Cancer Treatment Centers of America

Could the stress and anxiety triggered by a cancer diagnosis amount to PTSD?

CTCA,
PTSD

Cancer diagnoses often hit patients like punch in the gut. "It's so common for people to have their lives flash before their eyes when they are told they have cancer," says Katherine Puckett, PhD, MS, MSW, LCSW, Director of the Department of Mind-Body Medicine at Cancer Treatment Centers of America® (CTCA). "They'll say, 'Is this it? Is this the end?' It is traumatic for a lot of people, and obviously, people deal with it in different ways." For some patients, the reaction to a diagnosis in the days and weeks that follow may mimic some of the signs associated with post-traumatic stress disorder (PTSD), such as depression, anxiety, sleeplessness and hypervigilance. But is it really PTSD?

It's so common for people to have their lives flash before their eyes when they are told they have cancer. It is traumatic for a lot of people, and obviously, people deal with it in different ways.”
- Katherine Puckett, PhD, MS, MSW, LCSW, Director of the Department of Mind-Body Medicine at CTCA®

According to research conducted at the University of Malaysia in Kuala Lumpur, 13 percent of the 469 cancer patients studied met the full criteria for PTSD the first six months after their cancer diagnosis. Another 8 percent experienced some symptoms of PTSD during that time. The study, which sparked international headlines when it was released in November, found that 6 percent of patients still suffered from PTSD when the four-year study concluded. "While PTSD is more often associated with traumatic events such as violent physical and sexual attacks, serious accidents and natural disasters, this includes being diagnosed with cancer, the experience of undergoing cancer treatment and surviving cancer," study author Caryn Mei Hsien Chan told the Reuters news service.

But Robert W. Bloom, MD, Psychiatrist at our hospital in suburban Chicago, cautions patients not to "glom on to that PTSD diagnosis.” “It's become a favorite label," he says. "PTSD is becoming over-diagnosed." The disorder is a specific condition, with distinct symptoms and criteria defined by the American Psychiatric Association. "There are lots of people who have lots of stress who wouldn't necessarily meet the criteria for true post-traumatic stress disorder," Dr. Puckett says. Patients may instead be dealing with similarly distressing conditions, such as acute stress disorder or cancer-related post-traumatic stress. It's also possible, Dr. Bloom says, that a cancer diagnosis may not be the primary source of a patient's stress. "Usually, if you see PTSD in a cancer patient, it's the activation of a trauma that happened previously," he says.

PTSD originates in the amygdala, a pair of almond-shaped lobes deep inside the brain that reacts to threats to life or safety, putting the brain into escape mode. The amygdala (named after the Greek word for almond) also retains memory of traumatic events and triggers responses when stimulated by memories or external stimulus, such as a loud bang. When the amygdala is stimulated, it may also release cortisol, a steroid that may cause increased heart rate, high blood pressure and other stress-related symptoms. "Sustained and persistent stress can become deleterious to people’s health," Dr. Bloom says. "They may wind up with hypertension. They could develop diabetes, sleep apnea or sleep disorders. There are a whole host of consequences." Many of those consequences may hinder a cancer patient's ability to handle treatments and fight off disease, he says. Some cancer patients with PTSD may develop a behavior known as "learned helplessness." These patients behave as if they have collapsed under the weight of their condition and appear to have given up the fight. "They can be non-adherent with their cancer treatment," Dr. Bloom says. "They might be smoking or drinking, and they may abuse their narcotic prescriptions."

Whatever the diagnosis, Dr. Bloom stresses the importance of getting a thorough psychological examination that explores events and other conditions that may be contributing to stress. "PTSD is almost never seen in isolation," he says. "It's usually associated with a mood disorder, an anxiety disorder, substance disorder, even sleep disorder." It's also important, he said, for patients embrace their journey in life. Reliving and sharing experiences, be they joyful or traumatic, may help patients get to the root of their stresses and find better ways to cope with them. "Don't lose yourself as a person," he says. "Don’t define yourself as a cancer patient. Instead, identify yourself as a person who has cancer. You can get through this and survive emotionally, which will help improve your physical strength, too."