There are two forms of psychological overlay:
[*]Injuries that result in a mood disorder such as major depressive disorder or anxiety disorder such as posttraumatic stress disorder
[*]Injuries for which psychological factors such as a pain disorder are more of an influence than is the physical injury itself
For individuals who are unable to stop reliving their accidents (such as assault victims or individuals who have a horrifying injury), you need merely to look at the way in which the injury occurred or the nature of the injury (amputation, severe burn, electrical shock, etc). You can reasonably expect those whose injury was characterized by a threat to life or a threat to the integrity of the body will develop at least acute stress symptoms. Approximately 25% will go on to develop posttraumatic stress disorder.
You can anticipate that a pain disorder will arise in those who have severe financial and marital problems, who have few alternatives for their occupational future and/or who reasonably feel someone else was responsible for their injury.
An injury is always a disruption to the normal course of life. For many injured workers, there is also the added complication of blame and fear of the future.
Patient place a lot of emphasis on the anniversary of their injury. If they have not returned to work after one year, pessimism emerges.
Always remember while the patient may complain of pain, their underlying concern may be far more complex. You need to know the patient’s true concerns rather than relying solely on the current physical findings.”