Cristina Culiolo-Peck LPC Intern, LMFTA, EMDR trained Supervised by Michael Sliwa LPC, LMFT, CCHMC
When we hear about post-traumatic stress disorder (PTSD), we imagine war zones, wounded soldiers, and destroyed cities. While the number of servicemen and women returning home with PTSD has focused public attention on the disorder, it’s not confined to combat zones. In fact, PTSD can be found in our neighborhoods and in our homes.
To understand the link between breast cancer diagnosis and PTSD, it’s best to start by exploring the definition of the disorder. Post-traumatic stress disorder is a cluster of symptoms resulting from one significant traumatic event or multiple small traumatic events that have happened throughout one’s life. These traumatic experiences are often intense and frightening enough that the person may perceive his or her own life as being threatened. Life-threatening situations that can result in PTSD include natural disasters, car accidents, terrorist attacks, the death of a loved one, a divorce, or sexual, emotional, or physical abuse. Any high-intensity, fearful event – even one of short duration – can cause PTSD.
How do we recognize PTSD? Symptoms may include varying degrees of depression, anxiety, flashbacks, and nightmares. The individual may be unaware she is affected by PTSD; often family members are the first to notice that something isn’t right. A woman with PTSD may start feeling sad, eat more or less, have a low level of energy, and avoid people and situations she enjoyed before. Emotionally, she may feel numb or she may have unexplained feelings of guilt. Changes in sleeping patterns and a high level of anxiety or panic attacks are typical of PTSD.
Flashbacks are the hallmark of PTSD – reliving the event without a real understanding that the memory is coming from the past. Similar situations may cause a person with PTSD to become hyper alert. Because the physical reactions and emotions caused by the disorder are very intense, some people start self-medicating with alcohol and/or drugs.
The question that comes to mind for many women is “Why me?” Not everyone who undergoes the same life-threatening experience will develop PTSD. At present, researchers are trying to discover why some people are more prone to PTSD than others. From the standpoint of neurobiology, there is a strong correlation between genetics, fear, production of stress hormones, and past and present memories.
How does this relate to breast cancer? The Journal of National Cancer Institute published an interesting study concluding that 1 in 4 women were likely to have PTSD after a diagnosis of cancer. The researchers found that Asian and black women were more at risk than white women but they remain unsure about the reason for the racial disparity.
Maria is in her 40’s, married with two children. When she learned that the lump in her breast was malignant, she was frightened. Because of the type and stage of her cancer, her medical team recommended a mastectomy and lymph node removal, as well as radiation and chemotherapy to minimize the risk of recurrence.
After receiving her diagnosis, Maria started to think about her life and wondered what she did to deserve it. She felt depressed, angry, helpless, and confused as she confronted her disease and her options.
Today, a year after surgery, Maria continues to have nightmares about her experience. She has flashbacks every time she sees the hospital or hears sounds or smells that make her remember her cancer treatment. She has a high level of anxiety and depression, and when she realized she was isolating herself from others, she sought help for PTSD.
Adrienne, who suffered complications during her treatment, also developed PTSD. After a double mastectomy, lymph node removal, oophorectomy, breast implants that later had to be removed and finally, lateral flap reconstruction, she is considered cured. Adrienne describes PTSD this way: “With breast cancer, you feel your body is an unsafe environment, the ‘war zone’ so to speak. Treatment for PTSD is difficult while you’re still in treatment for cancer because you feel unsafe in your own body so there is no safe place to be.“
Where do you turn for help when the war zone is inside of you? Even positive thinking may not help. “Young women are told to be tough and fight, which is good but this can cause unrealistic expectations of control,” Adrienne says. “You can fight all you want, but your body does something else.”
Often patients in treatment are told by health care providers, family, and friends that they must be positive. Candice, a five-year glioblastoma survivor, believes this creates an unnecessary burden of guilt for some patients. “If I was not positive, I felt like something was wrong with me, and that it was somehow my fault,” she says. “We’re already dealing with a lot without having to live up to an expectation that for many is unrealistic.”
Will Maria’s and Adrienne’s PTSD resolve with time if they don’t participate in therapy? The answer is no. While the individual and those around her may develop some coping skills, PTSD won’t be resolved without treatment and professional support. If left untreated the traumatic event will stay frozen in time. A cyst is a good metaphor. When a foreign object enters a tissue or organ and isn’t removed, tissue begins to form around the object, producing protective layers as a defense mechanism to separate the foreign object from the rest of the organ. The foreign object is still there, possibly causing infection and damage to the rest of the body. It’s the same with trauma. It stays there in our memory and forces us to develop defensive coping skills to avoid the painful memories. Those coping skills may include a range of behaviors, including panic attacks and addiction.
Therapy has a good track record of improving life for women with PTSD after breast cancer treatment. For some, it’s useful to have the support of a friend during treatment. Reading about the experience of others in blogs can also provide support and relief, as can involvement in support groups with others who have undergone the same experience. In general, it’s wise to talk with people who understand what you’re going though. Some women feel the only way to really heal is to give back to other women in need of support through volunteering or work that relates to their traumatic experience.
Doctors may prescribe medication to help control the level of anxiety you’re experiencing but a long-term solution should include therapy with a trusted professional counselor trained in the treatment of PTSD. Many types of therapy are available and proven to be helpful; the choice depends on your readiness for change and personal preferences, but early intervention always provides the best results.