Understanding Psychological Injury

Where to get help, resources. – What to do in ... Application of statistical data re functioning .... Data show that earlier return encourages recovery. ○ Help avoid.
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Understanding Psychological Injury Dr. James Arnold, RDPsych

What is a Psychological Injury?  

Specific incident Series of incidents, cumulative –

usually less intense than the specific incident situation

Chronic overwork –

e.g., performing two jobs, burnout with excess job hrs and demands

Typical Origins of Incidents 

Happened personally to worker, e.g., involved in fatal MVC Happened to another worker, i.e., observed, attended to injured worker

Interpersonal, e.g., assault, harassment, threat

Arose from the injured worker's behaviour, e.g., with equipment

Arose from another worker's behaviour

On a continuum with the type expected work, or completely out of expectations

Critical Incident Stress Management 

Education and information aspect is helpful – – –

Where to get help, resources What to do in immediate aftermath Communication of company responses

Some forms of discussion may be harmful – –

A group may respond to the most traumatised person and gravitate to that level Some debreifers not involved in the incident may be working out their own prior trauma

DSM: Diagnostic and Statistical Manual of Mental Disorders  

 

DSM-5 replaced DSM-IV DSM lists symptom clusters, does not specify how to diagnose DSM is descriptive, does not specify causes Updated criteria so that direct contact with injury situation is required for a trauma incident exposure to qualify

Typical Diagnoses 

PTSD (post-traumatic stress disorder)

ASD (acute stress disorder)

Adjustment Disorder with depressed/anxious/irritable mood Some symptoms of psych trauma, not full syndrome – “Other Specified Trauma- and Stressor-Related Disorder”


Panic Disorder


PTSD Criteria 

Life threatening or horrifying incident

Intrusive recall

 

Psych & physical over-arousal, and/or emotional numbing Avoidance to control other symptoms Delayed onset is possible, usually in response to triggers

ASD  

Short term psychological trauma symptoms Initially dazed or in shock, with fluctuating and unstable symptoms May last up to 1 month, usually 2-4 days 

 

Immediate emotional reactions: depression, anxiety, anger, despair Behaviour may be hyperactive, withdrawal from others Sleep, appetite, routines all disrupted

Adjustment Disorder 

 

Temporary psych symptoms in the presence of a stressor Not a life threatening or horrifying stressor May show similar symptoms of depression, anxiety, irritability etc., akin to a trauma

Diagnosis Three levels of diagnosis for WCB  Reason for Visit (RFV)  Working Diagnosis (WD)  Full Assessment Diagnosis (FAD)

RFV (Reason for Visit)    

Why patient is seeing the doctor Brief, symptom oriented visit A diagnosis is provided to describe the visit Limited or no diagnostics

WD 

Worker is attending appointments with a counsellor, therapist, psychologist Focus of meetings is on work incident, symptoms and managing Diagnosis based on worker's report of symptoms and applying an understanding of typical symptom clusters

Full Assessment Diagnosis (FAD) 

   

Worker referred for a “Mental Health Assessment” Contains the self-report of symptoms and issues Psychological testing and assessment Application of statistical data re functioning Projec