he had once handily beaten. Thus, once again, he engaged in self-protective behavior and sought verification from sportsmedicine professionals. Diagnosis of Tom's condition was possible only through the collaborative efforts of the athletic trainer, physical therapist, sport psychologist, and family physician. Professionals involved in sportsmedicine must be aware of the critical role that highly valued activities like sports play in the psychosocial development of adolescents. To the adult, these activities may seem trivial, frivolous, and removed from the "real world," but to the adolescent, they are an important source of self-esteem during a critical and volatile period of self-concept edification. During a period of awakening sexuality and heightened awareness of their physical being, activities that emphasize the physical aspect of self gain prominence. Those who derive positive experiences benefit from enhanced feelings of physical self-efficacy and self-esteem.(ABSTRACT TRUNCATED AT 400 WORDS)