Contributing Attorney

Michael P. Earner

the Topic

Psychological Injuries: A Crash Course For Attorneys

Traumatic injury events sometimes have more than a physical impact on victims, they also have mental and emotional impacts as well. It is absolutely common and expected that someone would feel a little shaken up after an accident; however, research suggests that the majority of people who survive serious motor vehicle accidents do not develop any serious or ongoing mental health problems that warrant treatment. However, a notable small group does, and the most common issues among that group are: Post Traumatic Stress Disorder (PTSD), Major Depression, and Anxiety Disorders.

Posttraumatic Stress Disorder (PTSD)

 

PTSD is a psychiatric disorder that may occur after you experience or witness a traumatic event such as a car accident, natural disaster, a terrorist act, war/combat, or other violent action. In the United States, PTSD affects approximately 3.5 percent of adults and about 1 in every 11 Americans will be diagnosed PTSD in their lifetime. Women are two times more likely to have PTSD than men.

PTSD is characterized by intense and disturbing thoughts and feelings that are tied to the traumatic experience that last long after experience is over. When you suffer from PTSD you may “relive” the event through flashbacks, dreams, or nightmares. You may also feel extreme sadness, fear, or anger and feel detached from the people around you. It is also common to avoid situations or people that remind you of the traumatic event.

In order to have PTSD, you must have an actual exposure to a traumatic event. However, you do not have to experience it first-hand. For example, PTSD could occur in a parent learning of a traumatic death of a child, or through lengthy and ongoing vicarious trauma (vicarious trauma is trauma you absorb from other people through long term exposure – like a social worker who works with victims of sexual assault).

Symptoms of PTSD generally fall into four general categories. Specific symptoms can vary from person to person and it is possible to experience one or more of them simultaneously. The four general categories of symptoms are:

  • Intrusive thoughts
  • Avoidance
  • Negative thoughts
  • Heightened Arousal

Intrusive Thoughts

Intrusive thoughts include unwanted, repeated, involuntary memories that can’t be controlled or cleared from your head. They also include stressful dreams or flashbacks of the traumatic event while you are awake. These dreams and flashbacks are often so real and vivid, that you feel like you are re-living the actual experience (in the first-person) or seeing it unfold again before your eyes (third-person).

Avoidance

Avoidance happens when you make an effort to avoid reminders of a traumatic event. You may avoid certain people or places, types of activities, or even certain objects that bring on distressing memories. If an accident happened at a certain intersection, you may go out of your way to avoid ever entering that intersection again. This is done to avoid remembering or causing yourself to think about the traumatic event. Avoidance also includes not discussion of the event at all, with anyone.

Negative Thoughts

Negative thoughts and their corresponding feelings could include distorted beliefs about yourself or others. Examples of this include an ongoing (constant or sporadic) sense of horror, fright, fear, anger, guilt or shame. These thoughts lead to a lifestyle of reclusiveness and a loss of interest in activities you previously enjoyed. They can also build up and make you feel alone and detached from other people and the world.

Heightened Arousal

Heightened arousal is characterized by having outward reactions such as being irritated, having outbursts and behaving recklessly or in a self-destructive way. You may also be easily startled or struggle to sleep or concentrate. It is a physical manifestation of inner feelings that can be observed by others.  They may be subtle, like never traveling in a certain lane, or severe, like starting a fight.

Many people who experience car accidents or other traumatic events develop symptoms like those described above in the days immediately after a traumatic experience. However, it is possible they could be delayed for weeks, months or even years. When the symptoms arise, they often resolve in just a few days or weeks, and when they resolve quickly, it is not PTSD. However, if they do not resolve in a relatively short period of time (about a month or less), it is possible that it is PTSD, and seeking treatment is recommended.

Acute stress disorder occurs after exposure to a traumatic event, like PTSD does, and the symptoms and characteristics are similar. However, with Acute Stress Disorder, the symptoms occur close to the time of the event, but not more than one month after.

Acute Stress Disorder

Acute stress disorder occurs after exposure to a traumatic event, like PTSD does, and the symptoms and characteristics are similar. However, with acute stress disorder, the symptoms occur close to the time of the event, but not more than one month after. Acute stress disorder may cause you to relive the trauma, have flashbacks or nightmares and manifest as feeling numb or detached from yourself.  Approximately 15-20 percent of survivors of car accidents develop acute stress disorder, but only about half of them go on to be diagnosed with PTSD. Psychotherapy, including cognitive behavior therapy may help control symptoms of acute stress disorder and help prevent the symptoms from getting worse and developing into PTSD. Also, medication, such as selective serotonin reuptake inhibitors (SSRI) (antidepressants) may help ease the symptoms.

Major Depression

Major depression is generally characterized by a depressed mood lasting for most of the day, along with a loss of interest in normal activities and relationships. In order to be diagnosed with major depression, you must have the symptoms present every day for at least two weeks.

