Recognizing the Risk of PTSD in Our Patients

When we think of PTSD, many practitioners automatically think of soldiers, rape survivors, or childhood abuse survivors.

Few of us think about other groups of people, particularly the patients in our hospitals, with a high risk of developing PTSD.

According to a new study published in the Journal of the American Academy of Orthopaedic Surgeons (JAAOS), one of these groups would include individuals who have undergone orthopedic surgery.

Daniel Aaron, MD, from Brown University’s Department of Orthopedics, was the paper’s principle author.

He noted that between 20-51% of patients with musculoskeletal injuries develop PTSD, with the result being that returning to work, activities of daily living, patient perception of physical recovery, and objective physical parameters are all highly affected.

Similar findings have been suggested from papers published on women who have undergone ovarian cancer treatment and intensive care patients.

In the May 2011 issue of the Journal of Psychosomatic Research, researchers Gonçalves, Jayson, and Tarrier from the University of Manchester, United Kingdom, found that 36-45% of the 121 ovarian cancer survivors in their longitudinal study experienced PTSD at some point between the start of their chemotherapy treatments and the 3-month follow-up appointment post-treatment.

You may remember the 2008 study published in General Hospital Psychiatry, which showed that 20% of intensive care patients experience PTSD following their hospital stay.

Other articles have continued to show this same trend.

I am pointing out these statistics mainly because we in the health and mental health fields are all in a position to do something about it.

One suggestion was published last year in the journal Critical Care.

Richard Griffiths, MD, and Christina Jones from the University of Liverpool, United Kingdom, worked with 352 intensive care patients in 12 hospitals in 6 European countries.

162 of these patients were given diaries which were completed daily by nursing staff and family members. Written entries had corresponding photos attached to them.
Diaries can help prevent PTSD
After the patient left the intensive care department, they were given these journals and walked through them by the nursing staff.

When compared to the control group, these patients with diaries were less than half as likely to develop PTSD.

This is one way to address the issue of PTSD development in our patients.

We have created a new teleseminar series, New Treatments for Trauma, in an attempt to offer cutting edge information on the treatment of trauma and PTSD.

Each week, we will be interviewing a new expert in the field, who will discuss topics like:

  • How to Expand the Window of Tolerance
  • What Practitioners Need to Know About Trauma and the Nervous System
  • Screening for PTSD: 4 Simple Questions
  • The Traumatized Individual: From Paralysis to Transformation
  • Attunement, Misattunement, and Re-attunement: The Recipe for Building Stress Resilience

For more information, please click here.

What techniques or suggestions do you have for keeping patients from being traumatized due to medical procedures and medical conditions?

Please comment below.


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15 Comments

  1. Nancy Nadolski says:

    I am looking for a Bosnian speaking therapist for my patient. She arrived with her translator to my office with unremitting insomnia and chronic pain. While I did not ask for her trauma story, it came tumbling out. After 16 years in the US she does not speak English. I have found resources for written materials in Bosnian for PTSD. Does anyone in this community know a licensed therapist who has a strong grasp of the Bosnian language and would be willing to Skype. Thank you in advance for any information you can get for me. Blessings and peace, Nancy Nadolski, FNP

  2. Matthew John says:

    Circumcision!—definitely the beginning of TRAUMA in one’s life. THEN, look at the insecure, ambivalent, chaotic, etc. types of ATTACHMENT BONDS (mother-infant) that result. The resulting LACK of emotional centeredness and security (typically learned from Mom, it’s not innate behavior) easily leads to all sorts of clever coping strategies that cover up a potentially BORDERLINE PERSONALITY DISORDER (BPD).

    But there is Great Hope. Read this AMAZON review, THE ANGRY HEART. (Connect the dots and see how a small, innocent infant might have deep-seated anger at the world. Taken from Mom, love & warmth… and put under the knife. Many circumcisions were done w/o pain killers years ago, even today. See Doctorsopposingcircumcision.org)

    REVIEW: “Some persons with BPD really cannot use therapy very well, and in many parts of the country–outside the NYC and San Francisco and a couple of other major urban centers–it is hard to find therapists who really know how to work with borderlines. Indeed, many therapists don’t even recognize BPD when it’s right in front of them, especially if the borderline is talented (as so many are) at knowing what the therapist wants to see in order to think well of him or her. Especially when a very smart BPD, having spent a lifetime at pleasing authority figures and cajoling them into the role of caretaker, encounters a rather less smart therapist, the stage is set for a folie a deux, with the therapist ratifying the patient’s pathology and falling into something like the role of worshipful caretaker.
    Thus, self-study is sometimes the best route for the BPD who is serious about getting better.

