Many people are now familiar with the concept of trauma, and just how broad those experiences can be. Medical trauma in particular, is one of the types of trauma that impacts many people and can present additional and unique health challenges. It can often be overlooked as an underlying cause of mental health concerns, and can manifest in diagnoses ranging from anxiety, depression, to PTSD.

What is medical trauma?
Medical trauma is defined as the psychological, emotional and physiological distress that is due to a negative health care encounter. It is broad in its definition and can result from a single event of feeling dismissed by a medical professional.

Medical trauma can come from: 

1. An invasive medical procedure,
2. A diagnosis of a life altering illness,
3. A medical error,
4. A lack of communication with health care providers,
5. A difficult birth experience.

Medical trauma can happen even if the health care provider is not at fault. How medical trauma impacts an individual is deeply personal, and people will respond differently to similar events.

One common element of trauma is the sense of fear, and lack of safety that people experience and can continue to feel long after the event. These emotions originate in the nervous system; the brain’s perception of threat activates the body’s response to danger. In the process of dealing with the traumatic experience, the nervous system becomes overworked, resulting in being either overstimulated (fight, flight), or shutting down (freeze). These body responses are ways in which our bodies are trying to regulate.

With medical trauma, something unique is that the source of the fear and danger is internal-within the body-which makes it more challenging to manage. We can’t escape our own bodies- they are our home. When the body is the source of the pain and fear, we may want to disconnect from ourselves, which moves us away from healing. Another risk is developing avoidant behaviour, not wanting to seek medical help or treatment because of the fear. Developing avoidant behaviour is a common response to fear- but when we avoid taking care of our health, the consequences can be significant.

In addition to the physical responses to medical trauma, including pain, lack of mobility, illness, digestive issues and a variety of other uncomfortable symptoms, there can be a whole host of psychological symptoms to manage. With the increased sense of fear often comes elevated anxiety, stress and depression. Symptoms of PTSD (Post Traumatic Stress Disorder) can manifest.

The following list are some common symptoms seen with medical trauma:

1. Heightened anxiety, sadness, hopelessness, helplessness, anger,
2. Avoidance, fear of medical settings or professionals,
3. Emotional numbing,
4. Exaggerated startle response,
5. Intrusive thoughts,
6. Flashbacks, nightmares,
7. Thoughts of self harm, suicide.

Because this kind of trauma can go unacknowledged or dismissed, a person can also experience “disenfranchised trauma”. Not having your experience acknowledged and not feeling considered can add to the negative feelings of frustration and powerlessness. It can also be that the individual believes they should “just get over it” and that something is wrong with them because they are struggling. This perspective can then lead to guilt and self blame, which is not helpful for healing. Trauma needs to be validated in order for healing to happen. Trauma needs compassion and self compassion.

Depending on the nature of the medical trauma, a person’s entire identity may be changed by what has happened. Relationships at home and at work may change. A partner may need to become a caregiver which may be a new role for them. There may be other losses that have accompanied the medical trauma that need to be processed and accepted.

What can be done about medical trauma?

1. Recognize that your trauma is real and worth of being acknowledged:
   Learning about trauma and understanding that your feelings are a natural response to the event and validating your own experience is an important part of healing. Educating others close to you can also be useful, to help them understand as well.
2. Know your triggers:
   Trauma from a medical event typically shows up as fear. The fear responses can be lessened through awareness, education and learning self care techniques. Knowing what your triggers are and being prepared with strategies can help with coping. Deep breathing, mindfulness, visualization and tapping are some of the ways we can calm the nervous system.
3. Find ways to get your power back:
   Because part of trauma is the lack of or loss of control, and the loss of safety, it is important to find ways to get your power back. For example, preparing for appointments, and developing skills of self advocacy can help reinstate a sense of control. Being clear in your communication, writing down questions, and asking for what you need to make the appointment feel safe for you are other ways you increase your confidence. Bringing a trusted person with you to be another set of ears and eyes, as well as emotional support, is another way to create more safety.
4. Find people who share similar experiences:
   This can be powerful. Support groups in person or online can provide the empathy and understanding that can help with healing. Developing a network of support is known to make a difference in positive outcomes for wellness.
5. Focusing on good self care practices:
   Along with self care practices, a healthy life balance is also critical for healing from trauma. Remember the SEEDS acronym: Sleep 7-8 hours a night, eat healthy, Exercise, Downtime (Play) and Socializing are key elements for wellness. Learning mindfulness practices, engaging in yoga or tai chi, and learning new hobbies are also some ways to strengthen the brain and body connection.
6. Seek support from a therapist:
   It is important to find a therapist who is educated about trauma. It is difficult to heal from trauma on your own. Having a safe space to talk about your experiences, process your emotions as well as addressing the underlying fears are things that an experienced therapist can provide.

Types of treatment for trauma:
Treatment approaches such as EMDR (Eye Movement Desensitization and Reprocessing) and trauma-informed CBT (Cognitive Behaviour Therapy) are both recognized as gold standard, evidence-based treatment approaches to addressing trauma.

The therapies that are recommended for medical trauma tend to incorporate the body as part of the healing process. EMDR is one of the therapies that builds upon the body-brain connection.

The unique aspect of EMDR is that it uses the body’s own ability to heal as part of the treatment process. The “dual attention stimuli” (eye movements, tapping) helps initiate parasympathetic (nervous system) activation, which is helpful in reaching calming body states and mimics the state of REM sleep, the stage that promotes healing and integration.

Both EMDR and CBT can help with addressing deeply held negative beliefs that continue to perpetuate in your life. In this way, unhelpful thoughts and beliefs can be targeted and released, and new neural pathways are formed. After a traumatic event, it is common for people to be left with beliefs about themselves, others and the world that increase anxiety and fear, and can contribute to a lack of trust in others or in self, and in feeling disconnected. Understanding how traumatic experiences impact our thinking and our emotions is an essential part of the healing process.

Through increased awareness of medical trauma and the signs and symptoms, medical settings can become more trauma informed and increase trust and safety. Many health care settings have moved toward this goal, recognizing the cost of trauma for individuals, families and communities.

Final Thoughts:
For people who have experienced medical trauma, you deserve to be heard and understood. Having self compassion for your traumatic experiences, engaging in clear and open communication with health care professionals, and seeking the support you need are ways that you can begin to heal and rebuild trust. You are not alone.

This blog was provided by RSW Christine Bibby. This blog is not designed to replace seeking the support of a trained mental health professional. For more information, or to book a free consultation, reach out to us at 519.302.2300 or email reception@brantmentalhealth.com