Expert Witness Journal Issue 67 June/July 2026 - Flipbook - Page 21
Psychiatric Disorders Following
Physical Trauma - A guide for the
Non-Specialist
by Dr Stephen Davies, Consultant Psychiatrist (General Adult & Liaison).
Dr Davies is a General Adult and
Liaison Psychiatrist from Wales
with an interest in the interface of
Physical and Psychiatric disorders.
vulnerable to developing dependence on prescribed
painkillers after an injury, and this in turn can
contribute expression of pain or to impaired
function for longer than expected. Unexplained
physical symptoms or prolonged recoveries may be
due to a variety of psychiatric disorders including
somatoform disorders.
Summary
There is a strong association between physical
injury and Psychiatric disorders, and this goes
beyond Post-Traumatic Stress Disorder to include
mood disorders, substance misuse, Somatoform/
Dissociative Disorder and anxiety disorders. If an
expert witness practising outside of the 昀椀eld of
mental health is asked to make recommendations
about need for a psychiatric evaluation they might
consider asking some key questions or make use
of rating scales. As ever, experts should not stray
outside of their own 昀椀eld of expertise.
An association between injury and Psychological
symptoms does not demonstrate causation, of
course. There can be good reasons why individuals
with existing psychiatric disorders are more prone to
physical injury, aside from attempted suicide or selfinjury. For example, cognitive impairment, sedative
medication or excessive alcohol may all predispose
to falls, road tra昀케c accidents (RTAs), or burns.
People with ADHD (with or without associated
Neurodevelopmental Incoordination Disorder) are
more prone to sustaining accidental injuries and
road tra昀케c accidents.
The expert witness who sees a claimant about their
physical injuries often does so many months before
an appointment with a mental health expert takes
place. It can be helpful at this stage if the presence
or absence of a few key Psychiatric symptoms
is recorded. Experts in medical and surgical
specialities are not expected to have detailed
knowledge
of mental health conditions, nor
should they give opinions outside their expertise.
But an understanding that is more than basic may
be needed to say why a Psychiatry or Psychology
report is required. Psychiatric symptoms can alter
the course and manner of presentation of physical
injuries or disease in a number of ways. Clinical
Depression, Anxiety Disorders or Post Traumatic
Stress Disorder may manifest as physical symptoms
such as tiredness, pain, palpitations or weakness.
Patients with depression or anxiety disorders may be
reluctant to participate in rehabilitation (including
physiotherapy) or resume work or exercise because
of reduced motivation or fear of further injury.
Patients with substance misuse may be more
EXPERT WITNESS JOURNAL
Psychiatric diagnoses are standardised in ICD-11
(World Health Organisation) introduced in 2022)
and DSM5 (American Psychiatric Association,
Text Revision, 2022). The former is more widely
used in UK and is freely available online. Table 1
lists some disorders that a reporting Orthopaedic,
Neurology or Pain Medicine Expert may want know
a little about. It is worth these experts checking
they understand some of the more commonly used
terminology.
Table 1 – Psychiatric Disorders Relevant to
Physical Injury
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Post Traumatic Stress Disorder
Depression
Anxiety Disorders
Somatoform Disorders
Functional Neurological Symptom Disorder
Alcohol and Opiate Use Disorders
Factitious Disorder and Malingering
JUNE 2026
