Psychological injury

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A psychological injury is the psychological or psychiatric consequence of a traumatic event or physical injury. Such an injury might result from events such as abusive behavior, whistleblower retaliation, bullying, kidnapping, rape, motor vehicular collision or other negligent action. It may cause impairments, disorders, and disabilities perhaps as an exacerbation of a pre-existing condition (e.g., Dalby, Maclean, & Nesca, 2022; Drogin, Dattilio, Sadoff, & Gutheil, 2011; [1] Duckworth, Iezzi, & O'Donohue, 2008; [2] Kane & Dvoskin, 2011; [3] Koch, Douglas, Nicholls, & O'Neil, 2006; [4] Schultz & Gatchel, 2009; [5] Young, 2010, [6] 2011; [7] Young, Kane, & Nicholson, 2006, [8] 2007 [9] ).

Contents

Psychological injury is considered a mental harm, suffering, damage, impairment, or dysfunction caused to a person as a direct result of some action or failure to act by some individual. The psychological injury must reach a degree of disturbance of the pre-existing psychological/ psychiatric state such that it interferes in some significant way with the individual's ability to function. If so, an individual may be able to sue for compensation/ damages.

Typically, a psychological injury may involve posttraumatic stress disorder (PTSD), traumatic brain injury (TBI), a concussion, chronic pain, or a disorder that involves mood or emotions (such as depression, anxiety, fear, or phobia, and adjustment disorder). These disorders may manifest separately or in combination (co-morbidity). If the symptoms and effects persist, the injured person may become a complainant or plaintiff who initiates legal action aimed at obtaining compensation against whoever is considered responsible for the injury.

Diagnosis and treatment

Psychologists and psychiatrists are those professionals typically qualified by their regulating or licensing bodies or boards to diagnose and treat psychological injuries. Psychologists are trained in the study of behavior and its assessment, diagnosis, and treatment. Many psychological tests are limited in their use to psychologists, as psychiatrists are unlikely receive substantial training in test administration and interpretation. However, being medical professionals, psychiatrists have skills and a knowledge base not typically available to psychologists. The Diagnostic and Statistical Manual of Mental Disorders—now in its fourth edition (DSM-IV-TR, American Psychiatric Association, 2000 [10] )—will soon be updated by a fifth edition slated for publication in 2013 (see Young and First, 2010, [11] for a critique). This Manual is prepared under the aegis of the American Psychiatric Association, but psychologists contribute to this process by participating in its working groups.

Rehabilitation and other clinical psychologists—such as trauma psychologists—may be in professional contact with injured survivors at the onset injury, shortly thereafter, and throughout the course of recovery, such that these professionals, too, need to know about the legal ramifications of the field. They may employ cognitive behavioral approaches to help their patients deal with any physical injuries, pain experience, PTSD, mood, and effects of their brain injuries (Young, 2008b [12] ). They may assist the families of the injured, including spouses and children. They typically adopt a systems approach, working as part of rehabilitative teams. Their hardest cases occur when there is a death in the family as a result of the event for which legal action is involved and therapy is needed. These clinical, rehabilitation, and trauma psychologists refer to treatment guidelines in preparing their treatment plans, and attempt to keep their practices evidence-based when feasible.

Major psychological injuries

Chronic pain

Chronic pain is another controversial psychological condition, labeled in the DSM-IV-TR as Pain Disorder Associated with Psychological Factors (with or without a Medical Condition). The "biopsychosocial approach" recognizes the influence of psychological factors (e.g., stress) on pain. It was once thought that chronic pain could be the result of a "pain-prone personality" or that it is "all in the head." Contemporary research tends to dismiss such conceptualizations, but they continue persist and cause distress to patients whose pain is not recognized as real. Psychologists have an important role to play in helping patients in pain by providing appropriate education and treatment (for example, about catastrophizing or fearing the worst), and by using standard cognitive and behavioral techniques (such as breathing exercises, muscle relaxation, and dealing with cognitive distortions) (see Gatchel, Peng, Fuchs, Peters, and Turk, 2007; [13] Schatman and Gatchel, 2010 [14] ).

Traumatic brain injury (TBI)

TBI refers to mild to severe pathophysiological effects in the brain and central nervous system due to strong impacts, such as severe blows to the head and penetrating wounds that might take place in accidents and other events at claim. Neuropsychological deficits associated with TBI include those relating to memory, concentration, attention, processing speed, reasoning, problem solving, planning, and inhibitory control. When these effects persist, other psychological difficulties might arise, even in mild cases (such as concussions). However, the underlying reason for the perpetuation of the symptoms beyond the expected time frame might be due to associated factors, such as poor sleep, fatigue, pain, headaches, and distress. Psychologists can help patients with TBI by guiding them in cognitive remediation and dealing with family. When the effects are serious and even devastating, the degree of care from the team may be intensive, covering multiple aspects of daily living (see Ruff and Richards, 2009 [15] ).

