Post-Traumatic Stress Disorder
While post-traumatic stress disorder, or PTSD, is not one of the more common disorders seen in the MRI environment and is rarely discussed, it remains a major contender in the cause of anxiety and prematurely terminated/canceled exams. I’ve chosen to include it as having this knowledge may help you understand patients who suffer from this potentially debilitating disorder. PTSD is more common than you may think: 7–8% of the U.S. population will develop PTSD at some point in their life and 1–6% of people worldwide65.
Unlike the three previously discussed anxiety disorders, PTSD is a psychiatric disorder that results from a person experiencing or observing a traumatic event that results in symptoms that disrupt their life for one or more months66,67. The first thing that may come to mind is a veteran who has experienced the ugliness of war and death. Although anyone who has suffered a traumatic event, such as being locked in a closet, a serious car accident, a natural disaster, a near-death experience, or even a death threat can suffer from PTSD (see chart). Likewise, PTSD can happen to anyone regardless where they live, their culture, ethnicity, or age although the onset of PTSD varies it often begins in a person’s early to mid-twenties59. It should be noted that in the U.S., African–Americans, Native Americans, and Latinos suffer from PTSD more than non-Latino whites, and women are twice as likely to suffer from PTSD than men66.
People who suffer from PTSD experience powerful feelings and troubling thoughts that last well after the distressing incident. Often, reliving the event through flashbacks and nightmares is common and may cause them to become fearful, angry, and have feeling of detachment along with sadness59,66. Avoidance of people, places or situations that remind them of the event as well as self-isolation is common. Their reaction to commonplace situations may seem exaggerated or disproportionate to the circumstances; for example, something as simple as a loud sound, scent, or being touched in a certain place may trigger a reaction for PTSD sufferers but have no effect on others66.
The sound of the MRI machine or being in the enclosed space of the MRI machine’s bore may act as a trigger that reminds them of the traumatic event, causing them anxiety or even a full-blown panic attack. In my own practice, I’ve had patients tell me that being in the magnet reminded them of when they were a kid and their big brother put them in a box and rolled them down a hill. Another patient said being in the magnet reminded her of being trapped in a car after an accident.
It was found that people who suffer from PTSD, have hypoactivity in their brain’s prefrontal cortex which helps regulate emotions, while the amygdala that assesses a threat level becomes hyperactive59. Thus, PTSD suffers may not be able to easily regulate their emotions and may perceive a threat at a higher level than in actuality. It is important for technologists to know that these physiological processes in the prefrontal cortex are automatic or implicit. Therefore, patients who suffer from PTSD may have difficulty controlling their symptoms59. Symptoms of PTSD can vary in severity and can manifest in the days or months after the event, or be delayed for years, and can last months or even years afterwards66,67. These symptoms fall into four categories:
Intrusion: Intrusion is when there are repeated unwanted intrusive thoughts such as nightmares or flashbacks. Flashbacks can cause major anxiety as the person may feel as if they are reliving the traumatic event.
Avoidance: Some people may avoid anything that reminds them of the traumatic event. This includes people, places, objects, or certain activities. Avoidance also includes not wanting to talk or think about the distressing event.
Alterations in cognition and mood: This is when a person blocks out or forgets either part or all of the thoughts or feeling of the traumatic event. This disconnect may cause people to have a distorted view about themselves, others, and the traumatic event that results in anger, fear, self-blame, estrangement from others, and the inability to feel happiness.
Alterations in arousal and reactivity: This is when a person becomes easily aroused and hyper-reactive, which results in them being easily scared, irritable and unable to concentrate, have outbursts of anger, be overly vigilant, or engage in self-destructive behavior. A good example of this would be a patient who for no known reason becomes unreasonably angry or abusive during their MRI exam, forcing the technologist to terminate their exam66.
Figure 9. Top Causes of PTSD68
Figure 10. PTSD Symptoms70