“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.

• Trichotillomania, a compulsion to pull out one’s own hair,  represents another behaviour which can result as a secondary response to emotional abuse in sport and has never before been documented.
• Child abuse in sport appears to have parallels with religious cult psychology and where low level, long duration (years of) abuse is in operation, signs and symptoms of complex post traumatic stress disorder (C-PTSD) may also be apparent.
• Emotional abuse of all types continues to be directed at children in sport despite huge steps forward in recognition for and implementation of child protection policies.

• Children who participate in elite sport are rarely seen as vulnerable, and are certainly not considered to be ‘at risk’; this assumption should be challenged.
• Emotionally abusive behaviour appears to be endemic in the culture of elite child sport and steps should be taken to confront this behaviour and enhance awareness of its destructive nature.
• Cases of child abuse in sport are not always straight forward and patients may not always respond well to conventional treatment. In such cases treating both the acute symptoms and the underlying causes are extremely important.

• Without treating underlying causes, the risk of further psychological damage appearing years after the event is significantly increased.

[Citation: Gervis M, Godfrey R (2013) Emotional Abuse in Sport: A Case Study of Trichotillomania in a Prepubescent Female Gymnast. J Clin Case Rep 3: 264.
Brunel Centre for Sport, Health and Wellbeing, Middlesex, United Kingdom *Corresponding author: Misia Gervis, PhD, Brunel Centre for Sport, Health and Wellbeing, Heinz Wolff Building, Kingston lane, Uxbridge, Middlesex, United Kingdom, UB8 3PH, E-mail:; Published March 23, 2013 ]

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