Psychological Impact of Physical Injury
Mind, Emotion, Body and Sport: Physical injury can affect psychological health. Psychological health influences the recovery of physical injury.
Minor physical injuries can be managed with little to no disruption in activities of daily living (e.g. working, self-care) and rarely trigger psychological impact or emotional trauma. However, empirical studies demonstrate some physical injuries cause substantial physical, psychological, cognitive, and emotional overwhelm.
In particular, the emotional trauma of incurring physical injury resulting from events such as sports injury, assault, car accident, or accidental fall — can increase the risk of a person developing symptoms and disorders such as, anxiety, depression, panic attacks, anger/frustration, isolation, lack of motivation, insomnia, substance use or abuse, post-traumatic stress disorder (PTSD), and post-concussive syndrome.
Moreover, scientific studies report for some individuals even minor physical injury can unmask mental health issues that includes presentations of hysteria and psychosomatic reactions due to personalty coping defenses. The more deeply an individuals personality or identity is connected to their physical form and/or physical ability and performance, then often is greater the emotional reaction.
Equally important, research in Behavioral Medicine, Health Psychology, and PsychoNeuroImmunology also demonstrate Mind-Body connection/interaction and dynamics are positively correlated and also causal with the speed and rate of recovery from physical injury and return to pre-injury functional levels.
In addition, mental and emotional symptoms and disorders can be further complicated and exacerbated when injuries result in a loss of skills and opportunities that include the following: being unable to participate in everyday activities such as work, study and socializing; worries about finances and the future. In more serious cases, however, an individual may be an athlete and his/her playing career may be at stake.
Sports psychology research indicates that when an individual is physically injured, there is a normal initial emotional reaction that includes processing the medical information provided by the physician or medical team about the injury as well as coping emotionally with the injury and emotionally coping with any possible surgeries.
How an individual responds to injury may differ greatly, and there is no predictable sequence or reaction as each person’s coping mechanisms are unique. Typically, however, in uncomplicated cases, the response to injury extends from the time immediately after injury through to the post-injury phase and then rehabilitation and ultimately with return to activity.
Empirical studies report the physician and/or medical team should consider consult to a clinical psychologist even when the individual denies emotional burden, as is often the case that a sports athlete will most likely deny emotional problems.
Emotional or psychological impact in some athletes may also be related to performance failure. When athletes sustain bodily injury associated with time loss from their sport, they can suffer both physically as well as emotionally with a decrease in their quality of life. Concussion is another injury that can be very challenging for athletes to handle given the associated emotional and cognitive symptoms (e.g. post-concussive syndrome).
It is important for individuals whether athlete or not to understand and process that a brief initial emotional reaction to injury is normal. However, problematic reactions aforementioned are those that either present, do not resolve, worsen over time, or where the severity of symptoms seem excessive. Consult to a Clinical Psychologist to assess and if necessary address psychological/emotional issues is a significant component of the recovery process.
For the individuals with concussion, it is especially important to watch for problematic psychological responses to the injury. Some individuals experience emotional symptoms as a direct result of the brain trauma that can include feeling sad or irritable. If these symptoms don’t seem to be going away it is important to explore whether they might be related to a mental health issue such as depression and not directly to the injury itself. In some cases, the psychological reaction to the concussion – rather than the concussion itself – can be the trigger for the depression. When this is the case, simply waiting for the brain to recover isn’t enough: the depression also needs to be treated.
It is also important to be aware that with increasing media attention to neurodegenerative diseases such as chronic traumatic encephalopathy (CTE) among professional athletes, some athletes might fear that even the mildest concussive injury will make them susceptible to these highly distressing outcomes. Though there is very little known about what causes CTE or the true incidence of CTE: the concern for possibly developing permanent neurodegenerative disease can be extremely frightening.
A neuropsychologist can help educate injured athletes about the known risks associated with concussions and can help them focus on managing the injury in the present. It is also worth mentioning again, that athletes who are expressing a high level of anxiety could be experiencing a mental health condition that requires mental health treatment.
SEEKING TREATMENT
Injured athletes who are having a problematic psychological response to injury may be reticent to seek treatment. They may be afraid to reveal their symptoms, may think seeking counseling or psychotherapy as a sign of weakness, may be accustomed to working through pain, and may not have developed healthy coping mechanisms to deal with failure. In addition, many athletes have not developed their identity outside of that as an athlete. Thus, if this role is threatened by injury or illness, they may experience a significant loss.
Speaking to an athlete to consider mental health treatment can be challenging if you are an athletic trainer or team physician. However, it is important to be aware of common signs and symptoms for various mental health issues and promote the truth of the Mind+Body+Emotion connection. It is important to de-stigmatize mental health issues and allow athletes to understand that symptoms of mental health issues are as important to recognize and treat as symptoms for other medical issues and musculoskeletal issues. ****Underscoring the availability of sports medicine staffs to provide for early referral and management of mental health issues is essential.
Thank you for reading. If you have any comments, questions or concerns, please connect with me. I would love to hear from you.
Shawna M. Freshwater, PhD
Licensed Clinical Psychologist and NeuroPsychologist
Wonder why my Doctor has not advised me on the mental effects resulting from serious fall !
Having a terrible time adjusting to injuries, no life compared to before fall.
Yes, had to loose lot of opportunities post injury. The chronic pain post injury can leave you mentally exhausted.
Mental health during the recovery period cannot be ignored.
Fractured ankle after a fall has left me feeling depressed, anxious and extremely irritable. My OH, who suffers from chronic health conditions is lashing out (quite understandably) when my mood darkens and we’re both really struggling. I’m normally very active, running and/ or walking every day, and I hate asking him to do anything for me as he suffers from constant pain and fatigue. He gets angry with me doing too much with my injury, then complaining about the pain. It’s a perfect storm.
Very interesting reading, thanks. I have just had a minor injury resulting from losing balance after jumping from a wall. I also have MS, and one part of me that is affected is my balance. I have been processing the psychological effects since the I just, and realised some are connected to a fear of my MS symptoms worsening. I wonder if this is something you have experienced in any of your clients? Jon