6 June 1969
as yet known
as yet known
Mr Brown. I am a Chartered Clinical Psychologist. My specialist
field is psychological trauma an area within which I have worked
over the past seven years. Full details of my qualifications entitling
me to give expert opinion and evidence are set out at the end of
case concerns an accident dated 3 November 2002 in which the claimant
allegedly suffered personal injury. I have been jointly instructed
by Clay More Solicitors and Pailess Insurance to investigate for
the court whether the claimant has suffered a formal psychological/psychiatric
condition as a result, and the effects and prognosis of this if
appropriate. I have been provided with the claimant’s general
practice notes and records.
OF INTERVIEW: 6 October 2003
INTERVIEWED: Mr Jones (Husband)
Jones presented entirely appropriately and gave a clear and consistent
account of the accident and its impact upon her. She was clearly
distressed by her level of anxiety in relation to the driving situation.
THE INCIDENT AND SUBSEQUENT DEVELOPMENTS
the 3 November 2002 Mrs Jones was returning home from work and travelling
through the village of Mulsoe. She described how a car in front
suddenly braked to turn into a driveway and as she came to a halt
she was hit from behind by a lorry. Her immediate reaction was,
“Oh no, I can’t cope with this”. She “disintegrated
into tears” and was surprised by the extent of her reaction.
of distress persisted in the aftermath of the accident and a woman
from a nearby house came to her assistance. She remained in the
car and contacted her husband on her mobile phone, to inform him
of the accident. At the scene she recalled feeling “totally
pathetic”, and unable to control her emotions. The police
were called and dealt with the aftermath of the accident and she
later returned home with her husband.
remained very tearful when she arrived home and went to bed saying,
“I felt I wanted to be out of it”. Generally felt that
she was unable to cope with the extent of her reaction. She was
aware of an overwhelming sense of vulnerability in that accidents
could occur at any time. She did not want to talk about the accident
but described vivid intrusive images of the accident that would
repeatedly come into her mind.
following day Mrs Jones awoke in great pain from her neck and made
an appointment to see her doctor. He diagnosed a whiplash injury
and recommended that she rest for a few days. Mrs Jones was off
work for a week or so, during which time the pain was severe. However,
she noted that this has improved since and the pain generally recovered
within a period of several months. On interview she did not report
any ongoing pain related problems.
Jones gained a replacement vehicle from her insurance, which she
needed to attend work. She reflected that she lives in a rural area
and was dependent upon a car for transportation. However, when the
car arrived she described feeling “terrified of driving”
and that the trip to work became “a horrendous experience”.
This has persisted until the present day and has dominated her life
and caused her significant difficulty.
Jones has not been able to avoid driving, but generally endures
this situation with dread. She lives in an isolated rural location,
has to travel some ten miles to work, and there is no public transport
for her to use. Consequently, she has no option but to drive and
experiences severe and disabling anxiety when she does so. The intensity
of her reaction tends to fluctuate depending on her experiences
on the day. Sometimes she is able to make the journey in one go
but more often than not she will have to stop and compose herself,
for example if someone is driving too close behind her, suddenly
pulls into her pathway, or if there are lorries in close proximity.
She is unable to drive in the dark or if the weather conditions
are poor. Her employers have been sympathetic toward her difficulties
and have provided her with a computer at home with e-mail, so if
she is unable to drive she can continue to work from home.
than avoiding driving in the dark, she also avoids driving on motorways.
She will avoid any non-essential journey and will not even go out
shopping, now buying goods over the Internet. She acknowledged that
short local journeys are not too distressing although she endeavours
to limit the time that she spends in the car.
a result of her driving anxiety her social life has been considerably
curtailed. Whereas she used to drive to see friends, she now no
longer does so. She generally prefers to remain at home and whilst
she will occasionally go out to town if necessary, she will avoid
doing so if at all possible. She is exceedingly wary of other vehicles
on the road, particularly those travelling behind her. She feels
that she is constantly looking in her mirror and as a result is
aware that she is driving unsafely.
is also very anxious as a passenger, reflecting that at times she
will scream out, and on one occasion even tried to get out of the
car. She will make the driver, usually her husband, pull over at
times given the extent of her distress. She does not feel in control
and feels that the driver tends to go too fast for her. If they
do have to go anywhere socially then she prefers to travel by train.
feels very despondent about the extent of her anxiety as she is
aware how limited her life has become as a result. For example,
she and her husband no longer go for days out in the ca for pleasure
and neither does she go on shopping trips in town which she used
She has endeavoured to seek help for her difficulties. She underwent
a course of driving lessons but was told that there was nothing
wrong with her driving and that it was in her head. She was referred
by her doctor to a counsellor but did not find this of any help
in managing her anxieties.
