While the physical injuries caused by burns often receive the greatest attention from medical staff, the psychological and psychiatric injuries caused by burns cannot be overstated. As reported in the American Journal of Clinical Dermatology, more than 90% of burn victims experience some symptoms of stress within the first week of the injury and more than 45% develop chronic signs of stress that can be categorized as Post-Traumatic Stress Disorder (PTSD) after one year. Approximately one third of survivors of major burn injuries suffer from post-traumatic stress disorder (PTSD) after being discharged from the burn center.

The earliest phases of burn care often focus largely on the medical treatment of physical injuries. However, medical staff often lack experience in screening for psychological issues, including PTSD, in their patients. That is why it is so important for burn survivors and their families to seek out qualified psychologists, psychiatrists, and social workers who can help identify and manage non-physical injuries. Psychiatric symptoms do not always manifest themselves early in burn survivors and may not appear for several months after the injury.

According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), certain diagnostic criteria must be met for a diagnosis of PTSD. First, the survivor must have either witnessed or experienced some type of trauma. Second, the survivor must re-experience at least one of the following symptoms:

• Recurrent, involuntary, intrusive thoughts or memories of the trauma;
• Recurrent distressing dreams of the event;
• Reliving the experience as if it were recurring (flashbacks);
• Intense emotional distress after exposure to trauma reminders;
• Intense physical reactions to trauma reminders.

If the first two criteria are met, we next look for the presence of avoidance symptoms. Avoidance symptoms are:

• Intentional avoidance of thoughts/feelings associated with the trauma; and/or
• Avoidance of situations, activities, or places that remind the survivor of the trauma.

Next, we must determine if the survivor experiences negative changes to thoughts or mood. Under this criterion, the survivor must exhibit at least two of the following symptoms:

• Can’t remember important aspects of the trauma;
• Persistent, exaggerated negative beliefs about herself, others and the world;
• Persistent, distorted thoughts about the cause of the trauma that leads to self/other blame;
• Persistent negative emotional state;
• Decreased interest in significant activities;
• Feelings of detachment from others;
• Persistent inability to experience positive emotions

Lastly, we must determine if the survivor experiences increased arousal symptoms. At least two of the following symptoms must be exhibited by the survivor to meet PTSD criteria:

• Irritability or anger outbursts;
• Reckless or self-destructive behavior;
• Hypervigilance;
• Exaggerated startle response;
• Difficulty concentrating;
• Problems falling or staying asleep

If you or someone you know survived a burn and are experiencing symptoms associated with PTSD, it is important that you seek out qualified psychological or psychiatric care. Remember, the symptoms of PTSD may not show up right away after a burn. By arming yourself with knowledge of PTSD, you can better help yourself and your loved ones manage it.