What are the Psychological Effects of an Amputation? How Can One Help?

Most individuals that undergo an amputation will experience a significant and complex transition that doesn’t only affect their physical well-being but also plays a big part in one’s mental and emotional state. It can, in fact, lead to a wide range of psychological reactions. Losing a limb makes self-care and care for one’s family very hard, especially during the adaptation period. This sense of incapacity and inability to perform in apparently simple routines leads many people to develop severe psychiatric problems[1]. In most cases, the major experience of the amputee is that of loss, including not only the evident loss of the limb, but also losses in function, self-esteem, career, and relationships [1–3].  

According to a study [4] conducted in 2015 more than 30% of amputees struggle with depression and often experience an increase in social isolation as a result. Beyond this, many amputees experience post-traumatic stress disorder (PTSD) or residual limb pain, which exacerbates depressive and anxious thoughts. 

The way an individual responds to limb loss may be related to different factors [5,6]:  

• The etiology of amputation: Was it congenital, traumatic, or disease-related? What is the level of amputation? 

• The individual aspects: How old is the amputee and what is their health status? How will the loss of the limb and eventual posterior prosthetization affect the amputee financially? 

• The social-historical moment: How has the amputee coped with demanding situations before? What is their usual attitude about health-related problems? Do they feel a sense of control despite the loss? 

• The patient’s interpretation of the symptoms and comorbidities.

• The physical and social environment: Do they have a support system in place? Are the services they need accessible and appropriately identified? What are their living arrangements, and how can they be modified to accommodate to their limb loss? 

The Psychological Consequences of Amputation 

Every amputation is distinct, and every amputee has a different recovery process. However, there is some common ground among the amputee population in what concerns obstacles to their daily lives. 

The multidisciplinary team can benefit from understanding the psychological effects of limb amputation as it helps them create efficient counselling and rehabilitation programs.

Traumatic Effects 

After suffering a traumatic amputation, the individual may develop PTSD or other mental illnesses as a result of recalling the trauma of that moment. In addition to PTSD, amputees also commonly deal with psychological issues such as impulse control disorders, panic disorders, anxiety disorders and depression [3].  

It is known that individuals who have experienced a traumatic amputation frequently feel the psychological and emotional effects of their experience more strongly than those who undergo planned amputations[3].  

Body Image 

Body image, defined as ‘the individual’s psychological picture of themself’, is disrupted when a limb is amputated [7,8]. People who have undergone an amputation frequently worry about how others may react and what they may think when they perceive their limb differences. 

Adapting to amputation 

Amputees may experience different challenges that are caused by the original traumatic accident or condition that led to the amputation and other associated problems may develop over time as people adjust to their new disability. In some circumstances, a person may find it difficult to adjust to the lack of feeling on a missing limb and may have psychological strain from dealing with ongoing discomfort and pain. This is another factor that may lead to depression, both in the early and later stages of living with an amputation.  

Check out our previous article “Perspective on prosthetic technology and mental health of lower limb amputees” to know more about how the right prosthesis can improve mental health in users. 

Social Impact 

The amputation can affect the individual’s ability to participate in the activities that they used to enjoy and do with ease.  

When these problems appear, social isolation can occur and lead to feelings of loneliness. Amputees’ interpersonal interactions may be significantly impacted. Someone with a missing limb may avoid social interaction with their friends and family completely. The rehabilitation process of these individuals can be adversely affected by a negative attitude of their family, who needs to be helpful during this time.  

In a previous study conducted by Simsek et al[1], it is patent that, after an amputation, patients must have thorough examinations of their mental health conditions during their normal follow-ups. Moreover, necessary psychological support must be provided by specialized professionals, and the family members must be included in the whole process, so they may express their thoughts, acknowledge what changes they may have to adapt to and understand how they can be helpful, compliant, and effective in the recovery and adaptation of the amputee to their new reality. A noteworthy finding is that the amputees involved in the study claimed that having access to a mental health expert’s advice and personalized tools would allow them to obtain mental relief and open up about their condition and the difficulties they’re facing.

While side effects from trauma, distorted perception of one’s body image, depressive symptoms and social isolation are perfectly explainable by the underlying condition of an individual with an amputation, that does not mean that all amputees will respond in the same way. Personalized care is key for a full recovery, insertion into society and acceptance of the condition.  

On the other hand, social constructs and other barriers that hinder the perfect inclusion of amputees in society are still a reality and must be deconstructed. Acceptance of limb differences, creation of infrastructures that facilitate mobility, destigmatization of mental health support and encouragement of the act of asking for help when needed, both in physical and mental scopes, are the next steps to be taken toward an inclusive society and healthy amputees.

References 

1. Simsek N, Ozturk GK, Nahya ZN. The Mental Health of Individuals With Post-Traumatic Lower Limb Amputation: A Qualitative Study. Journal of Patient Experience. 2020;7(6):1665-1670. doi:10.1177/2374373520932451 

2. Therapy for Amputees 3rd Edition. Therapy for Amputees, 3rd Edition. Barbara E, Catherine V de V, eds. Published online 1999:352. Accessed July 15, 2022. https://www.elsevier.com/books/therapy-for-amputees/engstrom/978-0-443-05975-9 

3. Ta Lina Roșca ˘, Constantin Cosmin B, Burtăverde V, Mateizer A. Psychological Consequences in Patients With Amputation of a Limb. An Interpretative-Phenomenological Analysis. Front Psychol. 2021;12:537493. doi:10.3389/fpsyg.2021.537493 

4. Ghous M. Depression: Prevalence among amputees. Professional Medical Journal. 2015;22(2):263-266. Accessed July 15, 2022. https://www.researchgate.net/publication/313793023_DEPRESSION_PREVALENCE_AMONG_AMPUTEES 

5. Chihuri S, Wong CK. Factors associated with the likelihood of fall-related injury among people with lower limb loss. doi:10.1186/s40621-018-0171-x 

6. Darter BJ, Hawley CE, Armstrong AJ, Avellone L, Wehman P. Factors Influencing Functional Outcomes and Return-to-Work After Amputation: A review of the literature HHS Public Access. J Occup Rehabil. 2018;28(4):656-665. doi:10.1007/s10926-018-9757-y 

7. Thompson JK, Heinberg LJ, Altabe M, Tantleff-Dunn S. Exacting beauty: Theory, assessment, and treatment of body image disturbance. Exacting beauty: Theory, assessment, and treatment of body image disturbance. Published online October 27, 2004. doi:10.1037/10312-000 

8. Gilg AC. The Impact of Amputation on Body Image . Published online 2016. Accessed July 15, 2022. https://aquila.usm.edu/honors_theseshttps://aquila.usm.edu/honors_theses/410