People of both sexes and all types of backgrounds, races, ages, and disability status are injured physically and psychologically in events at claim and in other situations. However, the research does not always consider these differences, and often the diagnostic manuals, psychological tests, and therapeutic protocols in use in the area also lack differentiation along these lines.

Disability and return to work

When psychological injuries compromise daily activities, psychologists need to address the degree of disability (see Schultz, 2009; [16] Schultz & Rogers, 2011 [17] ). Patients express symptoms that might be accurately diagnosed as PTSD, Pain Disorder, and/or TBI. However, the critical issue is the degree of impairment, limitation, and participation restriction in daily activities in which patients would normally participate at work, at home, in childcare, and in schooling. When the patient cannot undertake the functions involved in these important roles, the psychologist or other mental health professional may conclude that a disability is present, but this cannot be ascertained by the mere presence of a diagnosis of one sort or another. Rather, the psychologist must demonstrate that the person is disabled from the essential duties, tasks, or activities of the role at issue. For example, a forefinger injury leading to chronic pain might mean relatively little to an investment banker—as long as medications control it and other areas of functioning are not greatly affected—but might be devastating to a violinist. Psychologists may refer to the American Medical Association's Guides to the Evaluation of Permanent Impairment (Rondinelli, Genovese, Katz, Mayer, Müller, Ranavaya, & Brigham, 2008 [18] ) in arriving at disability determinations, which addresses mental health, neuropsychological, and pain issues. However, like the DSM-IV-TR, this compendium is sometimes questioned for its scientific validity and usefulness.

Tort actions and other civil actions are often based on serious, permanent and important psychological injuries that create disabilities of a substantial nature in other areas, such as leisure activities, home care, and family life. Often, psychologists in court lock horns over the degree to which the event at claim and its psychological effects have created serious and potentially permanent psychological disabilities—in part, because there is no one test that can measure "disability," per se.

Treating psychologists try to help clients return to work (RTW) or to their other functional roles and activities of daily living (ADLs). Clients are expected to adhere to treatment regimens, or be compliant with treatment recommendations. Partly, this serves to mitigate their losses, or attempt to return to their pre-event physical and psychological condition. When they reach or are progressing to their maximum medical recovery (physical and psychological/ psychiatric recovery), RTW might be attempted on a modified, part-time, or accommodated basis, and treatment might continue to help full re-integration into the workforce or other daily roles, and to maintain gains and avoid deterioration. Or, clients might be sent for training or education, based on their transferable skills residual to the event at claim and its effects. For those who do not make full recovery and remain disabled because of their permanent barriers to recovery, the goals of rehabilitation include optimizing adjustment, quality of life (QOL), residual functionality, and wellness.

Psychological testing

Psychologists need to use the most appropriate tests available for detecting the person(s) responsible for the psychological injury. In addition, psychologists need to be able to arrive at scientifically informed conclusions in their evaluations that will withstand the rigors of scrutiny by psychologists on the opposing side and of cross-examination in court.

In terms of their education and training, psychologists need to be able to address the full array of areas under discussion, especially in forensic, rehabilitation, and trauma areas. They must become experts in assessment and testing, especially regarding (a) personality tests (e.g., the MMPI-2; Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989; [19] Butcher, Graham, Ben-Porath, Tellegen, Dahlstrom, & Kaemmer, 2001; [20] and the revision the MMPI-2 RF; Ben-Porath & Tellegen, 2008; [21] as well as the PAI; Morey, 2007 [22] ), and their embedded validity scales, such as the F family of scales in the MMPI tests, and (b) stand-alone symptom validity tests (e.g., the TOMM; Tombaugh, 1996; [23] WMT; Green, 2005; [24] SIRS; Rogers, Bagby, & Dickens, 1992; [25] and the revision SIRS-2; Rogers, Sewell, & Gillard, 2010 [26] ). The key factors in the development of tests that are acceptable to psychologists and to court is that the tests should have acceptable psychometric properties, such as reliability and validity. Also, such tests must be standardized by using populations that make sense for the area of psychological injuries, such as accident survivors experiencing pain and other trauma victims.

