Evaluating the Psychological Impact of Burns

Evaluating the Psychological Impact of Burns

Jane K. McNaught, Ph.D.

Licensed Psychologist

Fellow, American Board of Forensic Examiners

Physical traumas such as a serious burn injury can be profoundly traumatic. Serious burns result in sudden unanticipated trauma related to the individual’s exposure to a potentially life-threatening experience. One day the burn victim begins their day like any other, and by the end of the day the burn victim’s life may be changed forever by the traumatic event experienced. A Forensic Psychological Expert utilizes well respected psychological tests to assess the emotional impact of such injuries. The psychological tests employed are statistically reliable and valid. The choice of valid and reliable psychological tests employed by a Forensic Psychologist are similar to tests used by a physician to diagnose diabetes or other medical disorders. Such tests offer norms that compare the individual in question to a large normative sample, in order to evaluate the burn victim’s psychological functioning compared to that of the “normal” person.

Depression and Post-Traumatic Stress Disorder (PTSD) are the most common psychological responses to severe burn injuries. PTSD occurs in approximately 20% of the people who experience perceived life-threatening events. Those who develop PTSD as a result of such injuries become highly susceptible to long term depression and anxiety. Prolonged PTSDinterferes with the individual’s day-to-day functioning. The emotional response to any trauma is intense fear, horror, and a sense of helplessness. Inherent in anylife-threatening event is the threat to basic security and safety. Severe burns can profoundly impact an individual’s’ ability to copewith subsequent life stresses as well as the ability to relate to others. Traumatic events also trigger the fight or flight response resulting in the victim’s inability to talk about the event for weeks, months, or even years after the traumatic event occurs. Other symptoms associated with PTSD include being easily startled, having difficulty falling or staying asleep, loss of interest in previously enjoyed activities, avoidance of places where the traumatic events occurred, pessimism about the future, hypervigilance and fear, and a detachment from others. Psychological tests are an effective way to assess the presence of PTSD as well as Depression.

In addition to burns being sudden, unexpected life-threatening experiences, burn injuries alsoinvolveextremely painful and intrusive medical procedures.The procedures alone can be traumatic in addition to the constant reminder of the traumatic event that caused the burn. Severe burns often requirefasciotomies. This is a painful procedure where the connective tissue covering the muscles and internal organs of the body is cut away to relieve tension or pressure. Further, in the case of severe burns, the victim goes through a series of Debridement procedures. These procedures involve theexcruciatingly painful removal of the damaged tissue by scalpel, forceps, or scissors. This leaves a bleeding wound that serves to promote eventual healing. The extent of the medical procedures required by the burn victim’s injury can greatly impact the level of trauma associated with the injury.

The more visible the disfigurement, the more the victim is reminded each day of the trauma he/she experienced in the accident. The disfigurement can exacerbate symptoms of PTSD because of the likelihood of flashbacks about the injury. Greater disfigurement also has a greater impact on the victim’s day-to day-interaction with others. These abrupt and permanent lifestyle changes can trigger depression in burn victims, along with nightmares, flashbacks and PTSD. (Pavoni et. al, 2010. Johns Hopkins Medicine Health Library.)

Severe burns also result in the inability to sweat and regulate body temperature, as well as result in sensation changes. Burn victims often become more sensitive to heat as well as dropping air temperatures. Consequently, such victims who live in climates where they are exposed to significant heat or cold temperatures often have difficulty tolerating extreme temperatures and are repeatedly reminded of the traumatic event. Severe burns also present the risk of amputation to the affected appendage.

Obtaining the assistance of a forensic psychologist can be an effective means of evaluating the emotional injury associated with severe burns. Psychological testing quantifies the impact of the injury. Such an evaluation also assesses pre-existing emotional difficultiesand previous life stressors in the burn victim’s life. Finally, psychological testing can be a vehicle to provide the jury with demonstrative evidence about the impact of the trauma to the burn victim.