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

What Do You Measure as Your Criterion?

Answers to this question require observational research and qualitative analyses of the types of intrusive thoughts that medical patients experience, and categorization of these experiences as being future or past event oriented. Extant research examining PTSD across the diagnosis and treatment continuum in cancer patients has shown that the diagnosis is the single most traumatic timepoint for breast cancer patients, but this research has not evaluated whether some intrusions are future oriented.[22]

In the MI literature, investigators have cued patients to answer questions about intrusive thoughts and avoidance as 'memories of your heart attack', 'the extent to which you've suffered from each of the acute stress disorder symptoms in response to the MI', 'the experiences related to the MI or coronary artery bypass graft', and 'thinking about your heart attack even when you did not mean to'.[16,17,28,29,30] In the HIV literature, patients have been asked about PTSD symptoms in reference to the HIV diagnosis,[33] but also in reference to how much they had been bothered by their reactions to whatever event had distressed them the most.[34] These examples underscore the importance of defining the traumatic event before conducting the study and using it consistently in measures and interview assessments. Questions surrounding 'your cancer experience' or 'whatever event caused you the most distress in the past month' do not provide further knowledge about the specific event that leads to PTSD, if one decides to use the PTSD model to measure psychological distress in medically ill patients.