title: Psychological appraisal and emotional response to physical injury: a clinical, phenomenological study of 109 adults.
abstract: We studied the cognitive, emotional and behavioral responses at four points of time in a random sample of 109 accidentally injured adults via audio taped semistructured interviews and self-assessment rating scales. Neither the subjects appraisal of death or disability, nor the emotional responses corresponded strongly to the severity of the physical injury sustained or the "objective" threat to life but, instead, reflected, to a large extent, the personal meaning of the injury or the accident. Dissociative responses reported by 17 persons were of short duration and associated with young age and immaturity, and did not predict or a poor longterm post-traumatic psychiatric course. Ratings of intrusion, avoidance and anxiety were more strongly associated with psychopathology than "objective" danger or injury severity. This study indicates that following civilian trauma, the cognitive, emotional and behavioral responses are strongly related to preaccident and accident-independent life circumstances. The findings question the validity of the DSM-IIIR criterion of stressors of PTSD in civilian accidents, and suggest that post-traumatic mental disorders should be evaluated in much the same way as psychiatric disorders after physical illness.
authors.affiliation: Department of Psychosomatic and Behavioral Medicine, National Hospital, University of Oslo, Norway.
authors.forename: U F
authors.initials: UF
authors.lastname: Malt
authors.forename: O M
authors.initials: OM
authors.lastname: Olafsen
mesh_terms: D000059:Accidents / Q000523:psychology*; D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D000368:Aged; D001924:Brain Concussion / Q000523:psychology* / Q000534:rehabilitation; D003674:Defense Mechanisms; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000523:psychology* / Q000534:rehabilitation; D010552:Personality Assessment; D010553:Personality Development; D012803:Sick Role; D012931:Social Environment