Psychological Injury
The assessment, diagnosis and treatment of a
psychological injury is generally less clear-cut than with a physical
injury. Unlike physical injuries that
can be observed - e.g. lacerations, or easily picked
up through investigative procedures such as x rays or CT scans, psychological injuries
are inferred. Physical disorders nearly
always have clearly demonstrable physical causes and associated physiological
(or anatomical) changes as a result of the illness or injury processes. The vast majority of psychological disorders
however do not have identifiable pathogens or a demonstrable organic basis.
Psychological Injuries or psychological health
problems can occur for a range of reasons.
Some of the most common include:
- Child hood trauma and experiences
- e.g. physical, sexual or emotional abuse
- Grief and loss - death of
someone close, loss of a relationship, the loss of physical or
psychological functioning and quality of life as a result of injury or
sickness
- Problems in a personal or family relationships
- Workplace problems ranging from conflict with a co-worker,
harassment, excessive workloads, lack of instruction and/or support in how
to do a job
- Trauma – e.g. being involved in a traumatic event such as armed
hold up, witnessing a fatal accident, being victim to assault or rape
- Overuse or interaction of substances – prescribed or otherwise
- Constitutional factors - Certain types of mental illness tend to
run in families.
Frequently the manifestation of a psychological health
problem or, (in the case of Workers compensation assessment) a psychological
injury is the interaction of a number of factors with varying degrees of
attribution to the manifesting psychological problem. It is the task of the psychologist or
psychiatrist assessor therefore to
assess, categorise, attribute causality and propose a plan of treatment.
There are many effective models in use for assessing
and assisting people who are experiencing psychological difficulties however
the one that stand s out and is used most regularly is The Diagnostic and
Statistical Manual of Mental Disorders 5 – DSM-V. This system of classification of
Psychological health difficulties although not linked into any particular
health care model does have an affinity with the Medical Model whose underlying
assumption is that an organic basis underlies most disorders. The group of professionals who are most
trained in use of this system of classification are psychiatrists (whose
background training is in general medicine) however a number of other
professionals such as psychologists, frequently have skills in utilising this
system of classification (see advantages and disadvantages of DSM-V system of
classification).
Irrespective of what system of classification is used,
the process of assessing, categorising and attributing causality in
psychological health problems relies on different assessment methods and tools
to those used when diagnosing a physical disorder. Information may be obtained in the following
ways:
- Through evaluating the problems and “symptoms”
reported by the clients e.g. changes in emotional, cognitive, energy levels
- Observation of client behaviours – e.g. disturbances
in their thinking, emotional responses, or behaviours
- Evaluation of information reported about client from a
third party
- Use of psychological tests that screen for
psychological difficulties and in some cases challenge the genuineness of
symptom reporting,
- Use of medical diagnostic tests such as CT scans, MRI
scans EEG’s drug screen to identify organic factors contributing to a mental
disorder– e.g. a tumour, and drug induced mental illness.
A sound assessment will be one that:
- Is from a professional who has experience and
training with psychological problems.
- Utilises at least 2 of the above methods in
information collection and evaluation
- Is neutral in context and not bias one way towards or
against a particular person or party involved in the assessment process
- Evaluates all possible factors of attribution in a
injured workers problem and explains reasons for conclusions
- Proposes strategies of assistance that identify
clearly defined goals that are realistic, achievable, within time frames and
are likely to have the approval of the various parties involved.
