Dr. David B. Adams – Psychological Blog

Psychology of Illness, Pain, Anxiety and Depression

Exacerbation of Pre-Existing Problems

Let_s take a brief example. A young adult male strains his back at work. There are no remarkable physical findings. He complains of pain and is irritable. Both of these are depressive symptoms. Is he depressed because of his injury? Is he in pain because of his injury?

The problem actually is relatively simple to solve.

First let_s look at the situation. Dependent upon the study, between one-fifth and (as much as) two-thirds of injured workers_ had one or more diagnosable psychological problems prior to injury.

These include not only mood and anxiety disorders but substance abuse and personality disorders.

That was their _baseline_ when they were injured. This baseline often involves dysfunctional marriages, extreme financial pressures, social inadequacies, conflicts with authority, etc.

The worker is injured and drops below this baseline.

The goal of injury treatment must be to return them as close as possible to their specific baseline which may be far below what we would consider _normal._

We must establish this individual baseline as soon after injury as possible. If we do not, then we assume responsibility for pain and mood complaints that actually arise from problems unrelated (and perhaps not even exacerbated by) injury.

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