Avoidant symptoms cloaking the diagnosis of PTSD in patients with severe accidental injury

In a pilot study of seriously injured accident victims, 15 patients selected in initial intake interviews were followed at 9- to 10-week intervals for 9 months after admission to a community shock-trauma center. Psychiatric diagnoses were based on a structured psychiatric interview. A total of six patients met criteria for PTSD. In two cases, PTSD was not diagnosed until 3 to 6 months after injury, primarily because of severe avoidant symptomatology. In another case, intrusive and arousal symptoms were not immediately explainable as a manifestation of PTSD, because it was mistakenly believed that the patient had been unconscious during the accident. Diagnosis in two of these would probably have been missed without frequent follow-up interviews. Findings suggest that avoidant symptoms of PTSD can interfere with diagnosis. This has important consequences for outcome studies. It is suggested that frequent follow-up after a traumatic event may reduce the level of false negatives in population studies.Presented at the 7th annual convention, International Society for Traumatic Stress Studies, October 25, 1991, Washington, D.C.