# Performance anxiety and burnout: when it is the head that stops, not the knee

> An injury is visible: you ice it, you book an appointment. A girl who cannot sleep the night before a match, who feels hollowed out three months into the season and has stopped enjoying any of it leaves no medical record — and gets filed away as «the anxious one» or «the one who lost her hunger». Research has measured both. Competitive anxiety breaks down into three distinct components, sport burnout has three dimensions and a prevalence estimate in adolescents. What the data say, what differs between girls and boys, and how to tell a bad week from a signal worth taking to a professional.

**In short:** Competitive anxiety is not one trait: it is measured as three separate components — somatic anxiety, worry about performing poorly, and concentration disruption — and in 1,038 athletes aged 9-14 worry was highest in girls, with differences the authors themselves describe as modest (Grossbard et al., 2009). Sport burnout, defined as exhaustion plus sport devaluation, was detected at elevated scores in 1-9% of 980 adolescent athletes (Gustafsson et al., 2007).

- Page: https://www.babsport.com/en/blog/ansia-prestazione-burnout-giovani-atlete
- Markdown source: https://www.babsport.com/en/blog/ansia-prestazione-burnout-giovani-atlete.md
- Published: 2026-08-29
- Updated: 2026-08-29
- Author: Sajid Hossain
- Publisher: BAB — Breaking All Barriers (https://www.babsport.com/)
- Tag: athlete-mental-health, athlete-burnout, competitive-anxiety, early-specialisation, drop-out
- How to cite: BAB — Breaking All Barriers, "Performance anxiety and burnout: when it is the head that stops, not the knee", https://www.babsport.com/en/blog/ansia-prestazione-burnout-giovani-atlete
- Note: educational content, not medical advice. Every health claim is anchored to a source listed under "Sources"; where a study was run on adults, the text says so.

---

What stops a young athlete is not always something an X-ray can show. A swollen knee has a pathway: ice, an appointment, recovery timelines, a return. A girl who does not sleep the night before a match, who feels hollowed out three months into the season and has stopped enjoying it leaves no medical record — and ends up filed away in two equally useless ways: «she's the anxious one», or «she's lost her hunger».

Research, though, has measured both. **Competitive anxiety** has been broken into distinct components in athletes of exactly this age, and **sport burnout** has an operational definition, a measurement instrument, and prevalence estimates in adolescents. These are not impressions: they are variables with numbers, and the numbers tell you where to look.

> **In brief**
> - Competitive anxiety is not one block: it is measured as **three components** — somatic anxiety, worry about performing poorly, concentration disruption.
> - In **1,038 athletes aged 9-14**, **worry** was highest in **girls** and in older athletes; boys reported more concentration disruption. The authors describe these differences as **modest**.
> - **Burnout** is physical or mental exhaustion plus **devaluation of the sport**: among **980 adolescent athletes**, **1-9%** had elevated scores.
> - **Specialising in one sport** is associated with more burnout on all three dimensions — but in the available comparison only **4.1%** of the sample were sport samplers.
> - In **adult elite female athletes**, rates of anxiety, depression, distress and disordered eating are higher than in male athletes; **sleep** is not.
> - The modifiable levers are always the same three: **injury, sleep, social support**.

## What is performance anxiety really, and why is «she's the anxious one» not enough?

**Because underneath that phrase sit three different phenomena, measured separately and addressed differently.** The reference instrument for under-15s, the *Sport Anxiety Scale-2*, does not return a single anxiety score. It returns three.

- **Somatic anxiety**: the body reacting before competition. Racing heart, tight stomach, tense muscles.
- **Worry**: the recurring thought of performing badly, of letting people down, of not being good enough.
- **Concentration disruption**: difficulty holding attention on what you are doing while you are doing it.

A confirmatory factor analysis in a sample of **1,038 athletes aged 9-14** verified that this three-factor model holds in this age range, and is **equivalent both across 9-11 and 12-14 year olds and across boys and girls** ([Grossbard et al., 2009](https://doi.org/10.1080/10615800802020643)). Translated: when a thirteen-year-old says «I'm anxious», she is not describing one thing, and asking *which of the three* changes the useful answer entirely. Pre-match physical tension is managed one way; a fixed thought about disappointing the coach quite another.

## Do girls have more performance anxiety than boys?

**On one component yes, on the others no — and the difference is modest, not a chasm.** In the same study of 1,038 young athletes, **worry about performing poorly was highest in girls** and in older athletes, while **boys** reported higher **concentration disruption** in competitive situations ([Grossbard et al., 2009](https://doi.org/10.1080/10615800802020643)).

