Dr. David B. Adams – Psychological Blog

Psychology of Illness, Pain, Anxiety and Depression


traumaticTraumatic events: As an employer, do you want the employee back in the workforce before s/he has had ample time for treatment, recovery, and appropriate desensitization to the injury site? Some employees are capable of working if the work environment is different from the one in which the injury occurred.

With that in mind, employers will create alternate jobs, assuming that the change in surroundings will be sufficient to allow work. They have difficulty understanding that a different job at the same facility may not be sufficient accommodation for the patient with true PTSD.

Just the act of driving past an injury site to get to the other entrance of a building can trigger flashbacks and involuntary physical responses, traumatic responses. Symptoms of PTSD impair the ability to function in the workplace and society and to maintain meaningful relationships. PTSD affects the way the brain functions and how the individual processes stress and emotional information. And there is a relationship between the severity of posttraumatic stress disorder (PTSD) symptoms and the probability of returning to the workforce.

Intrusive memories, hypervigilance, and exaggerated startle response are major roadblocks to recovery. The employee spends considerable time and effort trying to avoid thoughts of the trauma and environmental stimuli that call to mind the trauma itself. The more symptomatic the employee is, the less likely s/he is to work.

Here are two scenarios from the same accident:

A: An employee is injured when a boiler explodes nearby and even after physical recovery, cannot return to work with this employer. This is a significant problem because that worker has 27 years with the company, and this is the only job for which the person is trained.

B: A young coworker is injured in the same explosion but was new to this job, did not consider this a career and has no attachment to the employer. For the employer to place equal emphasis upon return to work is to expend a great deal of everyone’s energy and time trying to fix a problem that is only relevant to Worker A. Worker B is not well served by being forced to overcome a fear that is confined to a job he never planned on keeping. In fact, this desensitization may do more harm than good by postponing a more rapid recovery.

6.8% of American adults suffer from PTSD at some point in their lives, and the definitions of this disorder are broadening in society. Workplace bullying may not qualify clinically for a diagnosis of PTSD but may have as great an impact as PTSD. They can be traumatic without creating PTSD.

What we refer to as a toxic workplace environment can lead to employee distress and lost days at work even if they do not reach the diagnostic criteria for PTSD. The concept of having a blanket policy that those who are physically recovered can, and should, return to work even if diagnosed with PTSD, needs to be re-assessed.

Simply have the patient evaluated to determine if the pre-injury workplace, and being in the workforce in general, is truly an option. Clearly, sometimes it is not; bringing the patient back into the injury setting may not only harm the patient but prove markedly disruptive to the company.”


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