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consequences need to be considered not only in terms of distress and cognitive impairment, which may be severe enough to satisfy criteria for psychiatric illness, but also in terms of all the other aspects of outcome which may, in part at least, be affected by psychological and social variables (Table 1). Outcome is multidimensional.³ A full picture can only be obtained by systematic enquiry about each area of everyday life and functioning. It is important to avoid assumptions about what are the most important areas of outcome. We should be principally concerned with what is important to patients and their families and this may be very different to the apparently common-sense assumptions of doctors and lawyers.

68.5 Individual variation Following any particular physical disorder there is great individual variation in reaction which depends upon the individual's personality and circumstances as well as on the nature of the disorder and its treatment. This means there is no standard, expected or appropriate pattern of outcome by which individuals' own stories can be judged. Each whiplash victim's complaints and problems require an understanding of the person and the situation, as well as the varied severity and physical course of whiplash.

68.6 This chapter begins with a brief section on psychiatric classification and then describes the psychological consequences of major physical illness and the specific consequences of road traffic accidents before reviewing evidence about whiplash. Thereafter, there are sections on psychiatric complications, prognosis and on medico-legal examination, with a final section on areas of dispute.⁴

TABLE 1 Aspects of outcome which may be determined by psychological variables

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Mortality

Subjective severity of physical symptoms

Mental state

Limitation of physical function

Effects on quality of everyday life: work, social and leisure activities and