Severe Post-MVA Injuries That Can Be Challenging to Diagnose
Diagnosis & Diagnostic Equip

Severe Post-MVA Injuries That Can Be Challenging to Diagnose (Pt. 1)

Post-Traumatic Stress Disorder Secondary to MVA
Troy Freiheit, DC  |  DIGITAL EXCLUSIVE
WHAT YOU NEED TO KNOW
  • This article focuses on the psychiatric injury PTSD following involvement in an MVA, including important post-accident indicators leading to a PTSD diagnosis.
  • Symptoms of PTSD may not develop until the fourth week. Dissociative symptoms may be present and may have continued from the initial days following the accident.
  • A practical and clinically useful downloadable questionnaire is easy to implement beginning the fourth week following the MVA to identify patients likely to develop PTSD.

Editor’s Note: This is the first article in a series on diagnosing post-motor-vehicle-accident (MVA) injuries in clinical chiropractic practice. Future articles will discuss mild traumatic brain injury (mTBI) / concussion, acute stress disorder (ASD) and post-concussion issues.

Motor-vehicle accidents (MVA) may result in a variety of injuries. Physical injuries can include mild bruising, strain, sprain, disc herniation, fracture, mTBI (concussion and post-concussion syndrome), spinal-cord injuries (SCI), and even death. Psychiatric injury can include acute stress disorder (ASD) and post-traumatic stress disorder (PTSD). This article focuses on the psychiatric injury PTSD following involvement in an MVA, including important post-accident indicators leading to a PTSD diagnosis.

Definition

Post-traumatic stress disorder by definition is defined as “the somatic, cognitive, affective, and behavioral effects of psychological trauma.” PTSD develops in a person who has experienced an event that involves actual or threatened death or serious injury, or witnesses an event that involves death, injury, or a threat to the physical integrity of another person. Learning about unexpected or violent death, serious harm or threat of death or injury experienced by a family member or another close associate are other etiologies leading to PTSD (DSM-IV).2

Diagnosis

Diagnosing PTSD following an MVA depends upon ongoing and close observation of the MVA patient. Follow-up review studies of MVA survivors at three months and as late as three years have found an occurrence of 11%-33% that meet DSM-IV criteria for the diagnosis of PTSD. Motor-vehicle accidents are one of the leading causes of post-traumatic stress disorder. Approximately two dozen similar follow-up studies of individuals involved in whiplash injuries noted a PTSD incidence of 25%-33% at least 30 days following the injury.3-5

All patients who are eventually diagnosed with PTSD would have been involved in a psychologically traumatic incident. Involvement in military combat, an MVA or an interpersonal attack can cause PTSD. A patient involved in an MVA who has been diagnosed with mTBI also can develop PTSD.6

Symptoms of PTSD may not develop until the fourth week. Dissociative symptoms may be present and may have continued from the initial days following the accident. Dissociative symptoms include depersonalization and derealization.6-8

Psychological trauma can produce psychophysiological injuries. Post-traumatic stress disorder symptoms are categorized by four cluster groups: intrusion, avoidance, negative alteration of mood, and alterations in arousal and reactivity. Patients diagnosed with PTSD will demonstrate symptoms from each of the four clusters.9-10

There are three conditions diagnosable following survival of the MVA that would suggest a higher likelihood of the patient developing PTSD: concussion, post-concussion syndrome (PCS) and acute stress disorder (ASD).3,11 (These injuries will be reviewed in more detail in upcoming articles.)

A practical and clinically useful downloadable questionnaire is available. The questionnaire is easy to implement beginning the fourth week following the MVA to identify patients likely to develop PTSD. The downloadable questionnaire is available at the National Center for PTSD [click here to access].

Author’s Note: The next article in this series will review the link between PTSD and mild traumatic brain injury (mTBI) following a motor-vehicle accident.

References

  1. Wendlandt B, Ceppe A, Bradley N. et al. Posttraumatic stress disorder symptom clusters in surrogate decision-makers of patients experiencing chronic critical illness. Crit Care Explor, 2022 March 1;4(3).
  2. Evans R. Neurology and Trauma. New York: Oxford University Press, 2006: pp. 617-619.
  3. Fuglsang A, Hanspeter M, Ulrich S. Does acute stress disorder predict post-traumatic stress disorder in traffic accident victims? Analysis of a self-report inventory. Nordic J Psychiatry, 2004;58(3):223-9.
  4. Beck J, Coffey S. Assessment and treatment of PTSD after motor vehicle collision: empirical findings and clinical observations. Prof Psych Res Pr, 2007 Dec;38(6):629-639.
  5. Mayou R, Ehlers A, Bryant B. Posttraumatic stress disorder after motor vehicle accident: 3 year follow-up of a prospective longitudinal study. Behav Res Ther, 2002 June;40(6):665-675.
  6. Vasterling J, Jacob S, Rasmussen A. Traumatic brain injury and posttraumatic stress disorder: conceptual, diagnostic, and therapeutic considerations in the context of co-occurrence. J Neuropsychiatry Clin Neurosci, 2018 Spring;30:2.
  7. Bryant R. Acute Stress Disorder. New York: The Guilford Press, 2016: pp. 21-25.
  8. Arciniegas D, Anderson C, Topkoff J, McAllster T. Mild traumatic brain injury: a neuropsychiatric approach to diagnosis, evaluation, and treatment. Neuropsych Dis Treat, 2005 Dec;1(4):311-327.
  9. Mann S, Marwaha R, Tyler T. Posttraumatic Stress Disorder. Treasure Island, FLA: StatPearls Publishing, January 2025.
  10. Evans R, Op Cit, pp. 618-19.
  11. Dave S, Tichauer M. “Seven Potentially Devastating Traumatic Brain Injuries.” Medscape, Sept. 9, 2005.
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