Emotional and Psychological Reactions to Amputation

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  1. To enable the reader to be aware of the common emotional and psychological reactions to amputation and demonstrate an understanding of the stages of the grieving process (may ned to create another separate page for the grieving process)

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Introduction[edit | edit source]

Amputation proposes multi-directional challenges. It affects function, sensation and body image. The psychological reactions vary greatly and depend on many factors and variable. In most cases, the predominant experience of the amputee is one of loss: not only the obvious loss of the limb, but also resulting losses in function, self-image, career and relationships[1].

Many of the psychological reactions may be transient, some are helpful and constructive, others less so, and a few may require further action (e.g. psychiatric assessment in the case of psychosis)[1].

About 30% of amputees are troubled by depression[1]. Psychological morbidity, decreased self esteem, distorted body image, increased dependency and significant levels of social isolation are also observed in short and long-term follow up after amputation[2][3].

Psychological Reactions to Amputation[edit | edit source]

Immediate reaction to the news of amputation depends on whether the amputation was planned, occurred within the context of chronic medical illness or necessitated by a sudden onset of infection or trauma[4].

After learning that amputation may be required, anxiety often alternates with depression. This anxiety may be generalized (e.g., manifest by jitteriness, a decreased ability to sleep, silent rumination, and social withdrawal) or result in disturbed sleep and irritability. Anxiety may be directed toward the fate of the limb that will be removed[5], as well as about the prospect of phantom limb pain, which many patients (who know of other amputees) may be familiar with[4]. Findings by Parkes [17] also found that in first year 25% amputees suffer from depression, feeling of insecurity, self consciousness and restlessness18].

Post traumatic stress disorder (PTSD) appears to be more common in amputees following combat, accidental injury, burn and suicidal attempts[6].In contrast, PTSD is relatively rare (< 5%) among amputees whose surgery follows a chronic illness[7].

Cosmetic appearance appears to play as great a role in psychological sequelae of amputation.Body image, defined as ‘the individual’s psycho-logical picture of himself’[8] is disrupted when a limb is amputated[1]. A number of of body image-related problems may be frequently experienced following amputation such as anxiety and sexual impairment and/or dysfunction[8] (77% in males and 38% in females)[1].

The reaction to amputation may not always be negative. When amputations occur after a long period of illness and loss of function, the patient may already have gone through a period of grieving and have no need to grieve again for the amputation[1].

A study[9] that investigated positive thoughts in amputation showed that 56% of people thought about their amputated limb. People with bilateral or a trans-femoral amputation were more likely to think about their amputated limb than people with a trans-tibial amputation. This may refer to the fact that the more of a limb that is lost the greater is the difficultly in restoring physical functioning. Thinking about the amputated limb may arise questions (e.g. what happened to the amputated limb? What life would have been like if they had not lost a limb? Why me?  What the future held as a result of having a limb, What if?), and specific emotions (missing the limb, wish that they did not have an artificial limb, that they had their limb(s) back or that the accident had not happened and concern about getting employment).

In the same study, 46% considered that something good had happened as a result of the amputation. Participants stated many reasons as good things that happened following amputation such as: the Independence given to them by the amputation and the prosthesis, subsequent change in their attitude of life, improved coping abilities, financial benefits, elimination of pain and that amputation was a character building for some of them. Furthermore, finding positive meaning was significantly associated with more favorable physical capabilities and health ratings, lower levels of Athletic Activity Restriction and higher levels of Adjustment to Limitation[9].

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References[edit | edit source]

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  1. ↑ 1.0 1.1 1.2 1.3 1.4 1.5 Therapy for Amputees: Third Edition by Barbara Engstrom MCSP DipMgt & Catherine Van de Ven MCSP
  2. ↑ Thompson D M, Haran D 1983 Living with an amputation: the patient. International Rehabilitation Medicine 5:165–169
  3. ↑ Srivastava, K., Saldanha, D., Chaudhury, S., Ryali, V., Goyal, S., Bhattacharyya, D. and Basannar, D. (2010). A Study of Psychological Correlates after Amputation. Medical Journal Armed Forces India, 66(4), pp.367-373.
  4. ↑ 4.0 4.1 Bhuvaneswar, C. G., Epstein, L. A., & Stern, T. A. (2007). Rounds in the General Hospital: Reactions to Amputation: Recognition and Treatment, 9(4), 303–308.
  5. ↑ NOBLE, D., PRICE, D. and GILDER, R. (1954). PSYCHIATRIC DISTURBANCES FOLLOWING AMPUTATION. American Journal of Psychiatry, 110(8), pp.609-613.
  6. ↑ Fukunishi I, Sasaki K, Chishima Y, Anze M, Saijo M General hospital psychiatry, vol. 18, issue 2 (1996) pp. 121-7
  7. ↑ Cavanagh, S., Shin, L., Karamouz, N. and Rauch, S. (2006). Psychiatric and Emotional Sequelae of Surgical Amputation. Psychosomatics, 47(6), pp.459-464.
  8. ↑ 8.0 8.1 Henker III, F. (1979). Body-image conffict following trauma and surgery. Psychosomatics, 20(12), pp.812-820.
  9. ↑ 9.0 9.1 Gallagher, P., & Maclachlan, M. (2000). Prosthetics and Orthotics International. https://doi.org/10.1080/03093640008726548
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