Can Cancer Cause PTSD?

[batgirl]

I was doing a search for cancer and PTSD online, and I discovered all these studies and theories about how a cancer diagnosis can be traumatic enough for someone to develop PTSD. Here's one of the articles I read:

Post-traumatic Stress Disorder and Cancer

National Cancer Institute

Introduction

This patient summary on posttraumatic stress disorder is adapted from the summary written for health professionals by cancer experts. This and other credible information about cancer treatment, screening, prevention, supportive care, and ongoing clinical trials, is available from the National Cancer Institute. Better treatment of many cancers has resulted in more patients experiencing longer periods of disease-free survival. This has also led to more patients experiencing psychological problems, which are collectively called posttraumatic stress disorder. This brief summary describes posttraumatic stress disorder, its symptoms, and its treatment.

Overview

Some survivors of cancer experience trauma-related symptoms similar to symptoms experienced by people who have survived highly stressful situations, such as military combat, natural disasters, violent personal attack (such as rape), or other life-threatening events. This group of symptoms is called posttraumatic stress disorder (PTSD) and includes avoiding situations related to the trauma, continuously thinking of the trauma, and being overexcited.

People with histories of cancer are considered to be at risk for PTSD. The physical and mental shock of having a life-threatening disease, of receiving treatment for cancer, and living with repeated threats to one's body and life are traumatic experiences for many cancer patients.

Diagnosis and Symptoms

Posttraumatic stress disorder (PTSD) is defined as the development of certain symptoms following a mentally stressful event that involved actual death or the threat of death, serious injury, or a threat to oneself or others. For the person who has experienced a diagnosis of cancer, the specific trauma that triggers PTSD is unclear. It may be the actual diagnosis of a life-threatening illness, aspects of the treatment process, test results, information given about recurrence, or some other aspect of the cancer experience. Learning that one's child has cancer is traumatic for many parents. Because the cancer experience involves so many upsetting events, it is much more difficult to single out one event as a cause of stress than it is for other traumas, such as natural disasters or rape. The traumatic event may cause responses of extreme fear, helplessness, or horror and may trigger PTSD symptoms.

PTSD in cancer survivors may be expressed in these specific behaviors:

• Reliving the cancer experience in nightmares or flashbacks and by continuously thinking about it.
• Avoiding places, events, and people connected to the cancer experience.
• Being continuously overexcited, fearful, irritable, and unable to sleep.

To be diagnosed as PTSD, these symptoms must last for at least one month and cause significant problems in the patient's personal relationships, employment, or other important areas of daily life. Patients who have these symptoms for less than one month often develop PTSD later.

Risk Factors, Protective Factors, and the Development of PTSD

As many as one third of people who experience an extremely upsetting event, including cancer, develop posttraumatic stress disorder (PTSD). The event alone does not explain why some people get PTSD and others don't. Although there is no clear answer as to which cancer survivors are at increased risk of developing PTSD, certain mental, physical, or social factors may make some people more likely to experience it.

Individual and social factors

Individual and social factors that have been associated with a higher incidence of PTSD include younger age, fewer years of formal education, and lower income.

Disease-related factors

Certain disease-related factors are associated with PTSD:

• In patients who received a bone marrow transplant, PTSD occurs more often when there is advanced disease and a longer hospital stay.
• In adult survivors of bone cancer and Hodgkin's lymphoma, people for whom more time has passed since diagnosis and treatment tended to show fewer symptoms.
• In survivors of childhood cancer, symptoms of PTSD occur more often when there was a longer treatment time.
• Interfering thoughts occur more often in patients who experienced pain and other physical symptoms.
• Cancer that has returned has been shown to increase stress symptoms in patients.

Mental factors

Mental factors may affect the development of PTSD in some patients:

• Previous trauma.
• Previous psychological problems.
• High level of general stress.
• Genetic factors and biological factors (such as a hormone disorder) that affect memory and learning.
• The amount of social support available.
• Threat to life and body.
• Having PTSD before being diagnosed with cancer.
• The use of avoidance to cope with stress.

