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Thursday, July 24, 2014

PTSD & Chronic Illness

4:14 PM Posted by Tiffany Taft , , ,
Most people know posttraumatic stress disorder (PTSD) as being commonly seen in war veterans, survivors of a natural disaster, sexual abuse survivors, motor vehicle accidents, etc. Little public attention however, is given to PTSD in chronic illness (CI) patients.  Our summer intern, Jessica Naftaly, writes about how experiencing a chronic illness can trigger PTSD in some people.


Signs of PTSD 
Unexpected, sudden, traumatic events related to a CI can be scary. According to the Diagnostic & Statistical Manual of Mental Disorders, 5th Edition (DSM-V), a few of these events include waking up while being under anesthesia; traumatic experience in the ICU; anaphylactic shock; and traumatic surgery. Not everyone who experiences these events has PTSD, however it is important to keep the signs of PTSD in mind after a traumatic event.

These signs after a traumatic event include:

• Unwanted memories/dreams/flashbacks involving the event
• Psychological/physical reactions to stimuli that remind you of the event
• Avoidance of things that remind you of the event
• Change in thinking patterns or mood after the event
• Change in behavior after the event such as impulsivity.

These symptoms have to last more than 1 month and affect your level of functioning. If this is the case for you, please seek professional help and talk to your doctor.

Do CI Patients Really Get PTSD?
Yes. Not only have I heard stories from my CI friends who have PTSD, but also a study that looked at PTSD prevalence in multiple cases (stroke, heart surgery, gynecology procedures, etc) found the highest PTSD rates in patients with HIV (30-35%) and patients in the intensive care unit (ICU) (14-59%). Interestingly, the majority of symptoms presented varied based in the CI.

Another research study that involved cancer patients found that a majority of the subjects in the study showed PTSD symptoms but were not severe enough to receive a PTSD diagnosis. There is also research on PTSD in multiple sclerosis patients. The final study stated that 50% of chronically ill college students showed symptoms of PTSD; but again the symptoms were not frequent or severe enough for a PTSD diagnosis.

Why do Some CI patients have PTSD but others don’t?
Factors that exist BEFORE the event occurs can predispose someone to PTSD. These factors may include:

• Personality
• Mental health diagnoses
• Stressful life events
• Medical diagnoses

Factors AFTER the event can also predispose someone to PTSD. These may include:

• Quality of social support
Coping skills
• Lack of relationship with medical staff

The researchers also found that these risk factors for PTSD varied depending on the CI. Across the board, the seriousness/severity of the medical illness was not predictive of PTSD. The seriousness/severity of treatments and medical care however, were correlated with PTSD.

Why is awareness of PTSD in CI patients important?
CI patients who also have PTSD are less likely to be compliant to medical treatment. Research shows that heart attack patients who have PTSD were less likely to take their medications because taking the medication reminded the patients of their heart attack, which triggered the PTSD. These patients may also not want to return for follow up appointments with the same medical team.

There are also physical symptoms surrounding a CI patient with PTSD. PTSD patients have more physical symptoms after the traumatic event. The research suggests that this may be due to an increased awareness of one’s pain. HIV PTSD patients had lower immune function ability. PTSD can also increase mortality. Finally, the increase in physical pain leads to a patient using healthcare more often, which then increase the cost of medical care.

Doctors may not always pay attention to the signs of PTSD after a medically related traumatic event. It is important for medical professionals to watch out for the signs of PTSD and to inform patients of those signs in case PTSD develops. If you are experiencing PTSD or PTSD symptoms please talk to your doctor or contact a mental health professional.

Has your doctor ever talked about PTSD in relation to chronic illness?