Golfer Gary Woodland’s PGA win spotlights PTSD caused by surgery and medical trauma

Professional golfer Gary Woodland’s recent Houston Open triumph shone a light on an infrequently discussed condition: post-traumatic stress disorder following surgery.

In September 2023, Woodland had a procedure to remove most of a lesion in the area of his brain that controls fear and anxiety. The lesion caused symptoms such as unfounded fears of death, unrelenting anxiety, hand tremors and chills. 

The surgery involved cutting a baseball-sized hole into the left side of Woodland’s skull and included risks such as vision loss and paralysis of the left side of his body. After the procedure, he spent time in the ICU.

Woodland said the surgery successfully removed as much of the lesion as possible without risking his eyesight and motor control. And although he returned to the PGA Tour in January 2024, he found his recovery slowed by complications. About two weeks before his big win, Woodland revealed in a Golf Channel interview that he’d been diagnosed a year earlier with PTSD. 

He hadn’t understood PTSD at first, he said in the March 9 segment, but he’d been learning how to manage symptoms such as hypervigilance. He said he hoped not hiding PTSD’s challenges would make it easier to continue playing professional golf.

As he played in Houston, Woodland said that openness indeed offered relief: "I literally feel like I got a thousand pounds off my back that day." 

Witnessing or experiencing a traumatic event can cause the mental health condition known as post-traumatic stress disorder. Many things can be considered traumatic, such as getting in a car crash, surviving a natural disaster or experiencing physical or emotional abuse. 

While PTSD is often associated with surviving military combat or sexual assault, the condition has also been linked to surviving life-threatening medical events including illness and major surgery.

A 2019 study out of Canada described research on traumatic stress after surgery as "in its infancy," but said postoperative traumatic stress including PTSD occurs in about 20% of patients. 

A surgery is a trauma to the body, said Dr. Eugene Lipov, an anesthesiologist, PTSD treatment researcher and co-founder of Stella Mental Health. Physiologically, the body responds to trauma similarly, whether that trauma is something like open heart surgery, being chased and breaking your leg, or getting shot, Lipov said. 

Physical injury increases inflammation and cortisol, the body’s stress hormone, and norepinephrine, a key part of the body’s fight-or-flight response, Lipov said. These biological signals tell the body it is experiencing something traumatic, which can trigger PTSD. 

PTSD symptoms are grouped in four main categories, including reliving the event, avoiding reminders of it, negative changes in cognition and mood, and feeling on edge or experiencing increased reactivity. Specific symptoms can include nightmares, flashbacks, irritability, hypervigilance, ongoing fear, trouble concentrating, problems sleeping, feeling detached or uninterested, avoiding people or places, resisting talking about the event, and forgetting parts of it.

When it comes to post-surgical PTSD, some people might have nightmares about the hospital or their surgery or procrastinate or avoid follow-up appointments, said Sharon Joag, a licensed psychotherapist at Oaks Integrated Care, a nonprofit mental health organization in New Jersey. 

To be diagnosed with PTSD, a person must experience symptoms in each category, but that looks different for each person, according to the U.S. Department of Veterans Affairs’ National Center for PTSD. 

After experiencing a traumatic event, a person might display some symptoms similar to PTSD in the short term, but for it to meet the clinical definition of PTSD, the symptoms must persist for longer than a month and cause significant distress or disruption to a person’s daily life and activity. Most people who experience trauma do not develop PTSD. 

Lipov advises patients who undergo surgery to consult with their doctor if they experience  significant changes in behavior, mood or sleep habits. Some symptoms associated with post-surgical PTSD such as low energy or depression could also be signs of infection or surgical complications, he said. 

Medical professionals aren’t entirely aligned on whether PTSD stemming from a traumatic health condition or surgery is notably different from PTSD that stems from combat or assault. 

But certain factors appear to increase a person’s risk of post-surgical PTSD.

A family history of PTSD indicates a genetic predisposition to the condition, Lipov said. 

The surgery’s severity and risks also play a role. A person is more likely to develop PTSD after a more invasive procedure such as open heart surgery or an event that requires a stay in the intensive care unit with intubation, Lipov said.

A person’s mental state going into a surgery can also impact the risk. 

"If they say you have a fifty-fifty (percent) chance of dying before the surgery, your sympathetic system is revved up already, so your chance to develop PTSD is higher," Lipov said

That means if someone previously had post-surgical PTSD, they could be at higher risk of developing it again because they already perceive negative associations between surgical procedures and hospital stays, he added. 

But the opposite could be true. If there’s a known fear of surgery or a history of post-surgical PTSD, "through therapy and support, subsequent or future surgeries can be handled very differently," Joag said.