Protective factors

Certain factors may decrease a person's chance of developing PTSD. These include increased social support, accurate information about the stage of the cancer, and a satisfactory relationship with the medical staff.

How PTSD may develop

PTSD symptoms develop by both conditioning and learning. Conditioning explains the fear responses caused by certain triggers that were first associated with the upsetting event. Neutral triggers (such as smells, sounds, and sights) that occurred at the same time as upsetting triggers (such as chemotherapy or painful treatments) later cause anxiety, stress, and fear even when they occur alone, after the trauma has ended. Once established, PTSD symptoms are continued through learning. The patient learns that avoiding the triggers prevents unpleasant feelings and thoughts, so coping by avoidance continues.

Although conditioning and learning are part of the process, many factors may explain why one person develops PTSD and another does not.

Assessment

It is important that cancer patients undergo a careful assessment for posttraumatic stress disorder (PTSD) so that early symptoms may be identified and treated. The timing of this assessment will vary with the individual patient. Cancer is an experience of repeated traumas and undetermined length. The patient may experience stress symptoms anytime from diagnosis through completion of treatment and cancer recurrence. In patients who have a history of victimization (such as Holocaust survivors) and who have PTSD or its symptoms from these experiences, symptoms can be started again by certain triggers experienced during their cancer treatment (for example, clinical procedures such as being inside MRI or CT scanners). While these patients may have problems adjusting to cancer and cancer treatment, their PTSD symptoms may vary, depending on other factors. The symptoms may become more or less prevalent during and after the cancer treatment.

Symptoms of PTSD usually begin within the first 3 months after the trauma, but sometimes they do not appear for months or even years afterwards. Therefore, cancer survivors and their families should be involved in long-term monitoring.

Some people who have experienced an upsetting event may show early symptoms without meeting the full diagnosis of PTSD. However, these early symptoms predict that PTSD may develop later. Early symptoms also indicate the need for repeated and long-term follow-up of cancer survivors and their families.

Diagnosing PTSD can be difficult since many of the symptoms are similar to other psychiatric problems. For example, irritability, poor concentration, increased defensiveness, excessive fear, and disturbed sleep are symptoms of both PTSD and anxiety disorder. Other symptoms are common to PTSD, phobias, and panic disorder. Some symptoms, such as loss of interest, a sense of having no future, avoidance of other people, and sleep problems may indicate the patient has PTSD or depression. Even without PTSD or other problems, normal reactions to the cancer diagnosis and treatment of a life-threatening disease can include interfering thoughts, separating from people and the world, sleep problems, and over-excitability.

Questionnaires and interviews are used by health care providers to assess if the patient has symptoms of stress and to determine the diagnosis.

Other problems may also exist in addition to PTSD. These problems can include substance abuse, emotional problems, and other anxiety disorders, including major depression, alcohol dependence, drug dependence, social fears, and/or obsessive-compulsive disorder.

Treatment

Effects of posttraumatic stress disorder (PTSD) are long-lasting and serious. It may affect the patient's ability to have a normal lifestyle and may interfere with personal relationships, education, and employment. Because avoiding places and persons associated with cancer is part of PTSD, the syndrome may prevent the patient from seeking medical treatment. It is important that cancer survivors receive information about the possible psychological effects of their cancer experience and early treatment of symptoms of PTSD. Therapies used to treat PTSD are those used for other trauma victims. Treatment may involve more than one type of therapy.

The crisis intervention method tries to lessen the symptoms and return the patient to a normal level of functioning. The therapist focuses on solving problems, teaching coping skills, and providing a supportive setting for the patient.

Some patients are helped by methods that teach them to change their behaviors by changing their thinking patterns. Some of these methods include helping the patient understand symptoms, teaching coping and stress management skills (such as relaxation training), teaching the patient to reword upsetting thoughts, and helping the patient become less sensitive to upsetting triggers. Behavior therapy is used when the symptoms are avoidance of sexual activity and intimate situations.

