Caregiver PTSD (particularly for family caregivers) is a prevalent mental health condition that impacts many people who are caregivers for elderly relatives, terminally ill relatives or other family members.
What is PTSD?
Post Traumatic Stress Disorder (PTSD) is a mental health condition brought on by traumatic experiences or events.
Anyone who experiences trauma develops PTSD.
Although PTSD often gets associated with war veterans, PTSD symptoms can have a detrimental impact on anyone who has experienced trauma (although not everyone who has suffered trauma will develop PTSD).
The symptoms associated with PTSD can affect anyone who has gotten exposed to trauma, including:
- People who have suffered abuse (emotional, physical and sexual)
- People who have encountered violence (or witnessed a violent scene)
- People who have survived a natural disaster or serious accidents
Does caregiving cause Posttraumatic stress disorder?
Broadly, caregiving (particularly those in a family caregiver role) is one of the leading causes of PTSD.
Although the psychological distress associated with taking care of a family member is very often understated – as a result, family caregivers are frequently overlooked by the healthcare profession and within familial communities.
Still, the psychological distress that many family caregivers endure can be burdensome and often wreaks havoc on their emotional and physical well-being.
Family caregivers
Occasionally referred to as the ”hidden casualties,” family caregivers usually have many responsibilities ranging from:
- Making important medical decisions on a loved ones’ behalf
- Dealing with the mental and physical exhaustion of taking care of a loved one (whether it be at home or in a healthcare facility)
- Dealing with incredible amounts of stress and anxiety, mainly when the caregivers loved ones’ are getting treated in an intensive care unit
- Financial implications of caregiving such as medical bills and long absences from work due to caregiving demands
Ambiguous loss
Another aspect of family caregiving is the unsupported grief that many family caregivers experience.
Often referred to as ambiguous loss, family caregivers are at increased risk of developing complicated grief due to the nature of their caregiving role since the person they love is both here and gone.
Grief from traumatic events
Ambiguous loss is intangible grief mainly due to the absence of death, which frequently causes confusion for both the griever and the people around them.
Those experiencing ambiguous loss often get catapulted into a state of grief limbo, a world where it can feel impossible for people to move forward and learn to live with the uncertainty of their loved ones’ health predicament.
Symptoms of ambiguous grief
Ambiguous grievers may experience:
- Confusion
- Doubt
- Sadness
- Depression
- Anxiety
- Guilt
- They may also develop complicated grief disorders from their unresolved or frozen grief.
Symptoms of PTSD
As briefly mentioned, PTSD gets induced when a person gets exposed to a series of traumatic events or witnesses a traumatic event.
Those who develop PTSD may not be aware that they are suffering from a mental health problem or believe that their symptoms are due to another mental health condition such as anxiety disorder or depression.
Signs
Typically, the symptoms associated with PTSD include:
- Reliving – hallucinations, flashbacks and nightmares of the incident
- Intrusive thoughts, negative thoughts or feelings such as guilt or anger
- Avoiding – avoiding places, people, things or memories that are a reminder of the traumatic experience
- Excessive arousal including anger, rage, hatred or irritability, increased alertness, trouble sleeping, or concentrating
- Flat affect
Other signs
Family caregivers often experience markedly different PTSD symptoms compared to other people living with PTSD. These symptoms include:
- Increased levels of anxiety – this includes night terrors, particularly when caregivers are given the role of next of kin and receive continuous late-night calls from healthcare providers about their loved one’s condition. Equally, those taking care of a loved one at home may experience profound anxiety, which puts them on high alert at night.
- Physical pain and emotional anguish – a large majority of caregivers report physical aches and pains that don’t seem to go away. They also experience headaches, stomach complaints and thoughts of hopelessness.
- Reliving the experience – many caregivers experience flashbacks – they may flashback to a time when their loved one was very ill and feel unable to get those disturbing images out of their mind. During a flashback episode, many people report feeling as though they were losing their loved one all over again. All this may get experienced alongside anxiety, where the person is suddenly on high alert and is easily startled.
- Emotional detachment – many studies reveal that family caregivers often experience numbness and separation from family and friends. All this can also get accompanied by compassion fatigue, where the person feels empty and numb even when confronted with highly upsetting situations. Caregivers are also at increased risk of suicide.
Stressful situations
Intensely stressful situations such as witnessing a loved ones’ health decline or being exposed to traumatic environments such as intensive care units or when loved ones become ICU patients are all trauma-inducing events.
Acute Stress Disorder
Repeated exposure to a stressful situation (like caregiving) can create an acute stress response where people go on to develop a condition called Acute Stress Disorder.
Acute Stress Disorder (ASD) typically occurs about a month after a traumatic event has taken place. The symptoms of ASD usually last around three days but can persist for up to a month.
Symptoms
The symptoms that get associated with ASD are similar to those experienced with posttraumatic stress disorder, with many ASD symptoms being dissociative – they involve:
- Derealization – this is when an individual’s environment seems strange or unreal.
- Depersonalization occurs when people’s emotions or thoughts don’t seem real or feel as though their feelings and ideas don’t belong to them.
- Feelings of numbness and detachment – this may include emotional unresponsiveness.
- Dissociative amnesia – this occurs when the person cannot remember important aspects of the traumatic event.
Research from The Department of Veteran Affairs states that around 6 to 33 percent of American citizens who experience a traumatic event will develop Acute Stress Disorder.
Literature
Medical literature is scant when it comes to the psychological impact that family caregiving can have on individuals.
However, recent findings have highlighted the post-intensive care burden for family members and researchers are looking at ways to treat the accompanying symptoms of stress, anxiety, and depression.
The ‘’forgotten’’ family
Fortunately, critical care providers now recognize the need to acknowledge and address the emotional and psychological needs of the family members and relatives early on post ICU admission.
Statistics show that a high proportion of family members present with symptoms of depression (35%) and anxiety (70%) after a loved ones’ intensive care admission.
Posttraumatic Stress Disorder and Acute Stress Disorder are also common mental disorders for people in this group.
Data were taken from the literature also reported that for people whose loved one’s died in hospital, up to 40% of them presented with criteria for psychiatric illnesses such as generalized anxiety, major depressive disorders and complicated grief.
Preventative measures related to post – ICU burden primarily involve communication strategies proposed to support and assist relatives.
Treatment plan
For those experiencing the debilitating symptoms of PTSD, life can feel like an extended episode of shell shock that seems never-ending. All this is especially true if you are a full-time caregiver or a primary caregiver.
Luckily, there are treatments available to support those dealing with challenging life experiences, such as family caregiving.
In particular, families of ICU patients would benefit from trauma treatment such as EMDR therapy (Eye Movement Desensitization Reprocessing), group therapy, family therapy and one to one counselling.
EMDR therapy is a renowned trauma treatment for people with PTSD. EMDR therapy enables clients to focus on a traumatic memory with the aim to reprocess the negative cognitions associated with a difficult event.
At the same time, a therapist gently guides clients through the process of bilateral movement, such as side to side eye movements, tapping or sound stimulation.
Eye Movement Desensitization Reprocessing therapy helps people process and discharge any negative images, emotions, beliefs, and body sensations that seem to be trapped.
EMDR was developed and is best known for treating trauma or Post-Traumatic Stress Disorder, this form of trauma treatment is recognized by the National Institute for Health and Care Excellence (NICE) and the World Health Organization (WHO) as an effective treatment for PTSD.
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