ABSTRACT
A high percentage of people who suffer trauma survive with permanent physical injury. Fifteen per cent of motor vehicle accidents in the UK result in permanent serious injury (Department for Transport, 2008) and 53% of physical assaults involving knife crime result in permanent injury (Davenport & Davis, 2008). Examples of injury include severe scarring, loss of limbs, paralysis, loss of sight, nerve damage, and chronic pain. Physical injury is a robust risk factor for post-traumatic stress disorder (PTSD) (e.g., Blanchard et al., 1995; Koren, Norman, Cohen, Berman, & Ehud, 2005) and appears to result in more severe PTSD than when there is no injury following trauma (e.g., Mayou, Tyndel, & Bryant, 1997). The injury is a constant reminder of what happened, inducing flashbacks, intrusive memories and ongoing upset more frequently than when reminders are external to one’s body and less frequently encountered. Whereas patients with PTSD without injury are more likely to discover that the trauma is an event in the past without enduring implications, this is not the case for those with physical injury. For these patients, the physical injury often means that the trauma has had and continues to have lasting implications. Further, individuals with permanent injury have the additional challenge of adjusting to their disability and the associated problems this may incur, such as depression, job loss, and reduced quality of life.
