Psychological Wounds of Trauma and Motor Vehicle Accidents
Psychological wounds of trauma are a diagnosis that is not very often understood or considered when an individual has experienced physical trauma or been involved in a motor vehicle accident. When a patient is not responding to the usual types of physical, medical, or chiropractic treatment interventions, it is important to consider the co-morbid issues and needs involved in the case. Such patients struggle to improve their pain and functioning, but continue to be blocked and overwhelmed by the psychological experience leaving providers frustrated and confused. Pain medications may be increased as the patient’s pain seems to only get worse and seems uncontrollable. In reality, trauma patients may well, unknowingly and ineffectively, utilize pain medications as a means to modulate their moods. Traumatic psychological variables are most predictive of injury case outcomes.
Traumatic Responding Patterns
Trauma occurs when the person has had an actual event or experience that has threatened his or her life, physical wholeness, or sanity, and it overwhelms the individual's ability to psychologically cope. The actual injuries can be minor yet it is estimated that up to 32% of such cases have had resulting traumatic symptoms. Though such traumas are usually associated with abuse, wars, natural disasters, and domestic violence, the incidence of reported traumatic responding patterns noted in car accidents is underreported.
Traumatic responding patterns occur as a result of feeling out of control of one’s physical and/or emotional experience. Since a sense of having control over one’s life is central to feeling stable and comfortable in one’s life experience, a loss of this sense can be quite overwhelming, exhausting, and confusing. When an extraordinary event or experience occurs that alters one’s existential experience, it is unexpected and threatens our sense of security and certainty in the world. It is especially difficult to handle when children, adolescents and young adults are involved in such experiences where their sense of security is threatened and changes their developmental realities. Further, the psychological trauma becomes multidimensional when an individual is struggling with other life stressors and/or changes that are now even more complicated by the injury/accident. In such a case, post-injury pain can lead to disability, depression, post-traumatic stress disorder and frequently last longer than a year, resulting in long-term, moderately severe pain and other significant problems in functioning.
Comorbid Psychological Symptoms
When physical or mental traumas occur, it is normal to be anxious, depressed, agitated, or to experience nightmares. Eighty percent of those experiencing trauma will find themselves struggling with such symptoms. However, up to 15% to 40% of those injured will struggle with more involved traumatic responding patterns that seem to continue and exacerbate their pain and injury. Figure 1 presents comorbidity statistics associated with post-traumatic stress disorders.
According to the diagnostic manual, post-traumatic stress disorders (PTSDs) are usually not fully diagnosable until the symptoms have continued for more than three months. Prior to that, the diagnosis is acute stress syndrome—a condition noted in the first three months following a trauma.
The typical symptoms are usually not acknowledged to providers unless more pointed questions are asked to gain additional information from the patient. Many patients are embarrassed about discussing such symptoms for multiple reasons. Frequently, patients feel guilty and weak for having such reactions and for not being able to be in control of their emotional and physical lives. Catastrophic negative thinking is common and adds to a sense of feeling overwhelmed, lost, and confused. Sleep problems and nightmares disrupt sleep-wake cycles causing more confusion, problems concentrating, and an increased sensitivity to pain.
The typical symptoms noted with a traumatic experience are feeling out of control and helplessness related to the injury incident. Three or more of the following trauma symptoms is usually sufficient for concern about the presence of trauma-responding patterns:
- Recurrent and intrusive distressing recollections of the event
- Recurrent distressing dreams of the event
- Acting or feeling as if the traumatic event were re-occurring
- Intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event
- Feeling "wound-up" and startling easily
- Physiological reactivation upon exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event
- Suddenly feeling or acting as if the accident/injury/trauma were recurring due to some incident or thought reminiscent of the original event causing the trauma
- Efforts to avoid thoughts, activities, places, people, or conversations associated with the trauma
- Persistent symptoms of increased arousal causing sleep problems
- Irritability, concentration problems, hyper-vigilance, and exaggerated startle response
The traumatic responses should not be seen as permanent in nature as long as the patient is involved in treatment directed at resolving, or reducing, these traumatic responding pattern issues. PTSD trauma responses are more likely when comorbid issues are present as the person is more susceptible to traumatic responses. Crises activate and aggravate previous unresolved crises/traumas—many of which the person has been trying to deny or avoid thinking about or seeking resolution.
The problem is that many patients can still have severe trauma reactions without having all of the qualifying symptoms noted above. For this reason, providers and patients tend to downplay the importance of these symptoms. However, when the pain and injury issues are not resolving, it is important to consider that traumatic responding patterns may be playing an important part in the full clinical picture. It is important to note that all three symptom clusters—1) hyper-arousal; 2) re-experiencing; and 3) avoidance and numbing—can aggravate sleep disorders which, in turn, increases a sense of being even more anxious and physically ill.
Considerations for Treatment
Psychological trauma impacts the level of depression and pain that is noted clinically. The following considerations are helpful in resolving such issues.