How Does PTSD From a Train Accident Differ From a Car Accident?

Post-Traumatic Stress Disorder is a common response to many traumatic experiences, ranging from interpersonal violence to serving in the military. Common symptoms include flashbacks, depression, anxiety, insomnia, and panic attacks related to triggers.

While car accidents are an unfortunately common experience, train accidents are rarer, which can make victims feel misunderstood when they seek treatment from counselors. In fact, only a few qualitative research studies have assessed the unique needs of train accident survivors, with the most pertinent published in 2011 in the International Journal of Qualitative Studies on Health and Well-Being. 

To better support this specific demographic, therapists and loved ones must consider how train accident experiences differ from car accidents. Some of the most essential elements of this landmark qualitative study include the following.

Impact on Crew Versus Passengers

When treating train accident victims, it's important to consider how the person's role in the crash influences how they respond psychologically. Both crew members and passengers will experience trauma, but there are different feelings to process.

Crew members report a sense of horror and inevitability, especially during collisions with pedestrians or other vehicles. They may have been the last person to see a motorist alive before a collision, which can cause them to fixate on what the victim's last moments were like and what they could have done to stop it. Even while the crew knows they may not have been able to avoid the accident, they often experience intense feelings of guilt and personal responsibility.

Passengers report a sense of helplessness and loss of control, especially as they may not have been aware that an accident was unfolding before they were jolted or thrown airborne. A car accident victim often has several seconds or more to recognize the impending collision and mentally brace for impact, whereas a passenger in a larger vehicle cannot.  

"Tumble-Dryer" Experience and Sense of Entrapment

Trains, such as a Chicago Transit Authority (CTA) train or an Amtrak train, are exponentially larger than a personal automobile. Even one train car can hold dozens of people, most of whom are not wearing seatbelts in the event of a collision. 

During a derailment, survivors report an overwhelming sense of chaos, as if they were suddenly thrown into a tumble dryer. Other people, equipment, and personal belongings are flung in all directions, and many victims suffer injuries from others landing on top of them.

Another aspect is that victims may lose track of where the exits are or may not be able to access them, depending on how the accident occurred. A car accident victim is typically close to the nearest exit, which can provide a sense of psychological relief and assurance that rescue will soon come. Train accident victims may feel consistently trapped and overwhelmed whenever they reflect on the collision. 

Existential Trauma and Long-Term Maladjustment

A car accident is a singular event that can respond well to targeted therapy. While victims may experience survivor's guilt for a fatal motor vehicle accident, particularly if they were the driver and other passengers died, car accidents are clearly defined and short-term events. This means that therapies like Eye Movement Desensitization and Reprocessing (EMDR) can target each moment step by step, while exposure therapy can help victims feel comfortable being in or near cars again. 

Train accidents are different because, to the victim, they may feel endless and existential. Survivors report feeling like they cheated death and face questions such as, "Why did I live while others died?" or "Why did I pick that seat?" 

Reports show that train accident victims still thought regularly about the event more than one year, and some reported significant trauma even a decade afterward. This significantly broadens the therapeutic horizon and suggests that long-term treatment is essential for progress. 

Therapeutic and Legal Help Is Available

Team-based mental health support can be incredibly helpful for train accident victims, as they have complex needs that may not be fully addressed by one professional. Pharmaceutical interventions, like medications to reduce nightmares, can be used in conjunction with therapy and social work to connect survivors with community-based support.

Victims may also choose to get help from a train accident lawyer in their area. In many cases, survivors can file a lawsuit against the train company, such as the Chicago Transit Authority or the freight line, and secure compensation for both their medical and psychological needs. 

Researchers are coming to understand the complexities of train accidents, recognizing that they require different approaches from other traumatic incidents. The sense of chaos, survivor's guilt, and loss of control should be considered when developing a therapeutic plan for victims, while long-term care can help manage symptoms and help build resilience. With a tailored and comprehensive approach to treatment, train accident victims can overcome their PTSD and experience post-traumatic growth.