Removing the Kelly v Hennessy Threshold for Psychiatric Injury Accompanying Physical Harm: Commentary on Sykula v O’Reilly [2025] IEHC 638

1. Introduction

This High Court decision, delivered by Ferriter J on 21 November 2025, considers the recoverability and quantification of psychiatric injury – specifically symptoms consistent with post-traumatic stress disorder (PTSD) – arising from a relatively minor rear-end road traffic collision.

Although liability for the accident was admitted and the case came before the Court as an assessment of damages only, it raised significant questions of:

Causation and remoteness: whether a minor “shunt” collision can be a legal cause of serious and enduring psychiatric injury; and how far the defendant is liable for downstream consequences such as homelessness and long-term work incapacity.
The relationship between physical and psychiatric injury: whether the stringent “nervous shock” requirements in Kelly v Hennessy and Harford v ESB apply when the plaintiff has also suffered physical injury.
Eggshell skull and psychological vulnerability: to what extent a defendant must “take the plaintiff as found” when the plaintiff has a pre-accident history of anxiety and depression.
Multi-factorial causation and discounting: how to apportion damages where the plaintiff’s psychiatric condition is worsened by major non‑accident stressors such as the housing crisis, homelessness, Covid‑related isolation and relationship litigation.
Assessment of general damages in multiple‑injury cases: application of the post‑Meehan v Shawcove methodology for valuing multiple injuries holistically and proportionately to the €500,000 cap.

The judgment is therefore important not merely as a quantum decision, but as an authoritative clarification that:

Where a plaintiff suffers both physical and psychiatric injury, the restrictive “nervous shock” criteria in Kelly v Hennessy and Harford v ESB do not apply; and
Courts may appropriately discount damages for psychiatric injury by a percentage to reflect significant exacerbating stressors that are not attributable to the defendant’s tort, without treating those stressors as breaking the chain of causation.

2. Summary of the Judgment

2.1 Facts in outline

On 9 December 2017 the plaintiff, Ms Katarzyna Sykula, was driving in Finglas, Dublin, when her car was gently rear-ended while she was moving off at a traffic light. She suffered soft tissue injuries to her neck, shoulder and back. An ambulance briefly attended, but she declined transport. Later that day and the following day she became unwell, attending Care Doc and Waterford University Hospital, where soft tissue injuries were confirmed.

At the time she was a single mother living in Carlow and working as a pharmacy assistant. Following the accident she:

Took approximately 7 weeks off work, returning in late January 2018.
Reported ongoing neck, shoulder and later lower back pain, headaches and fatigue.
Developed anxiety, low mood, flashbacks and sleep disturbance; she was prescribed psychotropic medication and attended counselling.
Reduced to a three-day week in 2019, went out on sick leave in 2020, and ultimately lost her job at the end of 2021.
Was granted invalidity pension in 2022 and had not worked since.
Fell into rent arrears and, in March 2023, she and her daughter became homeless, spending several months in emergency hostel accommodation.

She alleged that the accident had caused or materially contributed to a six-year course of physical pain and psychiatric symptoms, including PTSD, leading to loss of employment, financial collapse and homelessness.

2.2 Pre‑accident psychiatric history

Between 2013 and 2016 the plaintiff experienced:

Serious family bereavements: her mother’s breast cancer diagnosis (2013) and death (2015), and her father’s death (2015).
Work‑related stress in a coffee shop management role, including alleged bullying.

GP records from 2015–2016 documented:

“Adjustment reaction stress, risk of depression”, anxiety, poor sleep and panic elements.
Prescriptions for Seroxat (paroxetine) and anti‑anxiety medication, with improvement noted over time.

The plaintiff accepted this history but said that by April 2017 she had completed her medication, changed job, and was enjoying her new role in a pharmacy; she denied any ongoing psychiatric illness at the time of the accident. A once‑off Xanax prescription in August 2017 was said to relate to the stress of starting a new job rather than an ongoing disorder.

