What is PTSD in medicine? How PTSD May Emerge After Medical Treatment

 

Summer Ash recalls saying, "Fuck," as soon as she opened her eyes in the ICU after having heart surgery in 2012.

She tells Inverse that the piercing pain in her chest was unlike anything she had ever felt in her 36 years.

Her doctor had left for the evening, so the nurses were unable to raise the amount of pain medication prescribed. Ash claims that when the nurse reclined her, it painfully tugged at the area of her incision. The loneliness only made the hellish experience worse: after visiting hours had ended, Ash was left alone to spend the night alert and afraid.

Even though Ash wasn't formally diagnosed with PTSD until two years after the procedure, the experience was so bad that it caused her to develop the condition.

She's not alone either; research indicates that even prior to the COVID-19 pandemic, PTSD can occur up to five times more frequently in people who have undergone major surgery, spent time in an intensive care unit, or undergone other serious hospitalizations

Like Ash, I didn't receive a PTSD diagnosis in writing until several years after my operation. It took me even longer to acknowledge that I had medical PTSD and that it was a real condition.

I had two emergency surgeries after having stomach pains that led to my hospital admission in 2006. In the first, medical professionals cut out a tiny portion of my large intestine. I was rushed into a second surgery after complications from the first surgery caused sepsis; I was then wrapped in ice to lower my temperature. In the hospital for almost a month.

After that, I found it emotionally and occasionally even physically impossible to manage any interaction in a medical setting.

 

                   HOW IS MEDICAL PTSD DEFINED

According to psychiatrist and trauma expert Davis Reiss, it is a common misconception that trauma is the result of an external event, such as a roadside bomb, violent attack, or natural disaster. This is because that is how trauma used to be defined.

The previous standard required that a person either directly experience or witness a traumatic or event that could have resulted in death. But when you examine the process [of trauma], everything that causes anything that sets off the body's "fight or flight" response counts as trauma.

When someone feels that they or others are in danger, their bodies go into "fight or flight" mode, slowing down normal functions like digestion while releasing a rush of hormones like cortisol and adrenaline. It is a mechanism built into us by evolution to assist us in overcoming or escaping danger.

When the body continues to produce the fight-or-flight response after the terrifying event has passed, or produces it in hypersensitive ways, PTSD results.

According to Sacha McBain, a clinical psychologist and assistant director for physical trauma recovery at the University of Arkansas for Medical Sciences, the traumatic experience is a medical event when it comes to medical PTSD.

The distinction between medical PTSD and solely external trauma, she says, is what makes it special. We are unable to escape from the ongoing danger that resides within the body.

When compared to other kinds of trauma, Tiffany Taft, a psychiatrist and assistant professor at Northwestern University School of Medicine, says that while procedures, surgeries, and hospitalisations can certainly result in traumas, their primary source is your own body. "The crime is over when the conflict is over. I could leave if I felt unsafe if I was assaulted here in Chicago, giving me a sense of power over my surroundings.

According to Taft, who also has Crohn's disease, many of her patients suffer from medical PTSD as a result of their difficulties dealing with inflammatory bowel disease.

It "has a consciousness of its own" with chronic conditions like Crohn's and ulcerative colitis, she claims. Patients who have it consequently feel as though they could end up back in a hospital or emergency room at any time. They are unable to flee it.

McBain continues, "The other thing about Medical PTSD that's really significant is that it's enacted within the system of care itself. "So, it's approximately that's happening interpersonally, in the setting of affairs, structures, and schemes, as well as intrapersonal, something that's in within you as an different."

WHAT ARE SOME OF THE USUAL RISK ELEMENTS FOR THE DEVELOPMENT OF MEDICAL PTSD?

Medical PTSD can result from a wide variety of medical events, but study indicates that some situations are more likely to cause PTSD than others. Invasive surgeries, cardiac disease, stays in intensive care units, miscarriage, childbirth, cancer, inflammatory bowel disease, HIV/AIDS, and Covid-19 are among the medical conditions or events that are closely linked to PTSD.

A background of trauma, however, is one of the biggest indicators that a patient will experience PTSD following a medical event.

"In terms of pre-trauma risk, we know having a pre-existing trauma history is a significant risk factor in developing PTSD after a medical event," explains McBain. People with marginalised or oppressed identities who have experienced prejudice and oppression are at higher risk, it has been demonstrated.

Lack of straightforward communication of information and a lack of confidence in the clinician are additional risk factors for patients.

Ash says her heart surgeon gave her unrealistic expectations about what her recovery would be like.

You're youthful; you'll recover, he said, according to me. He implied that if I carried out my responsibilities, every day would be better than the one before, she says. That wasn't the situation, either.

Following a medical event, complications, the length of the stay, and medical debt can all add to the development of PTSD.

When Mimi Cabral-Martin was 21 years old, she was almost fatally injured in an automobile accident: Her intestines split due to the crash's impact, and surgeons had to remove some of it. Getting the right medical treatment — and having it covered — in the years since, despite the fact that her seven-year hospital stay was traumatising, has added to her PTSD.