Naomi Osaka's anxiety concerns make perfect sense - mental health issues in athletes are wildspread, according to experts

• Naomi Osaka announced she would be withdrawing from the French Open, citing mental health reasons.
• She initially boycotted post-match press conferences, before pulling out altogether.
• Media attention can exacerbate anxiety and depression and "impostor syndrome," according to experts who spoke to Insider.

Naomi Osaka withdrew from the French Open this week after saying she gets "huge waves of anxiety" when dealing with press. The 23-year-old tennis pro was fined $15,000 for skipping a post-match press conference, and then pulled out of the tournament altogether when she was threatened with expulsion.

"I get really nervous and find it stressful to always engage and give you the best answers I can," Osaka, who is currently the number two female tennis player in the world, wrote on Instagram. "So here in Paris I was already feeling vulnerable and anxious so I thought it was better to exercise self-care and skip the press conferences."

Osaka's words highlight the pervasiveness of high-functioning anxiety.

Psychiatrist Dr. Leela R. Magavi, the regional medical director for Community Psychiatry, who has worked with many student and professional athletes, told Insider media attention can exacerbate insecurities in sports players, which can lead to "debilitating anxiety as athletes may feel pressured to look, speak or present a certain way."

It can also increase the chance of developing, or worsen feelings of "imposter syndrome" - a psychological phenomenon where people doubt their skills and talents and constantly worry they will be exposed as a fraud.

"Many athletes ruminate about what they said during an interview or how they were portrayed in an article or television segment," Magavi said. "They may replay portions of what they expressed and blame themselves for the content of their speech."

Some athletes have told Magavi in therapy sessions they felt that one comment or statement they made could ruin their professional careers or personal lives, she said. This means some will agonize over questions they might be asked in interviews for hours, and prepare how they might respond if controversial topics are brought up.

"This anticipatory anxiety could adversely affect their processing speed and their performance during the match, game or tournament," Magavi said. "This kind of pressure can cause demoralization and cause or exacerbate self-esteem concerns, eating disorders, depression, anxiety, insomnia, and suicidal thoughts."

Osaka's decision could be a turning point in what is expected from athletes

Ronald Stolberg, PhD, a licensed clinical and sports psychologist and professor at Alliant International University, told Insider Osaka's situation may be a "watershed moment" for awareness around mental health issues in athletes.

"A young, female, international superstar being bullied by the four major events in her sport because of a mental health condition has awful optics for the tennis tour and sport in general," he said. "This incident highlights the pressure placed on athletes to participate in press conferences right after competing in their sport."

Interviewees in other areas of expertise have time to prepare, while tennis players have questions fired at them straight away when they are still full of adrenaline - running on a high of their success, or potentially beating themselves up for under-performing. It could be especially difficult for them if those questions focus on topics they would rather avoid, such as their dating life, finances, lawsuits, or political issues.

Scottish tennis player and former number 1 in the world, Andy Murray, for example, admitted in 2013 he would give bland post-match interview answers on purpose, so he wouldn't have to deal with "the aftermath of any scandals."

Psychotherapist Amy Morin, the editor-in-chief of Verywell Mind who specializes in mental strength, told Insider anxiety is most likely an evolutionary trait that has stuck with us from the early days of humanity, when we developed "fight or flight" in response to danger. It probably used to serve us well when we were faced with a predator, but the adrenaline response in modern-day life is sometimes disproportionate.

Morin said in if an athlete's body is in a heightened state of awareness, and they're distracted by looming worries about public speaking, it could be difficult for them to perform at their best.

Sometimes it takes just as much strength to give up on something than to force yourself to keep going

Athletes are masters of self-discipline, but this can feed into a misconception that nothing ever bothers them. Just because someone is an excellent sportsperson, doesn't mean they will be equally skilled at delivering a talk in front of a crowd.

Morin said she is a big believer in people facing fears in life, but not when it costs them more than it's worth. It's about figuring out where your boundaries are and not stepping over that line if the costs are not worth it.

While a common mantra in sports is to never quit, Morin thinks we should actually give up on things far more often than we do. She said ego gets in the way sometimes and forces us to complete a task we set out to do, when it would serve us much better to throw in the towel.

"It takes courage to say to people, I'm not doing this anymore, and facing backlash from people who are going to say, 'You're a quitter, you gave up, you didn't try hard enough,'" she said. "Sometimes it takes a lot more strength to quit something and then it does to keep going."