Clinical Review ABC of psychological medicine

Trauma

BMJ 2002; 325 doi: http://dx.doi.org/10.1136/bmj.325.7361.426 (Published 24 August 2002) Cite this as: BMJ 2002;325:426
  1. Richard Mayou,
  2. 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.



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    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.

    View this table:

    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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