Support groups may also help people who experience posttraumatic stress symptoms. In the group setting, patients can receive emotional support, meet others with similar experiences and symptoms, and learn coping and management skills.

For patients with severe symptoms, medications may be used. These include antidepressants, antianxiety medications, and when necessary, antipsychotic medications.

There are many more articles. You just have to search for cancer and PTSD and there are tons.

Honestly, I never thought of cancer being bad enough to cause PTSD. I mean it doesn't fit all the criteria in my mind.

Anyways, I was just wondering what others think about this.

 

[anthony]

Cancer is definately a cause for PTSD. What you must look at to determine what can, and what cannot, cause PTSD, are the initial criteria for diagnosis, being:

1. Did you experience, witness, or were confronted with an event/s that involved actual or threatened death, serious injury, or a threat to the physical integrity of yourself or others?
2. Did your response involve intense fear, helplessness, or horror?

Now, to be diagnosed with PTSD, you must be able to answer yes to both these questions, and then determined under the DSM as abnormal trauma, outside normal expected life trauma, such as death of a loved one under normal circumstances, mild emotional abuse such as your sibling telling you to get out of their room, etc. These type things are classed as normal life trauma, and will not be recognised for PTSD.

Cancer however, is not a normal expected life event, thus it is "abnormal". Would a cancer sufferer be confronted with #1? Yes. Would a cancer sufferer have thoughts pertaining to #2? Yes. A cancer sufferer would be thinking they are going to die, even if they aren't, so the fear, helplessness, etc, all present, which means the person has suffered abnormal trauma and met the two criteria to continue evaluation. If you don't meet the first two criteria, evaluation for PTSD stops, and a lesser diagnosis will be looked at.

 

[Jim]

Interesting. Initally I would have said no, it's not traumatic enough. But you're correct, it does fit the criteria, and it is an abnormal life event. Not ever having cancer myself, can't honestly judge how badly a person feels having it. Definitely something for me to consider, especially in how I've treated various family members with the diagnosis.

Jim.

 

[mac]

I'm no expert or doctor, but I would be as bold to say that the symptoms of PTSD can be so severe as to cause/initiate cancer itself.

 

[anthony]

Oh, I will add though, in that just because a person does meet the initial two criteria, that does not mean they have PTSD, obviously as they must meet all the rest of the criteria. The first two criteria are merely to evaluate whether a physician would continue that avenue of diagnosis or move to another.

 

[batgirl]

Thanks for this Anthony. I change my mind then, I guess it can cause PTSD. It is really interesting. But if you already have PTSD and then you get cancer, are you re-traumatized or something? Or does it matter?

 

[anthony]

What mac actually said also, is actually very accurate, in that PTSD itself can cause cancer if untreated because the sheer stress upon the body breaks down the bodies natural immune system in which it fights against such illness being formed within our body. PTSD can most definately cause PTSD if left untreated... though from my experience, heart attack will generally get a person first though, alcohol / nicotine second, then other issues.

 

[batgirl]

So then I could have cancer because I have PTSD ??? Actually I do have cancer indirectly from being shot... stomach trauma increases your chances of stomach cancer by quite a lot...

But yeah that makes sense, if you don't treat PTSD you can die from self-medicating or a heart attack, etc, not taking care of yourself in some way. The nurse at my panic group said untreated anxiety can wreck your health and eventually kill you.

 

[porkyrees]

Tend to agree with mac and anthony I would suspect PTSD to cause the cancer not vice versa.Definately leads to heart disease I have a few dead mates that can testify to that.Porky Rees

 

[anthony]

Porky, you too have seen it in action then, hence why your fixing your own lifestyle now. Besides my inability to accept that I was being told I could not function in life again, seeing my mate who has PTSD from the same operations I got it, having heart attack after heart attack, five last time I had seen him a few years ago, bypass also, he is a couple of years older than me, was certainly enough to wake me up.

