Medical trauma is fairly common, but many people don’t know about it and they don’t have practical skills to manage it. In this post, Emma explores how medical trauma is different from other traumas and she shares how to begin healing and how to prevent this trauma.
I know I’m not the only one who gets nervous about going to the dentist. Medical procedures can be really scary and intense. They can even be traumatizing. In one of my recent group calls with the Therapy in a Nutshell members, I met Kathy. We had a follow-up call in which she described what it was like to have her heart restarted.
The Reality of Medical Trauma
Kathy: “You know the science fiction movies where they go into a black hole and there’s nothing around you? It’s just total blackness. [It’s like] I don’t have a ceiling, I don’t have walls, I don’t have a floor. I am just free falling into blackness. And it’s like falling into this pit of black and no control and just totally, totally terrifying. Just totally terrifying. This is what the experience has been.”
What Kathy described is called medical trauma, which is psychological trauma that stems from a medical incident. This can happen after an emergency or accident, or with planned treatment like surgeries or routine procedures. It might come with a new diagnosis like cancer, or even from dealing with dismissive or harmful medical professionals.
Kathy: “ I had congestive heart failure when I was in my thirties. And they couldn’t figure out why it happened. I went through a series of treatments for that for 30 plus years, and then I ended up with an ICD [implantable cardioverter-defibrillator] because the heart was getting weaker. Those machines, they zap you. They implant it inside your body and you get zapped from inside out to get your heart going again…[My] heart stopped, and [I] got zapped sometimes to the point of knocking you out. It’s not a pretty picture. So not pleasant, but I’m alive.
[I’ve] got that mom voice saying, okay, buck up, you can do this. Just grit your way through it. Just push, you’re okay. Just do it. And you keep doing it. And I’ve realized now that I live in hypervigilance and overwhelm most of my life.”
Kathy’s hypervigilance and overwhelm are typical PTSD responses. Medical trauma is surprisingly common, so let’s explore what causes it, how your body can become your trigger, how you can heal, and some things you can do to prevent it for yourself or your kids.
What Causes Medical Trauma?
Medical emergencies are often painful, frightening, or even life-threatening experiences, so it makes sense that they are stressful. But there are some critical aspects that make them more likely to lead to PTSD. These include:
Physical pain or shock When your body is in pain, overwhelmed or shutting down it can’t process what’s happening very well, and you may dissociate. For Kathy, it felt like she was free falling in a black hole.
Loss of control You often can’t help yourself in emergency situations such as car accidents, heart attacks, surgeries or even recovery. ICU patients are often restrained or on medication that leaves them disoriented, and they feel confused or powerless. When you don’t know what is happening and you’re dependent on others to save you, that helplessness can be traumatic. This is why children are especially vulnerable to medical trauma.
Here’s what Kathy shared about losing some control in her life:
“ I lost a lot of my independence with the defibrillators because you’re not allowed to drive if you had a [heart] incident within a month. And because I was getting shocked almost every month, I had to depend on someone else to pick me up and take me to work. And I’m not someone that asks for help. I hate that.”
When a medical condition takes away physical capabilities, that loss of control can put someone into a grieving process.
Betrayal of trust When the people who are supposed to help you add to your pain, this can fuel medical PTSD. For example, misdiagnoses or malpractice, lack of pain management, botched surgeries or unnecessary procedures that lead to more pain can leave you feeling vulnerable.
Kathy experienced this with a technician who was running an echocardiogram after her heart transplant. “There was this young technician and he kept pressing [on] a scar from the transplant. And he kept pressing, and I said, ‘That hurts.’ And he’d say, ‘That’s okay.’ And he just kept doing that over and over and over. And finally I said, ‘It’s not okay. It hurts!’ And instead of stopping, he just said, ‘Well, I’m almost finished.’
