The internal threat of medical trauma

Written by

Amye Archer, MFA

Last updated: 11/10/2023

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When Robin Black woke up from what she thought would be a short procedure to remove some of her parathyroid glands, she was stunned to learn she’d been in surgery for almost seven hours. Her doctors had discovered cancer during the operation, and as a result they wound up removing Black’s thyroid and several lymph nodes.

“I remember just, like, bursting into tears. I don’t normally get panicky or hysterical, but I was really close,” she says. Still grieving her estranged husband’s recent death, Black was struggling to feel at peace in her body. Her surgical experience worsened the posttraumatic stress disorder (PTSD) she’d suffered in her marriage, and it soon became a chronic condition.

What Black went through is called a medical trauma. Trauma in a medical setting is not new, but experts have only recently begun to study the long-term impact it can have on our mental and physical health.¹

What is medical trauma?

Medical trauma is defined as “a set of psychological and physiological responses to pain, injury, serious illness, medical procedures, and frightening treatment experiences.”²

Sacha McBain, PhD, a psychologist who specializes in medical trauma, says that what makes this type of trauma unique is that the threat is internal. “Medical trauma is when something has impacted the body’s integrity,” McBain explains. “Something has happened within the body that is a source of threat and danger.” If this occurs at a young enough age, the patient may not even be aware of the driving force behind their body’s trauma response later in life.

Other factors also influence the severity of a medical trauma response. McBain describes this as the intersection of your trauma with your relationship to the health care system and your own support network. For a person without health insurance who has experienced only emergency care and not routine care, for example, a medical trauma might elicit a stronger response.

What does a medical trauma response look like?

According to McBain, depression, anxiety, and PTSD are common primary responses to a medical trauma.

Black says she experienced anxiety and depression after her medical trauma. “I was 46 and still trying to grasp the idea that I might never be in a marriage again after my husband’s death,” she recalls. “My biggest fear at that point in my life was that I could wind up alone. It put me into a tailspin.”

Sometimes a medical trauma response can be hard to spot, but McBain says there are two core behaviors to look out for.

Avoiding self-care: “Sometimes we’ll see people who might be going to lots of doctors’ appointments and lots of follow-up and staying really focused on their health,” says McBain. “Then that drops off and they’re not doing their self-care or taking their medications.” She adds that this is more common in people with chronic illnesses, who may experience a version of burnout at the thought of having to manage their health in the long term.

Overusing health care: “Sometimes people go to an emergency room because they’re seeking reassurance that there’s nothing seriously wrong with them,” McBain says. “But that ends up creating more issues because they can feel invalidated in an emergency room setting when they’re told nothing is wrong.” The patient might then come back to the ER repeatedly looking for someone who will validate their concerns.

Secondary crises

In addition to a trauma response, other related crises can take place in the aftermath of a medical event. Experts call these secondary crises, and they can also affect our physical and emotional health and our relationships, among other outcomes.³

For example, says McBain, a financial crisis might stem from a hospital stay or a diagnosis. “Thinking about the catastrophic financial impact of a hospitalization or chronic illness—having to pay for life-saving medications and not being sure if you can afford them—is a crisis,” she explains.

Risk factors

Anyone can experience a medical trauma. However, McBain says, you’re likely to have a more pronounced traumatic response if you’re from a marginalized community, identify as female, or have a preexisting mental health disorder.

People from marginalized communities

Immigrants, Indigenous people, and people of color, particularly Black Americans, have historically received inadequate care in emergency departments across the country.⁴ “Experiences of discrimination, bias, and oppression are reenacted within the health care system,” says McBain. “So not only am I in a pain crisis, but because I have a history of substance use or I’m a person of color, it’s being perceived that this pain isn’t real, or that I’m being difficult, and so it just compounds the experience of medical trauma.”

