Dr. David B. Adams – Psychological Blog

Psychology of Illness, Pain, Anxiety and Depression

Injury & Child Abuse

PTSD [posttraumatic stress disorder] can be an impressively disabling disorder with the injured worker awakened by frequent nightmares, plagued by intrusive thoughts of the accident, easily startled and attempts at avoidance of anything that reminds him/her of the injury. This can generalize in severe cases in which the individual may have lost a finger in an accident involving a specifically defective piece of equipment. Over time the patient cannot tolerate the sounds of similar or even remotely similar equipment. The patient may begin to avoid using knives, scissors or even using eating utensils.

However, not every trauma, even a severe trauma, results in PTSD. For a variety of reasons, some individuals are more prone to develop PTSD. Two individuals may encounter the same trauma; one develops the disorder and one does not. Additionally, the disorder may develop many months after the traumatic event (called delayed onset PTSD).

There are a variety of medications that will help the patient deal with not only the anxiety associated with the event but deal with anxiety over their own symptoms. That is, quite often patients develop “anticipatory anxiety” in which they become anxious as night falls, and they fear the occurrence of their nightmares.

In true cases of PTSD, the patient may be embarrassed by their own symptoms, fearing that others will ridicule their avoidant or anxious behavior.

With regard to treatment, there are desensitization procedures that will reduce the individuals anticipatory and reactive anxiety. But not all patients are responsive to psychological care. They may only partially invest in the treatment process, not fully comply with what they are instructed to do, and when they are being financially compensated for their symptoms, they are not always faithfully honest about the severity of the symptoms.

Much depends upon the patient’s intentions with regard to their job: Do they plan to, wish to, or work toward returning to the job? Or has the injury become their exist strategy to a job they did not like, help briefly or for which they had grown weary? Again, it is important to determine the patient’s motivation before assessing whether care will benefit them.”

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