What Is Medical Trauma?
Traumatic events are intense stressors that cause distress and exceed a person's ability to cope. When a traumatic event isn't processed and a feeling of safety isn't regained, a person may experience ongoing symptoms and/or develop a mental health condition(s), like acute stress disorder (ASD) or post-traumatic stress disorder (PTSD). Mainstream culture often recognizes traumatic events like war, natural disasters, and sexual assault as potential causes of ASD and PTSD. However, chronic illness and medical events can also cause traumatic stress.
The phrase "medical trauma" can seem confusing since, in a medical setting, the term "major trauma" is used to describe physical illness or injury that could be life-threatening or lead to long-term disability. Medical trauma differs from major trauma in the sense that it specifically describes psychological trauma that stems from illness or medical experiences rather than the physical trauma itself.
What causes medical trauma?
According to the Diagnostic and Statistical Manual, Fifth Edition (DSM-5), any experiences can become traumatic experiences if they result in a person being exposed to death, threatened death, serious injury, or threatened serious injury. During traumatic experiences, a person often feels shocked, helpless, and not in control.
Chronic illnesses or medical procedures can lead to medical trauma if these conditions are met. For example, a person may experience threatened death when being told they have developed a life-threatening illness or when severe symptoms make them fear or feel as if they're dying. If a person is hospitalized or in another medical setting as part of their treatment, they may witness the death or dying of other patients. Serious injury or chronic pain can also be traumatic, as a person may feel shocked by the intensity and helpless to stop the pain or change their situation.
Childhood medical trauma
Some experts believe that children face a particularly high risk for medical trauma. In children, medical trauma is referred to as pediatric medical traumatic stress (PMTS). A child may develop medical trauma if they experience serious illness or injury, painful or invasive medical treatments, or caregiving experiences in a hospital or other medical settings that they view as scary, overwhelming, or threatening.
Medical trauma might also impact children more severely than it does adults. Children—especially those in early childhood—are in the midst of rapid development. They are growing in their ability to form relationships with others, describe their experiences, and regulate their emotions. Experiencing trauma during this time has been found to impact the brain, sensitivity to pain, relationships, and development in the physical, social, and emotional spheres.
Not all children who experience medical trauma also experience long-term negative effects from it. How a child reacts to medical trauma is thought to be greatly influenced by the situation and their closest relationships. Children are very sensitive to those around them, especially their parents/caregivers and close family members, and they turn to these close relationships for a feeling of safety. Seeing how others react to the child's illness, injury, or medical treatment can influence how safe the child feels and how the experience may impact them long-term.
Symptoms of medical trauma
The symptoms of medical trauma are similar to the symptoms of any other trauma. In the acute phase of trauma, which refers to the days and weeks after a traumatic event, a person may notice multiple changes. For example, they may have trouble sleeping, difficulty focusing, mood swings, a desire to isolate themselves, and/or increased impulsivity. They may also struggle with memory, have an exaggerated startle reflex, and/or feel more sensitive to touch, sounds, and other sensations.
If a person's response to medical trauma is more severe or long-lasting, it may qualify as a diagnosable mental health disorder. Two common, trauma-related mental health conditions are acute stress disorder and post-traumatic stress disorder.
Acute stress disorder (ASD)
To be diagnosed with acute stress disorder (ASD), a person must be exposed to a traumatic event and then experience more than eight symptoms from a list of symptoms that fall into five categories:
- Intrusion symptoms: distressing memories, nightmares, or flashbacks to the illness or medical event
- Negative mood: struggling to feel happy, successful, or loved
- Dissociative symptoms: feeling detached from oneself and one's emotions, having amnesia surrounding the illness or medical event
- Avoidance symptoms: avoiding thoughts, feelings, and memories related to the illness or medical event, avoiding people and places that act as reminders of the illness or medical event
- Arousal symptoms: sleep problems, irritability and rage, high levels of alertness to surroundings, increased distractibility, and strong reactions to sudden changes in one’s environment
ASD symptoms last between three days and four weeks. They can majorly impair a person's ability to function, whether at work, socially, or in other daily activities. If ASD symptoms last over a month, then the person may have PTSD.
Post-traumatic stress disorder (PTSD)
The diagnostic criteria for post-traumatic stress disorder (PTSD) are similar to those for ASD. A person must be exposed to a traumatic event, which they then re-experience through nightmares, flashbacks, or intrusive memories. As a result, they try to avoid thoughts, feelings, or situations that remind them of the traumatic event. At the same time, they experience an increase in negative thoughts and their nervous system is increasingly aroused. Nervous system arousal may be seen through physical symptoms like sleeping problems and an increased startle response.
The primary difference between these two mental health disorders is their timing and duration. Unlike ASD, with PTSD, symptoms last over one month. If the symptoms don't occur until at least six months after the traumatic event, it’s usually considered to be PTSD with delayed expression. If a person develops ASD and receives treatment for it quickly, they may reduce their chances of developing PTSD.
Effects of medical trauma
Some experts suspect that medical trauma can negatively impact a person's health outcomes above and beyond the amount that trauma normally impacts health. It is well-established that PTSD is often linked to other illnesses and that developing PTSD can negatively impact a person's health in many ways. On top of this, a person whose PTSD resulted from medical trauma may experience avoidance behaviors around medical care. For example, fear stemming from their past medical trauma may keep them from receiving vaccinations, attending routine medical checkups, or undergoing necessary surgical procedures.
Another potential effect is the concept of cumulative adversity. In the context of medical trauma, cumulative adversity is a phenomenon in which a person with a chronic illness or disease experiences trauma as a result, which in turn worsens their condition or leads to the development of a new illness or disease. One reason is that people who have experienced medical trauma may develop maladaptive coping mechanisms for challenges related to their illness. These coping strategies could then worsen the course of their illness or cause new illnesses. With time, this pattern may lead to a snowball effect in which a person's mental and physical health are worsened as one continually, negatively impacts the other.
Remote therapy for medical trauma
It’s generally recommended that people experiencing the effects of trauma—including medical trauma—meet with a mental health professional for treatment. Remote therapy is one option that may feel safer or more comfortable for people who might feel tense in a clinical setting due to their medical trauma history. Remote therapy can be attended from the comfort of home or anywhere with an internet connection.
BetterHelp is an online therapy platform that can connect you with a therapist who specializes in your areas of need. Research suggests that, in many cases, online therapy can be as effective as in-person therapy for addressing symptoms of PTSD.
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