Post-traumatic stress disorder (PTSD) is on our minds lately, often as it relates to veterans. However, people with medical illnesses develop PTSD too, and this happens more often than you might imagine.
As you may know, the DSM IV-TR (4th ed., American Psychiatric Association, text revision, 2000) requires the following criteria for PTSD: (a) a traumatic event that involves actual or threatened death, or the threat of physical integrity to self or others and the person’s response to that event was intense fear, helplessness, or horror; (b) at least one symptom of re-experiencing of the event, such as intrusive memories, nightmares, a sense of reliving the event, and/or psychological distress when reminded of the event; (c) three or more symptoms of avoidance, such as avoidance of thoughts, feelings, or reminders of the event, inability to recall aspects of the event, withdrawal from others, emotional numbing, sense of a foreshortened future; and (d) two or more symptoms of increased arousal, such as insomnia, irritability, concentration difficulties, hypervigilance, and exaggerated startle response.
Those of you who have been seriously ill or know someone who has may recognize some or all of these symptoms. Roughly one-forth of medical patients with heart disease and cancer meet criteria for PTSD. Some studies suggest that rates of this anxiety disorder are even higher.
As common as PTSD is, it is striking that medical clinicians don’t talk about this more with patients. Then again, maybe it is not so surprising. Talking about trauma requires a great deal of sensitivity, time and vulnerability on the part of physicians. Medical professionals often experience trauma as well, as least the vicarious kind. Having to watch patients suffer over and over again can be overwhelming.
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