PTSD can be due to medical trauma

Dear Dr. Roach: I work with a group for people with a type of cancer resistant to chemo or radiation, and many of the members have had to have numerous, life-altering surgeries, including amputations. A member asked whether others had symptoms of PTSD and said two therapists told her that PTSD could not be caused by medical issues. But I have read a few articles saying that it can be induced by trauma from medical procedures and illnesses. Can it?

T.M.H.

Answer: The term “posttraumatic stress disorder” is used informally by nonprofessionals to describe many things, from anxiety to unpleasant tasks. When used in its proper medical sense, it is a complex reaction to psychological trauma, and may have physical, intellectual, emotional and behavioral symptoms. Among the most important diagnostic features of PTSD are intrusive thoughts, nightmares and flashbacks of traumatic events, and these lead to poor function at work or in personal relationships.

A discussion of the formal diagnosis of PTSD is beyond the scope of this column, but to qualify it must include a traumatic event; intrusive symptoms such as flashbacks; a change in behavior to avoid reminders of the trauma; unpleasant changes in mood or thought; and unpleasant symptoms, such as irritability or poor sleep.

It also may include behavior changes as a result of the trauma.

Your question is about the type of trauma that can lead to PTSD. While we often think of extreme singular events, such as those faced by military personnel or first responders, the trauma in people diagnosed with PTSD may be a series of multiple events, not one particularly horrible one. Sexual assault and mass displacement from famine or warfare are other traumatic events that commonly trigger PTSD.

Medical causes account for approximately 6.5% of PTSD in a recent study. Heart attack, stroke and a stay in intensive care for any reason are the most reported traumatic medical events associated with PTSD. Life-altering surgeries such as amputations certainly could trigger PTSD, and the therapists who denied this were simply wrong.