Evie... I don't see your PTSD giving you cancer, more the shooting and surgery gave you your cancer. Normally cancer takes much longer to progress from stress than just five years. I am talking 10 - 20 years of high stress living, that will do it. But... there are no time limits on cancer, that is for sure. Some peoples immune system is less than others, and PTSD itself certainly has its role on the immune system when uncontrolled from anxiety and stress. People with PTSD will often get the flu more than those without trauma, as their systems are not as stressed, with all the good antibodies working so hard to just keep things functioning, let alone introducing a new bacteria to the body.

Evie, the shooting itself is not what gave you cancer or PTSD IMO. What gave you PTSD was that your father shot you, and the circumstances surrounding the shooting, being your family got shot. If you got shot in war, your outcome would be very different. You have emotional value attached to your shooting, hence why it is completely different from say someone just being shot by a stranger. Yes, fear of death will still produce PTSD possibly, but yours is much more than just a shooting. Your surgery most likely produced the cancer, though the surgery was a result of the shooting, and in order to save your life, was essential and a good risk. Doctors where looking for it, as they knew it would be along, just a matter of when, not so much if!

Ironic as it is, having cancer can cause PTSD because a person feels they may die; yet having PTSD from another trauma can then cause cancer in itself. Look at people who have PTSD, they also tend to have a higher rate of smoking, or depending on some type of drug or addictive method in which to help keep anxiety in check, depression even. These drugs, methods and things we do to our bodies increase our chances of many illnesses, smoking, alcohol, medications, drugs (pot), over the counter drugs (headaches caused by stress)... the list goes on.

The more you get into these cycles, these methods, the more you increase your chances of earlier death. Simple as that really. You can live with PTSD without drugs, without alcohol, without cigarettes, pot, etc etc... it just takes a lot of solid hard work to achieve. You can function in life healthier than ever before, and I have said it before, its a lifestyle change, one you must be prepared to stick with and fight for in order for survival.

 

[batgirl]

Evie, the shooting itself is not what gave you cancer or PTSD IMO. What gave you PTSD was that your father shot you, and the circumstances surrounding the shooting, being your family got shot. If you got shot in war, your outcome would be very different. You have emotional value attached to your shooting, hence why it is completely different from say someone just being shot by a stranger.

Yes that's very true I guess.... being shot is not the issue at all. If my dad stabbed me or tried to beat me to death, etc, the outcome would be the same likely. It all boils down to my dad being the perpetrator. A stranger would have been much easier to take. My uncle was shot by a stranger in Croatia and needed surgery, but he's totally fine, no emotional trauma at all. No long term physical problems either. I'm jealous...

I get colds, flus, and other minor illnesses really easily, and I never used to. Never quite made the connection, but being stressed out constantly is most likely a factor. I hope that when I've recovered from being ill, I can concentrate more on eating properly, exercising, etc, to minimize my stress levels. I'm already free of drugs, alcohol and cigarettes, I've even given up caffeine now. So it's a good start.

 

[anthony]

That is really well done Evie.... people don't realize just how much of a problem those substances are, and how they actually contribute to unbalancing your system when PTSD is present. Nicotine and caffeine are one thing without PTSD, but because PTSD throws out our neurological balance, it then as a consequence tunes our susceptability to other things, ie. caffeine, nicotine, alcohol.... and we become more easily depressed using any off them merely because the imbalance our brain has already endured. Nicotine is a stimulant, but the stimulant effects adjusts our balances, and whilst we with PTSD use things that we believe are helping us, they actually hinder us more than do good, its just people can't see it because they go into withdrawal symptoms, lose control, and think its all to do with the nicotine or caffeine, etc... when in fact its our bodies over exagerated response because of PTSD due to withdrawals. Fight withdrawals of any substance, and you should actually find things are easier to maintain if you have the knowledge and determination to fight.