2.3 Medical evidence at trial

Orthopaedic evidence – Mr Michael O’Riordan (for the defendant):
- Three examinations (2018, 2020, 2022) confirmed soft tissue strains to neck and back.
- Objective findings showed some restriction of cervical movement but largely normal functioning.
- He expressed concern about a “mismatch” between reported disability and relatively normal clinical findings, and expected full resolution in time.
- He accepted that the plaintiff remained symptomatic and that psychiatric conditions could impede physical recovery.
Psychiatric evidence – Dr Catherine Corby (for the plaintiff):
- Assessed the plaintiff in November 2023 (almost six years post‑accident).
- Diagnosed PTSD under DSM‑V, emphasising flashbacks, nightmares, panic attacks, low mood and disturbed sleep.
- Stated that the accident, though apparently minor, was subjectively traumatic to the plaintiff and constituted exposure to threatened serious injury for DSM‑V purposes.
- Stressed that the plaintiff’s condition was “multifactorial”: the accident was a cause, but much later deterioration was largely driven by homelessness and other life stressors.
- Considered the plaintiff vulnerable to psychiatric illness at the time of the accident but not actively ill then; she expected a return to work within 1–2 years with appropriate treatment.

The defendant did not call any psychiatric expert, notwithstanding earlier indication that a psychiatrist would be called.

2.4 Credibility, exaggeration and non‑disclosure

Ferriter J accepted the plaintiff as “generally a credible witness” whose account broadly matched the documentary record, but found:

She had a tendency to overstate the severity of her symptoms.
Her late disclosure of her 2015–2016 psychiatric history was “distinctly unimpressive” and supported a view that she wished to present her post‑accident mental health as entirely attributable to the collision.
Her attendance at the gym several times a week in 2018 was “inconsistent with the level of physical discomfort” she claimed.

Nevertheless, he accepted that by the date of the accident she had recovered from her earlier adjustment disorder and was not suffering from a psychiatric illness, though she remained psychologically vulnerable.

2.5 Core legal findings

Key determinations included:

Causation (“but for” test):
On the balance of probabilities, but for the accident the plaintiff would not have suffered the anxiety, depression and PTSD‑type symptoms she experienced from early 2018 onwards. The accident was therefore a legal cause of her psychiatric injury.
Eggshell skull and vulnerability:
The plaintiff’s psychological vulnerability – rooted in earlier bereavements and workplace stress – did not bar recovery. Applying the “eggshell skull” principle (from Walsh v Tipperary County Council and Fletcher v Commissioner of Public Works), the defendant had to take the plaintiff as he found her, even if she reacted more severely than a typical person.
Scope of the Kelly v Hennessy / nervous shock rule:
The nervous shock criteria apply only to pure psychiatric injury unaccompanied by physical harm. Because Ms Sykula suffered physical injuries, she did not have to show that the collision amounted to a “shocking, horrifying or calamitous” event in order to recover for her PTSD and related psychiatric damage.
Multi-factorial causation and discounting:
The plaintiff’s psychiatric state was substantially worsened by non‑accident stressors (Covid, relationship litigation, relocation, rent arrears and homelessness). These did not break the chain of causation but did justify a 50% reduction in the damages awarded for psychiatric injury, to reflect that only half of her symptoms were properly attributable to the accident.
Damages:
- Psychiatric injury (mild–moderate PTSD over six years, with anticipated improvement within 1–2 years): starting point €60,000 (past €50,000 + future €10,000) reduced by 50% = €30,000.
- Physical soft‑tissue injuries to neck, shoulder and back: uplift of €35,000 (past €30,000 + future €5,000), using Book of Quantum ranges and recognising that recovery was hampered by psychiatric issues.
- Total general damages: €65,000.
- Special damages and loss of earnings (agreed): €25,000.
- Total award: €90,000.

3. Detailed Analysis

3.1 Precedents and Authorities Considered

3.1.1 Walsh v Tipperary County Council [2011] IEHC 503 – the eggshell skull principle

In Walsh, Clarke J (as he then was) restated the “eggshell skull” rule: if personal injury is a foreseeable consequence of the defendant’s wrongdoing, the defendant is liable for the full extent of the injury actually suffered, even if the plaintiff’s pre‑existing vulnerability makes that injury more severe than expected.

