Expert Witness Journal Issue 67 June/July 2026 - Flipbook - Page 25
required, and the threshold is lower than concepts
con昀椀ned to physical dependence and withdrawal.
Criteria for other substances eg opiates are similar.
AUD can develop anew following a physical injury.
Sometimes claimants will say that following an
incapacitating accident or injury, they found they
had more time on their hands and their drinking
crept up. Or that they began drinking to help with
impaired sleep, due to pain or anxiety. Sometimes
there is a pre-existing or previous pattern of heavy or
dependent drinking which becomes worse following
a physical injury. For the non-specialist, often it is
su昀케cient to obtain an account of the current pattern
of drinking and comparing it to the pre-injury
account or recommended limits. Rating scales such
as the Audit-10 can be useful.
Anxiety Disorders
These might include Generalised Anxiety Disorder,
Panic Disorder and speci昀椀c phobia. It is helpful to
think of both physical symptoms (eg palpitations,
dry mouth) and psychological symptoms (worry,
feelings of impending doom, wish to escape) when
considering anxiety. Identical symptoms can occur
as appropriate responses to fear, but also during drug
or alcohol withdrawal, or as side e昀昀ects of stimulants.
Generalised Anxiety Disorder denotes free 昀氀oating
anxiety as well as problems with concentration,
sleep, worries and restlessness. A panic attack is
a severe paroxysm of anxiety unrelated to speci昀椀c
triggers or situations. It does not simply denote
“panic” as used in an everyday sense, “I am in a panic
because I am late for my appointment”. The term
“speci昀椀c phobia” may conjure images of spiders or
needles, and may seem irrelevant to physical injury.
But this diagnosis might apply to someone unable to
resume travel by car due to severe anxiety following
a RTA (assuming the other features of PTSD are
not present). Also, in the elderly, after injuries to
the lower limbs, fear of falling is fairly common
and can itself impair mobility. This can also occur
following other fall injuries and in younger adults.
Psychiatrists and Psychologists rarely see patients
with phobic presentations in the clinical settings,
and often they will be managed by pragmatic way eg
by Physiotherapists. Speci昀椀c phobia presentations
often resolve with simple measures or with time,
but are amenable to formal psychological treatment
if symptoms persist. Sometimes care is needed
to di昀昀erentiate this situation from one in which
somebody has taken a rational decision to not longer
participate in a particular activity, e.g. motorcycling,
hang-gliding, following an injury. It is helpful to ask
whether the person misses the activity again, or if
they are glad not to have to do so.
Somatoform Disorders
The psychiatric classi昀椀cation of these conditions has
changed in recent years, with new terminology of
Somatic Symptom Disorder (DSM5) or Bodily Distress
Disorder (ICD-11). They are no longer thought of as
psychological or social factors “causing” pain, nor
is it required to invoke unconscious mechanisms.
It is best to think of these as conditions de昀椀ned by
disproportionate levels of concern, behaviour or
thinking about a physical symptom eg pain. There
is not a requirement that there be a total absence
of any physical disease process, but rather that
thinking, actions or worries are disproportionate or
excessive. It is helpful if the physical health specialist
can say whether, based on their experience the
person’s level of concern or behaviour is within
the range of what is typically expected following
an injury of this type, at this stage. If it is outside
the expected range, then this is very helpful to the
Psychiatrist or Psychologist considering a diagnosis
of a somatoform disorder. In many cases, there will
have been a similar patterns of thinking, behaving
or worrying in relation to health concerns (not
TABLE 2 - Psychologist or Psychiatrist? Which to
recommend?
There is a lot of overlap. Both usually use a bioPsycho-social approach. A Psychiatrist will usually
have more expertise in Bio-medical matters and will
be able to make recommendation about medication
as well as Psychological therapy. Psychologists
will often have more expertise in Psychological
therapy and Psychometric testing. But expertise
varries between individuals and solicitors will
have particular experts they work with. So suggest
a report by a “Psychiatrist or Psychologist with
relevant expertise”
Alcohol Use Disorder
Features can include physical tolerance, craving,
wanting to reduce or stop drinking but being unable
to, continuing consumption despite physical harm
or impact on work/relationships, and repeatedly
consuming more than intended. For mild Alcohol
Use Disorder (AUD) just 2 or 3 symptoms are
EXPERT WITNESS JOURNAL
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JUNE 2026
