Stress disorders following traumatic injury: Assessment and treatment considerations

Traumatic injury is a relatively common occurrence, with approximately 40 million injury-related visits to emergency departments in the United States per year. Psychiatric complications of physical injury are a public health concern. Approximately 12% to 16% of survivors of traumatic injury are diagnosed with acute stress disorder (ASD), and 30% to 36% warrant a diagnosis of posttraumatic stress disorder (PTSD) 12 months after the traumatic event. Phenomena related to injury, such as blood loss, pain, administration of narcotic analgesics, and traumatic brain injury, as well as high rates of premorbid psychiatric and substance abuse and/or dependence disorders, often overlap with stress-related symptoms of psychological origin. This complicates the assessment of dissociative processes required for the diagnosis of ASD, as well as the three core PTSD symptom clusters (re-experiencing of the trauma, avoidance and numbing, and hyperarousal). This article reviews specific aspects of stress disorders in the context of traumatic injury, with a focus on aspects of assessment. Psychopharmacologic and behavioral treatment recommendations are also reviewed.