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Personality and Whiplash

What is the relationship between personality and the long-term outcome of whiplash injury? This current study1 provides some answers, as well as an excellent review of the recent literature:

"Common neck sprain injuries (whiplash) are usually caused by car collisions and the characteristics of these injuries are the occurrence of considerable pain and prolonged disability in some patients despite a lack of objective signs of pathology. Many studies have been published to explain this phenomenon. One suggestions is that persisting symptoms after neck sprain injury are caused by neurosis. Hodge2 even named this condition whiplash neurosis. He claimed that almost all these individuals with prolonged disabilities after neck sprain injury had preexisting personalities with strong elements of hostility and dependency, but he gave no empirical support for his views. Hoffman3 studied 110 patients, most of them suffering from whiplash syndrome, and claiming for compensation. He found that 89% of the patients suffered from emotional symptoms and 30% from exaggerated personality traits or personality disorders; that is, traits which had been aggravated by the accident. In a prospective study, Yarnell et al.4 found that 8 of 14 whiplash patients had abnormal scores on measures of depression, anxiety, and character disturbance. In contrast, recent prospective studies using less selected and larger samples, have found that psychological and social variables do not predict the persistence of physical symptoms related to the injury at 1-year5 and 2-year6 follow-up, although the latter study suggested that the baseline scores of nervousness and spontaneous aggressiveness, as measured by the Freiburg Personality Inventory, were higher for symptomatic compared to asymptomatic patients. Interestingly, a study by Drottning et al.7 found that whiplash patients with higher emotional responses measured only hours after the injury, reported more neck pain 4 weeks later. This finding is consistent with Malt and Olafsen8 who found that psychological and emotional short time responses were strongly related to preaccidental life circumstances in accidentally injured adults."

This current study examined 88 whiplash patients on scales of psychiatric symptoms, personality, and physical symptoms immediately after their accident; they were then re-evaluated six months later. At the follow-up, the 88 patients were divided into three groups: those deemed recovered, with no or few symptoms; those symptomatic; and those who also reported pre-existing headache or neck pain.

One interesting finding: 84.8% of the patients symptomatic at six months were in a rear-end collision, while only 56.1% of the recovered patients had been in a rear-end collision. The symptomatic patients were also five years older, on average, than were the recovered patients.

The three groups of patients were then compared to each other on personality characteristics, as measured by the Millon Clinical Multiaxial Inventory (MCMI-1). The study found that all three groups of patients fell in the normal range for this personality scale, and that there was no difference between the three groups—even though some were symptomatic and some were not.

The researchers also compared the MCMI-1 scores of the whiplash patients to a collection of control subjects—those with localized musculoskeletal pain, those who were depressed, and a group of health care providers. The depressed patients were different from all of the other groups, and did not match with the whiplash patients. The whiplash patients most closely matched with those people with localized musculoskeletal pain.

The researchers concluded by stating that at the six month follow-up, 38% of the patients still reported daily or constant headache, neck pain, or neck stiffness. "These results support the view that long-lasting physical symptoms after neck sprain injury are not influenced by premorbid personality styles or psychiatric symptoms."

  1. Borchgrevink GE, Stiles TC, Borchgrevink PC, Lereim I. Personality profile among symptomatic and recovered patients with neck sprain injury, measured by MCMI-1 acutely and 6 months after car accidents. Journal of Psychosomatic Research 1997;42(4):357-367.
  2. Hodge JR. The whiplash neurosis. Psychosomatics 1971;12:245-249.
  3. Hoffman BF. The demographic and psychiatric characteristics of 110 personal injury litigants. Bulletin of the American Academy of Psychiatry and Law 1991;19:227-236.
  4. Yarnell R, Rossie GV. Minor whiplash head injury with major debilitation. Brain Injury 1988;3:255-258.
  5. Mayou R, Bryant B. Outcome of whiplash neck injury. Injury 1996;27(9):617-623.
  6. Radanov BP, Begres, Sturzenegger M, Augustiny KF. Course of psychological variables in whiplash injury—a 2-year follow-up with age, gender and education pair-matched patients. Pain 1996;64:429-434.
  7. Drottning M, Staff PH, Levin L, Malt UF. Acute emotional response to common whiplash predicts subsequent pain complaints—a prospective study of 107 subjects sustaining whiplash injury. Nord J Psychiat 1995;49:293-299.
  8. Malt UF, Olafsen OM. Psychological appraisal and emotional response to physical injury: a clinical, phenomenological study of 109 adults. Psychiatric Medicine 19XX;10:117-0134.