A cancer diagnosis produces tremendous emotional upheaval. Painful feelings such as disbelief, shock, fear, and anger are common. A few people, however, may experience a type of psychological trauma called posttraumatic stress disorder (PTSD) that goes beyond these feelings.
The symptoms of PTSD may include repeated, intrusive and distressing images, thoughts, or perceptions; nightmares; flashbacks; difficulty sleeping; poor concentration; or feelings of detachment; and/or avoidance of thoughts, feelings, activities, places, and people that are associated with the trauma, according to the American Psychiatric Association?s Diagnostic and Statistical Manual of Mental Disorders IV.
These symptoms can have a tremendous impact on a person?s ability to function. Reminders or symbols of the condition may trigger intense distress. They may be upset to the point where they are unable to concentrate or control emotions.
For example, one woman began to have anxiety attacks several times a day after being diagnosed with stage I breast cancer. Overwhelmed by fear and helplessness, she was unable to finish projects at work. She constantly worried about what treatment would be like but didn?t ask for information from her nurses or doctors. Nightmares often interrupted her sleep, and she became more withdrawn and disconnected from her own feelings and other people. She began to feel numb most of the time as though she was in a daze.
How PTSD Developed
PTSD is an old concept that has recently been applied to the field of oncology. During World War II this phenomenon was called "combat fatigue." It has also been used to describe some people?s reactions to traumatic events such as natural disasters, kidnappings, severe car accidents, and violent personal assaults such as robbery, sexual abuse, or rape. In 1994, the criteria for diagnosis of PTSD were redefined to include "a life-threatening illness or learning one?s child has a life-threatening illness."
Since this change in diagnostic criteria, researchers and clinicians have begun to identify PTSD in cancer patients. It is not yet clear how common it is. Because one of the symptoms of PTSD is avoidance, it may be difficult for physicians to identify the syndrome.
Studying PTSD
So far, only a few studies have specifically assessed PTSD in adults diagnosed with and treated for cancer. One study identified PTSD in five to ten percent of women with breast cancer and another found PTSD in 12 to 19 percent of women who had undergone bone marrow transplantation.
PTSD may happen at any time throughout the cancer experience-- from diagnosis through treatment or recurrence.
There are a few factors that may make some people more likely to develop PTSD. Trauma research in other areas has found these may include a history of trauma, pre- existing personal problems, poor coping strategies, lack of social support, and genetics.
Symptoms of PTSD have not only been detected in people with cancer, but also in family members. Everyone in the family is affected by the potential threat to life, treatments, and the side effects. Family members may sometimes experience more severe PTSD symptoms than patients.
If PTSD goes undiagnosed, it may lead to despair, hopelessness, recklessness, impulsiveness and poor follow through on treatment recommendations.
Treating PTSD
Because PTSD is a relatively recently recognized side effect of cancer, more research is needed to determine how common it is, develop assessment tools and treatment options, and identify risk factors for PTSD in people with cancer.
It does seem clear, according to most experts, that while some cancer survivors may experience some symptoms of PTSD, most do not. After the initial shock of diagnosis and the beginning of treatment, most find that they are able to continue their normal lives. They learn to adapt and continue with work, entertainment, and social relationships. Many cancer survivors say being diagnosed with cancer gave them an opportunity to re- evaluate their lives and find strengths and abilities they did not know they had.
