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Home » Health Professionals » Psychological Injury » Overview of most common psychological disorders experienced by injured workers

Overview of most common psychological disorders experienced by injured workers

 

Although there are arrange of psychological health problems that can occur as a result of workplace injury, the most frequently reported, diagnosed and treated disorders have described below:

 

 

Trauma-Associated Disorders

 

These are some of the most frequently reported and recognised psychological disorders in the workplace and are a response to an event that is outside the range of usual human experiences that would be markedly distressing to almost anyone. They are frequently a response to events such as armed hold-ups, physical assault, prolonged psychological harassment, sexual harassment or assault, witnessing a major accident within the workplace or occur whilst travelling to or from work.

 

 

Post Traumatic Stress Disorder

 

People who survive extremely traumatic events often have Post Traumatic Stress Disorder (PTSD). People who have survived combat and torture are the most frequent victims, however people who have survived other disasters such as rape, abductions, hold-ups, hostages or airplane crashes are likely to be affected.

 

Criteria for PTSD

Morrison (1995) outlines the DSM-IV criteria for diagnosis of PTSD. Essential features are that the patient has experienced, witnessed or was confronted with an unusually traumatic event that involved actual threatened death or serious physical injury to the patient or others and resulted in feeling intense fear, horror or helplessness. The patient relives the event through one of the following:

 

  • Intrusive distressing recollections, repeated distressing dreams, flashbacks, hallucinations or illusions
  • Marked mental distress in reaction to external or internal cues

 

Physiological cues:

 

  • Patient repeatedly avoids trauma related stimuli, and has a numbing of general stimulus
  • Patient has symptoms of hyper-arousal that were not present before the event and will include two of the following, ie. insomnia, angry outbursts or irritability, or excessive vigilance
  • The symptoms have lasted more than one month and the symptoms cause clinically significant distress or impair work, social or personal functioning

 

Acute Stress Disorder is a relatively new classification and shares all the elements required for Post Traumatic Stress Disorder, except that symptoms have not occurred for longer than one month.

 

 

Other Disorders

 

Panic Disorder is a common anxiety disorder in which the sufferer experiences panic attacks and fears of having another. Approximately half of panic disorder sufferers also have symptoms of agoraphobia. As a result there are two types of diagnosable panic disorder – with and without Agoraphobia.

Morrison (1995) outlines the DSM-IV criteria for diagnosis of Panic disorder. Essential features are as follows:

 

 

Panic Disorder Without Agrophobia

 

Patient has recurrent panic attacks, which are unexpected for a month or more after at least one of the attacks. Patient has had one of the following:

 

  • Ongoing concern that there will be more attacks

  • Worry about the significance of the attack’s and consequences for health, control, sanity

  • Change of behaviour, such as doing something to avoid or combat the attacks

  • Patient doesn’t have agrophobia.

 

Panic disorder with agrophobia

 

As for the above definition, but patient displays signs of agrophobia. Panic disorder in context of workplace injuries may occur when a worker has been subject to regular and significant harassment by an employer/supervisor or work mate, or had unreasonable demands placed upon them over a prolonged period of time – e.g. has had to carry out the work of 2 or 3 staff for a prolonged period of time and /or were not provided with appropriate support or supervision.

 

 

Pain Disorder

 

Morrison (1995) in his book “DSM-IV, The Clinician’s guide to diagnosis” comments that pain disorder is one of only 2 disorders within DSM-IV that require “a clinician’s judgement that psychological factors play an important role in the development and maintenance of symptoms”. The implications therefore are that what seems psychologically important to one clinician may seem irrelevant to another and objectivity is at question. In practice and at worse this could mean that a patients persisting complaint of pain could be ignored by a clinician who has not done adequate examinations or investigations of physical causes and interpreted the complaints as “psychological” or predominantly influenced by psychological factors. On the other hand, excessive and unwarranted investigations could be ordered and reordered by a clinician who does not identify psychological and social factors as factors influencing the patients pain experience.

 

DSM-IV criteria for pain disorder:

 

  • The patients presenting problem is clinically important pain in one or more body areas

  • The pain causes distress that is clinically important or impairs work, social or personal functioning

  • Psychological factors seem important in the onset, maintenance, severity, or worsening of pain

  • Other disorders do not explain the symptoms better

  • The patient does not consciously feign the symptoms for material gain.

