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Expert Q&A

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Could I have PTSDfrom a hospital stay?

Asked by Katja Clever, Henderson, North Carolina

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I recently had a terrible experience in the hospital. After surgery, while I was still mostly under and groggy, someone came and pulled the tube out of my mouth rather roughly then inserted another tube without ever speaking one word. This trauma has left me with a rather large problem: I do not eat solid food anymore. I know that this is all in my head, but I cannot overcome this. I am on antidepressant med and have seen a throat specialist. Can anyone help?

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Mental Health Expert Dr. Charles Raison Psychiatrist,
Emory University Medical School

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I am sorry to hear of your situation. Unfortunately, your story is all too common. We now know that many people develop post-traumatic stress disorder from their experiences in the hospital. While everybody's story is a little different, the general theme of emerging from the modern medical environment with PTSD is an under-recognized risk of being very ill and/or undergoing serious medical or surgical procedures.

In fact, I have heard of stories like yours. I treated a patient once who had a somewhat related problem. He was a very successful musician who pulled into a parking lot one day with the intent of sampling something sweet at a local ice cream parlor. He was standing in line when suddenly a mighty blow came crashing on his head from behind. Then he was suddenly lifted high in the air and thrown against the glass ice cream case. Unable to see what was going on, he crashed to the floor and began to be kicked. Finally, in the midst of this process, he was able to turn around. At that moment he was sure he had lost his mind and he was sure he was going to die, because he saw a giant man delivering these blows. He was taller than any human could possibly be. The man was cursing and screaming at him. Then, as quickly as it had started, it was over, and the giant stormed off.

As it turned out, my patient had been attacked by a very famous basketball player who was upset over personal problems and had mistakenly thought the patient had flipped him off in the parking lot as they vied for a parking spot.

My patient developed many classic symptoms of PTSD. He felt ashamed and helpless and enraged. He had nightmares and couldn't work. He felt emasculated and ruminated constantly on some type of revenge. But the symptom that caused him the most practical problems was becoming unable to drink anything from a glass. He would become terrified as he brought a glass to his lips. This symptom did nothing but humiliate him further.

Like you, he was on an antidepressant, which helped in general but didn't touch his fear of drinking from a glass. To eradicate this problem a therapeutic intervention was required. First, he needed to understand why he had this particular symptom. I pointed out the first terrifying thing that had happened to him during the attack was that he was thrown against the glass of the ice cream case, which might explain his fear of anything made of glass approaching his face. While he had not thought of this, it immediately struck him as true and he found some relief in this.

You are one step ahead of the game, because you understand the genesis of your swallowing problem. Like my patient, you were violated in a moment of utter vulnerability in a way that provided no warning. This is a classic recipe for the development of PTSD symptoms.

But knowledge alone was not enough for my patient, so I'm not surprised it is not enough to liberate you from your symptom either. What my patient needed, and what you need, is a behavioral approach that allows for breaking the big problem into smaller manageable pieces that can be conquered one at a time. In my patient's case I hit upon the idea of him carrying a straw in his pocket to use whenever it was necessary to drink from a glass. He found the straw gave him enough distance from the glass to tolerate the experience (as well as an all-important sense of control), while at the same time bringing him close enough to the glass that over time he became more and more comfortable with the situation. In time, he was able to gradually set the straw aside and resume normal drinking behavior.

Because I am not working with you directly, I cannot make specific therapeutic recommendations for developing a plan to help you conquer your fear of swallowing solid food. But I do have two important general suggestions. The first is that you set aside any embarrassment you may have over your problem. It is not unusual and it is nothing to feel awkward about. Rather, it is a challenge to be surmounted one step at a time. My second suggestion is that you make an appointment to see a psychotherapist who specializes in behavioral interventions for anxiety disorders. You might identify such a person by contacting whomever is prescribing your antidepressant. If he or she doesn't know someone appropriate, contact your state's chapter of the American Psychiatric Association or American Psychological Association for a referral.

It is very important that you don't wait any longer to get appropriate psychotherapeutic treatment for this very disabling and potentially medically threatening symptom. A good behaviorally oriented therapist will develop a plan for your recovery, and with its implementation you will likely be back to normal fairly quickly.

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