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”
Depression
Panic Disorder
Agoraphobia
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
