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Military inStep - A Publication of the Amputee Coalition in Partnership with the U.S. Army Amputee Patient Care Program. 2005.
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The Psychological Concerns of the Soldier Amputee

Physical and psychological trauma can be overwhelming to any soldier who experiences it. It can, in fact, change your life.

Military man attending to patient in hospital bedIn addition to the possible loss of certain bodily functions, soldiers may experience other psychological, emotional, cognitive, and physical problems. Battle fears from persistent threats, anxieties related to your military performance, and emotional reactions to the overwhelming experiences you have had may all contribute to your struggles. Though any of these alone may be enough to disrupt a person’s psychological balance, combined with the loss of a limb or any other part of your body, the trauma can be especially devastating. The resiliency and strength of each individual can be remarkable, however, and acknowledging these feelings does not in any way diminish these soldiers. In fact the ability to share emotions, feelings and perceptions may set the stage for future growth.

Most soldiers who must have amputations were young and healthy before their war injuries. Like many others, you may have only recently married, you may be hoping to marry soon, you may be a new parent, you may be single and worrying about dating, or you may be wondering what your future holds as far as education and a career are concerned. Losing a limb has the potential to affect all of these areas of your life and, therefore, it may be extremely difficult to deal with. Of course, there are many possible ways to respond to this loss and trauma, and soldiers’ responses may vary. Support from family, friends and professionals, as well as observing successful amputees as role models, may help restore the balance.

Responses to Trauma

After your initial trauma and throughout your rehabilitation process, you may experience depression, anxiety, flashbacks, resentment, anger, rage, fear, helplessness, hopelessness, and the loss of body integrity. You may express anger in many ways, and it is important to understand that anger is a normal expression. If you are suffering from depression or anxiety, you may benefit from medication, psychotherapy and professional support.

Some patients describe the loss of a body part as similar to the loss of a loved one. However, though a brief period of mourning for the loss of your limb is considered normal, lengthy mourning periods may cultivate additional psychiatric responses, disrupt the rehabilitation process, and hinder your ability to adjust to your loss. Professional support can be beneficial.

Avoiding or denying the loss of a limb can for some lead to persistent phantom pain. While some amount of phantom and residual limb pain is normal, if it interferes with sleep or function, more aggressive treatment should be sought.

Unfortunately, the loss experienced by amputees is not only the physical loss of a body part but also the loss of your former appearance, function, athletic ability, and hobbies. You may, in fact, grieve more for the loss of these functions than for the loss of your limb.

Following an amputation, you may have many concerns. Some express more concern about maintaining their physical appearance, while others express more concern about regaining normal function. You may have fears about social and personal relationships, and you may wonder if your peers and family members will accept you with an amputation. You may also be worried about the impact an amputation will have on employment possibilities and recreational activities.

Some patients fear that an amputation will affect overall functioning in some way. You may experience a fear of falling, a fear of not being able to master the use of your artificial limb, and a fear of your artificial limb malfunctioning. You may become very frustrated if these problems actually occur, even if only temporarily.

Changes in your physical appearance may initially make it more difficult for you to engage in personal relationships and may have a significant impact on your ability to view yourself sexually. You may wonder if members of the opposite sex will still find you attractive or if your limb loss will be a “turn off.” If you are an upper-limb amputee, you might even have more specific questions about weight-bearing during sexual activity. If you have any of these concerns, it is important that you discuss them with your healthcare team before you are discharged from the hospital. Additional personal concerns may develop after your return home, and it may be helpful to ask for support then as well.

Family Responses to the Patient’s Amputation

Many spouses and family members have an overwhelming sense of hopelessness in response to learning of the serious injury of a relative. They may feel stressed due to uncertainty about the future, lack of control over the patient’s rehabilitation, lack of information, lack of support, and fear about or resistance to role changes. Spouses may, in fact, display more depressive symptoms than the patients themselves.

In a 1984 study by Thompson and Haran, primary caregivers (often spouses) of amputees were often more realistic about amputees’ abilities and limitations than the patients were (“Living With an Amputation: What It Means for Patients and Their Helpers,” International Journal of Rehabilitation Research). Although patients in this study initially welcomed discharge from the hospital and the ability to return home, caregivers were realistically more apprehensive.

Family members may also respond with denial and feelings of anger and guilt. Their social interactions with other family members and friends may decrease due to their new role as a caregiver and their added responsibilities. Therefore, primary caregivers of amputees may be prone to developing depression, and they too may need support from team members, peers, other family members and professionals.

Children of new amputees may also face difficulties adjusting to their parent’s limb loss. Your child might think that your amputation is a punishment, be concerned about your pain, fear that it can happen to them, be concerned that it is their fault in some way, fear that it is contagious, or be afraid that you will no longer be able to play with them.

The Importance of Social Support

Social support is important during the rehabilitation process. You may want to vent your concerns about your loved ones, your concerns about how you will be perceived after your amputation, your feelings about how to respond to stares from others, and many other things.

It is important that a safe place be provided where you can discuss such anxieties, concerns, and personal problems in confidence. The medical staff may be able to alleviate some of your anxiety by merely taking the time to listen to you and understand your fears. Whether they are from the surgical, medical, nursing, or psychiatry services, or whether they are physical or occupational therapists, they may play an important role in your psychological rehabilitation. All staff members should, therefore, be prepared to provide emotional support to reinforce your strengths and help you regain your independence.

Visits from other amputees, especially those who have had training in peer support, can be extraordinarily helpful. In fact, the members of the healthcare team who continue to receive the highest satisfaction rating from patients attending the Amputee Clinic at WRAMC are the volunteer peer amputee visitors (PAVs).

Attendance in support groups can also provide you with support from others who have lost limbs and have gone through an experience similar to the one you are going through. This type of support, along with group discussions, can help facilitate your acceptance of your limb loss. Group therapy has been shown to be helpful during Operation Desert Storm, the embassy bombing in Nairobi, and the conflicts in Iraq and Afghanistan.

Talking with others who have gone through amputation themselves and are living happy, successful lives can give you hope for your own future. Seeing amputees who are happily married, who are employed in a wide variety of occupations, and who are active in all kinds of sports can change your entire perspective on the possibilities that are open to you. Once you realize that there are others who have gone through amputation and have returned to a “normal” life, you will perhaps believe that you can too.

—by Harold J. Wain, PhD

To learn more about other amputees who are not merely surviving after limb loss, but thriving, contact the Amputee Coalition of America at 888/267-5669 for a subscription to inMotion magazine and a copy of First Step – A Guide for Adapting to Limb Loss.

 

Disclaimer: The views and opinions expressed in this publication are those of the authors and are not necessarily those of the Amputee Coalition, the Department of the Army, the Army Medical Department, or any other agency of the US Government.


Back to Top Last updated: 12/07/2014
© 2005. Amputee Coalition. Local reproduction for use by Amputee Coalition constituents is permitted as long as this copyright information is included. Organizations or individuals wishing to reprint this article in other publications, including other World Wide Web sites must contact the Amputee Coalition for permission to do so.