Symptoms of Major Depression include:

  • Tiredness or loss of energy
  • Feelings of pointlessness
  • Feelings of guilt
  • Inability to concentrate
  • Indecisiveness
  • Insomnia
  • Hypersomnia (excessive sleeping)
  • No interest or pleasure in activities
  • Restlessness
  • Feeling stuck or slowed down
  • Recurring thoughts of death
  • Recurring thoughts of suicide
  • Significant weight loss or gain

Major depression is usually diagnosed by a thorough medical evaluation by a doctor. It is a serious, but treatable illness. Depending on the severity of symptoms, you may be treated with antidepressant medication and psychotherapy. There are other treatment options for clinical depression, like electroconvulsive therapy, also called ECT (shock therapy) that may be used if drugs are not effective or if symptoms are extremely severe.

Anxiety Disorders

Anxiety disorder is a high level classification of different conditions that share similar symptoms, but have slight nuances. These include:

  • Panic Disorders
  • Social Anxiety Disorders
  • Specific Phobias
  • General Anxiety Disorder

Panic disorder

This is when you feel terror that strikes at random. It is very likely that during a panic attack you will sweat, experience chest pain, and feel unusually strong irregular heartbeats in your chest (called palpitations). People often describe it as feeling like they are having a heart attack or choking.

Social anxiety disorder

This is when you feel an abnormal and overwhelming amount of worry, self-consciousness, and fear about everyday social situations that is abnormal for the situation you are in. The most common manifestation is fixated thoughts about others judging you.

Specific phobias

This is when you feel an intense fear of a specific object or situation. Common examples are a fear certain things like heights or spiders.

Generalized anxiety disorder

This is when you feel excessive, unrealistic worry and tension with little or no reason and none of the above listed disorders apply.

Common symptoms shared among all anxiety disorders include:

  • Panic, fear, and general uneasiness
  • Sleep disturbances
  • Inability to stay calm or in homeostasis
  • Clammy limbs such as cold, sweaty or numb hands or feet
  • Shortness of breath
  • Irregular heartbeat (palpitations)
  • Dry mouth
  • Dizziness
  • Nausea

Medical professionals can’t seem to tie anxiety to any single root cause. They are not sure exactly what brings on anxiety disorders. However, similar to other mental illnesses, they seem to be related to a combination of things. Among those things are stress, genetics, human growth and development changes. There is some evidence that some of the disorders run in families. However, there are people who experience anxiety disorders who are the only ones in their families that do. This suggests that the disorders may be linked to the way the brain is able to control fear and other emotions.

Diagnosis

If you have symptoms, your doctor will examine you and ask for your medical history. They may run tests to rule out medical illnesses that might be causing your symptoms. No lab tests can specifically diagnose anxiety disorders.

If your doctor doesn’t find any medical reason for how you’re feeling, they may send you to a psychiatrist, psychologist, or another mental health specialist. Those doctors will ask you questions and use tools and testing to find out if you may have an anxiety disorder.

Your doctor will consider how long and how intense your symptoms are when diagnosing you. She’ll also check to see if the symptoms keep you from carrying out your normal activities.

Treatments

Most people with the condition try one or more of these therapies:

Medication: Many antidepressants can work for anxiety disorders. They include escitalopram (Lexapro) and fluoxetine (Prozac). Certain anticonvulsant medicines (typically taken for epilepsy) and low-dose antipsychotic drugs can be added to help make other treatments work better. Anxiolytics are also drugs that help lower anxiety. Examples are alprazolam (Xanax) and clonazepam (Klonopin). They’re prescribed for social or generalized anxiety disorder as well as for panic attacks.

Psychotherapy: This is a type of counseling that addresses the emotional response to mental illness. A mental health specialist helps you by talking about how to understand and deal with your anxiety disorder.

Cognitive behavioral therapy: This is a certain type of psychotherapy that teaches you how to recognize and change thought patterns and behaviors that trigger deep anxiety or panic.

About the Author

Michael has always had a passion for helping people and always seeks out opportunity to serve others. When Michael was in his early 20’s, he answered a call to give back by joining the US Army shortly after September 11, 2001. Michael was injured during a combat patrol in Afghanistan and he opted to undergo an early, honorable, medical discharge from the military. He is now a disabled veteran rated at 100%. Michael decided to continue his service to others as a lawyer and used his GI Bill to go to law school. Michael has earned five college degrees including two undergraduate (A.S, B.A.) and three graduate degrees (J.D., L.L.M., M.B.A) and has completed additional graduate coursework in the field of Forensic Psychology as well as completing professional courses at Massachusetts Institute of Technology and Cornell University.

Want to be Featured?

Click the link below for more information on how to submit.

Explore More Contributions

How Can A Focus Group Help My Case?

Contributing Attorney the Topic Whenever I speak with a trial lawyer who has never used our focus group services before, the two most common questions they have are: 1) how a focus group can help them win or settle their

Read More »

Circumstances That Warrant DME/IME Attendance

Client Advocate the Topic Circumstances Warranting TTS DME Attendance If your client is actively in litigation for a personal injury claim, there is a high likelihood that at some point, he or she will have to submit to an “Independent

Read More »