    Self-study is always helpful for the BPD, even the BPD who has a savvy therapist–that is, a therapist who does not want to be a hero or the sole source of help. (If your therapist doesn’t like the idea of your doing self-guided study, run.) For that purpose, too, this book is excellent.

    The authors have constructed some absolutely brilliant exercises, and they guide you through the kind of structured work that BPD’s need in order to acquire inner order in place of their terrified chaos.

    If you’re a therapist who works with BPD’s, look at this book as something you might want to suggest that your patients buy and use in conjunction with therapy. If you are, or have reason to suspect, you suffer BPD, have a look–especially if therapy hasn’t worked so well for you.

    In my experience as a therapist, I found that patients with BPD are often the most intelligent, gifted, and tragically damaged of patients–but that precisely because their inner lives are so chaotic, they are better able to acquire good structure than “more functional” patients who had well-developed maladaptive structures already in place. Taking apart a long-reinforced structure is very hard, while building from chaos is, in a sense, free of that task. This book can help with finding authentic structure, in an autonomous process that minimizes some of the dangers of BPD-in-therapy.

    I have come to believe that two things, not taught in textbooks, indicate whether a BPD can get well: courage and a good heart. If you have those things, you should never let anyone, therapist or otherwise, discourage you from the path to a whole, integrated life. If you have those, buy this book at help yourself toward a life free of the horrors of your early days.”–Bob F.

  3. I was circumcised as a little girl in Kansas, and I suspect that was what set my mind against “modern medicine” and MDs. I have PTSD due to the circumcision. I avoid doctors and medicine. I go to great lengths to take care of myself so that I will be well and not need medical “care”. I think circumcision might be why men, in general, also tend to avoid medical care.

    I wrote a book about my circumcision and have another in the works about the problems with hospital births. I am a trauma therapist and I see women break down in tears, shake and refuse to speak about their hospital births – they tell me they felt railroaded, humiliated, disrespected, overpowered, helpless to protect themselves or their babies.

    When a child is cut prematurely from her placenta, she is separated from her life support system. Ironically, she is then rushed to the NICU where she is given blood and oxygen – the very nurturance she would have received if the umbilical cord had not been cut. Studies show how physically detrimental the practice is – iron count, oxygen – yet it persists. It’s another trauma many experience.

    Then, if a child is circumcised, he is held down, restrained by adults far larger than himself, and cut on the tenderest, most exquisitely sensitive part of his anatomy, imagine the life-long trauma that causes. Putting a knife to genitals welds in the child’s mind, feelings of helplessness, hopelessness, sex and violence. I do not believe it is a coincidence that only three cultures that circumcise their young and they are at war in the Middle East. Other countries know better than to join in that war.

    Problem is, the medical field is comprised largely of circumcised men. It’s difficult to conceive of gentle, respectful care if you were not treated kindly yourself. And so the “sins” of the fathers are passed on generation after generation… Much healing is needed.

  4. Bringing light to the problem of trauma and PTSD resulting from surgeries and stays in a hospital is invaluable. From intake, through anasthesia, surgery, and recovery, the experience is all too often lacking in care and support. And what about the effects on children? Memorial Hospital in Long Beach, CA has a model program in place to help mitigate the effects on children by letting them experience aspects of what’s to come in a play setting beforehand: dressing up as doctors, playing with stethoscopes and other equipment, riding a gurney, etc. With more education on the problem of developing trauma symptoms from medical care, programs such as this may become more widespread. Hopefully.