Jones did not describe dwelling on the accident and neither did
she note spontaneous intrusive imagery of such. However, she is
reminded of the accident whilst travelling in a car and is always
conscious of vehicles travelling behind. The main psychological
impact of the accident would appear to be her shattered belief in
her sense of safety whilst travelling in a car and that there is
nothing she can do to protect herself. This is in marked contrast
to her former confidence driving, where she was able to undertake
long distances in the car and had even driven on her own to Scotland
she did not describe having recurrent dreams of the accident she
did describe anxiety type dreams in relation to the driving situation
where she will be trying to drive from the back seat of the car
and unable to reach the pedals.
general her sleep has not been markedly affected by the accident.
However, she will wake up worrying in the middle of the night if
she has a particular journey to undertake the following day.
did not describe being anxious in other situations other than in
relation to car travel. However, even news of accidents on the television
will cause her to worry and feel anxious, as she fears that she
will be involved in a similar incident.
was no indication of symptoms of emotional numbing. She reflected
that “life goes on” and is generally happy whilst at
home. She did not describe any loss of interest in her previous
hobbies of knitting and sewing, but does feel frustrated that her
social life has been affected on account of her driving anxiety.
relationship with her partner has not been effected as she remains
close and loving toward him and, indeed, he would appear to be very
patient and sympathetic over her difficulties. She is not generally
more irritable, although does get uptight in the car and rows can
did not describe any significant concentration difficulties reflecting
that she has been able to cope with her work. However, she does
worry that, whilst her employers have been sympathetic in the past,
they would appear to be increasingly frustration about her situation
in respect to her driving anxiety and avoidance.
There is no sense of a foreshortened future.
husband, who attended part of the interview, noted a number of changes
in Mrs Jones. These included:
The main change has been in respect to driving and car travel and
whereas she used to enjoy going out at weekends, they no longer
2. They no longer have the same social life as they used to and
holidays have been curtailed as these usually involve driving.
3. If scenes of accidents occur on the television, then he has to
change channels straight away.
4. It is difficult to accompany her in the car now given the extent
of her anxiety.
5. She is more cautious when she is driving herself.
6. As a passenger, she insists that he pulls over if anything comes
up from behind.
7. Her sleep is disturbed prior to any notable journeys.
(2.2) PREVIOUS PERSONAL HISTORY
Jones was born in South Yorkshire and grew up in Lincoln. She has
one sister. She has good memories of her childhood although her
mother suffered from poor health and died when she was in her twenties.
She has remained close to her father whom she continues to visit
on a regular basis. He is now retired and in his eighties.
Jones enjoyed school and left at the age of sixteen after her GCSE
examinations. She went on to study business and administration at
college and has worked with the same company since then in administration.
She is happy in her job and did not describe any other concurrent
has been married since 1995 and she and her husband generally have
a good relationship together. They do not have any children.
(2.3) PREVIOUS MEDICAL HISTORY
Jones described her medical history noting that she had generally
been fit and well. She did not note any previous psychological problems
and history of such in her family. She recalled a previous road
traffic accident several years before that in question, although
this had not affected her confidence driving. She has never taken
any psychotropic medication and neither has she undergone any psychological
therapy prior to the accident. Since the accident, she has seen
a counsellor, but did not find this of any help, reflecting that
generally the counsellor just let her talk about her feelings and
thoughts associated with the accident.
claimant’s general practice records from 1970 have been obtained
and studied in respect of references to psychological or psychiatric
symptoms/conditions which predate the matter under litigation, or
occur subsequent to it, and which may be relevant to the current
PRIOR TO THE INCIDENT
RTA, hit from the side, low speed, some neck pain. Nil else.
Some stress at work, not sleeping. Doesn’t want medication.
Feels better now.
SUBSEQUENT TO THE INCIDENT
Had accident yesterday, some neck pain. Tearful, not depressed.
?PTS. Advise rest.