 

 

Adjustment Disorder

 

Adjustment disorder is a diagnostic category that clinicians seem to use when their patients cannot be classified with other disorders. Morrison (1995) recommends the diagnosis of adjustment disorder “when an identifiable stressor leads to impaired relationships in the patient’s work or social life, or when the symptoms seem excessive for the degree of stress that is present”. As with pain disorder, there is a great deal of interpretation in such a definition. Morrison also comments that adjustment disorder patients may be responding to one or more stressors, it may be chronic, and it may simultaneously affect a number of people. Any relatively commonplace event can be a stressor, e.g. marriage or divorce, starting a new job - whatever the stressor the sufferer feels overwhelmed by their environment

 

DSM-IV criteria for Adjustment Disorder:

 

  • Within 3 months of a stressor as a response to it, the patient develops emotional and behavioural symptoms

  • demonstrates clinical significance of these symptoms

  • The symptoms result in materially impaired job, academic or social functioning

  • The distress that is experienced markedly exceeds what would normally be expected from such a stressor

  • They don’t last longer than 6 months after the end of the stressor

 

Adjustment disorder may occur in response to a range of work or work related stressors. Symptoms may manifest in response to issues of functional loss and enforced life style change from a physical injury. Alternatively symptoms may occur as response to workplace difficulties outlined for panic disorder that is regular and significant harassment by an employer or work mate, unreasonable demands placed upon them over a prolonged period of time.

 

 

Major Depressive Episode

 

This is one of the most common problems for which patients seek help from mental health professionals. Injured workers who are appropriately and correctly assessed as experiencing a major depressive episode will be experiencing disturbances in psychological functioning that significantly impair their capacity to cope with the demands of life. Morrison (1995) states that a major depressive episode must meet five criteria, which includes the following:

 

  • A quality of depressed mood

  • Duration – the patient must have felt bad most of the day, most days, for at least two weeks

  • It is accompanied by associated symptoms (meeting a specified number such as loss of interest ion people or things, changes in eating habits and weight, changes in sleep patterns, changes in psychomotor activity, fatigue, feelings of self worthlessness, impaired concentration and preoccupation with thoughts of death)

  • Has resulted in disability – severe enough to cause material distress in the patients work (or school performance, social life or some other area of functioning)

  • Does not violate list of exclusions – such as depression due to substance use, general medical disorder or bereavement.

 

Major depression may result from the workplace stressors such regular and significant harassment by an employer or work mate, unreasonable demands placed upon them over a prolonged period of time, the response to issues of functional loss and enforced life style change from a physical injury.

 

Depression is often secondary to other psychological disorders – e.g. Post Traumatic Stress Disorder, or one of the anxiety disorders, particularly when distressing and crippling symptoms have not been treated effectively. Since major depression is one of the more serious psychological disorders, and one where a suicide attempt is a potential risk, accurate assessment and reliable follow up is essential.

 

 

Malingering

 

Is defined as the intentional production of the signs and symptoms of a mental or physical disorder. The purpose is some sort of gain, obtaining something desirable (money, drugs, insurance, compensation) or avoiding something unpleasant (punishment, work, military service, jury duty). Morrison. J (1995)

 

Malingering is easy to suspect but difficult to prove and according to Morrison (1995), when it involves symptoms that are strictly mental or emotional, detection can be impossible. Morrison comments that ‘the consequences of this diagnosis are dire,’ it will lead to total alienation of the clinician from the patient. He recommends that this diagnosis is only used in the most obvious and imperative of circumstances. It is also strongly advisable that the clinician takes into consideration and evaluates particular difficulties or circumstances in the patients’ life that has lead them to exaggerating symptoms for personal gain. (See ‘Scenarios leading to psychological injury – Secondary problems’)

 

 

Personality Disorders

 

All humans have traits of personality that well ingrained and concern things like how we think, experience, or interact with those around us. People who have personality disorders have collections of traits that are very rigid and ultimately work to their, or those around them disadvantage.

 

Personality disorders are characterised by life long patterns of maladaptive thinking and behaviours rather than specific signs and symptoms that characterise other diagnosable psychological disorders. Individuals who have personality disorders frequently lack insight into difficulties they inevitably find themselves in and often do not learn from their mistakes.

 

Although not psychological disorders as such, they are worthy of mention because of the disruption people with personality disorders cause in workplaces. In workplace settings it is often workers who are affected by the behaviours of those with personality disorders that are most likely to experience a stress related psychological difficulties – the worker with a personality disorder may be unaware of the affect they are having on those around them.

 

 

Summary of Generic Criteria for Personality Disorders

 

Morrison 1995 defines identifies the generic criteria for personality disorders as follows:

 

  • A lasting pattern of behaviours and inner experience that markedly deviates from the norms of a patient’s culture. The pattern is manifested in at least 2 of these areas:

 

  1. Affective (inappropriateness, intensity, lability and range of emotions)

  2. Cognition (how the patient perceives and interprets self others and events)

  3. Impulse control

  4. Interpersonal functioning

  5. The pattern is fixed and affects many personal and social situations

 

  • The pattern causes clinically important distress or impairs work, social or personal functioning.

 

  • This stable pattern has lasted a long time and can’t be better explained by another mental disorder.

 

*Modified from Morrison, J. (1995). The DSM-IV Made Easy: The Clinicians guide to diagnosis.

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