Author: Richard H. Adler

Posttraumatic stress disorder (PTSD) is a greatly misunderstood diagnosis frequently made with individuals who have been traumatized physically and emotionally. There is no doubt physical trauma caused by motor vehicle collisions, trip and falls, pedestrian or bicycle collisions, head injuries as well as the violent wartime or criminal incident contexts can and often does lead one to develop post traumatic stress disorder.

Scientific evidence has established that Post Traumatic Stress Disorder is a debilitating condition of both the body and the mind. As stated by the Surgeon General of the United States in his Report on Mental Health issued in 1999, the distinction between mental and physical is no longer tenable in this area:

One reason the public continues to this day to emphasize the difference between mental and physical health is embedded in language. Common parlance continues to use the term“physical” to distinguish some forms of health and illness from“mental” health and illness. People continue to see mental and physical as separate functions when, in fact, mental functions (e.g., memory) are physical as well (American Psychiatric Association, 1994). Mental functions are carried out by the brain. Likewise, mental disorders are reflected in physical changes in the brain (Kandel, 1998).

It is now accepted in the health care community based on a growing body of scientific literature that persistent and profound changes in some of the body’s physiologic systems occur in individuals with Post Traumatic Stress Disorder. Researchers have found evidence of damage to the physical systems associated with Post Traumatic Stress Disorder such as increased sympathetic nervous system activity, alterations in stress hormones secretion, memory processing and limbic system abnormalities in brain imaging studies of traumatized patients

The mere presence of psychological distress related to traumatic injury does not in and of itself mean the patient has posttraumatic stress disorder (PTSD). In order for psychological injuries to rise to the level of a diagnosis of PTSD, it must meet all of the specific diagnostic criteria of the DSM-IV (Diagnostic and Statistical Manual) published by the American Psychological Association:

• Exposure to a traumatic event in which "the person experienced, witnessed, or was confronted with . . . actual or threatened death or serious injury, or a threat to the physical integrity of self or others." The patient must also have experienced the event with "intense fear, helplessness, or horror.”
• The traumatic event is persistently reexperienced "by distressing recollections of the event, distressing dreams, reliving of the event, or intense psychological or physical distress at exposure to cues that remind the patient of the trauma."
• Persistent avoidance of stimuli associated with the trauma or "numbing" of the senses. Examples include: avoiding thoughts of the event; avoiding activities, places, or people that arouse memories of the event; inability to recall important aspects of the trauma; diminished interest or participation in life activities; feelings of detachment; reduced range of emotional expression; or a lack of a sense of future.
• "Persistent symptoms of increased arousal." Examples are: insomnia, irritability, difficulty concentrating, or an exaggerated startle response.
• A duration of more than one month, with a disturbance in the person's social and work life.

Clearly, the diagnosis of PTSD is detailed and specific. Oftentimes, when PTSD is suspected, the actual psychological dysfunction may be of a lesser nature, commonly diagnosed as "stress disorder" or "phobic reaction."

Regardless of the diagnosis or label attached, healthcare providers need to be aware of the significant risk posed to patients with traumatic injuries of developing PTSD or one of the lesser-included conditions of psychological distress. In the area of motor vehicle , pedestrian motor vehicle and bicycle automobile collision injuries, there are characteristics that make for a greater risk of PTSD or related psychological problems, such as:

1. The event is out of the control of the auto accident victim, much like an unprovoked and completely unexpected physical attack.
2. Auto, pedestrian and bicycle accident injuries and the events causing them often involve feelings of helplessness and fear. Even more so is the case when the auto accident victim is aware of the impending impact and is unable to do anything to avoid or prevent it.
3. Auto, pedestrian and bicycle accidents can create phobias. Fear of driving, riding or walking on the streets or fear of the traumatic event's location.
4. Traumatic injuries can be very painful. PTSD has been associated not only with the gross trauma of a violent event, but also arising from the post-accident pain experienced intensely by the patient separate from the traumatic event itself. Prolonged and severe pain experienced immediately after an auto accident before the intervention of care in and of itself can be the traumatic experience leading to PTSD symptoms.
5. Brain Injury can increase PTSD symptoms. Cognitive disorders following a traumatic head injury are often not diagnosed early on. This can have a negative psychological impact on the injured person who experiences further fear, anxiety or depression because real symptoms are not believed or validated by the treatment provider. This can lead to exacerbation of PTSD symptoms.

Treatment and therapy for PTSD will most likely include "desensitizing" techniques. In the case of those with fear of driving, travel or the location of the accident, therapy will likely include repeated exposure to the phobic stimuli, including the "imagining" of the traumatic event. These techniques result in desensitizing the patient to the impact of the provocative stimuli and thereby lessen or eliminate the victim's fear. Cognitive behavior therapy and relaxation training employed in the treatment of chronic pain have also been found to be effective in the treatment of PTSD symptoms. In certain situations, medications are needed and can include antidepressant drugs.

Should your patient exhibit all or some of PTSD-like symptoms listed in the DSM-IV criteria stated above, it may be wise to refer that person to a competent mental health professional experienced with trauma-related issues for diagnosis and treatment. As this is an area fraught with medical/legal and insurance claim issues, a referral to an experienced personal injury attorney well versed in post traumatic stress disorder early on is recommended as well. The personal injury recovery attorneys of Adler Giersch ps are available for free consultation through their offices in Seattle, Everett, Bellevue and Kent.

¹ Adler Giersch, P.S., would like to thank John R. Alexander, attorney at law, for researching and writing this article.