Psychological Response to Whiplash Develops after Physical Symptoms

This study1 evaluated both the physical symptoms and psychological status of 50 patients who had been hit from the rear while in a stationary vehicle. The subjects were reviewed one week following the accident, at three months, and at two years. The range of neck movement was noted at three months.

Three patients had no symptoms one week following the injury, yet all 50 patients reported discomfort at three months. At two years, one-third of the subjects still reported "intrusive or disabling symptoms;" these patients tended to be female and had restricted neck movement at the three-month evaluation.

The psychological scores returned at one week were normal for all patients. However, the psychological scores increased significantly at the three-month and two-year assessments in patients who had reported an increase in the severity of symptoms.

Therefore, the clinical outcome at two years could be predicted with 90% accuracy by both the range of neck movement and psychological scores at three months. This evidence strongly implies that both physical and psychological symptoms are involved with whiplash syndrome.

But, the researchers stress that the behavioral response emerges during the immediate three months following injury and the psychological response develops after the physical symptoms. To explain the occurrence, the authors discuss the link between whiplash symptoms and litigation:

"Other authors have addressed the effect of litigation on outcome. Gotten found a higher rate of recovery among those not involved in litigation, but Schutt and Dohan and Pennie and Agambar found no difference. De Palma and Subin and Hohl recorded better outcomes in litigants. MacNab found that symptoms had persisted in 45% of patients at two years after settlement of litigation. Squires et al found this in 70% after 15 years, with abnormal psychological scores on the GHQ in 37% of symptomatic patients. Litigation may influence the late behavioral response, but this appears to become established during the initial three months from injury, and if it had been consciously adopted for financial gain, it is curious that it should persist for so long after compensation has been paid." [For more information on the relationship between symptoms and litigation, see The Complete Guide to Whiplash, (800) 295-3346.]

One particular risk factor involved in litigation is the adversarial approach taken by insurance companies:

"In a chapter of a new book, Evans3 discusses the relation of litigation to symptoms, noting that many clinicians and certainly the insurance industry and the defense lawyers believe strongly in the concepts of secondary gain and compensation neurosis."2

Thus, a pattern of chronic whiplash seems to develop:

  1. A whiplash accident with soft-tissue injury.
  2. Patient is thrust into confrontation with the insurance company.
  3. Stress from interactions with the insurance company exacerbates the pain symptoms,
  4. Resulting in chronic physical and psychological symptoms.

The authors suggest that the first three months after the accident are pivotal in preventing this cycle of disability:

"Our findings suggest that the symptoms of whiplash injury have both physical and psychological components, and that the psychological response develops after the physical damage. Both physical and behavioral responses to these injuries are established in most cases within three months of injury. This suggests that the greatest potential for influencing the natural history of the syndrome is within this period."1

  1. Gargan M, Bannister G, Main C, Hollis S. The behavioural response to whiplash injury. Journal of Bone and Joint Surgery [British] 1997;79-B:523-526.
  2. Ratliff AHC. Whiplash injuries. [Editorial] Journal of Bone and Joint Surgery [British] 1997;79-B:517-519.
  3. Evans RW. Whiplash injuries. In: Macfarlane R, Hardy DG, eds. Outcome after head, neck and spinal trauma. Oxford, etc: Butterworth Heinemann, 1997:359-372.