The authors' own caution is worth carrying over rather than inflating the finding: gender and age were **modestly** related to anxiety scores. This is not «girls are anxious by nature». It is that, on average, the more common form of anxiety in girls is the *evaluative* kind — fear of judgement on performance — and that is operationally useful, because fear of judgement is precisely the variable that coaching language moves most. We have written about it in the article on [how staff language shapes athlete health](/en/blog/parole-allenatore-salute-atlete).

## Does sport burnout really exist at 14?

**Yes, and it is measured: it is not a word borrowed from office life.** Athlete burnout has a three-part operational definition: physical or mental **exhaustion**, a **reduced sense of accomplishment**, and the consequence that binds the first two — **devaluation of the sport**, the moment something that mattered stops mattering. The *American Academy of Pediatrics* clinical report on overuse, overtraining and burnout in young athletes defines it this way and names it as **one of the primary reasons for attrition in youth sports** ([Brenner et al., 2024](https://doi.org/10.1542/peds.2023-065129)).

On frequency, the most cited reference remains a Swedish study: a burnout inventory administered to **980 adolescent athletes** (402 girls and 578 boys) across **29 different sports**. The result: between **1% and 9%** showed elevated scores on the subscales ([Gustafsson et al., 2007](https://doi.org/10.1123/tsp.21.1.21)). Two necessary caveats: this is a screening instrument in a sample of competitive Swedish youth athletes, not a set of clinical diagnoses, and the hypothesis that burnout would be more prevalent in individual sports **was not supported** in that sample.

A range of 1-9% does not describe an emergency. It does describe something concrete: in a club with **a hundred registered girls**, **one to nine** of them. And burnout, unlike a sprain, has no recognisable start date — which is why it is noticed late, often once the girl has already left.

## Does playing one sport all year round raise the risk?

**The available data say yes on all three burnout dimensions, but the comparison behind them is unbalanced and should be read with that reservation.** A systematic review and meta-analysis compared adolescent athletes who **specialise** — one sport, played more than eight months a year, to the exclusion of all others — with those who sample several.

It included **8 studies covering 1,429 athletes** (mean age **15.59 years**, range 12.5-17.2). Specialisers reported **higher burnout on all three dimensions**, with a difference of means of **0.87** (95% CI 0.67-1.08) on reduced sense of accomplishment ([Giusti et al., 2020](https://doi.org/10.1177/2325967120907579)).

The limitation is substantial and worth declaring: of the 1,429 athletes, **1,371 (95.9%) were specialisers** and only **58 (4.1%)** were samplers. A comparison group that small makes the result **indicative, not conclusive**. It remains consistent with what is seen on the injury side, which we covered in the article on [early specialisation](/en/blog/specializzazione-precoce-giovani-atlete): a girl's calendar is a health variable, not just a technical choice.

## Do female athletes report more anxiety and depression than male athletes?

**In elite data yes, with sizeable differences — but those data are largely adult, and that is a bridge you cannot cross in silence.** A systematic review and meta-analysis of **60 studies** in elite athletes compared symptom rates by sex ([Kew et al., 2024](https://doi.org/10.1177/19417381241264491)):

| Symptom | Rate ratio (female / male) | 95% CI |
| --- | --- | --- |
| Anxiety | 1.17 | 1.08-1.27 |
| Depression | 1.42 | 1.31-1.54 |
| Distress | 1.98 | 1.40-2.81 |
| Disordered eating | 2.19 | 1.58-3.02 |
| Sleep disturbance | 1.13 | 0.98-1.30 (not significant) |

Male athletes, by contrast, reported more alcohol misuse (0.74; 0.68-0.80), illicit drug use (0.82; 0.75-0.89) and gambling problems (0.14; 0.08-0.25).

Two readings belong together. First: the sharpest difference concerns **disordered eating**, more than double in female athletes — and that is where this subject touches [low energy availability and RED-S](/en/blog/red-s-bassa-disponibilita-energetica) directly, the point at which the line between a mental health problem and a physiological one stops being clean. Second: **sleep** is the only entry with no significant sex difference, which does not mean it is fine — [sleeping less than eight hours is the norm in adolescence](/en/blog/sonno-atlete-adolescenti), it is simply the norm for everyone.

And the caveat that holds up everything else: **these are elite athletes, largely adults**. The data tell you which direction to look when a fourteen-year-old is in front of you, not how common any of it is at her age. There is no equivalent meta-analysis in adolescent female athletes, and that gap is worth naming rather than filling.

