PTSD following a life-threatening diagnosis

PTSD following a life-threatening diagnosis

If you have recently been diagnosed with cancer or any other life-threatening illness, you may be feeling helpless, fearful or like your life is in danger. These are not uncommon feelings to have, and you’re not alone. For many people experiencing these kinds of emotions, there is the possibility that they may develop post-traumatic stress disorder (PTSD) or Complex PTSD as a result of this.

Medical conditions associated with an increased risk of PTSD include cancer, heart attack, sepsis, and stroke – any medical condition which makes you fear for your life can lead to PTSD or even C-PTSD. Hospitalisation into intensive care units, or medical procedures such as mastectomy, have also proven to create a high risk factor.

How can a diagnosis of a life threatening illness cause PTSD?

Any traumatic event can cause PTSD, but with a diagnosis of a life-threatening illness or injury, there are many traumatic elements in the ‘timeline’ of a life threatening condition, such as:

  • The diagnosis itself (perhaps experiencing a loss of certainty and change in perspective about the future)
  • Pain from the condition or other physical issues it causes
  • Invasive and long running tests and treatments
  • Test results (and the anticipation and worry while waiting)
  • Treatments which can cause a change in physical appearance such as amputation, disfigurement or severe scarring
  • Long hospital stays or treatments
  • The conditions return or fear of its return

Any of these traumatic events can cause PTSD, which can lead to many significant symptoms.

For example, its estimated that approximately 40% of patients with cancer experience significant emotional and social distress during treatment, with one study finding that 20% of cancer patients experience symptoms of PTSD, and about one-third of these continued to have consistent or worsening PTSD four years after their cancer diagnosis. This figure can go up to 55% for some types of cancers.

How do I know if I have PTSD following a life-threatening diagnosis?

Symptoms of PTSD don’t always happen straight away. Sometimes it can take months or even years following a traumatic event for them to become apparent. The symptoms are often characterised as experiencing an emotional numbness and avoidance of certain places, activities or people that serve as reminders of the trauma. It can also be the re-experience of the trauma of diagnosis through intrusive or distressing recollections of what has happened, including nightmares and flashbacks.

Additionally, it can come through increased arousal, which may involve difficulty sleeping or concentrating, becoming easily angered or irritable, and feeling jumpy. It can often cause an intense and prolonged feeling of psychological distress, which can also lead to physical symptoms too. PTSD may also come hand-in-hand with anxiety and depression.

You may find that after your diagnosis of cancer, or another life-threatening illness, that you are feeling more hypervigilant, aggressive, reckless or self-destructive. You may also be having difficulties concentrating, or with staying asleep or falling asleep. Your nights may involve restless, broken episodes of sleep, which can cause irritability and frustration. Additionally, you may be struggling with experiencing positive emotions, feeling detached or estranged from those around you, or be feeling less interest in participating in certain activities.

You may also find yourself feeling persistently angry, guilty, fearful or ashamed, and may find yourself blaming yourself or others for your diagnosis. This could also involve holding a sense of negativity, especially in belief systems about yourself, others, or the world around you. It may also include memory loss about certain events, trying to avoid certain memories, or flashbacks and distressing dreams. You could also find yourself being triggered by intrusive memories when you’re not expecting it.

Treatment for PTSD and C-PTSD

“Unfortunately, many patients are not referred or do not accept referral to psycho-oncology (in the case of cancer) services to be assessed and treated, as high levels of sadness and anxiety are often perceived as ‘normal’ reactions to a diagnosis and treatment; thus mood, anxiety and other psychological disorders are commonly mistaken for unexpected ‘manageable’ sadness and preoccupation with the disease.”

This can all feel equally as stressful and upsetting as your diagnosis, but the good news is that you aren’t alone. You may only have one of these symptoms, or you could have many. The most important thing to understand is that this can be perfectly normal – and can be treated.

NICE guidance updated in 2018 recommends the use of trauma focused psychological treatments for Post Traumatic Stress Disorder in adults, specifically the use of Eye Movement Desensitisation Reprocessing (EMDR) and trauma focused cognitive behavioural therapy (CBT). Speak to your GP as soon as possible about your concerns and they can refer you to your local mental health team for diagnosis and treatment options.

PTSD in caregivers and loved ones

PTSD can also affect caregivers. Learning that a loved one has a life threatening illness, seeing a loved one in pain, and having a medical emergency are traumatic events. A caregiver may develop PTSD during treatment or years after.

