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Case study 30 - Psychological injury PTSD

Summary

This case investigates the symptoms of hyperarousal and rumination, and if these symptoms are considered as part of a minor injury.

Introduction

The claimant was involved in a motor vehicle accident (MVA) where their car was hit perpendicular (T-bone) on the passenger’s side. The claimant noted braking severely and attempting to avoid the accident however was unable to do so. Immediately following the accident, the claimant reported being fearful for the welfare and safety of their child.

The claimant noted following the accident that the other vehicle involved was significantly damaged and they were worried the other driver had been killed.

The claimant noted there was a delay in the vehicle doors opening however they could get out. As they did so their right leg gave way and sharp pain in the hip and leg area commenced.

Ambulance attended the site of the accident, and the claimant was taken to hospital. They were discharged the same day and observations/investigation at hospital were unremarkable.  

The assessment

There is a dispute about whether the injury is a minor injury under Schedule 2 section 2(e) of the Motor Accident Injuries Act 2017 (the Act).

Clinical examination

Prior to the Accident

  • Engaged in administrative tasks to support partner’s business.
  • Driving without any symptoms or difficulty.
  • High focus on personal care and domestic tasks including cooking and cleaning.
  • Socialising frequently, engaging in tennis, swimming and gym based exercise.
  • No signs or symptoms of anxiety.

Post-accident

  • Has been attending physiotherapy and approximately 3-5 sessions with a psychologist. Commenced attending psychologist 6 months post-MVA.
  • Observed and reported low mood and anxiety, fatigue, and phobia of driving.
  • Sleep interrupted, specifically noted very limited sleep. This was noted to be due to dreams of recurring accidents and increased arousal due to cognitive ruminations.
  • Hypervigilant when in a vehicle, currently driving as part of psychological therapy however is aware of being slower, taking more time and having significant anxiety while driving.
  • Sense that their “life has shortened” and awareness of being hypervigilant about anyone in cars and particularly their children and partner.
  • Panic attacks commenced one week post-MVA and have continued to date. Highly distractible and has difficulty concentrating. Noted that they have ceased completing administrative tasks at work and subsequently ceased working.
  • Noted and observed loss of interest in personal care.
  • Relies on takeaway food or misses meals frequently.
  • Reduced socialising and specifically only goes out when able to leave easily and resting is available.
  • Significant reduction in appetite, subsequently lost 6 kilograms.

Review of Documentation

The application for personal injury benefits documents indicate the claimant was taken to hospital and states “injured all […] bones and muscles in ‘there’ body, severe headaches, neck, back, leg and wrists.”

GP records indicate one month post-MVA “low back pain, described anxiety and low mood, fatigue”.

Psychological records indicate the commencement of exposure to a traumatic event and the commencement of exposure therapy. The psychological report indicates intrusive and distressing thoughts about the accident, avoidance with driving, negative beliefs about self, markedly diminished interest in pleasant activities.

Diagnosis

The claimant reported hypervigilance, increased anxiety and panic attacks. They further have rumination about the injury, and recollections of the accident through reliving.

The claimant has noted changes in concentration, and secondary changes in mood and function due to physical pain.

Based on the above information, the claimant meets the criterion A for Post-Traumatic Stress Disorder.

Intrusive symptoms of unwanted memories, flashbacks and nightmares, in addition to increased arousal and anxiety are criterion B symptoms.

Finally, avoidance of trauma related stimuli is Criterion C for Post-Traumatic Stress Disorder.

The claimant’s symptoms have been present for longer than one month and therefore doesn’t have Acute Stress Disorder and the extent and nature of the symptoms exclude a diagnosis of an adjustment disorder. The claimant has not reported a melancholic mood which would relate to a symptom of Major Depressive illness.

Minor Injury

Section 1.6(3) of the Act:

A minor psychological or psychiatric injury is a psychological or psychiatric injury that is not a recognised psychiatric illness.

Part 1 clause 4 (2) of the Motor Vehicle Injuries Regulation 2017:

2) Each of the following injuries is included as a minor psychological or psychiatric injury

a) acute stress disorder

b) adjustment disorder

3) In this clause, acute stress disorder and adjustment disorder have the same meanings as in the document entitled Diagnostic and Statistical manual of Mental Disorders (DSM-5).

Based on the clinical findings and documentation available it is the opinion of the Assessor that these symptoms are diagnostically Post-Traumatic Stress Disorder which is not a minor injury.

The following injury is not a minor injury

  • Post-Traumatic Stress Disorder