Examining PTSD as a Complication of Infertility
Medscape General Medicine. 1997;1(2)
"Posttraumatic stress disorder (PTSD) is a psychiatric disorder that may develop following exposure to threatened or actual injury or death. While commonly associated with war or natural disaster, symptoms of PTSD have been described in patients who are undergoing or who have completed infertility treatment or high-risk pregnancies....."
"Posttraumatic stress disorder (PTSD) is diagnosed in patients with persistent psychiatric distress resulting from events involving actual or threatened death or injury. Subsequent to the trauma, victims experience feelings of intense fear, helplessness, or horror. The precipitating trauma sets in motion a series of physical and emotional reactions that can have major and long-lasting effects. The characteristic triad of PTSD symptoms include (1) persistent re-experiencing of the event, (2) avoidance of reminders and numbing of responsiveness, and (3) increased arousal. Significant distress and functional impairment may result. Psychologically, PTSD is characterized by a classic triad of intrusive, avoidant, and hyperarousal symptoms."
"Although PTSD commonly occurs in situations such as war or natural disaster, other life-threatening situations like sexual or physical assault, being kidnapped or taken hostage, or being diagnosed with a life-threatening illness have been cited as precipitants....""The inability to conceive can catapult some patients into a state of shock, disbelief, and helplessness.Infertile couples must grieve 2 losses simultaneously: the loss of their ability to procreate as well as the loss of the hope for children. Women who have difficulty conceiving may react to these dual realizations as simply loss, or alternatively as psychological trauma. Those who experience a loss may subsequently develop major affective or adjustment disorders, but those who experience this loss as a trauma may instead develop PTSD. We have observed the development of PTSD in women who have experienced a variety of reproductive problems, including infertility, miscarriage, complicated pregnancy or delivery, and multiple births."
"When PTSD develops in response to infertility or other adverse reproductive events, patients exhibit the classic triad of symptoms described above. They may re-experience the trauma as nightmares, flashbacks, and intrusive thoughts about distressing procedures or pregnancy loss. Symptoms may manifest as extreme distress under seemingly innocuous circumstances, such as seeing a pregnant woman, menstruating, or visiting the doctor's office; these types of occurrences may trigger a recollection of the infertility battle or mark an anniversary of events in the struggle to conceive and/or to complete a difficult pregnancy."
"Avoidant symptoms include hesitance to discuss the trauma or to engage in any activities, thoughts, and feelings connected with infertility, pregnancy, or childbirth. The woman may be reluctant to discuss the experience with even her most intimate contacts. Avoidance may result in failure to bond, or a delay in bonding, with a newborn. Some PTSD-afflicted women even experience an aversion to the baby and become anxious just holding the infant. Other symptoms include amnesia regarding certain aspects of the trauma, apathy toward previously cherished pleasures or toward other children at home, hopelessness, feelings of isolation, and a general dulling of emotional responsivity."
"Comment. This case demonstrates the feelings of shock and helplessness associated with infertility itself. Some patients become overly involved in their infertility treatment as a defense against feelings of inadequacy. Further, the infertility work-up and treatment may be perceived as trauma in that it can be painful, humiliating, and intrusive. The nature of the treatment may lead to estrangement from one's own body and sexuality and a distorted perception of the self as merely a vessel for conception. This case also demonstrates some of the marital and sexual problems typical of patients with infertility.[9,10]"..... Social withdrawal is common with PTSD and has the effect of depriving the woman of much-needed support of friends and relatives. The stigma of infertility is another barrier to seeking support."
"... It is painfully ironic that many of the patients who win their battle with infertility subsequently develop PTSD or another psychiatric illness during or after the pregnancy. Since the full implications of the relationship between infertility and PTSD have yet to be fully explored, this area remains very worthwhile for future research"
Allyson Bradow, director of psychological services at Home of the Innocents, a nonprofit organization in Kentucky
"The definition of trauma should be expanded to include expectations of life," said Bradow, who went through fertility treatments herself, and conducted the study as a doctoral student at Spalding University in Louisville. "Having children, expanding your family, carrying on your genetic code — that's an instinctual drive that we have as human beings. And when that is being threatened, it's not necessarily your life being threatened, but your expectation of what your life can be or should be like," she said.
To find out how widespread these feelings were, Bradow and colleagues surveyed 142 people who had undergone fertility treatments, and who visited online support groups for infertility. Survey participants — 97 percent of whom were women — completed an online survey to assess their symptoms of PTSD. They were asked to consider their infertility diagnosis and fertility treatment as their traumatic event...Overall, 46 percent met the criteria for PTSD. Among this group, 75 to 80 percent said they felt upset at reminders of their infertility, such as seeing commercials for baby diapers. Other common symptoms included feeling distant or cut off from people, or feeling irritable. Many also said they felt hopeless, and had changes in their personality."