Supplementary file 1_From violation to stigma: a literature review of athletes' lived experiences following anti-doping sanctions.docx

Despite its protective intent, the anti-doping system functions in a complex, high-stakes environment where strict liability and public scrutiny can produce unintended harms for sanctioned athletes. To date, limited insights exist into the lived experiences of individuals sanctioned for Anti-Doping Rule Violations (ADRVs) under the World Anti-Doping Code. We located twelve English-language outputs published between 2011 and 2025 containing relevant empirical data, and used descriptive and bibliometric techniques, narrative synthesis, and citational analysis to evaluate the composition, impact, and practical relevance of this emerging body of work. Through narrative synthesis, we identified five key areas of concern: (1) psychological and emotional distress; (2) social isolation and reputational damage; (3) perceived procedural injustice and institutional abandonment; (4) disruption to career and athletic identity; and (5) a sense of resolution or clarity despite adversity. Difficulty in reaching and recruiting participants was noted in most studies. Highly cited articles were referenced across diverse domains, often due to their dual focus on doping motivations and firsthand experiences with ADRV sanctions. The direct translation of existing research into anti-doping policy remains limited. Gaps in reporting standards, the underrepresentation of female athletes, and regional imbalances in the evidence base constrain a comprehensive understanding of the personal consequences of ADRV sanctions. Despite these early limitations, this review marks a critical step toward evaluating the legitimacy of anti-doping rule enforcement from the perspective of those most directly affected. The findings highlight the urgent need for future research to inform more humane, equitable, and athlete-centred regulatory practices.