See also

Related Research Articles

Psychological testing refers to the administration of psychological tests. Psychological tests are administered or scored by trained evaluators. A person's responses are evaluated according to carefully prescribed guidelines. Scores are thought to reflect individual or group differences in the construct the test purports to measure. The science behind psychological testing is psychometrics.

<span class="mw-page-title-main">Brain injury</span> Destruction or degeneration of brain cells

Brain injury (BI) is the destruction or degeneration of brain cells. Brain injuries occur due to a wide range of internal and external factors. In general, brain damage refers to significant, undiscriminating trauma-induced damage.

Rehabilitation of sensory and cognitive function typically involves methods for retraining neural pathways or training new neural pathways to regain or improve neurocognitive functioning that have been diminished by disease or trauma. The main objective outcome for rehabilitation is to assist in regaining physical abilities and improving performance. Three common neuropsychological problems treatable with rehabilitation are attention deficit/hyperactivity disorder (ADHD), concussion, and spinal cord injury. Rehabilitation research and practices are a fertile area for clinical neuropsychologists, rehabilitation psychologists, and others.

<span class="mw-page-title-main">Concussion</span> Medical condition

A concussion, also known as a mild traumatic brain injury (mTBI), is a head injury that temporarily affects brain functioning. Symptoms may include loss of consciousness; memory loss; headaches; difficulty with thinking, concentration, or balance; nausea; blurred vision; dizziness; sleep disturbances, and mood changes. Any of these symptoms may begin immediately, or appear days after the injury. Concussion should be suspected if a person indirectly or directly hits their head and experiences any of the symptoms of concussion. Symptoms of a concussion may be delayed by 1–2 days after the accident. It is not unusual for symptoms to last 2 weeks in adults and 4 weeks in children. Fewer than 10% of sports-related concussions among children are associated with loss of consciousness.

The Minnesota Multiphasic Personality Inventory (MMPI) is a standardized psychometric test of adult personality and psychopathology. A version for adolescents also exists, the MMPI-A, and was first published in 1992. Psychologists and other mental health professionals use various versions of the MMPI to help develop treatment plans, assist with differential diagnosis, help answer legal questions, screen job candidates during the personnel selection process, or as part of a therapeutic assessment procedure.

Psychological trauma is an emotional response caused by severe distressing events that are outside the normal range of human experiences. It must be understood by the affected person as directly threatening the affected person or their loved ones generally with death, severe bodily injury, or sexual violence; indirect exposure, such as from watching television news, may be extremely distressing and can produce an involuntary and possibly overwhelming physiological stress response, but does not produce trauma per se. Examples of distressing events include violence, rape, or a terrorist attack.

<span class="mw-page-title-main">Traumatic brain injury</span> Injury of the brain from an external source

A traumatic brain injury (TBI), also known as an intracranial injury, is an injury to the brain caused by an external force. TBI can be classified based on severity ranging from mild traumatic brain injury (mTBI/concussion) to severe traumatic brain injury. TBI can also be characterized based on mechanism or other features. Head injury is a broader category that may involve damage to other structures such as the scalp and skull. TBI can result in physical, cognitive, social, emotional and behavioral symptoms, and outcomes can range from complete recovery to permanent disability or death.

Post-concussion syndrome (PCS), also known as persisting symptoms after concussion, is a set of symptoms that may continue for weeks, months, or years after a concussion. PCS is medically classified as a mild traumatic brain injury (TBI). About 35% of people with concussion experience persistent or prolonged symptoms 3 to 6 months after injury. Prolonged concussion is defined as having concussion symptoms for over four weeks following the first accident in youth and for weeks or months in adults.

Psychological evaluation is a method to assess an individual's behavior, personality, cognitive abilities, and several other domains. A common reason for a psychological evaluation is to identify psychological factors that may be inhibiting a person's ability to think, behave, or regulate emotion functionally or constructively. It is the mental equivalent of physical examination. Other psychological evaluations seek to better understand the individual's unique characteristics or personality to predict things like workplace performance or customer relationship management.

A psychiatric assessment, or psychological screening, is the process of gathering information about a person within a psychiatric service, with the purpose of making a diagnosis. The assessment is usually the first stage of a treatment process, but psychiatric assessments may also be used for various legal purposes. The assessment includes social and biographical information, direct observations, and data from specific psychological tests. It is typically carried out by a psychiatrist, but it can be a multi-disciplinary process involving nurses, psychologists, occupational therapist, social workers, and licensed professional counselors.

Traumatic brain injury can cause a variety of complications, health effects that are not TBI themselves but that result from it. The risk of complications increases with the severity of the trauma; however even mild traumatic brain injury can result in disabilities that interfere with social interactions, employment, and everyday living. TBI can cause a variety of problems including physical, cognitive, emotional, and behavioral complications.