‘One study found that nearly 20% of families with teenage survivors of childhood cancer had a parent who was experiencing PTSD. Research also shows that it is common for parents of children receiving cancer treatment to develop stress-related symptoms.’ You can find out more support for Friends and Family in this website section

Sources
  • Post-Traumatic Stress Disorder and Cancer
  • Stuber ML, Shemesh E. Post-traumatic stress response to life-threatening illnesses in children and their parents. Child Adolesc Psychiatr Clin N Am. 2006 Jul;15(3):597-609. doi: 10.1016/j.chc.2006.02.006. PMID: 16797441.
  • Leano, A., Korman, M. B., Goldberg, L., & Ellis, J. (2019). Are we missing PTSD in our patients with cancer? Part I. Canadian oncology nursing journal = Revue canadienne de nursing oncologique29(2), 141–146.
  • Some cancer patients have PTSD years after diagnosis, study finds

  • “Cancer-Related Post-traumatic Stress”. National Cancer Institute. Retrieved 2017-09-16., Swartzman, Samantha; Booth, Josephine N.; Munro, Alastair; Sani, Fabio (2017-04-01). 
  • “Posttraumatic stress disorder after cancer diagnosis in adults: A meta-analysis”. Depression and Anxiety. 34 (4): 327–339. doi:10.1002/da.22542. ISSN 1520-6394. PMID 27466972., 
  • Cordova, Matthew J.; Riba, Michelle B.; Spiegel, David (April 2017). “Post-traumatic stress disorder and cancer”. The Lancet. Psychiatry. 4 (4): 330–338. doi:10.1016/S2215-0366(17)30014-7. ISSN 2215-0374. PMC 5676567. PMID 28109647;  
  • Edmondson, Donald; Richardson, Safiya; Falzon, Louise; Davidson, Karina W.; Mills, Mary Alice; Neria, Yuval (2012). “Posttraumatic stress disorder prevalence and risk of recurrence in acute coronary syndrome patients: a meta-analytic review”. PLOS One. 7 (6): e38915. doi:10.1371/journal.pone.0038915. ISSN 1932-6203. PMC 3380054. PMID 22745687.; 
  • Edmondson, Donald; Richardson, Safiya; Fausett, Jennifer K.; Falzon, Louise; Howard, Virginia J.; Kronish, Ian M. (2013-06-19). “Prevalence of PTSD in Survivors of Stroke and Transient Ischemic Attack: A Meta-Analytic Review”. PLOS One. 8(6): e66435. doi:10.1371/journal.pone.0066435. ISSN 1932-6203. PMC 3686746 . PMID 23840467.;
  • Davydow, Dimitry S.; Gifford, Jeneen M.; Desai, Sanjay V.; Needham, Dale M.; Bienvenu, O. Joseph (September 2008). “Posttraumatic stress disorder in general intensive care unit survivors: a systematic review”. General Hospital Psychiatry. 30 (5): 421–434. doi:10.1016/j.genhosppsych.2008.05.006. ISSN 0163-8343. PMC 2572638 . PMID 18774425.;
  • Arnaboldi, Paola; Riva, Silvia; Crico, Chiara; Pravettoni, Gabriella (2017). “A systematic literature review exploring the prevalence of post-traumatic stress disorder and the role played by stress and traumatic stress in breast cancer diagnosis and trajectory”. Breast Cancer: Targets and Therapy. 9: 473–485. doi:10.2147/BCTT.S111101. ISSN 1179-131, 
  •   Liu, Chunli; Zhang, Yi; Jiang, Hong; Wu, Hui (2017-05-05). “Association between social support and post-traumatic stress disorder symptoms among Chinese patients with ovarian cancer: A multiple mediation model”. PLOS One12(5): e0177055. doi:10.1371/journal.pone.0177055. ISSN 1932-6203. PMC 5419605. PMID 28475593.

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Treatments for PTSD

It is possible for PTSD to be successfully treated many years after the traumatic event occurred, which means it is never too late to seek help. For some, the first step may be watchful waiting, then exploring therapeutic options such as individual or group therapy – but the main treatment options in the UK are psychological treatments such as Eye Movement Desensitisation Reprogramming (EMDR) and Cognitive Behavioural Therapy (CBT).

Traumatic events can be very difficult to come to terms with, but confronting and understanding your feelings and seeking professional help is often the only way of effectively treating PTSD. You can find out more in the links below, or here.