Medical crises can be emotionally traumatic experiences. Historically, traumatic stress related mood disorders such as post-traumatic stress disorder (PTSD) have been thought of as occurring after an external event, such as war, sexual assault, natural disaster or car accident. However, in the past 10 to 15 years, these stress conditions have been increasingly recognized by psychologists as occurring following any event, including those that happen within us. It is now understood that a range of medical diagnoses, including cancer, cardiac arrest, traumatic fall and stroke are emotionally traumatic. A highly traumatic event is defined as any experience that involves the threat of death or serious injury, particularly when sudden or unexpected, that results in intense fear or feelings of helplessness. If we do not acknowledge traumatic stress symptoms as an aspect of a medical crisis, we miss an opportunity to provide complete care and optimize recovery.
Following a medical crisis, there is a range of “normal” emotional reactions. Most commonly, these include shock (“I can’t believe this has happened”), fear (feeling more vulnerable naturally leads to fear), self-blame (“Why didn’t I do more to prevent this?”) and guilt (remorse that the person in crisis is burdening his or her loved ones with caregiving needs). The time to get concerned is when these emotions are very high in intensity, worsen over time (particularly three months following the event) or interfere with recovery (refusing to do physical therapy).
Four main symptom clusters characterize traumatic stress disorders: re-experiencing (re-living the event in your waking mind or in nightmares; Feeling as though the event is happening again), avoidance (avoiding situations, people or thoughts that remind you of the traumatic event), emotional numbness (feeling cut off from others, reluctance to discuss the event, avoiding reminders of the event) and hyperarousal (feeling “wound up” and “on alert”).
Serious mood symptoms that don’t go away over time following a medical crisis are associated with poorer outcomes (less physical recovery and less return of independence) and reduced quality of life for both the person directly affected and his or her loved ones, especially caregivers.
by Karen D. Sullivan, PhD, ABPP
Pinehurst Neuropsychology and the I CARE FOR YOUR BRAIN with Dr. Sullivan Program