Functional disorders are a group of recognisable medical conditions which are due to changes to the functioning of the systems of the body rather than due to a disease affecting the structure of the body.

Somatic symptom disorder, also known as somatoform disorder, or somatization disorder, is defined by one or more chronic physical symptoms that coincide with excessive and maladaptive thoughts, emotions, and behaviors connected to those symptoms. The symptoms are not deliberately produced or feigned, and they may or may not coexist with a known medical ailment.

<span class="mw-page-title-main">Veterans benefits for post-traumatic stress disorder in the United States</span> VA disability compensation for PTSD

The United States has compensated military veterans for service-related injuries since the Revolutionary War, with the current indemnity model established near the end of World War I. The Department of Veterans Affairs (VA) began to provide disability benefits for post-traumatic stress disorder (PTSD) in the 1980s after the diagnosis became part of official psychiatric nosology.

Jon Elhai is Distinguished Professor of clinical psychology at the University of Toledo. Elhai is known for being an expert in the assessment and diagnosis of Posttraumatic stress disorder (PTSD), forensic psychological assessment of PTSD, and detection of fabricated/malingered PTSD; as well as in internet addictions.

Because of the substantial benefits available to individuals with a confirmed PTSD diagnosis, which causes occupational impairment, the distinct possibility of false diagnoses exist, some of which are due to malingering of PTSD. Malingering of PTSD consists of one feigning the disorder. Post-traumatic stress disorder (PTSD) is an anxiety disorder that may develop after an individual experiences a traumatic event. In the United States, the Social Security Administration and the Department of Veterans Affairs each offer disability compensation programs that provide benefits for qualified individuals with mental disorders, including PTSD. Malingering can lead to a decline in research and subsequent treatment for PTSD as it interferes with true studies. Insurance fraud may also come about through malingering, which hurts the economy.

Starke R. Hathaway was an American psychologist who co-authored the psychological assessment known as the Minnesota Multiphasic Personality Inventory (MMPI). He was a longtime faculty member of the Department of Psychology at the University of Minnesota.

The Structured Inventory of Malingered Symptomatology (SIMS) is a 75-item true-false questionnaire intended to measure malingering; that is, intentionally exaggerating or feigning psychiatric symptoms, cognitive impairment, or neurological disorders.

Sleep disorder is a common repercussion of traumatic brain injury (TBI). It occurs in 30%-70% of patients with TBI. TBI can be distinguished into two categories, primary and secondary damage. Primary damage includes injuries of white matter, focal contusion, cerebral edema and hematomas, mostly occurring at the moment of the trauma. Secondary damage involves the damage of neurotransmitter release, inflammatory responses, mitochondrial dysfunctions and gene activation, occurring minutes to days following the trauma. Patients with sleeping disorders following TBI specifically develop insomnia, sleep apnea, narcolepsy, periodic limb movement disorder and hypersomnia. Furthermore, circadian sleep-wake disorders can occur after TBI.

Rehabilitation psychology is a specialty area of psychology aimed at maximizing the independence, functional status, health, and social participation of individuals with disabilities and chronic health conditions. Assessment and treatment may include the following areas: psychosocial, cognitive, behavioral, and functional status, self-esteem, coping skills, and quality of life. As the conditions experienced by patients vary widely, rehabilitation psychologists offer individualized treatment approaches. The discipline takes a holistic approach, considering individuals within their broader social context and assessing environmental and demographic factors that may facilitate or impede functioning. This approach, integrating both personal and environmental factors, is consistent with the World Health Organization's (WHO) International Classification of Functioning, Disability and Health (ICF).

