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CRF-hyperresponsiveness, pediatric ophthalmic surgeries and adult presentation of generalized anxiety disorders: a clinical hypothesis

Molecular Psychiatry volume 5, pages 127–128 (2000)Cite this article

SIR – Stressful experiences in early life are correlated with the development of psychiatric disorders. These early experiences do not necessarily precipitate onset of psychopathology, but may instead render an individual vulnerable to its subsequent appearance. For example, the literature investigating a possible relationship between early traumatic experiences and subsequent presentation of posttraumatic stress disorder found trauma to be a significant risk factor.1, 2 Additionally, it has been found that major medical illness as a child can increase the risk of subsequent psychological problems.3, 4

It is argued here that pediatric ophthalmic surgeries may also result in increased risk of post-treatment psychiatric disorders. Specifically we hypothesize that these procedures may result in a predisposition to pathological anxiety that is exacerbated when these individuals become young adults. Several factors specific to ophthalmic surgeries suggest that this might be the case. First, in some instances, bandaging results in temporary post-operative blindness, which is profoundly disorienting. Second, the patients may experience more than one surgery. There is a repetitive disruption of visual acuity. These factors contribute to a diminished sense of control over ones life. This is known to be a behavioral factor in the genesis of anxiety disorders.5 Additionally, in contrast with other surgical procedures, for example a tonsillectomy, the traumatic experience is not limited to the surgery and the immediate post-operative period. The surgery results in an abrupt, dramatic and irreversible transformation of the patient's visual universe. Even though the outcome is positive, a pervasive and incomprehensible event has occurred, contributing to a loss of confidence in the accuracy of information processing. This is also a recognized factor in the development of anxiety.5 Finally, the surgeries occur when the patient is very young. This is significant because the patient may be preverbal, making it impossible to counsel the patient prior to treatment (thus exacerbating the traumatic nature of the experience), and because the patient's immature central nervous system is highly plastic.

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Authors and Affiliations

  1. Department of Pharmacology and Physiology, The Medical College of Pennsylvania Hahnemann University, USA

    P E Rapp

  2. The Arthur P Noyes Clinical Research Center, Building 52, Norristown State Hospital, 1001 Stergere Street, Norristown, 19401-5397, PA, USA

    P E Rapp

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Rapp, P. CRF-hyperresponsiveness, pediatric ophthalmic surgeries and adult presentation of generalized anxiety disorders: a clinical hypothesis. Mol Psychiatry 5, 127–128 (2000). https://doi.org/10.1038/sj.mp.4000703

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