Ferriter J quotes this passage (para 45 of the judgment) to underscore two points:

The relevant foreseeability is of some personal injury (here, injury from negligent driving), not of the precise type or severity.
Once that threshold is crossed, an unusual psychiatric reaction in a vulnerable plaintiff is not too remote.

He then reinforces this with a passage from Fletcher (discussed next), explicitly referencing minor soft tissue injuries precipitating “acute psychiatric injury” as an example of routine application of the eggshell skull rule.

3.1.2 Fletcher v Commissioner of Public Works [2003] 1 IR 465

Fletcher is central to two strands of the Court’s reasoning:

The eggshell skull in psychiatric contexts: Keane CJ noted that courts are familiar with apparently minor physical injuries leading to serious psychiatric illness, yet damages are nonetheless recoverable. Ferriter J cites this (para 46) to validate compensation for an unexpectedly severe psychological reaction to a low‑velocity collision.
Defining “nervous shock” cases: Keane CJ emphasised that the “nervous shock” line of cases concerns psychiatric injury in the absence of any physical injury. Ferriter J relies heavily on this (para 50) to confine Kelly v Hennessy and its progeny to pure psychiatric injury cases.

By explicitly invoking Keane CJ’s formulation, Ferriter J aligns Sykula with a long‑standing doctrinal distinction: once there is any physical injury, psychiatric damage is treated as another head of consequential damage, not as “nervous shock”.

3.1.3 Kelly v Hennessy [1995] 3 IR 253

Kelly laid down the core “control mechanisms” for recovery in nervous shock cases: a recognisable psychiatric illness; caused by shock; arising from the sudden perception of death, injury or its immediate aftermath to a loved one; with a close tie of love and affection; and reasonable foreseeability. Over time, this framework has been strictly applied to restrict liability for pure psychiatric injury.

The defendant in Sykula sought to invoke this authority – amplified by Harford – to argue that the plaintiff could not recover for PTSD because the collision was not a horrifying, terrifying or calamitous event, nor did it objectively involve threatened death or serious injury.

Ferriter J rejects this argument as a misapplication of Kelly, emphasising (para 50) that:

Kelly and its associated authorities govern cases where psychiatric injury is “unaccompanied by physical injury”.
They do not impose an additional threshold in ordinary personal injury actions where the plaintiff already has physical harm (however minor).

This is a key clarification of the hostile overlap between personal injury law and nervous shock jurisprudence.

3.1.4 Harford v ESB [2022] 2 IR 541

In Harford, the Court of Appeal (Noonan J) reaffirmed that:

Psychiatric injury is not compensable, even if reasonably foreseeable, unless:
1. it is accompanied by physical injury; or
2. it results from “nervous shock” within the Kelly framework.
For pure psychiatric injury, there must be a “sudden event” that is “shocking, distressing, horrifying, terrifying or calamitous”.

The defendant tried to rely on this language to preclude recovery for PTSD arising from what was, on a purely objective view, a relatively trivial rear‑end shunt. Ferriter J, however, draws a precise line (para 50):

He endorses Harford’s principle that psychiatric injury is only recoverable if there is physical injury or nervous shock.
He points out that the “shocking, terrifying” requirement is expressly described in Harford as a prerequisite to recovery for purely psychiatric injury.

Because Ms Sykula did suffer physical injuries, her case falls into the first category in Harford, not the second. Thus the “terrifying event” test is inapplicable.

3.1.5 O’Sullivan v Broxda [2022] IECA 163 – proportionality and general damages

Ferriter J cites O’Sullivan as the leading contemporary statement of the principles governing general damages:

The objective is to arrive at a fair and reasonable figure.
Proportionality must be observed both in relation to:
- the statutory “cap” on general damages (€500,000); and
- awards in comparable cases.
Societal factors and the common good must be considered.
The award remains personal to the plaintiff and must reasonably compensate their specific pain and suffering.

These principles frame the quantum exercise and underpin his final “holistic” review of the €65,000 general damages award.

3.1.6 Meehan v Shawcove [2022] IECA 208 – multiple injuries and holistic assessment

Meehan is pivotal to the method used to value a constellation of injuries. Drawing on Noonan J’s guidance, Ferriter J:

Identifies the most significant injury (here, psychiatric injury) as the base.
Values that principal injury in light of comparable awards and the overall cap.
Uplifts that figure to reflect the additional, lesser injuries (neck, shoulder and back), rather than valuing each injury separately and aggregating the figures.
Ensures an overall proportional, non‑inflationary, award.

