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 are the Differences Between Lasting Effects of a Past Event and Ongoing Effects of a Persistent Stressor?

The lasting effects of a past event such as sexual assault can lead to a change in the victim's worldview and view of herself and others. She may fail to accommodate or rather overaccommodate, meaning that she can alter her beliefs about herself and the world to the extreme in order to feel safe and in more control. She may believe that all other men might be potential rapists or the world is not a safe place. She can also fail to assimilate and alter incoming information to match her previous beliefs. She may come to believe that because a bad thing happened to her, she must be getting punished for something terrible that she did, because bad things only happen to bad people, or she may question as to whether it really was a rape because she knew this man and thought he was a good person and a good person would not have done this (e.g. the world is a just and fair place).

For cancer and MI the individual can also overaccommodate, by believing that life is dangerous and that one should always fear what could potentially happen. Assimilation could also occur and people could believe that they must have done something very bad during their life to deserve this. However, during the normal processing of a past trauma the goal is for the individual to accommodate the trauma into his/her life, which means altering one's beliefs to incorporate the new information. For example, the cancer patient may start to believe that the world is not always a just and fair place and he is not a bad person for having cancer. Sometimes bad things happen to good people, and the world is not a dangerous place. However, if this person has a recurrence or there is a rational fear that the cancer might return, his fears and intrusions might be justified and therefore the natural process of accommodation might be more difficult for this patient.

A cancer diagnosis and MI also involve new and persistent stressors that follow the initial diagnosis and cardiac event. For both cancer and MI the patient may have subsequent bone pain, chest pain, fatigue, and loss of appetite that can result from the original disease or treatment-related side-effects. Shemesh et al.[29] found that MI patients who were symptomatic (e.g. experience angina) after MI were more likely to have intrusion and avoidance symptoms of PTSD than MI patients who were asymptomatic. PTSD symptoms were also strongly associated with poorer medication adherence. The stage and severity of illness or illness-related impairment should be more influential in determining the impact of medical stressors than the conditions themselves. However, cancer may have a different emotional impact, particularly just after the diagnosis. An important component of PTSD is the avoidance of reminders of the trauma. Medication use, follow-up visits and medical screenings could all serve as potential reminders of the cancer diagnosis or MI. If a patient is seeking to avoid these cues he/she may not be medically compliant with treatment and follow-up care, because doing these activities reminds him/her of the cancer or MI.