## Which risk factors can actually be changed?

**The ones around the athlete — and they are the three a club already has a hand on: injury, sleep, social support.** A systematic review analysed **52 studies covering 13,849 female student-athletes** to identify determinants of depression, anxiety and stress. **Seventeen** emerged, grouping into three families: **injury** (including concussion), **general health** (for example sleep hygiene) and **social factors** (for example perceived support). The pooled association estimated in the meta-analysis is **small but significant**: r = 0.15 (95% CI 0.05-0.24) ([Beisecker et al., 2024](https://doi.org/10.1136/bjsports-2023-107328)).

Here too the population must be declared: these are **US collegiate athletes**, therefore adults, in a sporting system unlike ours. But the three groups of determinants are not a college exclusive. Two of the three, in particular, have a precise address on this site:

- **injury** is not only a tissue problem: the psychological side of return is documented and routinely ignored, which is why [the knee heals before the head does](/en/blog/ritorno-allo-sport-dopo-infortunio). The same applies to head trauma, where emotional symptoms are part of the picture and not a side effect of character ([concussion in young female athletes](/en/blog/commozione-cerebrale-giovani-atlete));
- **sleep** is the most underrated lever and the most measurable one.

The third — perceived support — is not a soft factor: in the model above it sits alongside the other two as an equal.

## How do you tell a bad week from something more serious?

**Not with a home-made test, and it is not the coach's job.** An informational article cannot — and must not — supply diagnostic criteria. There are, however, features that in the clinical literature shift the needle from *observing* to *asking a professional for help*:

- **duration**: weeks, not days;
- **pervasiveness**: the distress does not stay in the gym but reaches school, sleep, friendships;
- **loss of pleasure** in something she used to enjoy — which is precisely the *sport devaluation* component in the definition of burnout ([Brenner et al., 2024](https://doi.org/10.1542/peds.2023-065129));
- **withdrawal from relationships**, and any marked change from that particular girl's usual behaviour.

The International Olympic Committee *consensus statement* on mental health in athletes is explicit about a principle that frames this whole article: mental health symptoms and disorders in athletes should be **recognised and managed like any other health issue**, by competent professionals ([Reardon et al., 2019](https://doi.org/10.1136/bjsports-2019-100715)). The document concerns elite athletes, largely adults; the principle — this is not weakness, it is health — has no age.

A coach does not have to diagnose. A coach has to **notice** and to **refer**. Those are two much simpler verbs, and they are already a great deal.

## What can a club do concretely?

Three actions, none of which requires a psychologist on staff (which remains the best option where it is possible).

- **Separate the person from the performance in everyday language.** «You misplaced that pass» and «you're a disaster» are not the same sentence in two registers: the second feeds exactly the anxiety component most common in girls, worry about performing poorly ([Grossbard et al., 2009](https://doi.org/10.1080/10615800802020643)).
- **Look at the calendar before the character.** If a girl plays one sport twelve months a year, the burnout risk described in the literature is higher ([Giusti et al., 2020](https://doi.org/10.1177/2325967120907579)) and recovery is not a reward to be earned: it is an ingredient of training. Before concluding that «she's lost her hunger», it is worth counting the weeks without a break.
- **Keep a route in.** A girl who knows who to tell tells someone sooner. And sooner, almost always, means reversible — whereas the moment the problem announces itself is usually the moment she stops.

## BAB's role

This is delicate ground, and it is worth being precise about what BAB does and does not do. BAB **is not a diagnostic tool** and does not identify disorders: there is nothing in this platform resembling a mental health screening.

What it offers comes earlier and is simpler. A **private space** where an athlete records her own signals — energy, mood and sleep quality among them — over time, so that a rough stretch becomes visible as a *stretch* rather than as one bad day. An **educational layer** that gives non-clinical names to real things, so that «I'm anxious» can become «I keep thinking I'll get it wrong», which is a sentence you can work with. And to clubs it returns **only aggregated, anonymous signals**, never an individual girl's data — a condition without which, on this subject more than any other, nobody would write anything true.

The value is entirely in the head start: spotting a pattern while it is still a pattern, instead of discovering it the day a registered player stops turning up. It is the same mechanism that drives [girls out of sport in adolescence](/en/blog/abbandono-puberta) — and there too, what is almost always missing is a way to say it sooner.

