Psychiatry's problem child: PTSD in the forensic context: (part 1).

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.