PTSD

by Sharon Joag, MSW, LSW

What is the first image you have when you think about Post Traumatic Stress Disorder? If you are like me, the first thing that pops into my head is a war veteran; and someone who has been through something that induces major trauma, sometimes lasting for a lifetime.

But what about those who have undergone major surgery? Although much less talked about, trauma from surgery has now become a global public health crisis. Globally, 310 million major surgeries are performed every year, and of those, 40-50 million surgeries are performed in the US (Dobson, 2020). From the moment a patient is given a diagnosis the black cloud of imminent surgery looms ahead. First, the anxiety sets in, and the rumination on the actual surgery, what it entails, what exactly will happen in the operating room. Questions in the minds of patients. “Will I feel anything while undergoing surgery? Will anesthesia work? What is going to happen after surgery?” 

Doctors typically do not and cannot always talk to a patient about every single minute detail of a surgery. Surgeons can only provide an overview of a surgery, but the details are vague and sometimes unknown, even to the surgeon, until the surgery is actually underway. This uncertainty creates a milieu of confusion, and unhealthy rumination on all that could potentially go wrong, culminating in a deep anxiety and post-surgical depression that can last for months or years after the surgery, inevitably aiding in extending the recovery time of a patient who has undergone a major surgical procedure.

These ruminating thoughts can be overwhelming to an individual. Having regular therapy appointments to monitor an individual’s thought processes, and talk through some of these traumatic future events, especially a planned surgery is important in helping patients find tools that they can use to decrease stress levels, understand their thoughts, and find ways to manifest optimal mental health.

Many people suffer tremendously pre, peri and post surgically with anxiety and depression. Major surgeries such as surgery to remove cancer (breast, a portion of the esophagus, stomach or colon). The physical changes that a person has to endure post-surgery takes a toll on the psyche. The brain has to catch up with its new body image, food and diet changes, and sometimes chronic pain which has become a part of the new life. Often times, a person faces depression, fear and PTSD which causes sleep disturbances, and further delays mental healing.

Coming to terms with and accepting the new person post-surgery is an enormous and daunting hurdle. Having someone to speak with confidentially who can help to guide a patient through this process is essential. In addition, the caregivers in the equation cannot be neglected. They too have to come to terms with their new partner or spouse or loved one who is forever changed. Helping the caregiver to grapple with these changes is also much needed, as caregivers are many times the primary support system for an individual who has undergone major surgery.

Making a plan, setting long term goals, and then short-term goals that are achievable are important in achieving success with positive mental health. Speaking to a health care professional and understanding the importance of a support system including friends, family, and community are the pillars of a successful and positive mental health post-surgery, and recovery from PTSD due to major surgery.

References:
Dobson, G.P., Trauma of major surgery: A global problem that is not going away. International Journal of Surgery, 2020. 81(47-54).

Stanzel, A., Sierau, S. Pediatric Medical Traumatic Stress (PMTS) following Surgery in Childhood and Adolescence: a Systematic Review. Journ Child Adol Trauma 15, 795–809 (2022). https://doi.org/10.1007/s40653-021-00391-9

Post-traumatic stress disorder (PTSD) is developed as a result of experiencing or witnessing a traumatic event, and it actually changes the structure of your brain; complex PTSD (C-PTSD) develops as a result of experiencing repeated traumatic events and is more likely to occur if the trauma was experienced at a young age. Common symptoms associated with PTSD include nightmares, flashbacks, stress and anxiety, and hypervigilance. Linked below are a few personal stories from people living with PTSD, and while it’s commonly associated with veterans, these stories show that PTSD doesn’t solely emerge from experiencing combat situations, but that there are multiple situations that may result in its development.

Daniel’s story details how he developed PTSD after undergoing an emergency heart procedure and then experiencing a subsequent anxiety attack that he thought was another heart issue. He explains that he felt chest pain which brought him back to the traumatic night of his procedure, and immediately went to the emergency room because he thought it was happening again, only to be told he was having an anxiety attack. After seeking therapy, he was diagnosed with an anxiety disorder and PTSD. He was able to get on medication and found a variety of techniques to help manage his symptoms.

Rita’s story describes how for her, PTSD manifested in repeated panic attacks that wouldn’t stop no matter how many anxiety-related therapies she tried. Eventually she found a therapist who was able to put a name to her feelings of panic and identify that her PTSD stemmed from childhood. When she started doing EMDR (eye movement desensitization and reprocessing) therapy with this therapist, she finally started feeling some relief after a few weeks’ time.

Denise’s story details how she developed PTSD after a student threatened her and the other students in her classroom with a knife. She blamed herself for the incident and became emotionally volatile, experiencing violent mood swings and suicidal thoughts. She ended up going to her doctor, who gave her a tentative PTSD diagnosis, before going to a psychologist who affirmed it. She was then able to get on medication to help manage her symptoms, and ended up moving to get away from her environmental triggers.

If you or a loved one are experiencing symptoms of PTSD, don’t be afraid to seek out therapy using sites like Psychology Today, or other informational resources online like the APA, the Anxiety and Depression Association of America (ADAA), the National Center for PTSD through the VA, or NAMI’s own website.