## When to see a professional

If the distress has lasted weeks, if it has left the pitch and reaches school, sleep and relationships, if a girl has stopped taking pleasure in something she used to love, or if any thought of self-harm appears, the route is not to wait it out: talk to your paediatrician or family doctor, who can point to the right pathway. You do not need a full-blown crisis to ask for an opinion — you only need someone to think it is worth asking for.

## Frequently asked questions

### What is performance anxiety in a young athlete?

It is not a single state of mind, and that is the most useful thing to know. The instrument most used under age 15, the Sport Anxiety Scale-2, breaks it into three distinct components: somatic anxiety (the body reacting — heart rate, stomach, muscle tension), worry about performing poorly, and concentration disruption. A factor analysis of 1,038 athletes aged 9-14 confirmed that the three-factor model holds for 9-11 year olds and 12-14 year olds alike, and for both boys and girls (Grossbard et al., 2009). In practice: two girls who both say «I'm anxious» may have two different problems, and it matters which.

### Do girls have more performance anxiety than boys?

On one component yes, but the difference is modest and worth stating precisely. In the study of 1,038 young athletes aged 9-14, worry about performing poorly was highest in girls and in older athletes, while boys reported more concentration disruption in competitive situations. The authors themselves describe the association of gender and age with anxiety scores as modest (Grossbard et al., 2009). So it is not «girls are more anxious»: it is that the most common type of anxiety differs, and so does what helps.

### Does sport burnout really exist at 14?

Yes, and it has been measured. Athlete burnout is defined as physical or mental exhaustion accompanied by a reduced sense of accomplishment, leading to devaluation of the sport; the American Academy of Pediatrics clinical report names it as one of the primary reasons for attrition in youth sports (Brenner et al., 2024). On frequency, the most cited study administered a burnout inventory to 980 adolescent athletes (402 girls, 578 boys) across 29 sports: between 1% and 9% showed elevated scores on the subscales (Gustafsson et al., 2007). Not an epidemic — but not zero either: in a club with a hundred registered girls, that is one to nine of them.

### Does playing one sport all year round raise the risk of burnout?

The available data point that way, with one important limitation. A meta-analysis of 8 studies covering 1,429 adolescent athletes (mean age 15.59 years, range 12.5-17.2) compared those who specialise in a single sport with those who sample several: specialisers reported higher burnout on all three dimensions, with a difference of means of 0.87 (95% CI 0.67-1.08) on reduced sense of accomplishment (Giusti et al., 2020). The limitation: of the 1,429 athletes, 1,371 (95.9%) were specialisers and only 58 (4.1%) were samplers — a very unbalanced comparison, which makes the finding indicative rather than conclusive.

### Do female athletes report more anxiety and depression than male athletes?

In elite data yes, but the population matters and must be stated. A systematic review and meta-analysis of 60 studies in elite athletes — largely adults, not adolescents — found higher rates in female athletes for anxiety (rate ratio 1.17; 95% CI 1.08-1.27), depression (1.42; 1.31-1.54), distress (1.98; 1.40-2.81) and disordered eating (2.19; 1.58-3.02); sleep disturbance was reported at similar rates in both sexes (1.13; 0.98-1.30, not significant). Male athletes reported more alcohol misuse, illicit drug use and gambling problems (Kew et al., 2024). These are adult elite data: they tell you where to look in a 14-year-old, not how common it is at her age.

### Which risk factors can actually be changed?

The ones around the athlete — which is good news, because they are the ones a club already controls. A systematic review of 52 studies covering 13,849 female student-athletes identified 17 determinants of depression, anxiety and stress, grouping into three families: injury (including concussion), general health (for example sleep hygiene) and social factors (for example perceived support). The pooled association is small but significant (r = 0.15; 95% CI 0.05-0.24) (Beisecker et al., 2024). The sample is US collegiate athletes, so adults: but load, sleep and support remain the three levers a sporting environment can pull at any age.

### How do I tell a bad week from something more serious?

Not with a home-made test, and this article is not for diagnosing. There are, however, features that shift the needle from observing to seeking help: duration (weeks, not days), pervasiveness (it does not stay in the gym but reaches school, sleep, friendships), loss of pleasure in something she used to enjoy, and withdrawal from relationships. The International Olympic Committee consensus statement is explicit on one point: mental health symptoms in athletes should be recognised and managed like any other health issue, by competent professionals (Reardon et al., 2019). A coach does not need to diagnose: a coach needs to notice and to refer.

