Claims of Posttraumatic Stress Disorder in civil litigation have increased in recent years. These are often supported by a letter or report from a therapist and/or an independent evaluator retained by the Plaintiff’s attorney. However, it is important for forensic evaluators, whether retained by the Plaintiff or the Defense, to understand the criteria for PTSD so as to make that diagnosis where it does apply, but also to recognize where it does not apply.
The DSM-IV-TR initial criteria for PTSD is:
A. The person has been exposed to a traumatic event in which both (italics mine) of the following were present:
- The person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others;
- The person’s response involved intense (italics mine) fear, helplessness, or horror.
Criteria A refers to the precipitating event. The remaining criteria deal with the symptoms. Certain classes of stressors may clearly meet Criteria A. These would include serious motor vehicle accidents, sexual assault/abuse, physical assault, natural disasters, etc.
There are other stressful situations that have been used by some clinicians as a basis for the PTSD diagnosis which clearly do not meet Criteria A. While being fired from a job or harassed, discriminated against, or retaliated against in the workplace may be “traumatic” in the layman’s use of the term, it does not meet Criteria A for PTSD unless physical harm is threatened or implied. Therefore, while the individual may have depressive and/or anxiety symptoms that can be classified under one of the Adjustment Disorder diagnostic categories, they cannot be legitimately diagnosed with PTSD.
Both general personality tests and tests specific for PTSD can be helpful in making the diagnosis, and also in determining whether an individual is exaggerating the frequency and/or the severity of genuine symptoms or, in the extreme, is malingering symptoms that do not exist at all. The MMPI-2 is the most widely used general personality test. It has scales that are reflective of anxiety, and therefore may produce information that is consistent or inconsistent with PTSD. This test also has nine validity scales which can help assess whether the individual is responding candidly or is over reporting symptomatology.
The most widely used measures specific to PTSD is the Detailed Assessment of Posttraumatic Stress Disorder (DAPS). This test has scales specific to PTSD symptoms (e.g. Re-experiencing, Avoidance, etc.), but also has a Negative Bias Scale and a Positive Bias Scale to assess whether there is minimization or exaggeration of symptoms. These tests, along with others, may be helpful in assessing the presence or absence of PTSD. However, the diagnosis is made on the basis of the DSM-IV-TR behavioral criteria, not on the test results.
In our modern world there is also an additional technique that is useful in assessing the validity of symptom complaints. If the person has a Facebook account this should be subpoenaed. Typically, a person puts pictures and status updates on their page. In addition, all of their friends can do the same. For example, in a recent case, a man alleged that because of his anxiety he had become socially withdrawn and was no longer involved in sports activities or social relationships that he was involved in prior to the incident. However, his Facebook account revealed participation on several athletic teams and attendance at parties (Halloween in costume, St. Patrick’s Day Pub Crawl, etc.), sporting events such as professional football games, and other activities. Many of the pictures showed him happy and smiling, surrounded by his friends. Along with exaggeration on both the MMPI-2 and the DAPS, this provided convincing evidence that these claims of impairment and functioning were greatly exaggerated.