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Posttraumatic Stress Disorder (PTSD) is a psychiatric disorder that occurs in people who have experienced a personal assault or who have witnessed a traumatic event. The exposure to an upsetting traumatic event can be indirect rather than first-hand such as of learning of a violent death of a close family member. In Sickle Cell Anemia patients, their own medical condition creates mental stress and with the anticipation always of pain, can in turn, cause the smaller blood vessels to constrict thus actually triggering a vaso-occlusive (pain) crisis.

Patients with Sickle Cell suffer from both witnessing traumatic events and having to experience them. The trauma of having repeated painful episodes of the chest, abdomen, back, and joints coupled with having painful medical intervention with needles is an ongoing cycle that begins in childhood. People with PTSD have recurring disturbing and intense thoughts and feelings related to their last experience with that traumatic event long after the event has ended.

For Sickle Cell patients, there is very little time in between the last traumatic event (a pain crisis) and the flashbacks and memories to the next new traumatic event. In between the pain crisis episodes, the Sickle Cell patient, like with any patient with PTSD, exhibits avoidance behavior of any situation or person that reminds them of the traumatic event and displays strong negative reactions to simple things such as an accidental touch or loud noises.

The Emergency Department is full of loud noises with monitor alarms going off, and people presenting at their worse. Just being a visitor within the Emergency Department, there is always the possibility of being exposed to any patient’s suffering. Because Sickle Cell Anemia patients are frequently in the Emergency Department for their own care, they too witness other’s suffering. Often, these patients with Sickle Cell begin to know each other in certain settings, where patients meet on in-patient wards or in Hematology Clinic.

They begin to care for each other as a Community and mourn the loss of each other while constantly thinking about their own demise. This undiagnosed Post-traumatic Stress Disorder (PTSD) in Sickle Cell Anemia patients creates another form of Healthcare bias.

Sickle Cell Disease patients are subject to significant Healthcare disparities as often they are not offered Mental Health Counseling as part of their Comprehensive Care Teams, like any other patient with Chronic and potentially fatal Medical Diseases such as Cancer patients. Sickle Cell Anemia patients live in constant fear of death and dying in a prolonged tortured painful state.

Like many patients with chronic pain syndromes, Sickle Cell patients also express anger, hopelessness, and despair regarding their fate with having a seemingly incurable disease and their own quality of life. Many patients who attempt to seek out higher education and employment must also cope with the stress of frequent absences and increasing Medical costs. Sickle Cell patients should have access to Mental Health Professionals as part of their treatment guidelines and protocols.

The adjunct involvement of a Mental Health Professional would seek to resolve the anxiety in both children and adults with Sickle Cell Anemia when presenting to the hospital setting.

References:

  • Hofmann MD, M. et al. Posttraumatic stress disorder in children affected by Sickle Cell Disease and their parents. American Journal of Hematology. Feb 2007. Volume 82 Issue 2. 171-2.
  • Alao MD, A. et al. Sickle Cell Disease and Posttraumatic Stress Disorder. The International Journal of Psychiatry in Medicine. March 2002. Volume 32 Issue 1. 97-101.