Emotional Issues and Solutions

People who undergo amputation experience a myriad of emotions. Some possible reactions to having an amputation include sadness, anger, grief, anxiety and depression. Others may even experience relief. For example, a person may have struggled with a devastating disease like an infected limb that threatened his or her life. With an amputation, the person may feel relieved that the source of the problem was taken care of and they are now cured. Others, like traumatic amputees, may be faced with a different situation where those closest to them may actually be happy for them to be alive. The individual may have had a horrific trauma and was in a coma, where the family feared that the person may not even live. The family may be extremely thankful when the loved one comes out of the coma with the only sacrifice being the loss of a limb. However, the new amputee may awake from the coma, never experiencing any of the trauma or the fear of dying, only to find the devastation of having lost a limb.

The different emotions experienced by the amputee may not only be due to the physical loss of a limb, but also what effects the amputee will have in terms of career, family life and socialization. Because of this, people with amputations just like those with other disabilities, may have higher rates of depression than the general public. It has been estimated that clinical depression in amputees ranges from 18-35 percent, but thankfully it goes away over time. Some symptoms of depression include sadness, irritability, difficulty sleeping, social withdrawal or isolation, decreased or increased eating, abuse of alcohol or drugs to help cope with the depression and finally poor motivation. Higher rates of depression occur in those who have a higher level of uncontrolled pain.

Despite these variable responses, most amputees go through a sequence of various emotions. The first is usually grieving over the lost of the limb. This may then be followed by disbelief or denial, anger, tearfulness, hopelessness and emotional outbursts. Over time and with appropriate counseling if needed, the amputee begins to cope with his disability and begins to carry on a fulfilling life.

Normal Chronology of Emotional Experiences Following an Amputation:

• Anxiety
• Anger
• Relief
• Fear
• Uncertainty
• Depression
• Frustration
• Embarrassment
• Regret
• Optimism
  

Amputees may also experience a distortion of body image which can affect sexual drive or intimacy. The cosmetic appearance of the residual limb may make the individual self-conscious and embarrassed because of the appearance of his or her body. Other reasons that have been cited for the decline in sexual function include decreased interest and mobility, an unwilling partner and fear of poor performance or injury.

Several factors may affect how an individual responds to an amputation. For example, an individual who experiences an amputation as a result of a traumatic occurrence such as a burn, motor vehicle collision or electrical injury may also have to cope with the stress of reliving the accident in his mind. Some may even fit criteria for post-traumatic stress disorder, a condition that can affect one’s mental well being after a serious accident or event. People who undergo amputation from peripheral vascular disease and diabetes may have had to cope with a long battle to keep the limb. Or they may have a hard time realizing that a small ulcer on the foot has translated into the necessity of removing the whole lower leg.

Certainly previous experiences with people who had disabilities may either help or hinder the mental recuperation of a new amputee. For instance, the individual may recall from childhood a grandfather who was in a wheelchair for his whole life after an amputation and equate all amputees with that mental image. Certain cultures and religious beliefs may view individuals with amputations as being of a lower status or guilty of committing a crime or sin. In other scenarios, a husband may have thoughts of failure. For instance, he may think that he will be unable to go back to work and cannot help the family financially or may not be a good father if he can’t play with or care for his children. Having a physical problem like an amputation can impact one’s life and lead to a variety of emotional responses beyond just the despair of losing the limb.

Treatment approaches for each of these emotions will most likely be varied; there is no one right answer regarding treatment. However, appropriate psychological counseling and therapy may help the amputee adjust emotionally. The timing of such treatment may be delayed ; many new amputees may not experience any emotional concerns until after they leave rehabilitation and are back home or in a residential setting.

Having a psychologist see the person before the amputation may be helpful. Depending on the individual situation, it may also be fruitful for the new amputee to discuss many of the challenges of having an amputation, both physical and emotional, with a person who has been living with an amputation for some time. In this way, the new amputee can ask questions about what it is like to live as an amputee, while also learning tips on how to function in society. Some organizations, like Amputee Coalition of America, can also help a new amputee get in contact with an experienced individual. Local support groups may be helpful for new amputees to meet others who may be going through similar experiences. Individuals in these groups may not only assist with tips on how to adapt to an amputation but may also serve as a peer for others with this new disability. In general, there is no cookbook answer to help amputees cope with their emotions but often seeing a counselor and/or working with a peer may be helpful strategies.