The medical definition of 'post-traumatic stress disorder' (PTSD) recognised the importance of distinct traumatic events, which involved death and threats to life, as causes of psychiatric disorder. There has been a continual increase in attempts to characterise better both the prevalence of experiences that might cause PTSD and the relative risks of PTSD arising after different types of traumatic events. There has been increasing focus on the acute responses to trauma and how they predict long-term reactions. This chapter describes the acute pattern of reaction in accident survivors. Clinical interviews were conducted on 120 Australian accident survivors, on the day after their admission to hospital, and two and ten days after the accident. The first author was the psychiatrist who conducted all the interviews. His impression was that there were four broad clinical categories of psychological response to accident, according to general level of anxiety, anxiety while describing the event, and quality of memory about the event: (1) absence of distress, and good recall; (2) very clear memory of the accident, with no associated effect; (3) minimal anxiety, but strong intrusive thoughts and dreams of the accident; and (4) persisting anxiety, intrusive recollection of the event, and 'cognitive reworking' of it.
Abstract