  5. Emilie says:

    It is heartening to see this discussed. I am 61 and have been a counselor for many years. I spent long years struggling with the trauma that I experienced as a 7 year old child in the hospital. Procedures done on me without anesthetic (cut downs on my ankles for IV tubes) and repeated catheterizations that continued in outpatient for about a year, resulted in severe PTSD for me. As an adult I realized a dicotomy in thinking between “natural pain” and “inflicted pain”, which included anything resulting from medical treatment. it left me determined to never submit to any procedure that would be painful. As I result it left me vulnerable and I knew that i would choose death over having treatment for anything, including cancer or heart disease. I still will not have a colonoscopy, in spite of the hypnotic drugs given, because I know I would be alert enough during the procedure and would only forget afterwards. I refuse to be aware at all so am treated like a mental case when I tried to schedule one under general anesthetic. They agreed but their irritation made me mistrust them so I still have not had one and probably never will.
    I have done a great deal of work around this as a trauma survivor and understand much of the dynamics about it. I have finally been able to allow myself to be catheterized when something happened that required it. It was very hard to allow however.
    I believe that in general the medical community finds a patient with PTSD from medical procedures to be an annoyance more than being able to understand and have compassion. It interferes with a person’s ability to heal from the trauma when the class of people responsible for it remain aloof and judgmental, maintaining the presentation of the perpetrator as carried in the mind of the “victim”.
    I also agree with the comments of the nurses. I work for a major medical center and many of my clients are nurses who are experiencing extreme stress and PTSD type symptoms from the long hours, demanding supervisors who expect more and more “output” in the time allowed, leaving them feeling overwhelmed and scared of making a mistake in the rush of it all. Depression and anxiety are common. We already have a shortage of nurses and are burning out those whom we do have. We need to readmit compassion into the equation of medical care.

  6. Your blogpost is timely. I was wondering, after reading your two previously released trauma articles, about how serious acute and chronic illness fit into the trauma spectrum. Having had a renal transplant and multiple acute rejection episodes and hospitalizations, followed by inability to return to work certainly feels like trauma.

    I have found that “sick on sick”, an acute illness occurring on top of a chronic illness, is a real trigger for trauma symptoms to arise.

    As a nurse practitioner this opens up a whole new realm of treating patients with the challenges of ongoing serious illness.

  7. Holly Eckert says:

    I am so glad to see this subject finally surface. I am a forty-four year old woman who began experiencing epileptic seizures about 10 years ago. Very quickly inside that confusing journey, I discovered that the scariest place that I can find myself surfacing out of a seizure is in a hospital. That’s right, the most traumatizing seizure events that occurred to me took place in hospitals with doctors. It became quickly apparent to me that those spaces are about making money and not taking care for people. The hospital industry preys upon people’s misfortunes and that is traumatizing unto itself. If I have a seizure in public and someone calls an ambulance, I will surface out of that seizure in a hospital bed. The hospital staff then tells me something I know very well — that I have epilepsy. I am then instructed to take lots of drugs. I get out of the bed, get my things, say my goodbyes and exit the hospital. That’s the extent of “the care” given. I then receive a bill in the mail from the hospital for literally thousands of dollars. It’s immoral and it’s obscene. I now wear a bracelet in public that literally says, “DO NOT CALL AN AMBULANCE.” The instructions in my wallet read “Whatever you do, please do not take me to a hospital.” I tell people, “The scariest place I know is a hospital.” I recognize that the industry places huge stresses on doctors, nurses and patients, but for a chronically ill person to walk through a so called “advanced civilized democracy” fearing a hospital, that’s tragic. My real healthcare hasn’t come from doctors at all. It’s come from massage therapists, intelligent friends, acupuncturists, counselors and other people who’s mission has really been “caring” for the ill not “preying” upon the ill. I am currently writing a book about my experience. I hope to have it published by next Fall. It’ll be called “Seized.”

  8. Healing Touch as a Treatment for PTSA

    Generalized anxiety disorder (GAD) has a wide array of psychological and physical symptoms. Although prescription drugs can help, they often have undesirable side effects. Many people experiencing symptoms of anxiety now turn to complementary therapies such as Healing Touch.

    Healing Touch uses touch to influence the human energy system, specifically the energy field that surrounds the body. This non-invasive technique utilizes the hands to clear, energize and balance the human and environmental energy fields thus affecting physical, mental, emotional and spiritual health and healing.

    There have been a great many research studies done on Healing Touch and its efficacy. Healing Touch is accepted, validated and utilized in hospitals, hospices, long term care, integrative health centers, private practices, clinics and incidentally, is an accredited provider of continuing nursing education by the American Nurses Credentialing Center (ANCC).

    The time is “now” to integrate alternative, non-invasive therapies with traditional medicine in order to facilitate health and healing in our patients.

