Unseen Wounds: The Impact of Medical Trauma and Chronic Illness
- laurenmcl6
- Sep 26, 2023
- 7 min read
The prevalence and treatment of trauma and Post-Traumatic Stress Disorder (PTSD) has been an increasing concern to the general public, treatment providers, health practitioners, and policy makers for at least the past decade (if not longer). What started as a way to diagnose and treat veterans who were returning from war has now continued to morph into other arenas such as abuse, neglect, accidents, acts of terrorism, natural disasters, and more. The more we are beginning to learn and understand trauma, the more we are becoming aware of the different ways that trauma can occur and impact a person. However, one area that still seems to be on the cusp of attention is medical trauma.
Medical trauma is defined as an emotional and physical response to pain, injury, serious illness, medical procedures, or frightening treatment experiences (ISTSS, 2020). In order to receive a diagnosis of PTSD, one of the criteria is exposure to actual, or threatened death, serious injury, or sexual violence either directly, by witnessing the event, by learning that it happened to a close friend or family member, or by repeated, or extreme, exposure to aversive details of the trauma (DSM, APA, 2013). According to the DSM definition, medical trauma may or may not be legitimized; however, it does without a doubt occur.
In the United States alone, there is a staggering amount of individuals who experience life-threatening medical diagnoses or treatments. As of January 2019, there were an estimated 16.9 million cancer survivors and this number is projected to increase to 22.2 million by 2030 (National Cancer Institute, 2020). In addition, the Centers for Disease Control (CDC, 2023) has estimated that at least 6 in 10 Americans live with chronic illnesses like heart disease, stroke, diabetes, etc. and these chronic illnesses are the leading causes of death and disability in America. Beyond just chronic illness diagnoses, the number of individuals who visit emergency rooms for chronic conditions is staggering. During 2017-2019, 22.9% of adult emergency room visits were made by people with one chronic condition, 15.3% were made by those with two, and 23.3% were made by those with three or more and these numbers rise with age (CDC, 2022). Considering the life-altering effects of even having a diagnosis in the first place, coupled with the high rate of using the medical system, and this area is ripe for potential medical trauma.
Other factors that can contribute to developing medical-related traumatic stress is the fact that many chronic illnesses come with the development of mental health conditions. Sometimes the mental health condition may be there prior to the chronic illness diagnosis and other times it may occur as a result of obtaining a chronic illness diagnosis. Either way, there have been numerous studies examining the connection between chronic conditions and mental health symptoms such as depression, anxiety, and grief and loss. Furthermore, having a chronic illness, and possibly struggling with mental health issues, can lead to isolation for many individuals, which predisposes someone to traumatic stress since they do not have a good support network in place. In addition, many individuals also experience secondary crises as a result of having a chronic condition. These secondary crises can include developmental (resulting in a change of quality of life), physical (such as physical limitations), existential (questioning one’s identity, meaning, and purpose), relational (relationships with others change), occupational (the ability to work or maintain a career changes), spiritual (questioning faith and beliefs), and self (how we view ourselves). In general, people can experience a wide range of reactions to having a chronic illness that may make them predisposed to developing medical traumatic stress symptoms.
Now, there are lots of different experiences that people have when managing a chronic illness and not all of them are negative. However, there can be experiences related to the illness or medical treatment that can be difficult, uncomfortable, or frightening. These can include a sudden, life-threatening illness and its related treatment, shock and feeling out of control when receiving a diagnosis, life-changing complications during or after a medical procedure, unexpected and/or invasive medical interventions, a missed diagnosis or delayed diagnosis, dismissive healthcare providers, or seeing frightening or disturbing images or thoughts due to delirium, being in a coma, or being under anesthesia. After these events a person may have a traumatic stress response. Now, this isn’t the same as developing PTSD. For many people, after a traumatic event occurs, they will develop what is called Acute Stress Disorder (ASD). This may include symptoms that are similar to PTSD, such as flashbacks, nightmares, intrusive memories, anxiety, difficulty sleeping, irritability, difficulty concentrating, etc. but they are short-term and will usually dissipate and ease up over time. This is normal and it is how people can react to an event. It is when a person gets “stuck” in these types of symptoms longer-term that it can develop into PTSD. But remember, each person does have their own unique responses.
