Limb loss isn’t something that many of us have to think about, fortunately. But for those who do have to think about it, it can be extremely traumatising. Limb loss is often associated with significant life events such as war, illness, or shocking trauma such as a car accident. Not only would the experience be traumatic but the psychological adjustment to living with the loss of a limb can be challenging to the extreme.
Psychological reactions vary greatly depending on an individual’s personal views/attitudes and experience of job loss/satisfaction, personal appearance and self-image as well as relationships. Approximately 30% of amputees suffer from depression influenced by decreased self esteem, distorted body image, increased dependency and significant levels of social isolation.
Post-Traumatic Stress Disorder
Post traumatic stress disorder (PTSD) appears to be more common in amputees following combat, accidental injury, burn and suicidal attempts. In contrast, PTSD is relatively rare (< 5%) among amputees whose surgery follows a chronic illness.
An individual’s self-perception is altered when they lose a limb. They may see themselves as different or possibly inferior and this can cause anxiety and low self-esteem issues.
As a Cognitive Behavioural Therapist (CBT)- we often help clients to focus on their perception of an event rather than the event itself. It’s often not what happens to you but what you tell yourself about what happened that will affect whether you cope after trauma.
In fact, this approach can help anyone in life to dismiss things that can create anxiety, obsession, and misery. CBT teaches you to let go of things rather than holding on to thoughts that bring you down. Losing a limb is an experience that can be looked at in many ways. It’s not all bad because for some – it enables them to be independent and that’s very empowering.
CBT will look at thoughts that may limit the individual or create further depression and anxiety. There are many ways to interpret life and it’s a good mental skill to focus on thoughts/beliefs that empower you and help you to foster hope.
Thoughts affect feelings, feeling influence how we behave and how we behave then further influences what we think and feel. Our thoughts are incredibly powerful and affect our quality of life immensely.
The most common causes of limb loss
Limb loss is much more common than many people realize, and the numbers are growing. By learning the facts about limb loss, we can start to be better advocates for our friends and family, feel less alone during our journey with limb loss, and raise awareness through meaningful, fact-based discussion.
1. There are 2.1 million people living with limb loss in the USA, and that number is expected to double by 2050.
2. 185,000 people have an amputation each year. This means that 300 to 500 amputations are performed every day.
3. 1,558 military personnel lost a limb as a result of the wars in Afghanistan and Iraq.
4. Around 30% of people with limb loss experience depression and/or anxiety.
5. 85% of lower limb amputations are proceeded by a foot ulcer.
6. Lifetime healthcare costs for people with limb loss is $509,275 compared to $361,200 for people without limb loss.
7. African Americans are 4 times more likely to have an amputation than White Americans.
8. Hospital charges for patients who underwent an amputation totaled $8.7 billion in 2013.
9. Of persons with diabetes who have a lower extremity amputation, up to 55% will require amputation of the second leg within 2‐3 years
10. Nearly half of the individuals who have an amputation due to vascular disease will die within 5 years. This is higher than the five year mortality rates for breast cancer, colon cancer, and prostate cancer.
11. The number of amputations caused by diabetes increased by 24% from 1988 to 2009.
12. Below-knee amputations are the most common amputations, representing 71% of dysvascular amputations1; there is a 47% expected increase in below knee amputations from 1995-2020.
13. The estimated cost to American private & public insurance agencies is $12 billion annually.
14. There are more than 1 million annual limb amputations globally -—one every 30 seconds.
15. The International Diabetes Federation (IDF) predicts that current global prevalence of diabetes will burgeon from 285 million to reach 435 million by 2030.
The 5 stages of grief
According to Elizabeth Kubler Ross, there are 5 stages of grief. These stages often occur after limb loss:
Feeling numb is common in the early days. Some people at first carry on as if nothing has happened. Even if we know with our heads that something has changed, it can be hard to believe.
Anger is a completely natural emotion, and very natural after trauma. Life can seem cruel and unfair, especially when you feel something unfair has happened.
When we are in pain, it’s sometimes hard to accept that there’s nothing we can do to change things. Bargaining is when we start to make deals with ourselves, or perhaps with God if you’re religious. We want to believe that if we act in particular ways we will feel better. It’s also common to find ourselves going over and over things that happened in the past and asking a lot of ‘what if’ questions, wishing we could go back and change things in the hope things could have turned out differently.
Sadness and longing are what we think of most often when we think about grief. This pain can be very intense and come in waves over many months or years. Life can feel like it no longer holds any meaning which can be very scary.
Grief comes in waves and it can feel like nothing will ever be right again. But gradually most people find that the pain eases, and it is possible to accept what has happened. We may never ‘get over’ what happened, but we can learn to live again.
Coping with limb loss
As I mentioned previously, everyone reacts differently but therapy can help someone to accept their new way of life as much as possible. Life can be happy again and many adventures still lie ahead. Thanks to a lovely lady called Marcy Rubic, I became aware of a wonderful organisation called The Limb Preservation Foundation (LPF).
The goal of LPF is to enhance the quality of life for those individuals facing limb-threatening conditions due to trauma, tumor or infection through research, patient assistance and educational programs.
The Limb Preservation Foundation funds hope, help and possibilities using a unique model that brings together world-class physicians and researchers, passionate healthcare professionals and patients to advance research, support care and enhance lives.
The Limb Preservation Foundation offers hope to those finding their way back to ‘normality’, they offer hope (the vital ingredient in healing) and they also fund life-changing research that accelerates improvements in treatment options and outcomes. This research benefits patients with limb-threatening conditions by minimizing the potential for limb loss. It’s a wonderful foundation that certainly requires praise for all that they do.
I have included an interesting video: