Amputation and PTSD: Causes, Risks, Prosthetics and Treatment

Amputation

Disarticulation: through the joint.

Closed: stump for prosthesis.

Minor: foot below the ankle joint (toes, or small bones in the foot).

Major: above the wrist or ankle (hemi-corpectomy (above hip), Syme (ankle)).

Causes

Vascular disease, cardiovascular disease, bone cancer, tumors (osteogenic sarcoma), congenital abnormalities.

Risks

• Edema (swelling)
• Ulceration
• Skin breakdown
• Contractures
• Bony growth
• Phantom limb pain
• Neuromas (nerve fibers)
• Hyperesthesia (stump sensitivity and different treatment)

Prosthetics

Speed vs. strength, lack of feedback, excessive energy, last 2-5 years.

Adjustment

• 20-50 years: return to work, most return to work, proximal amputation.
• Less return to work: lower limb amputation.
• 66% return to work.

PTSD

PTSD: About 8 of 100 people develop PTSD at some point. About 8 million adults a year. About 10 of 100 women develop it, and 4 of 100 men.

Military

23% of women reported sexual assault, and 55% of women and 38% of men experienced sexual harassment.

Diagnostic Criteria

All criteria are required to diagnose PTSD.

• Criterion A (Stressor, 1 required): exposed to actual or threatened death, serious injury, or sexual violence; direct experience; witnessing; learning that a relative or close friend was exposed to trauma; indirect exposure to details of trauma, including professional duties (e.g., first responders).
• Criterion B (Intrusion symptoms, 1 required): nightmares, flashbacks, emotional distress and physical reactions.
• Criterion C (Avoidance, 1 required): trauma-related thoughts or feelings and external reminders.
• Criterion D (Negative alterations in cognition and mood, 2 required): inability to recall key features of the trauma, negative thoughts and assumptions about self or world, blaming self or others for causing the trauma, negative affect, decreased interest in activities, feeling isolated.
• Criterion E (Arousal and reactivity, 2 required): irritability, aggression, risky or destructive behavior, hypervigilance, difficulty concentrating, difficulty sleeping.
• Criterion F (Duration, required): symptoms last more than 1 month.
• Criterion G (Functional significance, required): symptoms create distress or functional impairment (e.g., social, occupational).
• Criterion H (Exclusion, required): symptoms are not due to another condition.

Specifications

Dissociative specification: meets criteria for diagnosis and experiences high-level reactions to trauma-related stimuli.

• Depersonalization: being an outside observer or detached from oneself.
• Derealization: experience of unreality, distance, or distortion.

Delayed specification: full diagnostic criteria are not met until at least 6 months after the trauma.

Risk Factors

Women (4x more than men), predisposition to anxiety and depression, personality and temperament, brain regions, chemicals and hormones released under stress.

Treatment

Cognitive processing therapy, eye movement desensitization and reprocessing, emotional focus therapy, eclectic psychotherapy, narrative exposure therapy, CBT, medications, antidepressants and anxiety medications.