Car Accidents and PTSD *

David A. Gershaw, Ph.D.


The diagnosis of PTSD (Post-Traumatic Stress Disorder) first became prevalent during the Viet Nam War. Characteristic symptoms develop after being exposed to extreme, life-threatening, traumatic events. The symptoms can include reliving the event, whether while awake or in nightmares. PTSD sufferers may persistently avoid anything associated with the trauma. They may be unable to concentrate or remember. They could have a general feeling of numbness. Increased tension and irritability persist the person just can't relax. They may be hypervigilant always on the outlook for signs of danger. If others perished, PTSD victims might feel guilty for being survivors. Sleeplessness can also occur.

However, these symptoms are classified as PTSD only if they impair social or job functioning and last for over a month. If symptoms last less than three months, the disorder is labeled as "acute." Over three months in duration, it is called "chronic." The label, "delayed," indicates that the onset of symptoms occurred six months or more after the trauma.

Although PTSD was originally linked to the traumas of war, it can follow any extreme, life-threatening event. PTSD has been linked to major disasters like tornadoes, floods, fires and earthquakes. It has also been linked to rape and other violent crimes. Most recently, it has been connected with car accidents.

In the last few years, a research team evaluated 98 people who were injured in car accidents over a six-month period. All had sought medical attention within a week after their accident. They were interviewed 1-4 months after the accident occurred. Of the 98, 40 were diagnosed with PTSD. Another 25 had some of the symptoms, but they were not severe enough to be classified as PTSD. The remaining 33 were free of symptoms.

Six months later, the subjects were reevaluated. Half of the 40 people no longer had enough symptoms to merit the classification of PTSD. In other words, half of those previously diagnosed with PTSD were relatively free of symptoms. This is encouraging. It means that there is a relatively high rate of spontaneous recovery.

Examining the data more closely, researchers found two factors to be "prime indicators" for developing PTSD. First, the victims sustained more serious injuries. (Physicians determined the severity of the injuries.) Second, they had a greater fear of dying in the accident. This was found from psychological interviews that explored their perceived danger, fear of death and perceived level of control.

Only two persons were exceptions to these two factors. One was a severely injured woman, who demonstrated few stress symptoms. The other was a man with few injuries. However, he felt quite strongly that he was going to die.

Previously, PTSD was linked to extreme and relatively unusual events. However, statistics indicate that in 1993 alone over two million people had crippling injuries in motor vehicle accidents. Generalizing from the study above, over 800,000 of those injured will suffer symptoms of PTSD. As you may know, the highest rate of highway accidents occurs during the holiday season.

We believe it can't happen to us,
until it is too late.

I am concerned about the death rate on the highway during this holiday season. I also have a concern about severe and disabling injuries. However, to top these concerns, there are severe psychological symptoms of PTSD that can also occur. For these reasons and those who you love, I hope you will drive carefully this holiday season and the rest of the year.

Unfortunately, some of you will think that you are the exception to the rule "It can't happen to me." You will be correct right up to the time of the crash. Then it will be too late for warnings.

* Adapted from "Stress reactions to auto accidents common," The Menninger Letter, November, 1995, page 5.

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