Women and girls

In 2020, the Centers for Disease Control and Prevention (CDC) reported that the maternal mortality rate had increased 18% over the previous year.⁵ For non-Hispanic Black women, the rate was almost three times as high. The reasons why are rooted deep in gender bias, as well as systemic racism. Research shows that women are historically underrepresented in research studies and are less likely to receive appropriate emergency care than men with the same conditions.⁶

People with preexisting mental health concerns

A person who already has a mental health disorder is predisposed to a more intense response to medical trauma, McBain says: “For example, somebody has a preexisting history of sexual abuse, and now they’re in their gynecologist’s office. Whether they have a neutral or negative experience in the office, reminders of the prior trauma can arise and cause distress.”

Black says the grief and residual trauma she was feeling from her ex-husband’s death helped set the stage for the chronic PTSD that resulted from her medical trauma. “I had a foundation of PTSD,” she says. “I’d lived in an unpredictable and manipulative environment with my husband. My surgery shook whatever stability I had left.”

Your health can be affected even if you aren’t the one who experienced the traumatic event. “Like PTSD and trauma, medical trauma can come from something you’ve directly experienced, something you’ve witnessed, or something you’ve learned about,” says McBain. This type of trauma can affect caregivers and family members who regularly witness loved ones in a medical or hospital setting.

Treatment options

A therapist can be a valuable partner in working through trauma, especially if you find one who specializes in trauma-focused interventions. According to McBain, cognitive processing therapy (CPT), prolonged exposure therapy, and eye movement desensitization and reprocessing (EMDR) have proved effective and helpful for traumatic stress from many types of trauma, including medical trauma.

Black says she was lucky to have an established relationship with a therapist who understood her trauma and helped her work through it. “She let me feel angry, sad, and all those things I wasn’t sure I had the right to feel.”

If you’ve experienced trauma, medical or otherwise, a trauma-focused therapist can help you start along the path to healing. Browse our directory to find a licensed provider near you.

Why trauma-informed health care matters

A health care system that not only recognizes trauma but knows how to respond to it appropriately is essential for mitigating or preventing medical trauma. “A lot of medical trauma happens in the context of interpersonal relationships and systemic factors,” McBain says, “and trauma-informed care can get at some of those risk factors.”

Trauma from a medical event often shows up as fear. For example, someone may feel very afraid of getting shots. Though it’s normal to experience some level of anxiety or worry around needles, that fear can become overwhelming and prevent the person from getting needed medical care.

When that patient goes to a doctor’s office, they may not be treated with the psychological consideration they need because the care team isn’t trained to understand what trauma looks like. “In health care, they often only have the time and training to look at one slice,” says McBain. “Here’s a difficult or anxious patient who is complicating their care. Instead, what we need to do is to look deeper.” For instance, the patient may have been hospitalized often as a child, and now they’re reacting to the environment.

A trauma-informed care team knows how to look for signs of trauma and care for a patient who’s experiencing them. “They do things like get consent before touching, collaborate with the patient on decisions, and set expectations,” McBain says. These steps can help the patient feel safer and more in charge of their own body.

What does “trauma-informed” mean?

As defined by the Substance Abuse and Mental Health Services Administration (SAMHSA), a trauma-informed model of care operates under a set of principles called the “four R’s”:⁷

• Realize the widespread impact of trauma and understand potential paths to recovery.
• Recognize the signs and symptoms of trauma in clients, families, staff, and others involved with the system.
• Respond by fully integrating knowledge about trauma into policies, procedures, and practices.
• Actively resist retraumatization.

The importance of a strong support system

We have no control over past experiences that may put us at risk for medical trauma. They may have been random, like an accident or an assault, or they may have occurred in childhood. As society works to fix longstanding socioeconomic, racial, and gender inequities, progress can feel painfully slow. But one protective factor you can implement on your own is building a strong network of support.

Over the past five years, Black has put a lot of effort into developing her support system. Her immediate network consists of friends from different groups and walks of life, as well as a loving new partner. She has also kept up with therapy and still works diligently to process her trauma. “I have a lot of support and love around me now,” she says, “and that helps.”