He didn’t have to hurt me to do [the echocardiogram]. Nobody else hurt me to do that [test]. But to have someone that’s doing a medical procedure [not] listen [when] you tell them this hurts, and they won’t stop, and they won’t change what they’re doing–that’s abusive. That’s not traumatic. That’s abusive.”
Kathy went on to share that because the technician was dismissive of her pain, she had stronger fear reactions to other procedures too. I’ve heard many stories of doctors dismissing pain as just being anxiety. This kind of medical mistreatment can fuel trauma and PTSD.
So to recap, physical pain and shock, loss of control, and betrayal of trust can all contribute to developing medical trauma.
Signs of PTSD from Medical Trauma
Medical Trauma isn’t its own diagnosis. It fits under the category of PTSD. Not everyone develops PTSD after an intense medical event, but it is common to have Acute Stress Disorder. This is where you feel scared, anxious, have trouble sleeping, etc. in the first few weeks after a stressful situation. With some time, the brain and body often process that stress and help us bounce back. But if we get emotionally stuck and can’t work through those feelings, short-term reactions may develop into PTSD.
The definition of PTSD is that you have the following 4 key symptoms that have lasted at least 4 weeks after a threatening event, and they cause severe distress or disruption to your life.
- Avoidance Avoiding reminders of the event, such as specific people or places, is one sign of trauma. With medical trauma, you might avoid making follow up appointments or avoid driving by the hospital.
- Reexperiencing This can show up as distressing memories or nightmares where you feel like you’re re-living the trauma. You might have physical sensation such as pain or heart palpitations, which can fuel a cycle of chronic pain.
- Mood changes Changes in your mood could include feeling more sad, irritable, angry, or depressed. Or maybe you have difficulty feeling positive emotions. With medical PTSD, you might have health anxiety, which is where you constantly worry about your health and physical symptoms.
- Hyperarousal and Reactivity This is when you feel jumpy or on edge. You might have difficulty sleeping. Or you might feel more irritable or anxious. Often these difficulties come in reaction to something that triggers the memory of the traumatic event.
Christen Mullane is a medical trauma expert. I interviewed her on my Therapy in a Nutshell Podcast Channel, and it was interesting to hear how routine procedures can trigger PTSD from past medical trauma.
Christen Mullane:
“Medical trauma can look and present at different levels of care. Let’s take somebody who’s had…maybe a really painful dental procedure, and then they’re coming in for just a routine cleaning. That routine cleaning can be a trigger for memories of the root canal that didn’t go well, right? Or a primary care office visit can bring back memories of an ICU stay [because] there’s enough similarity in the environment that people can be reactive in that space. And then, because the reactivity is there, they’re walking to the doctor’s visit with maybe white coat syndrome, [and] their blood pressure rises—kind of a trauma symptom, right? They’re walking in hypervigilant already, [so] there’s more of a risk that they’re going to be re-traumatized in that space.
I’ve had patients who have had birth trauma in their past, but they didn’t really have PTSD symptoms until a…routine procedure years later. That’s when the PTSD symptoms started to present because that’s when they had enough [happen] medically that they started to think, “There’s something wrong with me. I’m different. I’m bad or wrong.”…We see a lot of different ways that a person’s whole self becomes impacted.”
Enduring Somatic Threat: The Body as a Trigger
One of the really unique aspects of Medical PTSD is something called Enduring Somatic Threat. It’s where your body becomes one of your trauma triggers—and it’s one you can’t escape. For example, if someone suffered a heart attack or had heart surgery, then when they see their scars, or they feel breathless, or their heart “skips a beat”, they might get triggered by their own body sensations and re-experience the trauma of their heart attack.
Or, a woman who loses a baby in childbirth may feel like her womb betrayed her, that her own body let her down. The grief and pain that come because of her own belly are something she can’t escape.
After a medical crisis, the brain might continue to scan the body for signs of danger, which keeps the stress response active. This differs from other forms of PTSD where the original trauma is a past event. In medical trauma, the body itself remains the perceived source of danger.
