Ultrarunning, an activity defined by the irrational desire to cover distances exceeding the traditional 42.195 kilometer marathon, has emerged as a fascinating clinical model for the study of extreme human resilience and, perhaps more interestingly, extreme human dysfunction.1 To the uninitiated, the sport looks like a collective of individuals participating in a slow motion survival crisis, often in neon spandex. To the clinician, it represents a unique cross section of psychological traits that somehow manage to coexist: superior mental toughness and emotional intelligence on one side, and a staggering risk for depression, anxiety, and obsessive compulsive behaviors on the other.1 This meta-analysis seeks to synthesize the current peer-reviewed evidence to understand how these athletes navigate the narrow ridge between peak performance and psychiatric collapse. While early research in the 1970s and 1980s viewed the ultrarunner as a biological anomaly, the modern era of sports psychology has begun to identify a very specific psychological "fingerprint" associated with the sport.4 The population often scores significantly higher than the general public in conscientiousness and emotional stability, which is helpful when you are trying to convince your legs to continue moving at 3:00 AM in a freezing forest.5 However, this same discipline often veers into the territory of exercise addiction and disordered eating, where the training volume becomes a mechanism for self-regulation rather than a healthy pursuit of fitness.3 The prevalence of mental health issues among these athletes ranges from 32.0% to 62.5% for eating disorders and 11.5% to 18.2% for exercise addiction.7 It appears that for many, the 100 mile race is less of an athletic event and more of a mobile therapy session with a very high entry fee and a significant risk of rhabdomyolysis.
Owen R Thornton (Sat,) studied this question.
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