You’ve heard of trauma. And you know all about medical illness. But have you heard of medical trauma?

Medical trauma occurs after someone undergoes a serious medical procedure or illness. Teens diagnosed with chronic or terminal illnesses may struggle with medical trauma, as can those with life-threatening injuries or surgeries. Research shows, for example, that many people who receive treatment for cancer and cardiac issues experience medical trauma. For others, just a visit to the emergency room or ICU can have traumatic implications as well.

Hmm, you might be thinking. I never knew medical procedures could cause PTSD.

That means post-traumatic stress disorder, in case you don’t know your mental health acronyms.

And yes, it’s true – medical treatments can result in trauma for several reasons:

• Procedures can be physically invasive and painful
• Unexpected diagnoses can cause extreme stress
• Immobilization or physical restraint can cause anxiety, fear, and/or pain
• An unfamiliar environment may be disorienting
• The side effects of some medications can cause physical or emotional stress

General Trauma and Medical Trauma: The Difference

There are many events and experiences that cause trauma in children and adolescents. Unfortunately, many times the trauma involves neglect or abuse (physical, sexual, or emotional). Other times it’s family violence, the death of a loved one, natural disaster, or school shootings. War and terrorist attacks like 9/11 are definitely traumatic events. Even exposure to media coverage of traumatic events can be classified as traumatic.

Then there’s medical trauma.

According to the National Child Traumatic Stress Network (NCTSN) medical trauma can occur as a response to any medical experience that involves pain, injury, serious illness, and frightening treatment procedures.

According to the NCTSN, up to eighty percent of adolescents who sustain a life-threatening illness, injury, or painful medical procedure end up having symptoms of trauma. These symptoms include:

Rumination

Rumination means that the teen keeps thinking a lot about the trauma, even when they do not want to. Of course, thinking about what happened is natural, but rumination can become obsessive, excessive, and intrusive. Rumination can become very distressing because the brain keeps playing an endless loop of the incident on repeat.

Nightmares and Flashbacks

A teen may re-experience the event through upsetting nightmares and flashbacks. He or she may also experience psychosomatic symptoms like trembling, hyperventilation, or shortness of breath when faced with triggers of the medical experience. (e.g. when she passes by the street of the hospital in which she was treated, or smells the scent of sanitizing alcohol, which could remind her of a procedure.

Avoidance

Teens who are experiencing symptoms of avoidance will expend truly herculean efforts to try not to discuss the traumatic incident at all or completely deny that it happened internally. Avoidance also can result in teens becoming hypervigilant and obsessive about certain issues; e.g. they may not get into a car if it’s raining if they were in a car accident once during bad weather.  Extreme avoidance or fears can become problematic when they interfere with a teen’s regular functioning.

Hyperarousal

When a child experiences a trauma, the memory imprints itself into the brain’s amygdala. This hijacks and alters the brain’s fight-or-flight response. Thereafter, everyday situations and events—even if they only slightly share a resemblance to the traumatic event—can cause the teen to experience hyperarousal. This happens because the adolescent interprets ordinary events as high-risk, threatening situations. For example, a teen who was badly burned during childhood, and required hospitalization treatment, may experience a disproportionate amount of distress whenever they handle something very hot.

Do All Medical Procedures Cause Trauma?

No.

Some trauma symptoms may fade after some time. Not all traumatic symptoms are equal in terms of intensity or frequency. However, when symptoms persist for more than two weeks or disrupt daily functioning, that’s a problem. Symptoms also require attention when they affect the ability to continue with medical treatment. If a teen undergoing chemotherapy is so depressed that they start to engage in life-interrupting behaviors such as self-harm, they require an immediate assessment by a mental health professional to determine if they need outpatient treatment or a short-term stay at a reputable residential treatment center.

Medical Trauma and PTSD

Sometimes, medical trauma can be severe in that it results in post-traumatic stress disorder (PTSD). According to the NCTSN, between 15-25 percent of children who experience persistent symptoms of medical trauma end up having PTSD. If left untreated, PTSD can significantly impact the ability to concentrate, sleep, and function normally. It can cause substance abuse issues, relationship problems, and other mental health or behavioral concerns such as self-injury or suicidal ideation. For these reasons, early intervention for medical trauma and PTSD is essential.

If you think your teen is experiencing PTSD from a medical trauma, your best next step is to get an assessment from a mental health professional with experience working with adolescents. A mental health professional can determine if your teenager’s PTSD requires immediate intervention at a mental health treatment center such as a residential treatment center, partial hospitalization program (PHP) or intensive outpatient program (IOP).