This approach avoids double counting and fits with the Book of Quantum / Personal Injuries Guidelines methodology in multiple‑injury cases.

3.1.7 M.N. v S.M. [2005] 4 IR 461 and Sinnott v Quinnsworth [1984] ILRM 523

These Supreme Court decisions are cited (via O’Sullivan) as foundational sources on:

The obligation to ensure proportionality and take account of “societal factors” and the “common good” (Denham J in M.N. v S.M.).
The core idea that damages are to be fair and reasonable in the circumstances (O’Higgins CJ in Sinnott).

They set the normative backdrop against which Ferriter J calibrates the €90,000 total award.

3.2 The Court’s Legal Reasoning

3.2.1 Causation: the “but for” test and psychiatric injury

Ferriter J explicitly applies the orthodox “but for” test (para 47): would the plaintiff have suffered her anxiety, depression and PTSD‑type symptoms but for the accident?

He answers in the negative, despite:

her prior vulnerability;
the relatively minor nature of the collision;
her tendency to exaggerate; and
the presence of multiple subsequent life stressors.

Crucially, he:

Accepts the psychiatric expert’s view that the accident precipitated the plaintiff’s PTSD‑type symptoms.
Rejects the defendant’s suggestion that her psychiatric problems were already ongoing at the time of the collision, finding instead that she had been “relatively well for a prolonged period before the accident” (para 42).

Thus, causation in law is established; the subsequent multi‑factorial analysis goes not to whether the accident caused psychiatric injury, but to how much of the overall psychiatric morbidity should be attributed to it for valuation purposes.

3.2.2 Psychological vulnerability and the eggshell skull rule

The Court’s approach to pre‑accident vulnerability is orthodox but carefully articulated:

The plaintiff’s earlier adjustment disorder, bereavements and workplace stress did not mean she was suffering from a psychiatric illness at the accident date.
She was more prone than the average person to developing psychiatric illness when confronted with subsequent stressors.
This vulnerability rendered her a “poor candidate for the accident”, but under the eggshell skull rule the defendant must still answer for the consequences (para 45).

This combination – no active illness at the time, but increased vulnerability – is important:

It avoids the conclusion that the accident merely “revealed” an existing disorder (which might have raised more difficult causation questions).
It supports the conclusion that the accident was a genuine precipitating cause of new psychiatric injury, albeit in a vulnerable personality.

3.2.3 Confining the nervous shock / Kelly v Hennessy requirements

Perhaps the most doctrinally significant passage is the rejection of the defendant’s submission that the plaintiff cannot recover for PTSD because the accident fails the “terrifying, shocking, horrifying, calamitous” test.

Ferriter J’s reasoning proceeds as follows:

Textual and doctrinal reading of earlier cases:
- He cites Fletcher’s clear statement that nervous shock cases deal with psychiatric injury “even in the absence of any physical injury”.
- He highlights Noonan J’s formulation in Harford that the “sudden shocking event” is a prerequisite for “purely psychiatric injury”.
Characterisation of the present case:
- The plaintiff indisputably suffered soft tissue injuries.
- Her psychiatric injury therefore arose in conjunction with, and consequentially upon, physical harm.
Legal consequence:
- Once some physical injury is reasonably foreseeable from negligent driving, the defendant is liable for psychiatric injury that results, even if the plaintiff’s reaction is highly unusual.
- The plaintiff does not have to show the accident was, in some objective sense, horrifying or life‑threatening.

This element of the judgment provides a clear and authoritative answer to an argument that, if accepted, would have significantly narrowed the recoverability of psychiatric injury in routine personal injury litigation.

3.2.4 Multi-factorial causation and partial attribution

The Court accepts that the plaintiff’s PTSD‑type condition is genuinely multi‑factorial, in line with the evidence of both her GP and Dr Corby:

The accident was a real and significant cause of her psychiatric symptoms.
However, later events – Covid, relationship litigation, moving to Tullow due to property pressures, rent arrears, homelessness and distressing hostel conditions – materially worsened and prolonged those symptoms.

