Psychiatry's Problem Child: PTSD in the Forensic Context: (Part 1)

Abstract

Objective: The aim of this paper was to consider some of the recent literature that has raised questions about the prevalence of, and problems with, post-traumatic stress disorder (PTSD) in the forensic context and whether it is a failure by experts to consider adequately Criterion A (1), which leads them into error and results in a skewed picture of the prevalence of PTSD in litigation. Method: The nature of the stressor criterion for PTSD from DSM-III to DSM-IV-TR, and recent literature relating to problems with the manner in which that stressor criterion is applied in forensic contexts, are considered. Results: It becomes clear that, notwithstanding that the class of persons who can suffer PTSD after a particularly traumatic event has widened since it was included in the DSM-III, the nature of the stressor required before a diagnosis of PTSD can be made has remained fairly constant. Conclusions: Whether it is because PTSD is commonly associated with receiving a benefit (e.g. through post-war disability benefits, victims of crime compensation or because of a desire to use it as an ideological weapon), PTSD has become a ubiquitous presence in the forensic context, notwithstanding objective (i.e. non-forensic) clinical studies which refer to its rarity. It is clear now that PTSD symptoms can be readily simulated when the simulator is seeking a benefit. It is also becoming clear that some psychiatrists are not being as rigorous in the forensic context as they might be in a clinical context. Thus, with discussion now underway regarding DSM-V, it may be timely to reconsider the utility of PTSD as a clinical condition.