Trauma from events that never occurred

A study just published in the medical journal Psychosomatics reports four case studies of people who developed PTSD after experiencing a traumatic event that never occurred – while their emotional reaction was real, the events were hallucinated.

Post-traumatic stress disorder can occur when someone has experienced a traumatic event over which they had no control. PTSD is diagnosed when memories of the event intrude into everyday life, the person feels the need to avoid anything which could remind them of the situation, and they feel excessively anxious and on edge.

The patients described in the article had all been admitted to intensive care for serious medical conditions, but this was not the direct cause of their trauma.

While in intensive care the patients became delirious, a state where consciousness is clouded, thinking is impaired, and delusions and hallucinations are common.

In these cases, the delusions and hallucinations led the patients to believe they were about to die horrible deaths, were being threatened or were experiencing horrific events.

Later, when they recovered from their primary condition, they had all the symptoms of PTSD – but specifically for the incident that had only occurred in their disturbed thinking.

Here’s one of the case studies:

“Mr. A” was a 56-year-old white man who developed end-stage liver disease from a combination of alcohol and viral hepatitis. Aside from remitted alcohol dependence, he had no other psychiatric history. After liver transplantation, he experienced a difficult medical course, with sepsis, renal failure, biliary reconstruction, respiratory failure, and immunosuppressive medication neurotoxicity from tacrolimus. Several electroencephalograms showed diffuse generalized slowing of the background rhythms and documented seizures. He had persistent delirium for several months postoperatively.

While having delirium, he was extremely agitated, requiring restraints to prevent him from hurting himself and/or dislodging lines and catheters. He appeared awake, but was frequently incoherent and disorganized. However, he was able to articulate paranoid delusions that the staff were trying to kill him and his son. He was also observed to be responding to auditory and visual hallucinations.

Four months after the transplant, when he was discharged from the hospital, his delirium had resolved. He was no longer confused or disoriented, was not actively hallucinating or delusional, and his mood was good, with only occasional, transient symptoms of anxiety.

Several months later, in the transplant clinic, he reported reexperiencing events he had hallucinated while having delirium in the intensive care unit (ICU), and, thus, he met DSM‚ÄìIV criteria for PTSD. He recalled detailed paranoid delusions that the hospital staff had chained his son to his bed and were beating him to death. He recalled struggling against the restraints, hoping to free himself to save his son. He described hearing his son’s screams for help and sounds as if his son was being pummelled.

He reported recurrent nightmares of these events and even daytime flashbacks of these experiences, typically when spending time alone. He attempted to avoid thinking about these events and the hospitalization, but described difficulty doing so because the thoughts were intrusive and difficult to dismiss. Not only did he avoid discussing the events, but he also had difficulty returning to the hospital because it caused him to recall these images. He was observed to be restless and hypervigilant in the transplant clinic.

Both the medical illness and the psychoactive painkillers can contribute to the disturbed thinking that lead to delirium. This in turn can significantly affect how people remember their recovery.

In fact, one study found that some patients had no factual recall of intensive care at all, their only memory of the time was of their delusions. This group were particularly likely to be traumatised.

People are sometimes embarrassed to talk about these experiences, but they are surprisingly common. Studies have estimated that between between 12.5% and 38% of ICU patients experience delusions and hallucinations.

Link to study abstract.

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