Rather than finding that these later events constitute a novus actus interveniens (a breaking of the chain of causation), Ferriter J treats them as:

Exacerbating factors that co‑cause the ultimate level of psychiatric morbidity.
Grounds for a quantitative discount in the damages attributable to the accident, not a complete defence on causation or remoteness.

He ultimately adopts a pragmatic apportionment (para 59):

“it would be fair to assess damages on the basis that 50% of her psychiatric symptoms in the period from the accident to the trial were attributable to the accident itself, and the balance from the external factors I have identified above.”

Although the 50% figure is necessarily impressionistic, the reasoning is carefully rooted in the evidence:

Contemporaneous GP reports in 2018 and 2021 documenting significant anxiety, nightmares and insomnia linked to driving and the accident.
The marked deterioration after homelessness in 2023.
The judge’s findings about exaggeration, suggesting that “moderate” rather than severe ongoing symptoms is a fair characterisation.

This approach illustrates the Court’s willingness to:

Recognise that mental health conditions in real life are rarely monocausal.
Allocate only that portion of morbidity fairly attributable to the defendant’s wrongdoing, while still accepting that the accident is a true cause.

3.2.5 Assessment of psychiatric injury

The Court accepts Dr Corby’s PTSD diagnosis (or, strictly, “symptoms consistent with PTSD”) and her opinion that:

The plaintiff’s symptoms were genuine and clinically significant.
They were of mild to moderate severity over six years, worsening to a moderate level after homelessness.
With adequate treatment, they should substantially resolve within 1–2 years, allowing a return to work.

Having determined that 50% of the psychiatric condition is properly attributable to the accident, Ferriter J:

Values six years of mild–moderate PTSD on a pre‑Guidelines basis (noting that the Book of Quantum did not have specific PTSD entries) at €60,000 (€50,000 past + €10,000 future).
Halves this to €30,000 to reflect multi-factorial causation.

Two subtle points emerge:

The Court remains anchored to the Book of Quantum era, notwithstanding the later introduction of the Personal Injuries Guidelines, because these injuries arose pre‑Guidelines and the parties approached the case as a “Book of Quantum” case.
There is an explicit acknowledgement that psychiatric and physical injuries are interlinked – the Court notes that physical recovery was hindered by psychiatric symptoms, which is relevant when valuing both heads of damage.

3.2.6 Assessment of physical injuries and uplift

Using the Book of Quantum ranges for moderate neck and moderate back injuries (roughly €20,400 to €30,200 for each), and considering:

The relatively low‑impact mechanism of injury.
The plaintiff’s gym attendance and lack of serious objective findings.
The “mismatch” observed by Mr O’Riordan between complaint and presentation.
The fact that lingering pain was prolonged partly by psychiatric factors already compensated.

Ferriter J values the physical injuries by way of an uplift of €35,000 to the psychiatric award, broken down conceptually as:

€30,000 for past physical suffering.
€5,000 for future physical suffering.

He then “steps back” to ensure the resulting €65,000 general damages award is proportionate when viewed against:

The maximum damages cap of €500,000.
The spectrum of awards for mild–moderate PTSD and neck/back soft‑tissue injuries in the Book of Quantum era.

He concludes that €65,000 is fair, reasonable and proportionate.

3.3 Impact and Future Significance

3.3.1 Clarifying the boundary of the nervous shock regime

The most significant doctrinal impact of Sykula v O’Reilly is its clear affirmation that:

The Kelly v Hennessy/Harford v ESB “nervous shock” requirements do not apply to cases where the plaintiff has suffered any physical injury.
In such cases, psychiatric injury is recoverable as another head of consequential loss if:
- There is a recognisable psychiatric disorder (e.g. PTSD, depressive disorder); and
- It is caused (or materially contributed to) by the physical injury or the circumstances of the accident.

Practically, this means:

Defendants cannot escape liability for PTSD or similar conditions by arguing that a relatively minor accident was not objectively terrifying.
Once negligent driving foreseeably causes some personal injury, defendants are liable for psychiatric sequelae, subject to orthodox proof of causation and absence of break in the chain.

