Why We Must Address the Psychological Impact of Burns

burn psych

Survival rates for burn patients have improved drastically over the years thanks to advances made in burn treatment. Unfortunately, the physical needs of patients often overshadow their emotional needs.

As more patients survive their injuries and return home, we must direct more energy toward efforts to reintegrate patients into society and home and treating the psychosocial effects of burn injuries. The emotional trauma caused by a burn can affect all parts of a person’s life: put stress on relationships, lead to depression or substance abuse, and even put additional strain on their physical health.

According to a study in Neuropsychiatric Disease and Treatment, stress disorders, including post-traumatic stress disorder (PTSD), are reported in as many as one-third of burn patients. These problems can develop up to a year or more after the injury. And these aren’t just people who had severe burns. Even a moderate burn that didn’t require much treatment can be emotionally devastating.

A few years ago, a patient of mine brought into sharp focus the challenges that accompany helping someone deal with the emotional side effects of a burn injury. This experience caused me to ask myself how my team could better address that aspect of the burn recovery process and ultimately led to a new position on our staff – a dedicated psychologist for The Burn Center.

How burns can take a psychological toll

Along with the physical pain of burns and the treatments they may require, patients also may face psychological stressors, such as:

  • Changes in body image
  • Depression
  • Family problems
  • Financial concerns
  • Vivid memories of the accident

These stressors can manifest in many ways. For example, symptoms of PTSD can include:

  • Avoidance of places that are reminders of the accident (such as a burn center)
  • Difficulty sleeping or having nightmares
  • Flashbacks of the accident
  • Irritability
  • Loss of interest in previously enjoyable activities
  • Negative thoughts about oneself
  • Social withdrawal

If you or a family member are experiencing depression or PTSD symptoms or are struggling to adapt to life after a burn injury, know that you’re not alone. There are resources in your community to help. Talk to your doctor about your options.

Just as physical recovery occurs in stages, psychological needs differ over time as well. Patients often are elated when it’s time to go home. However, that also tends to be when they start to melt down. They didn’t expect the stares they would get. Food doesn’t taste the same. Families didn’t realize the amount of care their loved one would need.

We try to help patients manage expectations while in the hospital. For example, we may tell them, “Your skin is never going to look the same again.” But these statements don’t always sink in because they’re grappling with everything else going on in that moment. In the back of their heads, they think that one day they’ll take off their compression garment and everything will look like it did before. When they realize this is never going to happen, it can be devastating emotionally.

Clinical challenges of treating the psychological side of burn injuries

Coordinating psychological care for burn patients is challenging, as was highlighted by my patient a few years ago. As an electrician, he suffered an electrical burn. We treat quite a few electricians and powerline workers with these types of burns, which can cause neuropathic pain for years despite all tests coming back normal. They require care from a neuropsychologist.

Because neuropsychologists are so specialized, they may not address depression or PTSD, instead focusing on the patient’s physical pain. So the patient also may need a psychologist to provide psychotherapy or a psychiatrist to prescribe medication. Coordinating this interwoven care can become immensely difficult. And community-based mental health centers often are unable to provide such complex care for these specific needs.

This was the challenge we faced with my patient. He had developed depression and substance use issues after his burn injury, and his relationship with his wife and children had become strained.

It took seven months to line up care to address his emotional issues. That was too long. I knew we had to do more.

How we treat the emotional side of the burn recovery process

Along with the after-care programs and services we offer, we’re also one of 60 Phoenix Society SOAR (Survivors Offering Assistance in Recovery) hospitals. The Phoenix Society is a not-for-profit founded by burn survivors. Many of our therapists are certified to train past patients to become peer supporters. These volunteers meet with patients one-on-one and lead group sessions.

Thanks to funding from organizations such as the DC Firefighters Burn Foundation, we also provide opportunities to attend adaptive recreation trips, in which an activity such as cycling or canoeing is adapted to accommodate a person’s specific needs.

Because a burn patient’s PTSD likely will manifest differently from someone who experienced another type of trauma, we shouldn’t treat them the same. Unfortunately, there just isn’t a lot of research and data to guide us in effectively treating the psychosocial side of burn injuries.

To help change that, we created a position within The Burn Center for a full-time psychologist. This person will provide more specialized, coordinated care for burn patients as well as study and develop best practices to treat psychosocial health from the moment of admission through treatment and beyond.

I expect this to be just the tip of the iceberg. At any given time, 50 to 70 percent of our burn patients are eligible to enroll in a clinical trial. I expect these numbers to increase over the years as we include trials geared toward psychosocial health and reintegration into society and home.

As one of only a handful of burn centers in the country to have a dedicated psychologist on staff, I’m positive we can make an impact in this important emerging field of study.

Burn Center Director, MedStar Washington Hospital Center; Burn Research Director, MedStar Health Research Institute

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