Accident 2/12 ago, terrified of travelling in car. Probs getting
to work. Requests counselling – refer M Lewis. Not depressed
…..fear of driving ? for psychotherapy
Letter of referral to M Lewis regarding fear of driving which is
clearly interfering with her quality of life
Letter M Lewis, Counsellor, noting referral and that an appointment
had been offered.
Still troubled by driving +++
(2.4) TEST RESULTS
DSM-IV POST TRAUMATIC STRESS DISORDER SYMPTOM CHECKLIST
compiled by the writer from the above interview)
(1) Event involving actual/threatened death, serious injury
or threat to physical integrity NO
Experience of intense fear, helplessness or horror ?
Current post accident but not
B RE-EXPERIENCE PHENOMENA
Recurrent/intrusive recollection NO NO
(2) Recurrent dreams NO NO
(3) Acting/feeling “As If” event recurring NO NO
(4) Distress on exposure YES YES
(5) Physiological reactivity on exposure YES YES
Avoidance of thoughts/feelings NO NO
(2) Avoidance of activities/situations YES YES
(3) Inability to recall NO NO
(4) Diminished Interest NO NO
(5) Estrangement/detachment NO NO
(6) Constricted affect NO NO
(7) Sense of foreshortened future NO NO
Sleep difficulties NO NO
(2) Irritability/angry outbursts NO NO
(3) Concentration difficulties NO NO
(4) Hypervigilance YES YES
(5) Exaggerated startle NO NO
a DSM-IV diagnosis of PTSD, positive answers are required from (A)
1 and 2, a minimum of one symptom from (B), three symptoms from
(C) and two symptoms from (D). In addition, there must be clinically
significant impairment of functioning.
Symptom present but not necessarily related to PTSD
symptomatology present but does not fulfil criteria
(3) DISCUSSION AND OPINION
a road traffic accident in November 2003 Mrs Jones has suffered
a marked psychological reaction.
would not at any time have qualified for a diagnosis of Post Traumatic
Stress Disorder. She described no significant symptoms of traumatisation.
However, the accident appeared to shatter her belief that she could
travel safely in a car and left her with a marked sense of vulnerability
which underlies her anxiety in relation to car travel.
Jones clearly suffers from a Specific Phobia in relation to driving/
car travel. Whilst she has continued to drive she experiences great
distress when she does so and generally endures this situation with
dread. The extent of her anxiety has had a marked impact upon the
quality of her life, as she, at times, has to work from home and
her social life and interests have been restricted. Despite counselling
there has been no improvement in the intensity of her psychological
reaction over time.
to the accident Mrs Jones will be noted to have experienced some
stress at work, although this was short lived and did not persist
for any length of time. There is no indication of a continuation
of a pre-existing condition, and anxiety related to car travel has
never been part of her clinical picture beforehand. Whilst she had
had a previous road traffic accident in 1996 this had not affected
her psychologically. Consequently, her symptoms of anxiety related
to driving and car travel can be entirely attributed to the accident
SUMMARY OF DIAGNOSIS
Jones has suffered a Specific Phobia to driving/car travel of moderate
intensity, which has persisted without improvement over the past
symptoms of anxiety related to driving and car travel can be entirely
attributed to the accident in question
has been little improvement to date in Mrs Jones’s symptomatology
despite being referred for counselling. However, this form of therapy
is rarely appropriate in such anxiety cases and can conversely make
the situation worse. She requires cognitive behavioural therapy
and with appropriate intervention there should be good recovery
within some six to nine months from the commencement of such.
Jones currently requires cognitive behavioural therapy with a therapist
such as a chartered clinical psychologist or cognitive behavioural
therapist. This should be sought privately given the long waiting
lists within the NHS and the cost of therapy should be budgeted
at between £90 to £120 per session. Some eight sessions
that my duty as an expert witness is to the court. I have complied
with that duty. This report includes all matters relevant to the
issues on which my expert evidence is given. I have given details
in this report of matters which might affect the validity of this
report. I have addressed this report to the court.
that I have not entered into any arrangement where the amount or
payment of my fees is in any way dependent on the outcome of the
that insofar as the facts stated in my report are within my own
knowledge I have made clear which they are and I believe them to
be true, and that the opinions I have expressed represent my true
and complete professional opinion.
Brown BSc. MSc. CPsychol
Chartered Clinical Psychologist
and Statistical Manual of Mental Disorders (DSM-IV) – 4th
Published by the American Psychiatric Association
ICD-10 Classification of Mental and Behavioural Disorders (1993)
By the World Health Organisation