Page 33 - Psychology of Wounds and Wound Care in Clinical Practice ( PDFDrive )

6 Chapter 1. Psychosocial Consequences of Wounds

Anxiety is not the only emotional response that may con-
tribute to a patient withdrawing from interactions with others.
The relationship between depression and social withdrawal
has long been recognised (Baddeley et al. 2013 ); thus the
depression associated with having a chronic wound may well
change social relationships. Furthermore, a spiral relationship
may well develop in which depression leads to withdrawal
from social interaction leading in turn to increased dysphoria
(Hawkley and Cacioppo 2003 ). Embarrassment has also been
highlighted as a reason for social withdrawal in this group.
This has been linked in particular to the unpleasant odour,
which can often accompanies a chronic wound. Concerns
about whether others can detect this malodour can lead to
patients trying to keep themselves safe from the scrutiny of
others, and the possibility of undesirable comments about
their cleanliness (Probst et al. 2013 ). Furthermore, reduced
personal hygiene can be a genuine concern; patients may
avoid washing for fear that dressings might get wet and that
this will disrupt the healing process (Douglas 2001 ; Ebbeskog
and Ekman 2001a , b ). Thus withdrawal from society can result
from embarrassment over these changes in levels of personal
care as well as the malodour of the wound itself.
Having a chronic wound may also change interpersonal
relationships in other ways. Role reversal in families, where
the previous head of the family becomes the dependent one,

has been described (Douglas 2001 ; see Chap. 8 ). In intimate
relationships for example, where a partner has to take on the
role of carer, the dynamic may well change; furthermore,
couples may experience a loss of physical and emotional inti-
macy (Gorecki et al. 2009 ).

Disrupted Body Image/Sense of Self

This change in the dynamics of intimate relationships may
also result from a shift in the patient’s self-perception and a
loss of identity (Probst et al. 2013 ). Research has highlighted
the impact of these issues on women in particular (Hyland