Some warning signs that you might be developing PTSD or are continuing to struggle with the medical event may be that you keep going over the details of the event in your mind. Memories can happen at any time and that can be typical but if it is more like a tape playing in your head over and over again, almost like an obsession, and it is causing you a lot of distress, then this can be a red flag. Also, if you are avoiding people, places, or things that remind you of the event, such as not wanting to go back to the hospital, not taking your medications, not wanting to go see your doctor, and it is interfering with your well-being, that is a red flag. In addition, if you, or others, have noticed that there have been changes in the way you think and feel or if you find yourself not trusting others, especially medical providers, red flag! Lastly, if you are constantly feeling on edge, jumpy, always looking over your shoulder, not sleeping, having trouble controlling your symptoms, and you always seem angry and irritable, that is another red flag.
What can we do to counter these red flags? Well, just like with a physical wound, your emotional wound will also need to be dressed and treated. The process may be uncomfortable, but it is necessary for healing and research in the field of trauma has shown that avoiding dealing with it just makes it worse and causes it to stick around longer. There are things that can help and there are resources that are available. For those of you who may have experienced medical trauma and are needing resources to cope, make sure to talk to someone about what happened. Again, you may want to avoid doing so but that can make it worse so choose those people, or professionals, that help to make you feel safe and secure and talk to them. It may be hard at first but over time talking about the events, emotions, and thoughts, will begin to feel less intense and you may understand yourself better and be more resilient against any events that occur in the future. Also, deep breathing, meditation, mindfulness, and grounding can be helpful to manage distressing situations, thoughts, and emotions. Slow, deep breathing can also help alleviate pain, slow down your heart rate, and reduce your blood pressure. There are many different types of exercises out there that you can do so experiment to find out what you like and what you do not like.
In addition, make sure to be gentle on yourself and take time to adjust. It can be difficult to get back into a routine after the event so go slow. Make time to do things you enjoy, take it one day at a time, and slowly return to a routine that works for you. If you think you need more professional assistance, make sure to seek the help of a mental health professional. Try to find someone that specializes in trauma and/or chronic illness and if the first person you find is not a good fit then try another person. Sometimes it takes a few tries to find someone you click with and that is okay. Remember, you are interviewing your professional healthcare team to ensure they are a good fit for you so don’t be afraid to ask questions and get a feel for whether you will feel safe and comfortable with this person. Also, educate yourself on medical trauma and its effects and what you can do to counteract it so you can appropriately advocate for yourself and set healthy boundaries. Lastly, some apps for mental health have been beneficial for some individuals. Apps such as Virtual Hope Box, PTSD Coach, Family Coach, Move Forward, CBT-I Coach, Headspace, Calm, and so much more can be helpful and right at your fingertips. Do some digging, try some out, and see if they can work for you.
For loved ones and professionals who are supporting someone with a chronic illness and medical trauma, some things to consider are to try to prevent symptoms from getting worse in the first place. In our society, we tend not to integrate physical and mental health care even though the two really should not be distinct. Loved ones can research and connect with professionals and support groups for themselves to learn how best to support the person and professionals can network with physicians so that physicians can make appropriate referrals. And trust me, physicians are always looking for mental health referrals for their patients. For healthcare professionals, assessment can be a great way to catch someone who has gone through medical trauma, or is experiencing ASD or PTSD, even if that is not what they come in for originally. Assessing possible trauma and specifically asking about any traumatic medical events can help to identify individuals who may be at more risk and may need further assistance and ongoing support. Next, if you have identified someone that may need further assistance, provide appropriate interventions that are tailored to that person’s unique needs. There are a wide variety of treatment options available including Trauma-Focused Cognitive Behavioral Therapy (TF-CBT), Mindfulness-Based Cognitive Therapy (MBCT), Cognitive Processing Therapy (CPT), EMDR, Neurofeedback, Narrative Therapy, and other holistic approaches. Finally, regardless of whatever treatment modality you have selected, try to focus on posttraumatic growth. Like other types of trauma, medical trauma can be a catalyst for growth, healing, and rediscovering meaning and purpose. Healthcare professionals play a significant role in helping individuals process their thoughts and emotions surrounding a traumatic event and it can be through this process that individuals arrive at new meaning and the realization of health and well-being that goes beyond the trauma.
Medical trauma is an often overlooked aspect of living with a chronic illness, but its impact can be profound. Whether you are a person with a chronic condition, someone who has experienced medical trauma, or a healthcare professional, just know that medical trauma is real. Your experiences are valid and the resulting reactions from those experiences are real. There are many options available for continued support and, with time, growth and healing is possible. Remember, you are not alone in this journey and there is hope for a better tomorrow.
For more information, check out the resources below.
コメント