### What can a coach do concretely?

Three things that need no psychology degree. First, separate the person from the performance in everyday language, because that is the fuel for worry about performing poorly — the anxiety component highest in girls (Grossbard et al., 2009). Second, look at the calendar before the character: specialising in a single sport year-round is associated with more burnout (Giusti et al., 2020), and recovery is an ingredient of training, not a reward. Third, keep a route in: a girl who knows who to tell tells someone sooner, and sooner almost always means reversible.

### Does telling an athlete it is «all in her head» help or hurt?

It hurts, for a precise reason: it pits against each other two things that coexist in reality. Burnout is defined with a physical as well as a mental exhaustion component (Brenner et al., 2024), and among the determinants of anxiety and depression symptoms in female athletes, injury and sleep quality sit alongside social factors (Beisecker et al., 2024). «It's all in your head» asks an athlete to choose between feeling ill and feeling weak, and the predictable consequence is that she stops reporting what she feels. The useful framing is the opposite: what you feel is real — let's look at what is feeding it.

## Sources

- Grossbard J.R., Smith R.E., Smoll F.L., Cumming S.P. **Competitive anxiety in young athletes: differentiating somatic anxiety, worry, and concentration disruption.** *Anxiety, Stress & Coping*, 2009;22(2):153-166. (confirmatory factor analysis in 1,038 athletes aged **9-14**; gender and age described by the authors as modestly related to scores) [doi:10.1080/10615800802020643](https://doi.org/10.1080/10615800802020643)
- Gustafsson H., Kenttä G., Hassmén P., Lundqvist C. **Prevalence of Burnout in Competitive Adolescent Athletes.** *The Sport Psychologist*, 2007;21(1):21-37. (980 Swedish adolescent athletes — 402 female, 578 male — across 29 sports; 1-9% with elevated subscale scores. A **screening** instrument, not clinical diagnoses; the hypothesis of higher prevalence in individual sports was not supported) [doi:10.1123/tsp.21.1.21](https://doi.org/10.1123/tsp.21.1.21)
- Giusti N.E., Carder S.L., Vopat L., Baker J., Tarakemeh A., Vopat B., Mulcahey M.K. **Comparing Burnout in Sport-Specializing Versus Sport-Sampling Adolescent Athletes: A Systematic Review and Meta-analysis.** *Orthopaedic Journal of Sports Medicine*, 2020;8(3). (8 studies, 1,429 adolescent athletes, mean age 15.59 years. **Highly unbalanced groups**: 1,371 specialisers vs 58 samplers) [doi:10.1177/2325967120907579](https://doi.org/10.1177/2325967120907579)
- Brenner J.S., Watson A., AAP Council on Sports Medicine and Fitness. **Overuse Injuries, Overtraining, and Burnout in Young Athletes.** *Pediatrics*, 2024;153(2):e2023065129. (American Academy of Pediatrics clinical report; a clinical guidance document, not a primary study) [doi:10.1542/peds.2023-065129](https://doi.org/10.1542/peds.2023-065129)
- Kew M.E., Dave U., Marmor W., Olsen R., Jivanelli B., Tsai S.H.L., Kuo L., Ling D.I. **Sex Differences in Mental Health Symptoms in Elite Athletes: A Systematic Review and Meta-analysis.** *Sports Health*, 2024;17(4):732-743. (60 studies in **elite athletes, largely adults**, not adolescents) [doi:10.1177/19417381241264491](https://doi.org/10.1177/19417381241264491)
- Beisecker L., Harrison P., Josephson M., DeFreese J.D. **Depression, anxiety and stress among female student-athletes: a systematic review and meta-analysis.** *British Journal of Sports Medicine*, 2024;58(5):278-285. (52 studies, 13,849 **NCAA female student-athletes**, therefore adults; meta-analysis of 13 studies, N=5,004, r = 0.15) [doi:10.1136/bjsports-2023-107328](https://doi.org/10.1136/bjsports-2023-107328)
- Reardon C.L., Hainline B., Aron C.M., et al. **Mental health in elite athletes: International Olympic Committee consensus statement (2019).** *British Journal of Sports Medicine*, 2019;53(11):667-699. (consensus document on **elite athletes**, largely adults) [doi:10.1136/bjsports-2019-100715](https://doi.org/10.1136/bjsports-2019-100715)

*This article is for information and education only and does not constitute medical advice or psychological counselling. If a girl shows distress that persists, that takes away the pleasure of what she used to do, or that reaches life outside sport, speak to your paediatrician or family doctor. If thoughts of self-harm are present, seek help from a healthcare professional immediately.*