Post-Traumatic Stress Disorder: A Silent Epidemic?

The diagnosis of PTSD has gained media attention regarding veterans returning from conflicts in Iraq and Afghanistan such that a basic knowledge and understanding of this disorder has become mainstream. The average person on the street has at least heard of the disorder and has some idea about what the symptoms are and perhaps even a basic idea of how it happens. Commonly associated with war, natural disasters, terrorist acts, or other forms of community violence, PTSD might be thought of as a survivor’s disease. Extrapolating from those groups of people to other populations such as battered women or children who have experienced physical abuse is not a big stretch. But medical patients? Let’s take a closer look.

Certain diseases and conditions come on suddenly, their diagnosis hitting you like a ton of bricks (cancer springs to mind). Treatment may be invasive and disrupt daily life, and is surrounded by intense emotions of fear and hope. Other conditions, like heart attacks or strokes, truly “strike” and in a moment change your entire life. These sudden onset life-threatening medical emergencies can put you in frightening and overwhelming situations where you may feel terribly out of control. When you give it a moment’s deeper consideration, it isn’t surprising that PTSD may develop, secondary to a major medical incident or diagnosis.

What sort of symptoms do people with PTSD from medical conditions experience? In order to be diagnosed with PTSD, you must meet the same criteria as any other person with PTSD: symptoms of re-experiencing the trauma as flashbacks or nightmares; avoidance of the trauma in ways such as literal avoidance (i.e., refusing to go to the place where the stroke occurred) or emotional avoidance (i.e., shutting down, sleeping a lot, refusing to socialize, or refusing to discuss what happened); and hyper-arousal, which means feeling tense, nervous and worried that something bad will happen. For stroke or heart attack survivors with PTSD, this can look like avoiding the room in the house where the stroke happened, or having flashbacks when you see the recliner you were sitting in when you had the heart attack. Insomnia and mood changes such as irritability or depression are common as PTSD develops.

Stroke Survivors

According to recent statistics, stroke survivors have a 23 percent chance of developing PTSD. That’s almost one in four, or one-quarter of all stroke survivors. That’s a huge percentage, and translates into almost 300,000 new diagnoses of PTSD among people who have suffered strokes each year.

Unlike in populations such as former combat veterans or people who have survived a community trauma (for example a hurricane or witnessing a terrorist attack), stroke survivors have not typically been seen as at risk for developing PTSD, and as such have not been identified as readily. Researchers believe that the numbers of stroke survivors suffering from PTSD may be even higher. Increasing attention and improving screening has been suggested as part of the post-stroke recovery protocol to improve recognition and treatment of PTSD in this population.

Cancer Survivors

Like people who have had a stroke, cancer patients undergo intense emotions and invasive procedures as part of their medical treatment. PTSD is not uncommon among survivors. Certain specific situations are correlated with a higher likelihood of developing PTSD:

  • Recurrence; if you have been cancer free for some time and the cancer returns, this seems more likely to result in PTSD than an original diagnosis.
  • If you have had a bone marrow transplant, a longer hospital stay is correlated with a greater chance of developing PTSD. Similarly, the more advanced the cancer is when you have your bone marrow transplant, the greater the chance of PTSD.
  • For children, the longer the treatment takes, the greater the chance of developing PTSD.
  • If you have other, previous traumas (such as being a combat veteran or a sexual abuse survivor), your chances of developing PTSD after your cancer treatment increase.

Heart Disease

A heart attack may be one of the most common and most feared traumatic medical emergencies you may face. The statistics indicate that women, especially women over the age of 35 who smoke, are at a greater risk than ever for developing heart disease and heart attacks, and heart disease is the leading cause of death for women in the United States. Like a stroke, a heart attack is a sudden, terrifying medical emergency that thrusts the victim into a situation in which you feel vulnerable, out of control, and overwhelmed.

In addition to the statistics regarding stroke, the converse is also true—that having been diagnosed with PTSD raises your risk of having heart disease. While this is a correlation (meaning that one does not cause the other) researchers report that for those people with heart disease who were also diagnosed with PTSD, their heart disease worsened at a faster rate.