This clarification will be particularly important in:

Routine whiplash/soft-tissue injury claims where plaintiffs allege anxiety, phobias of driving, sleep disturbance or low mood.
Cases where defence counsel attempt to import “nervous shock” limitations into ordinary personal injury actions.

3.3.2 Strengthening the eggshell skull principle in psychiatric contexts

The judgment reinforces that the eggshell skull rule applies equally to psychological as to physical vulnerability:

Minor physical trauma may, in vulnerable individuals, precipitate significant psychiatric illness.
So long as some personal injury is foreseeable, the defendant is not excused because the outcome is idiosyncratically severe.

Ferriter J’s reliance on Walsh and Fletcher confirms that courts will not lightly treat such reactions as too remote, even when – as here – the accident was objectively minor.

3.3.3 Managing multi-factorial psychiatric injury: discounting rather than disallowing

Sykula provides a workable template for dealing with psychiatric injuries clearly influenced by powerful external stressors (homelessness, financial collapse, relationship litigation, pandemic isolation).

Rather than:

Dismissing the psychiatric claim altogether as being “really about” other problems; or
Holding the defendant fully liable for the entire psychiatric morbidity,

the Court:

Accepts genuine multi-causality.
Applies a percentage discount (50%) to the damages for that head of loss.

Future courts may draw on this approach when:

Plaintiffs have complex life histories with multiple interacting causal factors.
Expert evidence frankly acknowledges that an accident is only one of several substantial causes of a psychiatric disorder.

The judgment may also encourage litigants and experts to embrace more nuanced causation analyses rather than forcing “all‑or‑nothing” positions.

3.3.4 Practice points: disclosure, expert evidence and pleadings

Several practical lessons emerge:

Pre‑accident psychiatric history:
- Non‑disclosure or late disclosure (as here) damages credibility and may support judicial findings of exaggeration.
- However, where contemporaneous records ultimately clarify the picture, the court may still accept a core claim while discounting its severity.
Defence expert evidence:
- Despite late introduction of a PTSD argument, the defendant did not field a psychiatric expert to counter Dr Corby.
- The Court clearly relied on the uncontradicted psychiatric evidence; future defendants may need to ensure psychiatric expertise is actually called where mental health causation is disputed.
Pleadings and timing of PTSD claims:
- The judge notes the late emergence of PTSD as a formal head of claim and finds it “unimpressive”, but does not treat it as fatal.
- This underscores that while late evolving diagnoses are not inherently abusive, parties should regularise pleadings promptly to avoid prejudice.

3.3.5 Quantum and the transition from Book of Quantum to Guidelines

Although the Personal Injuries Guidelines are now in force, this case remains rooted in the Book of Quantum era, reflecting:

The pre‑Guidelines date of injury (2017).
The relevant appellate authorities (e.g. Meehan) treating the Book as the appropriate yardstick for older claims.

Nonetheless, the method used – identify the primary injury, value it, uplift for lesser injuries, then “step back” in light of proportionality – is fully consistent with the Guidelines framework and is likely to remain relevant to mixed physical/psychiatric cases going forward, even under the new regime.

4. Complex Concepts Simplified

4.1 The eggshell skull rule

The “eggshell skull” rule is a long‑standing principle in tort law. It means:

If a defendant negligently causes some injury, they are liable for the full extent of the injury actually suffered, even if the plaintiff has an unusual vulnerability that makes the injury much worse than anticipated.
The defendant must “take the plaintiff as they find them” – emotionally, physically, psychologically.

Example: If a light blow to the head causes a serious brain haemorrhage because the plaintiff has a rare blood vessel abnormality, the defendant is still liable for the full damage. In Sykula, the principle is applied to psychiatric vulnerability: a relatively minor collision led to significant PTSD‑type symptoms because of the plaintiff’s psychological makeup. That does not absolve the defendant.

4.2 Nervous shock and Kelly v Hennessy

“Nervous shock” is a legal term (now somewhat outdated) for pure psychiatric injury where there is no physical injury. The classic example is a person who witnesses a horrific accident injuring a loved one and suffers a psychiatric breakdown from the shock, despite not being physically harmed themselves.