References

  1. ↑ Drogin, E. Y., Dattilio, F. M., Sadoff, R. L., & Gutheil, T. G. (2011). Handbook of forensic assessment. New York: Wiley. ISBN   978-0-470-48405-0.
  2. ↑ Duckworth, M. P., Iezzi, T., & O'Donohue, W. T. (Eds.). (2008). Motor vehicle collisions: Medical, psychosocial, and legal consequences. New York: Elsevier. ISBN   0-08-045048-2.
  3. ↑ Kane, A. W., & Dvoskin, J. A. (2011). Evaluation for personal injury claims. New York: Oxford University Press. ISBN   0-19-532607-5.
  4. ↑ Koch, W. J., Douglas, K. S., Nicholls, T. L., & O'Neill, M. L. (2006). Psychological injuries: Forensic assessment, treatment, and law. New York: Oxford University Press. ISBN   0-19-518828-4.
  5. ↑ Schultz, I. Z., & Gatchel, R. J. (2009). Handbook of complex occupational disability claims: Early risk identification, intervention, and prevention. New York: Springer Science + Business Media. ISBN   0-387-50167-3.
  6. ↑ Young, G. (2010). Causes in the construction of causal law: A psycho-ecological model. International Journal of Law and Psychiatry, 32, 73-83.
  7. ↑ Young, G. (2011). Erratum to: Trends in psychological/ psychiatric injury and law: Continuing education, practice comments, recommendations. Psychological Injury and Law, 4, 56-87.
  8. ↑ Young, G., Kane, A. W., & Nicholson, K. (2006). Psychological knowledge in court: PTSD, pain, and TBI. New York: Springer Science + Business Media. ISBN   0-387-25609-1.
  9. ↑ Young, G., Kane, A. W., & Nicholson, K. (2007). Causality of psychological injury: Presenting evidence in court. New York: Springer Science + Business Media. ISBN   1-4419-4214-9.
  10. ↑ American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders: Text revision (4th ed). Washington, DC: Author. ISBN   0-89042-025-4.
  11. ↑ Young, G., & First, M. B. (Eds.). (2010). Special issue: The DSM-5 draft: Implications for psychological injury and law. Psychological Injury and Law, 3.
  12. ↑ Young, G. (2008b). Psychotherapy for psychological injury: A biopsychosocial and forensic perspective. Psychological Injury and Law, 1, 287-310.
  13. ↑ Gatchel, R. J., Peng, Y. B., Fuchs, P. N., Peters, M. L., & Turk, D. C. (2007). The biopsychosocial approach to chronic pain: Scientific advances and future directions. Psychological Bulletin, 133, 581-624.
  14. ↑ Schatman, M. E., & Gatchel, R. J. (Eds.). (2010). Special issue on traumatically induced pain. Psychology Injury and Law, 3.
  15. ↑ Ruff, R., & Richards, P. M. (Eds.). (2009). Special issue on traumatic brain injury. Psychological Injury and Law, 3.
  16. ↑ Schultz, I. Z. (Eds.). (2009). Special issue: Disability and return to work. Psychological Injury and Law, 2.
  17. ↑ Schultz, I. Z., & Rogers, E. S. (Eds.). (2011). Work accommodation and retention in mental health. New York: Springer Science + Business Media. ISBN   1-4419-0427-1.
  18. ↑ Rondinelli, R. D., Genovese, E., Katz, R. T., Mayer, T. G., Müller, K. L., Ranavaya, M. I., & Brigham, C, R. (2008). Guides to the evaluation of permanent impairment (6th ed.) Chicago: American Medical Association. ISBN   1-57947-888-3.
  19. ↑ Butcher, J. N., Dahlstrom, W. G., Graham, J. R., Tellegen, A., & Kaemmer, B. (1989). Manual for the Restandardized Minnesota Multiphasic Personality Inventory: MMPI-2. An administrative and interpretive guide. Minneapolis: University of Minnesota Press.
  20. ↑ Butcher, J. N., Graham, J. R., Ben-Porath, Y. S., Tellegen, A., Dahlstrom, W. G., Kaemmer, G. (2001). Minnesota Multiphasic Personality Inventory-2: Manual for administration and scoring (2nd ed.). Minneapolis, MN: University of Minnesota Press. Product Number 24027.
  21. ↑ Ben-Porath, Y. S., & Tellegen, A. (2008). MMPI-2 RF (Minnesota Multiphasic Personality Inventory-2 Restructured Form). Minneapolis, MN: University of Minnesota Press and Pearson Assessment Systems. Product Number 25051/ A098765432.
  22. ↑ Morey, L (2007). Personality Assessment inventory: Professional Manual (2nd ed). Lutz, FL: Psychological Assessment Resources. Product Number WW-5966-TM.
  23. ↑ Tombaugh, T. N. (1996). Test of memory malingering. Tonawonda, NY: Multi-Health Systems. Product Number TOM20B.
  24. ↑ Green, P. (2005). Green's World Memory Test user's manual. Edmonton, Alta: Green's.
  25. ↑ Rogers, R., Bagby, R. M., & Dickens, S. E. (1992). Structured Interview of Reported Symptoms. Odessa, FL: Psychological Assessment Resources.
  26. ↑ Rogers, R., Sewell, K. W., & Gillard, N. D. (2010). Structured Interview of Reported Symptoms (SIRS) and professional manual. Lutz, FL: Psychological Assessment Resources. Product Number WW-6711-TM.
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