Issues In Forensic Psychology - Post-Traumatic Stress Disorder

ISSUES IN FORENSIC PSYCHOLOGY
Post-Traumatic Stress Disorder

Because life sometimes imitates art more than vice versa, both Hollywood and the general public have long assumed that traumatic experiences result in psychological distress. This assumption received formal diagnostic recognition via the inclusion of Post-Traumatic Stress Disorder (PTSD) in the Diagnostic and Statistical Manual of Mental Disorders-Third Edition (DSM-III, 1980). In fact, however, the diagnosis of PTSD involves numerous definitional problems.
Diagnosing PTSD obviously necessitates exposure to a stressful event, but the definition of such events has progressively changed over time. DSM-III only required a "... recognizable stressor that would evoke significant symptoms of distress in almost anyone." DSM-III-R, published in 1987, specified that the stressful event fall "... outside the range of normal experience and that would be markedly distressing to almost anyone ..." The current DSM-IV (1994) defines a stressful or "traumatic event" as one in which both of the following were present: "(1) the person experienced, witnessed, or was confronted with an event or events that involved actual threat or threatened death or serious injury, or a threat to the physical integrity of self or others, (2) the person's response involved intense fear, helplessness, or horror."
Quite clearly, PTSD criteria have become progressively more exclusionary between 1980 and the present. In other words, some cases qualifying for a diagnosis of PTSD per DSM-III criteria would not qualify per DSM-III-R criteria, and still other cases qualifying per DSM-III-R criteria could be excluded via DSM-IV criteria. Many psychologists and psychiatrists, however, remain unaware of the changes in PTSD criteria from 1987 to 1994. As a result, they continue to rely on the more liberal 1987 criteria.
Post-Traumatic Stress Disorder is an unreliable diagnostic classification because it depends excessively on clinical judgment and patient report. A 1994 study, for example, reported that 86% of naive subjects knew which symptoms to endorse to qualify for a DSM-III-R diagnosis of PTSD.
The diagnostic criteria for PTSD also are not particularly objective. For example, many of the defining symptoms of PTSD are not specific to that diagnosis. Defining features of PTSD such as problems in attention or concentration are common to 32 other diagnostic categories, "irritable mood or irritability" are common to 23 other categories, and "insomnia" is common to 32 other diagnostic classifications.
Because PTSD is such a poorly defined diagnostic category, clinicians can easily conclude - in response to their a priori expectations - that a given client qualifies for this diagnosis. Clinicians who sympathetically overidentify with their clients are especially apt to misdiagnose in this manner.
The relevant data indicate that the prevalence of PTSD is less frequent than most clinicians assume. A study of a representative sample of women (N=4008) found that 69% of the sample experienced some traumatic event over the course of their lives. Only 9.4% of this sample, however, developed PTSD; indicating that PTSD is a relatively rare occurrence even when specific stressor criteria are met.
When commenting on the damages supposedly associated with PTSD, psychologists and psychiatrists frequently insist that this condition necessitates long-term, intensive therapy. A review of the relevant data, however, indicates otherwise. Patients suffering from chronic nightmares, for example, responded quite well to a treatment protocol of only six hours of therapy. A follow-up of these patients found that 75% reported either total cessation of the nightmares, or at least great improvement. Related research reported significant symptomatic relief for individuals diagnosed with PTSD after only three forty-minute sessions.

If you would like to know more about Post-Traumatic Stress Disorder (PTSD), you may want to order the following publication authored by Dr. Campbell.

"Cross-Examining Psychologists and Psychiatrists as Expert Witnesses." This is a 79-page, single-spaced outline, containing 214 footnoted references. This outline is bound. (Order article #15, cost $59.00).

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