PTSD After the Accident
One unfortunate consequence of the high volume of automobile travel in the US is the number of accidents that result in personal injury and fatalities. It is thought that each year, approximately 1% of the US population (3 million people) will be injured in motor vehicle accidents.
Most people are in minor crashes and recover quickly, finding it more of a financial hit and an inconvenience, than a big problem. Some people have minor physical injuries, some have severe injuries, and though it happens less with today’s safer vehicles, there are still fatalities. Physical treatment generally starts with first responders, and then the ER. Medical personnel have something to visualize and treat, and a protocol to follow as they do . Unfortunately, what are frequently untreated are the unseen consequences of the accident.
Psychological reactions such as anxiety, depression, or Post Traumatic Stress Disorder have been recognized as a very real result of a motor vehicle accident, especially one where there was a severe injury or a fatality.
Research indicates that the majority of those who survive a serious MVA do not develop mental health problems but approximately 9% of MVA survivors develop PTSD. One large study of MVA survivors who sought treatment, 27% had an anxiety disorder in addition to their PTSD, and 15% reported a phobia of driving.
When an individual is involved in an accident with a fatality, they often feel anxiety (that could have been me), survivor’s guilt (it should have been me) or guilt because the accident actually was their responsibility. Although this issue has not received extensive study, Blanchard and Hickling (2004) suggest that individuals who are involved in a MVA that caused a fatality are at heightened risk of developing PTSD, even if the individual was not responsible for the accident (e.g., was not the driver).
Diagnostic criteria for PTSD is extensive but is generally diagnosed when 1) a person has been exposed to a traumatic event that involved actual or threatened death or serious injury and their response involved intense fear, helplessness or horror 2) The event is re-experienced in one or more ways (dreams, flashbacks, hallucinations or psychological/ physical distress at exposure to cues that symbolize the event). 3) Persistent avoidance of stimuli associated with the event (the people, driving) and a marked numbing of responsiveness including detachment, diminished interest in the future, lack of participation and 4) Persistent symptoms of increased arousal (insomnia, anger outbursts, hypervigilance, difficulty concentrating). If this criteria is familiar and lasts longer than a month, PTSD is a probable diagnosis.
The treatment for PTSD can include psychotherapy or medications but most studies lean toward cognitive behavior therapy. In this intervention, patients are generally educated about PTSD and stress. Deep relaxation, stress management and coping strategies are taught to help combat the effects of the anxiety associated with accident. Exposure to feared stimuli (such as visiting the scene of the accident) is gradually undertaken and different ways to think about or interpret the accident and future driving are encouraged.
If you know someone who has been in a motor vehicle accident and is exhibiting these symptoms, help them to get assistance. It is very difficult for them to do it themselves. Just talking with their primary care physician, and finding out what is available, will give them a start to recovery.
- Ryb GE, Dischinger PC, Read KM, Kufera JA. PTSD after severe vehicular crashes. Ann Adv Automot Med. 2009 Oct;53:177-93. PubMed PMID: 20184843
- Blanchard EB, Hickling EJ, Freidenberg BM, Malta LS, Kuhn E, Sykes MA. Two studies of psychiatric morbidity among motor vehicle accident survivors 1 year after the crash. Behav Res Ther. 2004 May;42(5):569-83. PubMed PMID: 15033502