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Posttraumatic Stress Disorder (PTSD), a type of
anxiety disorder that sometimes follows exposure to an "extreme
traumatic stressor", is manifested by the following:
 | Persistent re-experience of the traumatic
event in the form of nightmares and fear-evoking memories |
| Avoidance of thoughts, feelings and
activities that symbolize the trauma |
| Increased arousal which may take the form of
sleep problems, anger, concentration problems or exaggerated
startle response |
PTSD may be one of the most common diagnoses
assigned to plaintiffs in personal injury suits. Unfortunately, this
diagnosis is often misapplied. Some of the main reasons why a
diagnosis of PTSD may be incorrect have to do with the context in
which the diagnosis is typically made.
When a litigant is alleging that emotional distress has been caused
by a traumatic event, the litigant may seek mental health services
treatment from a treating psychologist, psychiatrist or social
worker. These mental health providers tend to function as follows:
| They may "bond" with their patients and tend
to accept, uncritically, what their patients tell them |
| They often do not administer psychological
tests because this is thought not to be a good use of their
patient's "treatment" time |
| If they do administer psychological tests,
they are often brief, "projective" or "self-administered" and
may include the Rorschach test, the Beck Depression Inventory or
the SCL-90-R; scientific studies show these tests are not useful
because of problems with accuracy and because positive findings
can be easily faked |
| Because of the time constraints involved in
mental health treatment, and the tendency for treatment service
providers to bond with their patients, they rarely consider the
possibility that their patient may be exaggerating or faking
emotional problems ("malingering") |
| Mental health patients and their therapists
may believe that questioning their a patient's truthfulness and
investigating the possibility of malingering is a breach of
trust or "boundary violation" and is harmful to the
doctor-patient relationship |
Mental health therapists may over-utilize the
diagnosis of Postraumatic Stress Disorder with patients who are also
litigants because:
| This diagnosis seems, conceptually, to "fit"
with the litigant's claim of being damaged by a trauma |
| PTSD is one of the relatively few diagnoses
found in the DSM-IV that is specifically related to traumatic
events |
| PTSD is one of relatively few diagnoses found
in the DSM-IV that depends primarily upon the patient's
allegations, rather than upon objective findings |
| PTSD is a well-known diagnosis that feels
comfortable for the service provider |
| The litigant may have been coached by his/her
attorney to provide a history and symptoms consistent with this
diagnosis |
| The service provider may feel pressure from
the patient or from the patient's attorney to provide a
diagnosis of PTSD |
Because the diagnosis of PTSD is sometimes made in
error, a careful determination should be made to determine if there
is a sound basis for such a diagnosis. Following are some
suggestions that will aid in such a determination.
The defense attorney, insurance company or IME company should select
mental health experts who are very familiar with the PTSD diagnosis
and aware that malingering is always a concern and must be
identified or ruled out when emotional distress is alleged within
the context of a lawsuit.
Good mental health defense experts have the following
characteristics:
| They meet with examinees for extended periods
of time (longer than 50 minutes) in order to observe their
behavior under conditions of stress and fatigue |
| They do not "bond" with examinees; instead
they maintain objectivity, are critical of even
reasonable-sounding statements made by the examinee and conduct
examinations in order to seek facts that can aid claims
examiners, judges and juries in determining the veracity of
emotional distress complaints |
| They usually administer psychological tests
because this is one of the best ways of obtaining objective
information about the examinee |
| They select psychological tests, such as
MMPI-2, that utilize "validity" scales that are able to identify
exaggeration and faking of emotional distress |
| They combine findings from psychological
testing with those from interview material and medical records
in order to test out diagnostic hypotheses about examinees |
The Minnesota Multiphasic Personality Inventory
(MMPI-2) is one of the best psychological tests to use in forensic
psychological exams because:
| The MMPI-2 is one of the few psychological
tests that contain "validity" scales that have been shown, via
controlled studies, to be effective in identifying exaggeration
and faking of emotional distress |
| There have been 10,000 books and articles
written about the MMPI-2 attesting to its reliability, validity
and usefulness in various contexts |
| The MMPI-2 has been translated into many
languages; it is a tool that can be used with a variety of
populations |
| The MMPI-2 has specific scales that are
useful in identifying or casting doubt upon the specific
diagnosis of Posttraumatic Stress Disorder |
| Results of the MMPI-2 have been admitted as
evidence into Federal and State courts including those in
Michigan and Massachusetts.123
(These legal citations were found in Pope, K.S., Butcher, J.N. &
Seelen, J. The MMPI, MMPI-2 & MMPI-A in Court: A practical guide
for expert witnesses and attorneys. American Psychological
Association, Washington, D.C., 1993). |
A forensic psychological examiner who takes a
careful history, scrutinizes the medical records and uses
psychological tests containing validity scales is in the best
position to determine if a diagnosis of PTSD is accurate or not.
1
Commonwealth v. Goulet, 402 Mass. 299, 522 N.E. 2d 417 (Mass. 1988)
MMPI administered to defendant, whom doctor opined was "faking bad".
2 Commonwealth v. Meech, 403
N.E. 2d 1174 (Mass. 1980). MMPI used to evaluate defendant on behalf
of the defense.
3 Anderson v. MK-Ferguson Co.,
191 Mich. App. 129, 477 N.W. 2d 465 (Mich. App. 1991) Employee who
was terminated because of his MMPI scores brought action for
damages. Personal representative of former employee appealed. |
