Psychiatric Aspects of Extreme Sports: Three Case Studies

Extreme sports, defined as sporting or adventure activities involving a high degree of risk, have boomed since the 1990s. These types of sports attract men and women who can experience a life-affirming transcendence or "flow" as they participate in dangerous activities. Extreme sports also may attract people with a genetic predisposition for risk, risk-seeking personality traits, or underlying psychiatric disorders in which impulsivity and risk taking are integral to the underlying problem. In this report, we attempt to illustrate through case histories the motivations that lead people to repeatedly risk their lives and explore psychiatry's role in extreme sports. A sports psychiatrist can help with therapeutic management, neuromodulation of any comorbid psychiatric diagnosis, and performance enhancement (eg, risk minimization) to cultivate improved judgment which could include identifying alternative safer recreational options. Because flirting with death is critical to the extreme sports ethos, practitioners must gain further understanding of this field and its at-risk participants.