Polio Survivors and PTSD
Question: For some unknown reason, I just had a flashback to when I had polio. I had a mild case. But, as a child I had surgery on both feet to correct some serious problems not related to polio. I was confined to bed during recovery and the only way I could get around was crawling or someone helping me transfer to a wheelchair. At night lying in bed, I started panicking about what would happen if the house caught fire and I could not get out. I can't have been the only survivor who has had that feeling.
When I started teaching, I was always aware of how to get my students out; no matter where I am I always check to see 'how to get out'. It isn't a major disruption in my activities, but I am becoming more aware again of being in places where, if I am on crutches, I could take a fall or not be able to get through, like when people put chairs in the aisles and block exits.
Last week, I became “unglued” when our church set up chairs, and there was only one aisle for everyone to use. I wonder how many of us have PTSD that goes back to when we were incapacitated, abused and felt trapped?
Dr. Bruno’s Response I'm sorry you have had frightening emotional and physical experiences triggering flashbacks and fears. Our research and experience since 1982 treating polio survivors reveal that those disabled as children (especially if they were hospitalized and neglected or abused by staff) are nearly universally afraid of fire or being trapped.
Many of our patients have very powerful memories of abuse and the terror of, things like:
being thrown into a pool as "physical therapy,"
being burned by boiled woolen "Sister Kenny” hot packs,
being strapped in their beds and punished if they dared cry in the ward at night,
and even the horror of sexual abuse.
It’s no wonder that participants in our 1995 International Post-Polio Survey who were hospitalized reported 34% more physical abuse and 94% more emotional abuse than did individuals without disabilities. Looking back, I believe that the high rate of refusal to comply with or even start the Post-Polio Institute treatment program in the 1980s was a direct response to fear and shame of publicly being seen as a polio survivor and again being subject to physical and emotional abuse.
Fortunately, very few of our patients have flashbacks and, perhaps surprisingly, we never have had a patient who even came close to meeting the criteria for PTSD (see below). PTSD is diagnosed not by the presence of a few incidental symptoms, but requires:
. . . at least 6 specific and recurring symptoms that persist for more than 1 month and cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
Your fear of being trapped and flashbacks of childhood experiences are disturbing but fortunately (based on what you have explained) don't meet the criteria for PTSD.
Recently a new diagnosis has been proposed: "Complex PTSD". While PTSD is related to individual traumatic events like being at the World Trade Center on 9/11 or having a severe automobile accident, Complex PTSD is related to experiencing recurring or long-term traumatic events such as living in a war zone, being in an abusive long-term relationship or having a long hospitalization. Unfortunately, the proposed symptoms of Complex PTSD are so similar to symptoms of PTSD that they are redundant, adding nothing to the accepted PTSD criteria.
If you are experiencing any of the symptoms of PTSD that interfere with your daily activities or peace of mind, be kind to yourself and see a psychotherapist who knows about trauma - regardless of whether you meet the diagnostic criteria for PTSD. Be well!
Post-Traumatic Stress Disorder - DIAGNOSTIC CRITERIA
1. At least one of the following intrusion symptoms associated with the traumatic event(s):
Recurrent, involuntary and intrusive distressing memories of the traumatic event(s).
Recurrent distressing dreams related to the traumatic event(s).
Dissociative reactions (e.g., flashbacks) in which the individual feels or acts as if the traumatic event(s) were recurring.
Intense or prolonged psychological distress or marked physiological reaction with exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event(s).
2. At least one of the persistent avoidance of triggers associated with the traumatic event(s) as evidenced by the following:
Avoidance of or efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s).
Efforts to avoid external reminders (people, places, activities, situations) that arouse distressing memories, thoughts, or feelings associated with the traumatic event(s).
3. At least two negative alterations in thoughts and mood associated with the traumatic event(s) evidenced by the following:
Inability to remember an important aspect of the traumatic event(s).
Persistent and exaggerated negative beliefs or expectations about oneself, others, or the world (e.g., “I am bad,” “No one can be trusted,” “The world is completely dangerous,” “My whole nervous system is permanently ruined”).
Persistent distorted cognitions about the cause or consequences of the traumatic event(s) that lead the individual to blame himself/herself or others.
Persistent negative emotional state (e.g., fear, horror, anger, guilt, or shame).
Markedly diminished interest or participation in significant activities.
Feelings of detachment or estrangement from others.
Persistent inability to experience positive emotions (e.g., inability to experience happiness, satisfaction, or loving feelings).
4. At least two marked alterations in arousal and reactivity associated with the traumatic event(s) as evidenced by the following:
Irritable behavior and angry outbursts (with little or no provocation), typically expressed as verbal or physical aggression toward people or objects.
Reckless or self-destructive behavior.
Hypervigilance.
Exaggerated startle response.
Problems with concentration.
Sleep disturbance (e.g., difficulty falling or staying asleep or restless sleep).
5. More than 1 month duration of the symptoms in B, C, D.
6. Symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
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