Medical Disorders as a Cause of Psychological Trauma and Posttraumatic Stress Disorder

Elizabeth Mundy; Andrew Baum


Curr Opin Psychiatry. 2004;17(2) 

In This Article

Are Medical Events Really Traumatic Stressors?

The defining characteristic of a traumatic stressor or of psychological trauma is the presence of an implicit or explicit life-threat and reactions that are extreme and generally negative. The development of PTSD may be only one of many related consequences of exposure to trauma. There are many other stressor effects that can be considered, most of which reflect the effects of life-threat on biological, emotional, or cognitive functioning. Traumatic stress may thus be associated with unusual or unique endocrine changes, immune system changes, upset and distress, cognitive distortions, and existential anxiety.[10,11,12,13] These changes may occur as a function of direct threat, as when one is diagnosed and treated for serious illness, or more indirectly, as a function of witnessing or caregiving for people with serious illnesses. For the most part they occur because of the life-threat involved, and this threat or its direct implications form the nucleus of an emotional complex that appears to cause the reordering or modification of one's worldview.[14,15]

Many medical stressors share these characteristics of traumatic stressors. Cardiovascular events such as myocardial infarct or malignant arrhythmia convey life-threat, as do the diagnosis and treatment of cancer, HIV disease and AIDS, and other acute and chronic disease states, and some of the treatments and remedies for underlying disease. As with more traditionally studied traumatic stressors, the intensity, immediacy, and certainty of life-threat will vary with the specific disease, prognosis, side-effects of treatment, and other exposure and response-modifying variables.

Medical diagnoses and events have been found to result in extreme fear, helplessness, or horror. For example, myocardial infarction (MI) connotes danger of disability and death, the event is sudden and usually unexpected, and the patient experiencing it can feel powerless to avoid it. Ginsburg et al.[16] found that the degree of life-threat during the MI predicted the severity of acute stress disorder in a sample of 116 patients who were assessed an average of 3.5 days post-MI. In a second study,[17] the degree of life-threat at the time of the MI predicted re-experiencing symptoms, the severity and frequency of intrusive thoughts and PTSD symptoms of intrusion and arousal. Anticipation of permanent disability from the MI, which can be construed as the degree of life-threat, was also significantly related to the development of PTSD based on DSM-III.[18] The subjective sense of life-threat is paramount for the development of PTSD, and was reported by MI patients who were then at heightened risk of PTSD symptoms.