PTSD… misunderstood
Gerald Lewis, Ph.D.

Post-traumatic Stress Disorder (PTSD) is often misunderstood. Originally delineated in the Diagnostic Statistical Manual III (DSM III) in 1980, it noted a unique clinical state for individuals who experienced a "... recognizable stressor that would evoke significant symptoms of distress in almost anyone." In 1994 the DSM IV changed the criteria to “significant event(s) that involved actual or threatened death or serious physical injury to them or to others, and also the experience of intense fear, horror or helplessness.” Unfortunately, the diagnosis of PTSD has continued to take on an expansive and often malapropos utilization.

Perhaps as an outgrowth of 24/7 news casting, it seems western society have developed a penchant for bearing witness to an increasing barrage of crises, traumas and disasters. While one may experience a “trauma” or feel “traumatized” by an event, these terms are not clinical diagnoses. Further, not all individuals experiencing a trauma that meets the experiential criteria manifest the requisite symptoms to establish a diagnosis of PTSD. In fact, many individuals may survive with little emotional reactions while some may become clinically depressed or develop a wide range of anxiety-based disorders. Others may never demonstrate any of these symptoms as they “manage” their reaction(s) by developing a substance abuse problem. Estimates are that approximately 15-25% of survivors of trauma will develop PTSD. And, within that diagnosis, there is a wide range in the level of disruption and damage to the individual.

Why is this an important issue for lawyers representing victims of crime and other traumas? First, there is a range of diagnoses that may cause significant impairment as a result of victimization; depression, substance abuse, panic and anxiety disorders, obsessive compulsive disorders are some of the more common diagnostic monikers. Second, PTSD is a complex diagnosis that may be inappropriately applied. If this happened, it could leave the case vulnerable to attack by the opposing party. Third, it is essential to have the client evaluated by an independent professional capable of determining the appropriate diagnosis and the subsequent level of impairment, if any. Fourth, attorneys should utilize the expertise of the independent clinical professional to determine an accurate diagnosis of the client and also to aid in the preparation of the case.

Finally, even if the client is receiving treatment from their own therapist, an independent evaluation should be conducted to ensure an accurate assessment of both the individual as well as the treatment.