What do you think of when I say the word Trauma? You might think about veterans, those in major car accidents or difficult childhoods. But we have come to understand that trauma can come from (nearly) anything an individual’s brain perceives as traumatic.

So, what is Posttraumatic Stress Disorder (PTSD) and why does this apply to cancer patients?

As cancer patients, families, and caregivers we go through A LOT during active treatment and post treatment. We may find ourselves having memories of the hospital, or conversations might play in our head. Certain smells like alcohol wipes may instantly remind us of lab draws. We might find ourselves avoiding people, places, foods, or activities that can cause us physical or emotional distress.

We will be covering the topic of trauma and posttraumatic stress disorder in a two-part series. Today, I will be providing the diagnostic criteria to give us a baseline understanding of PTSD. Then next time, we will discuss how this criterion may be manifesting in our lives, how to recognize and manage continued symptoms and learn skills to manage it.

A)

Posttraumatic stress disorder is defined as an adult, adolescent, or child (older than 6) being exposed to an actual or threatened death, serious injury or violence in the following ways:

• Directly experiencing the traumatic event (patient)
• Witnessing, in person, the event(s) as it occurred to others (family, friends, caregivers)
• Learning that a traumatic event(s) occurred to a close family member or friend
• Experiencing repeated or extreme exposure to adverse details of the event(s) (patient, family, friends, caregivers throughout treatment, after treatment, or relapse

B)

Patients who meet the above criteria then must have one (or more) of the following associated symptoms associated with the event(s), beginning after the event(s) occurred:

• Recurrent, involuntary, and intrusive distressing memories of the event(s)
• Recurrent distressing dreams in which the content and/or affect are related to the event(s) (nightmares, vivid dreams)
• Dissociative reactions (flashbacks) in which the individual feels or acts as if the trauma were reoccurring
• Intense or prolonged physical distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event(s) (racing heart, chest pain, stomachache, etc.)
• Marked psychological reactions to internal or external cues that symbolize or resemble an aspect of the traumatic event(s) (anxiety, panic, etc.)

*Intrusive Thoughts: unwanted thoughts/images/impulses that can pop into your head out of the blue or be triggered by stimuli.

*Dissociative Reaction: flashbacks/vivid memory of the past that may make an individual feel like they are back in the moment again.

*Dissociation: feelings of disconnection from one’s body and environment, may feel out of body or dream-like state. Changes in consciousness, memory, identity or perception of self for a period of time. 

C)

Persistent avoidance of stimuli associated with the traumatic event(s), beginning after the traumatic event(s) occurred, as evidence by at least one of the following:

• Avoidance of or efforts to avoid distressing memories, thoughts, feeling about or closely associated with the traumatic event(s) (pushing to the back of your mind, avoid talking about it/thinking about it)
• Avoidance of or efforts to avoid external reminders (people, places, conversations, activities, objects, situations) that arouse distressing memories, thoughts, or feelings about or closely associated with the traumatic events

D)

Negative alterations in cognitions and mood associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) for the following:

• Inability to remember an important aspect of the traumatic event(s)
• Persistent and exaggerated negative beliefs or expectations about oneself, others, or the world (thoughts like I’m broken, my life is over, I can’t trust anyone, etc.)
• Persistent, distorted cognitions about the cause or consequences of the traumatic event(s) that lead the individual to blame himself/herself or others (e.g., if I hadn’t played soccer, I would have never had bone cancer)
• Persistent negative emotional state (e.g., fear, horror, anger, guilt or shame)
• Markedly diminished interest or participation in significant activities that one would have previously enjoyed (sports, hobbies, jobs)
• Feelings of detachment or estrangement from others (loneliness, don’t feel you fit in anymore)
• Persistent inability to experience positive emotions (e.g., happiness, satisfaction, or loving feelings)

E)

Marked alterations in arousal and reactivity associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred as evidenced by two (or more) of the following:

• Irritable behavior and angry outburst (with little or no provocation) typically expressed as verbal or physical aggression toward people or objects
• Reckless or self-destructive behavior
• Hypervigilance and/or exaggerated startle response
• Problems with concentration
• Sleep disturbance (difficulty falling or staying asleep or restless sleep and/or nightmares)

*Hypervigilance: Exaggerated fear of danger often associated with anxiety, panic, paranoia. Watching your back, startle easily, waiting for the other shoe to drop.

F)

Duration of the disturbance (Criteria B, C, D and E) is more than 1 month.

G)

The disturbance causes clinically significant distress or impairment in social, occupation, or other important areas of functioning.

H)

The disturbance is not attributable to the physiological effects of a substance (e.g., medication, alcohol) or another medical condition.

Now that we have looked at the criterion for PTSD, we will look at how it is taking shape in our lives so that we can manage it. Stay tuned for our next post.

Courtney, MSN, PMHNP

Osteosarcoma Survivor