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Updated 10/2023
Introduction
Losing a limb is a life-changing experience. This process can affect nearly every aspect of an individual’s life ranging from work and play to friends and family. People respond differently to the loss of a limb. How an individual responds might relate to one or more of the following factors:
- Factors associated with the cause of the limb loss: Was it congenital, traumatic, or disease-related? What is the level of your amputation?
- Individual characteristics: What is your age or health status? What effect will this have on you financially?
- Personality traits: How have you coped with difficult situations before? What is your attitude about your health? Do you feel a sense of control despite this loss?
- Physical and social environment: Do you have a support system in place? Are the services you need appropriate and accessible? What are your living arrangements, and how might they be modified to accommodate your limb loss?
Recovery is an ongoing process and it can be difficult to predict when each stage will occur and in what order. Each of the 5 stages of recovery has unique challenges that require different coping strategies.
By working with individuals with limb loss and limb difference and consulting evidence-based literature, we have developed a model for recovery that is specific to our community.1,2,3 This model is less like driving instructions in which a new amputee crosses off the steps they have completed, and more like a map with major landmarks that can help orient them in this process that others have gone through before.
The 5 Stages of Recovery
| Enduring | Characterized by physical anguish, focusing on the present to get through the pain, and blocking out distress about the future. A conscious choice not to deal with the full meaning of the loss by virtue of a perceived self-protection. |
| Suffering | Characterized by emotional anguish. One might experience intense feelings about the loss (i.e. fear, denial, anger, depression) as well as a feeling vulnerable and/or confused. |
| Reckoning | Characterized by changing roles. One may begin to come to terms with the extent of the loss and accept what is left. Implications of the loss for the future will come into focus. |
| Reconciling | Characterized by a sense of regained control. One may experience an increased awareness of their own strengths and demonstrate an increased assertiveness in the self- management of their recovery. A returned desire for intimacy and healthier body image may also be indicative. |
| Normalizing | Characterized by regaining balance. One may begin to establish new routines or return to activities that were abandoned after the loss. By allowing priorities other than the loss to dominate one achieves a sense of new normal. |
| Thriving | This level of recovery is not attained by everyone. It is characterized by a sense of “being more than before,” and achieved through a desire to become a role model to others. |
Sometimes the road to recovery is bumpy and filled with detours, and you might experience a range of emotions. Research has found that the common types of emotional concerns after the loss of a limb are depression, anxiety, grief, and trauma.4,5 The following describes some of the emotional issues that could occur after an amputation, as described by the American Psychiatric Association:6
- Post-Traumatic Stress Disorder (PTSD): PTSD can occur in anyone who experiences a traumatic event, especially if that event was life-threatening. The symptoms can range from reliving the event (flashbacks), to overall emotional Other symptoms include anxiety, exaggerated startle reactions, nightmares, insomnia, and extreme avoidance of reminders of the trauma. Someone may also experience dissociative symptoms. Dissociative symptoms can include not knowing where you are, forgetting important parts of the traumatic event, or feeling as if you are outside of your body. A combination of these symptoms that occur six months after the traumatic event may be PTSD.6
- Acute Stress Disorder (ASD): The symptoms that define ASD greatly overlap with those for PTSD, with the major difference being the time since the traumatic ASD can occur in the first month following a traumatic event. If ASD symptoms continue for more than a month past the traumatic event, an assessment for PTSD may be appropriate.6
- Depression: There are many types of depression disorders, and most are marked by feelings of sadness and/or loss of interest in activities once enjoyed. It can lead to a variety of emotional and physical problems and can decrease a person’s ability to function at work and at home. Symptoms can vary from mild to severe.6
- Generalized Anxiety Disorder (GAD): GAD is characterized by chronic worry and irritability in multiple areas of life that seem to have no cause, and where symptoms have been present for at least 6 months. With GAD, the worry is more intense than the situation warrants. Restlessness, insomnia, difficulty concentrating, fatigue, and muscle tension are other symptoms.6 GAD can occur during any phase of recovery after limb loss.
- Grief: Grief is a strong, sometimes overwhelming emotion for people and a natural reaction to any loss, including amputation. Everyone experiences grief differently, and it will be influenced by the nature of the loss. There are five common stages of grief that can occur in any order and last for any amount of time.2 They include:
- Denial and isolation: A conscious or unconscious decision to refuse to admit that something is true.
- Anger: An emotional or physical act in an attempt to place blame.
- Bargaining: An attempt to postpone or distance oneself from the reality of a situation.
- Depression: A feeling of loss of control or hopelessness.
- Acceptance and hope: A feeling of stability or resignation as one becomes an active participant in their own life.2
Everyone’s emotional recovery will look different. The important thing to remember is that you are not alone on this journey, the Amputee Coalition can provide you with helpful information, support, and encouragement when it is needed most. To learn more, call us at 888-267-5669 or visit us online at https://https://www.amputee-coalition.org/limb-loss-resource-center/
References
- Roy, J., & Francis, J. L. (2011). The psychological recovery of physically wounded service members.
- Spiess, K. E., McLemore, A., Zinyemba, P., Ortiz, N., & Meyr, A. J. (2014).Application of the five stages of grief to diabetic limb loss and amputation. The journal of foot and ankle surgery, 53(6), 735-739.
- Bradway, J. K., Malone, J. M., Racy, J., Leal, J. M., & Poole, J. (1984).Psychological adaptation to amputation: an Orthotics and prosthetics, 38 (3), 46-50.
- Singh, R., Hunter, J., & Philip, A. (2007). The rapid resolution of depression and anxiety symptoms after lower limb amputation. Clinicalrehabilitation, 21(8), 754-759.
- Pomares, G., Coudane, H., Dap, F., & Dautel, G. (2020). Psychological effects of traumatic upper limb Orthopaedics &Traumatology: Surgery & Research.
- American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub.
It is not the intention of the Amputee Coalition to provide specific medical or legal advice but rather to provide consumers with information to better understand their health and healthcare issues. The Amputee Coalition does not endorse any specific treatment, technology, company, service or device. Consumers are urged to consult with their healthcare providers for specific medical advice or before making any purchasing decisions involving their care.
© 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 websites must contact the Amputee Coalition for permission to do so, by emailing a request to rc@amputee-coalition.org.
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