This study reviewed the literature that deals with the psychological complaints of whiplash and traffic accident patients, in particular, PTSD.1
The author focused on the characteristics of PTSD and a victim's phobic anxiety to both the traumatic event, and driving a car, in general. Overall, he concluded that although psychological morbidity decreases with time, in the long term, victims will have higher than average psychological complaints over the long-term.
The most important predicative risk factor for PTSD is the psychological impact of the stressor: studies show that when patients are tested for intrusion and avoidance reactions immediately following a traumatic event, high scores indicate the onset of PTSD at a later stage. Other predictive factors include a previous PTSD episode, premorbid psychological state, and questionable coping strategies. Severity of physical pain and possible financial compensation has not been shown as predictive risk factors in other studies.
The author dedicates attention to the psychology of coping. She cites a Radanov3 study that found:
"The authors concluded that it was not so much the subject's premorbid psychological functioning that determined the course of whiplash, but more the psychological problems (including the cognitive ones) that affected the subject's ability to cope with the somatic problems, particularly pain."
Avoidance behavior seems to a common pitfall/coping strategy for most car accident victims—avoiding thoughts or emotional reactions to the accident, or just avoiding driving altogether. Mayou2 found that even 4-6 years after the accident, one out of three victims still had anxiety or avoidance behavior towards road travel.
Due to the trend of avoidance behavior, a major aspect of treatment is exposure. Exposing the client to their trauma-related emotions and memories relieves the victim of the emotional weight of the stressful event, and anxiety and other symptoms may very well disappear. For other aspects of treatment the author recommends combining biological, psychological, and psychosocial disciplines. And, treatment should focus on the patient's response to trauma, not just the physical whiplash symptoms:
"Overall it can be assumed that psychological problems resulting from an accident are underestimated for traffic accident victims in general and for whiplash patients in particular. PTSD is especially common, but usually goes untreated. Instead of focusing most attention on the chronic whiplash complaints, it is recommended that priority be given to coping with the trauma. Afterwards it can be decided whether other complaints require treatment. "
Other studies have demonstrated, on the other hand, that the psychological symptoms disappear after the physical pain has been alleviated. Thus, waiting to decide whether the physical symptoms warrant attention may lead to chronic pain and dissatisfied patients. Very few patients would be willing to wait to deal with the physical pain.