Clinical Review
ABC of psychological medicine
Trauma
Cite this as:
BMJ
2002;325:426
- Richard Mayou,
- Andrew Farmer
Minor trauma is a part of everyday life, and for most people these injuries are of only transient importance, but some have psychiatric and social complications. Most people experience major trauma at some time in their lives.
Detail of Very Slippy Weather by James Gillray (1757-1815)
Psychological, behavioural, and social factors are all relevant to the subjective intensity of physical symptoms and their consequences for work, leisure, and family life. As a result, disability may become greater than might be expected from the severity of the physical injuries.
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Lifetime prevalence of specific traumatic events (n=2181)
Psychological and interpersonal factors also contribute to the cause of trauma, and clinicians should be alert to these and their implications for treatment. Tactful questioning, careful examination, and detailed record keeping are essential, especially for non-accidental injury by a patient or others:
Ask for a detailed description of the cause of the incident
Ask about previous trauma
Ask about substance misuse—alcohol and drugs
Look for patterns of injuries that may be non-accidental, deliberate self harm, or inflicted by others
Check records
If suspicious speak to other informants
Discuss findings and suspicions with a colleague.
Dealing with the acute event
At a major incident it is important that members of the emergency services, especially ambulance staff and police, should seem calm and in control. This helps to relieve distress and prevent victims from suffering further injury. Explanation and encouragement can reduce fear at the prospect of being taken to hospital by ambulance. The needs of uninjured relatives and others involved should also be considered. Clearly recorded details of the incident, injury, and the extent of any loss of consciousness may be useful in later assessment as well as in the preparation of subsequent medicolegal reports.
Immediate effects of frightening trauma
Causes a varied picture of anxiety, numbness, dissociation (feeling distanced from events, having fragmentary memories), and …
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