In Kelly v Hennessy, the Supreme Court laid down strict conditions for when such claims can succeed, including:

The plaintiff must have a recognised psychiatric illness (not just grief or upset).
It must be caused by a sudden shock.
The shock must arise from seeing or hearing about death, injury or the immediate aftermath affecting someone close to them.
The psychiatric injury must have been reasonably foreseeable.

In Sykula, those strict conditions do not apply because the plaintiff did suffer physical injury. Her case is, legally, an ordinary personal injury claim with physical and psychiatric components, not a nervous shock case.

4.3 PTSD and DSM‑V

PTSD (Post‑Traumatic Stress Disorder) is a recognised psychiatric disorder, defined in the DSM‑V (the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition). Key features include:

Having experienced or witnessed a traumatic event involving actual or threatened death, serious injury, or sexual violence.
Re‑experiencing the event in nightmares, flashbacks or intrusive memories.
Avoidance of reminders of the trauma.
Negative alterations in mood and thinking.
Increased arousal (e.g. hypervigilance, irritability, sleep disturbance).

In this case:

The psychiatrist considered the rear‑end collision sufficiently traumatic in the plaintiff’s subjective internal experience to meet the DSM‑V exposure criterion.
The Court accepted this expert view and treated the plaintiff’s condition as PTSD or at least “consistent with PTSD”, satisfying the requirement of a recognisable psychiatric illness.

4.4 Causation and “multi-factorial” conditions

“Multi‑factorial” means that a condition (here, a psychiatric disorder) has several significant causes, each contributing to its onset, severity, or duration.

Legally, this raises two distinct issues:

Did the defendant’s wrongdoing materially contribute to the condition?
Even if non‑tortious factors (like homelessness or bereavement) also played a role, the defendant is liable if their negligence is a real, not trivial, cause.
How much of the damage should be attributed to the defendant?
Courts may:
- award full damages if the other causes would not have produced the harm on their own; or
- discount damages where the evidence supports a rough division of responsibility, as in Sykula’s 50% allocation.

4.5 General damages and proportionality

“General damages” compensate for pain, suffering and loss of amenity – the non‑economic aspects of an injury. Irish courts must ensure that:

Awards are fair and reasonable to both plaintiff and defendant.
They are proportionate to:
- the statutory cap on general damages (currently €500,000 for the most catastrophic injuries); and
- awards for similar injuries in other cases.

In multiple‑injury cases the court:

Identifies the most significant injury.
Values it with reference to guidelines and comparable awards.
Uplifts that figure to account for additional injuries, avoiding simple addition of separate values (which risks over‑compensation).
Steps back to assess overall proportionality.

Ferriter J followed exactly this approach in arriving at €65,000 for combined psychiatric and physical injury.

5. Conclusion

Sykula v O’Reilly is an important High Court decision at the intersection of personal injury law, psychiatric injury and causation. It establishes or clarifies several key propositions:

Where a plaintiff suffers both physical and psychiatric injury, they do not have to satisfy the restrictive Kelly v Hennessy/Harford criteria for nervous shock. The “shocking, horrifying, calamitous event” test is reserved for pure psychiatric injury without physical harm.
The eggshell skull principle applies robustly in psychiatric contexts: defendants must accept plaintiffs with pre‑existing psychological vulnerability and cannot avoid liability merely because the psychiatric sequelae of a minor accident are unexpectedly severe.
At the same time, courts are entitled to recognise that psychiatric conditions are often multi‑factorial. Significant non‑accident stressors (such as homelessness and Covid‑related isolation) can justify a percentage discount in damages for psychiatric injury without breaking the chain of causation.
Assessment of general damages in multiple‑injury cases must follow a structured, proportional, and holistic methodology, anchored in appellate guidance like O’Sullivan and Meehan.
Credibility issues – including exaggeration and late disclosure of prior psychiatric history – will impact on quantum and judicial findings but will not necessarily defeat a claim if core causation is supported by medical evidence.

In broader terms, Sykula demonstrates a realistic and nuanced judicial approach to modern personal injury litigation: it acknowledges the complexity of mental health causation, faithfully applies existing doctrinal boundaries, and calibrates damages in a manner that is simultaneously compassionate to the plaintiff and fair to the defendant.