In our original call with the group, Kathy described how a harmless sensation in her body would trigger her fear response.
“Before the transplant, I had an internal defibrillator, and there was this feeling that I would get before it would go off. It’s this full-body sensation where pain rolls from your toes to your head, and that gets triggered from time to time. When I feel that–and [after the transplant] there’s no reason for it to actually be triggered anymore–when it gets triggered it’s scary. [I think], ‘Oh dear, what’s happening? Am I okay? Are we going down a bad path here? What do I need to do? Do I need to get help?’ [It’s] just fear.”
To cope with the ever-present triggers from the body, people might get stuck in avoidance behaviors, like refusing medical check-ups, avoiding activities that elevate heart rate, or overusing health monitoring devices. Their trauma says, “I have to constantly check my blood oxygen saturation or something bad could happen.”
This constant activation of the sympathetic nervous system (fight-or-flight response) leads to chronic stress, fatigue, and anxiety. And this makes it difficult for the body to return to a calm, safe state. This can leave you feeling anxious, exhausted, overwhelmed, and make it hard to sleep or function at work.
Healing from Medical Trauma: Therapy Options
The good news is that when we learn to recognize medical trauma, we can also learn how to heal from it, and even how to prevent it. Once you can see that you might have some PTSD, it’s probably most helpful to seek professional treatment. I’ll share what I would do if I were Kathy’s therapist so you can see that there are a lot of therapy options that can help. I’ll also walk you through some practical things you can do to prevent or overcome medical PTSD.
Treatment for medical PTSD includes talk therapy, body work, and the option of doing gentle exposures or medication.
Talk Therapy
If I were Kathy’s therapist, we would create a safe environment to work through triggers, memories, or unhelpful thinking patterns. Because trauma can impact your beliefs about yourself—“I can’t trust my body”—in therapy we would explore how to replace those false beliefs with something healthier. Group therapy, journaling, and even medication can be helpful with this because all these forms of therapy provide an opportunity to approach painful thoughts or feelings instead of avoiding them. And that’s key to decreasing symptoms of PTSD.
I think it’s important to recognize that PTSD isn’t about the past, it’s about how the body is still responding in the present moment. It’s about those sensations and nervous system responses that happen here, in the present moment. To help the body process the medical trauma, another really valuable tool is somatic therapy (body work).
Somatic Therapy
Somatic therapy helps release trauma stored in the body by addressing the ongoing sensory memories with gentleness. When triggers arise, it’s important to soothe yourself and return to your sense of safety, so we’d start with developing some resourcing skills. These might include
- Breathing techniques
- Grounding skills
- Vagus nerve exercises
- Visualization exercises
- Body-based techniques, such as massage or acupuncture
I have a free course that can teach you how to regulate your nervous system with Grounding Skills. Be sure to check out that link.
It’s also fundamental in somatic therapy to learn to relate to your feelings and sensations with gentleness and openness. Kathy gave some good examples of her self-talk during triggers:
“In the last nine months I’ve become much more of my own advocate, much more assertive. When I went to have an echocardiogram this year, the technician was wonderful—very gentle, very kind. And although part [of me] was waiting to come up and say, ‘They’re gonna hurt you again,’…I’ve learned with that to say, ‘Okay, thank you for reminding me that this might hurt, but let’s just wait and see. Let’s see what’s gonna happen, let’s give it a chance.’ And that technique for me in the last two months has been golden. To take that negative thought and say, ‘Okay, thank you for telling me that brain, but now, let’s just be interested, let’s be curious, let’s find out what happens.’…That kills the anxiety of that situation.”
Kathy is already doing a good job relating to her fear and sensations with openness, curiosity, and gentleness. Mindfulness training can help you learn to notice and create space for physical sensations without judging them or panicking.
In a medical emergency or event, patients are often immobilized, which means their body can’t complete its natural fight-or-flight response. Somatic therapy helps them release this trapped survival energy. If I were Kathy’s therapist, I would guide her through the following.
