Avoidant symptoms cloaking the diagnosis of PTSD in patients with severe accidental injury

Abstract

AbstractIn a pilot study of seriously injured accident victims, 15 patients selected in initial intake interviews were followed at 9‐ to 10‐week intervals for 9 months after admission to a community shock‐trauma center. Psychiatric diagnoses were based on a structured psychiatric interview. A total of six patients met criteria for PTSD. In two cases, PTSD was not diagnosed until 3 to 6 months after injury, primarily because of severe avoidant symptomatology. In another case, intrusive and arousal symptoms were not immediately explainable as a manifestation of PTSD, because it was mistakenly believed that the patient had been unconscious during the accident. Diagnosis in two of these would probably have been missed without frequent follow‐up interviews. Findings suggest that avoidant symptoms of PTSD can interfere with diagnosis. This has important consequences for outcome studies. It is suggested that frequent follow‐up after a traumatic event may reduce the level of false negatives in population studies.