  9. Janet says:

    Included in caregiver are family and friends who fill the gap between medical care and patient. I took care of both my parents through their journey with terminal cancer. The number of traumatizing experiences I (and other family members endured) is appalling. My mother crumpling on the floor next to her hospital bed and having it take over 10 minutes to get anyone to respond and then being scolded for “allowing it to happen.” My extremely articulate and well-educated older father’s stroke symptoms being dismissed as “just getting old.” Finding out that he had been placed on the lockdown floor with a certifiably insane roommate (who exposed himself to me) because all the beds were full and the “good” rooms were full with people they could do something for. (!) My father died 6 years ago. There is only one hospital in my county. When I had to have a routine test run there recently, I broke into a sweat a block away. While I wouldn’t go so far as to label it full on PTSD in my case, it’s unacceptable to have our places of “healing” be associated with fear, impotence and shame.

  10. I work limited hours in a hospital as a music therapist specializing with cancer patients at all stages of treatment, mostly with patients receiving chemo. Although I use many techniques, the most called for is relaxation/guided imagery exercises geared to their abilities. I teach a great deal and give them tools to use at home, including a CD. I run groups for cancer survivors that focus on wellness techniques. And yes, PTSD is quite common.

  11. Mary Kathryn says:

    I agree with Meryl and Lynda. The current system is a set up for PTSD for both patient and caregiver. I was hospitalized for 4 days 7 months ago, and I am now really starting to understand how serious the PTSD is for me now…I’m glad you raised this topic. I just hadn’t quite been able put a name on it..but now as I look back, yes, all the indications are that PTSD is still here in me, despite a previous earlier intervention. OK, more work to do and I have been pushing it under the rug. Feels so hard. I can do it.

  12. Lynda says:

    I think we also need to look at caregivers, especially nurses working 12 hour shifts as PTSD potentials. We say, “They can take it , they’re young.” I know some of the trauma I endured as a nurse and took it home or buried inside for years.
    As to Meryl’s comments. More hand-holding and less drugs is such an loaded insightful statement. What happened to TLC? The change in nursing is really stressful for we older nurses who have been the TLC givers and now have to pick up the pace, work longer hours, all stressing our loving natures.

  13. Peggy Mangan says:

    Hello Meryl,

    I too had a very frightening experience while being hospitalized for a bone marrow transplant. Upon discharge I had a clear case of PTSD with no resources available to help me. I learned about EFT (Emotional Freedom Technique) and began to work with a Life Coach who knew this technique. In a short while, despite a diagnosis of a terminal cancer, I regained my joy of life. I am now a coach and work with cancer and serious illness patients.

    Peggy Mangan
    Joy After Cancer
    http://www.joyaftercancer.com
    pmangan@avci.net

  14. Meryl says:

    I wanted to write about my experience, but it’s too uncomfortable. Even after therapy. Just don’t want to go there. Let’s just say, our for-profit, medical attack system is scary. We need more hand-holders and less drugs.

  15. don hall says:

    Trauma transcript holds gold. Recognizing Cannon and Seligman for their “Freeze” frame reference certainly deserved recognition … as you, Dr. B. stated, schools should definitely teach the Fight, Flight or Freeze principles. (30-40 years ago!)What has been done lately with PKMzeta?
    Researchers have found a molecule that stores complex, high-quality memories, in a discovery that may one day lead to the ability to erase debilitating painful memories and addictions from the brain.
    In a discovery that may one day lead to the ability to erase debilitating painful memories and addictions from the brain, researchers at SUNY Downstate Medical Center have found that a molecule known to preserve memories – PKMzeta – specifically stores complex, high-quality memories that provide detailed information about an animal’s location, fears, and actions, but does not control the ability to process or express this information. This finding suggests that PKMzeta erasure that is designed to target specific debilitating memories could be effective against the offending memory while sparing the computational function of brain.
    The findings are detailed in the December edition of PLoS Biology in a paper titled, “PKMzeta Maintains Spatial, Instrumental, and Classically Conditioned Long-Term Memories.” The paper is authored by Andre A. Fenton, PhD, associate professor of physiology and pharmacology, Todd C. Sacktor, MD, professor of physiology and pharmacology and of neurology, and Peter Serrano, PhD, research assistant professor of physiology and pharmacology, at SUNY Downstate, as well as by colleagues at other institutions in Michigan, New York, Wisconsin, and the Czech Republic.

    http://biology.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pbio.0060318

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