Dr. David B. Adams – Psychological Blog

Psychology of Illness, Pain, Anxiety and Depression

The All or None Rule

“All lost time injured workers, who fail to respond to usual and customary levels of care, have undiscovered and/or undisclosed complicating factors which are the predominate forces impeding recovery.

These may be undiscovered or incorrectly diagnosed damages, unreported or undiagnosed physical conditions unrelated to injury or, most commonly, mental and emotional problems which have not been explored by the primary provider.

This may be something as direct as mood or anxiety disorder or it may be something more covert such as hidden addictive disorders, but not infrequently the patient is attempting to shield the examiner from co-morbid psychological problems. This could be due to the patient’s shame/embarrassment over the problem and/or fear that if the psychological problem is acknowledged, the search for a physical cause will cease once a psychological component is uncovered or discovered.

Some examples include the patient whose injury was believed to have been to his neck and shoulder. Soon after injury, he had increasing lumbar pain. His treating physician was not authorized nor did he specialized in lumbar complaints. The patient’s shoulder improved with physical therapy, but his back pain worsened and impeded his return to work. Until the back pain was addressed, there was no chance of the patient successfully returning to work.

Another patient was involved in a same sex relationship with a promiscuous girl friend. After the patient’s cervical injury, she could no longer meet the needs of her girlfriend. Her fear of being abandoned, fear of being rejected, and fear of being alone contributed to depressive symptoms and ultimately to her failing to show for physical therapies and even for diagnostic studies. The false assumption was that the patient was malingering when, in reality, she was both frightened and discouraged.

A patient complained one year after lumbar injury that upon arising, he would fall and re-injure himself. His orthopedist rightfully reported that such falls were not the result of the lumbar injury and that the patient was likely being disingenuous. In reality, the patient had critically high and labile blood pressure. He was taking medication that caused the blood pressure to precipitously drop when he suddenly arose. He had not been treated for hypertension nor had the disorder ever been considered.

A final example is a patient who had relocated several times since injury, making it difficult for those treating him to maintain appointment scheduling for him. It was assumed by several that he was working. In reality, he had longstanding gambling debts, was selling off property to pay them, giving away his workers’ compensation in an attempt to cover the bets and relocating to avoid physical reprisals from those with whom he was placing bets.

These are but a few of the seemingly ordinary injuries for which the underlying problems are anything but ordinary.”
#AtlantaPsychologist #AtlantaMedicalPsychology #Dr. David B. Adams #Pain #Depression #Anxiety

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