PI Brief Update

Untangling Complex Presentations: Physical Conditions Which ‘Mimic’ Psychological Symptoms - Dr Jon Willows & Josh Williams

10/01/15. The accurate and reliable assessment of the breadth, severity and duration of psychological symptoms is central to psychological medico-legal enquiry. Within this context, the attribution of psychological symptoms in relation to a given ‘index event’ (for example a road traffic accident or an injury at work) is of central importance. The practice of medico-legal assessment typically involves an ‘untangling’ of multiple and complex trauma-related phenomena which frequently have both physical and psychological components. Chronic physical pain can undermine self-esteem, lower one’s mood and also lead to feelings of lethargy and frustration. Phobic anxiety, for example in relation to driving following a severe road traffic accident, is typically experienced in a very physical (or ‘somatic’) way with an elevated heart rate, surges of adrenalin and hyperventilation. There is, of course, a profound and ever-present connection between mind and body and much room for overlap and misinterpretation when we talk of ‘feeling anxious’ or ‘depressed’.

The careful, targeted and incisive assessment of the aetiology of psychological symptoms following a traumatic incident seeks to describe and measure these responses and to consider them in relation to known reactions to trauma.

The assessment process seeks to appraise the impact of the index event within the context of the individual’s pre-accident and post-accident history. This ‘history’ takes into account not only the person’s psychological history, such as previous episodes of mood disorder, but must also consider the possible background effects of a wide range of physical health conditions which, in and of themselves, may give rise to physical symptoms which reproduce or ‘mimic’ more clear-cut psychological symptoms.

Aims and objectives

This paper seeks to review some of the physical conditions which are often associated with such symptoms and to elaborate the means by which the assessment process seeks to untangle them. This process is important not only in terms of assisting the Court in establishing attribution and associated quantum but also has clinical implications when a course of psychological treatment is recommended as part of the outcome. Claimant’s can also find this process helpful in that it helps to ‘separate out’ what clearly belongs to the traumatic incident and what may be an exacerbation of a previous physical health condition. This can also help to identify the appropriate steps to be taken in the treatment of each...

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