- Tracking physical tension. If Kathy gets tension in her shoulders when she recalls the surgery, I might say, “What happens if you let your shoulders drop? Can you gently shake out your arms and see how that feels?”
- Taking movement to complete the response. As Kathy talks through her experience, I would help her find actions to take to finish her fight-or-flight response. For example, if she felt trapped in the hospital, she could make gentle pushing motions against a wall to simulate “escaping.” If she felt silenced, she might practice humming or vocalizing to reclaim her voice.
By allowing her body to complete these instinctual movements, Kathy’s nervous system learns that the danger is over and that she’s no longer helpless.
Exposure Therapy
In addition to talk therapy and somatic therapy, exposure therapy can also be helpful. If someone is very avoidant of doctors or hospitals, working with a therapist to gradually face those fears can greatly reduce anxiety and help you regain a sense of safety. And we don’t just jump into the deep end. We would go very slow and gentle.
- We might start by inviting Kathy to just imagine walking into a doctor’s office while noticing her body’s response. And we would practice grounding or soothing skills.
- Then we might look at medical images online while tracking any sensations of distress.
- Next, Kathy and I would visit a hospital parking lot without going inside.
- Then we would sit in a waiting room and practice relaxation techniques.
- And finally, Kathy would attend an appointment with support.
This slow, body-focused exposure could help desensitize Kathy’s nervous system without forcing her to re-experience the trauma too quickly.
I think it’s really important to work with the brain and body together in healing medical PTSD. With help from a therapist and courage and effort on your part, you can release stored trauma, learn to regulate distress, and regain a sense of safety around medical care.
Preventing Medical Trauma
In addition to treatment, I think it’s just as important to explore how we can prevent medical trauma. Providers and patients both play a role in preventing fears, phobias and PTSD from developing.
Medical providers have a responsibility to help patients feel safe, supported and protected during their experience at the clinic or hospital—even in an emergency situation. Care providers should take time to explain treatment options when possible, provide a soothing environment, and learn to recognize distress in their patients.
Patients and parents of children receiving medical care have the right to feel safe and heard in medical settings. Your voice and experiences matter in receiving good healthcare. You can shop around for medical professionals who listen and involve you in decisions. And you can learn how to advocate for your needs during medical appointments to regain a sense of agency. This might look like writing down your questions ahead of time, or taking someone with you to help advocate for you.
Here’s a link to a resource that can help parents, patients, and care providers know how to recognize and respond to distress so that medical interactions don’t become traumatic.
And here’s Kathy’s advice for preventing medical trauma:
“I wish I had learned to use my voice earlier. I wish I had learned to trust myself and my intuition and to know that I know my body better than anybody else. And when [a medical professional says] that what I’m telling [them] isn’t true, and I know that it is true, I need to tell [them], ‘You’re wrong.’ I don’t care what title you have behind your name, I know my body.
[I wish I had known to] trust my body. Because of all of those medical people that told me I couldn’t trust my body, I started believing that I couldn’t trust my body. And now I’m learning to trust my body again and to speak up for my body, and I would hope I wouldn’t let it happen again, that I would stand up and say what I need to say at the time. Yeah, learning to trust yourself sounds so easy, and it’s so hard.”
Conclusion: Steps Toward Recovery
Medical PTSD is all too common. There are a lot of people suffering like Kathy was. But, even though the trauma can feel overwhelming, healing from medical trauma is possible. Your brain and body are wired to process through these experiences and heal. If you have PTSD from medical care, I hope you’ll take one small step toward healing today, whether it’s scheduling therapy, journaling about your feelings, or seeking a support group.
If you’re interested in joining our weekly live calls, those are included as part of our membership at TherapyInANutshell.com. Click the picture below to learn more about it.
And if you don’t want all the membership benefits, you can still get my free course for Grounding Skills for Anxiety, as well as lots of other free resources on the website.
