Content warning: Includes brief examples of medical trauma and discusses potential medical triggers
What is Medical Trauma?
Experiencing medical trauma is life-altering. There is no way to predict precisely which way your life will be altered, but trauma changes our brains and bodies. Unfortunately, many people have experienced medical trauma and oftentimes this greatly impacts how you take care of your medical needs afterwards.
There are many ways a person can experience medical trauma, including:
Experiencing an unexpected medical emergency
Receiving scary news about your health or a loved one's health
Medical decisions being made for you without your input
Seeing a loved one experience pain during medical treatments
Experiencing physical pain (even if "normal" for the procedure)
Having a lack of autonomy over your body
Being physically harmed by a medical provider
Being dismissed and invalidated by a medical provider
Seeing someone being mistreated in a medical setting
and more.
As always, two people may experience the same event but each one may perceive and process it differently. The way we perceive threats is not within our control, when our body believes we are in danger, it decides for us that we are in danger. Hence, why the "fight, flight, freeze" response is quick and fast. It is meant to keep us safe.
When you think about it, it makes sense that medical settings may produce even more of the "being in danger feeling" because in medical procedures or appointments, we often are "stuck" either because we can't move, are not totally present (think anesthesia), and also are taught to think of the medical providers as the experts and we are expected to listen and not push back. With this in mind, it makes sense why medical settings may already prime our bodies to proceed with caution.
Symptoms of PTSD in Medical Care
The diagnosis of Posttraumatic Stress Disorder (PTSD in the DSM 5-TR includes four subsections of symptoms including
Intrusion symptoms (distressing memories, dreams, flashbacks, etc.)
Persistent avoidance of stimuli (will get into that below)
Negative alterations in cognitions and mood (beliefs about yourself, the world, negative emotional state, etc.)
Marked alteration of arousal (irritability, hypervigilance, startle response, etc.)
Avoidance symptoms in PTSD are particularly troublesome when it comes to medical trauma. Experiencing medical traumatic stress understandably makes people avoid anything having to do with their health, doctors, or medical care.
Avoidance in PTSD means avoidance of distressing memories, thoughts, or feelings about or closely associated with the traumatic event and avoidance of external reminders like people, places, conversations, activities, objects, and situations that arouse distressing memories, thoughts, and feelings associated with the traumatic event. As you can imagine, there are a lot of possible things to avoid that can be associated with medical trauma.
How Avoidance Symptoms from Medical Traumatic Stress Impact Health and Medical Care
Procedures:
People may avoid getting certain tests or procedures done at a doctor's office or medical center. This may look like not getting a pap smear when needed, not getting your blood drawn for yearly labs, not getting a PICC line placed when you need antibiotics, or not getting an ultrasound when necessary.
Appointments:
People may not make appointments or if they do schedule the appointment, they may skip or cancel it. This can happen for non-sick appointments and sick appointments. For example, someone may not go do an annual physical or gynecological appointment, not go to a specialist when they are referred, not go to the dentist, or not schedule a needed surgery.
Daily care:
Day-to-day tasks can lead to distressing memories, thoughts, and feelings as well. This may be why someone does not do their breathing treatments each day, why they may not call the pharmacy to refill their medications, or why they do not consistently check their blood glucose levels.
Dismissing worrisome symptoms:
PTSD avoidance can be dismissing health-related symptoms like dismissing palpitations that have just started, ignoring a sinus infection that has been happening for months, ignoring the increase in migraine days, or a change in bowel movements.
Talking to others:
Someone may not be open to discussing how their health is with family or friends or hearing about others' related concerns because talking about medical issues and medical care can be distressing.
While the avoidance may not make sense to an outsider, it makes sense to the protecting part of our brain. One may say, "I don't know why I am nervous to go to my physical, it is like not like anything they do there is painful". But because the brain is working overtime to protect someone after trauma, it doesn't care that it isn't the same doctor or that it won't be painful. The brain's job here is to consider anything related to the trauma as a threat. That is why you may not have been nervous about having your blood drawn before, but you react to the smell of the alcohol wipe because that smell brings intrusion symptoms. Reminders could also be the feeling of being on an elevator if your brain associates the elevator with the hospital or an advertisement for the hospital where your mother received chemotherapy at, or the sound of someone putting on latex gloves at the nail salon. While none of these are inherently dangerous, they may bring back unwanted distressing memories and feelings and your brain is trying to protect you from that distress.
How Protection Can Cause Problems
The problem with all of this is that the human body needs medical care and attention. If someone with a chronic illness is missing their appointments with a specialist, their quality of life is likely decreasing by worsening symptoms, they may not be able to get refills of their medication without seeing their team, or their illness is silently getting worse. If someone is in “good health”, they may not go to the dentist until their teeth are hurting or may not find out they have cancer until it is stage 3 or 4. Outside of potential health issues, it also is just hard to navigate the world because there are constant reminders of health and medical care. It could lead to you avoiding driving by the hospital which would make your commute 20 minutes faster, you may not go see a dear friend who is sick, or you can no longer watch Grey's Anatomy with your friends, which you always loved.
Working through trauma is a way to give you back the autonomy that was jeopardized by trauma. What may not seem like a “big deal” to some people, can be telling your nervous system you are in grave danger, that's the nature of trauma. Your brain is trying to help you survive by putting you in flight or flight when you experience medical trauma or you are near any reminders of it. But sadly, it is a bit misguided. Trauma therapy works to help you change your relationship with your thoughts, emotions, and physical sensations so that you can be flexible in how you respond to your triggers and allows you the space to make decisions for yourself, rather than your survival instincts doing so while firing false alarms.
If you would like help changing your relationship to your trauma, please reach out to schedule a free consultation call. You don't need to navigate this alone and I want to help you get back to the things that are most important to you.
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