Pitfalls in Psychological Injury Claims
Although only an expert in psychological injuries and PTSD can draw conclusions about the veracity of psychological injury claims, it is helpful to know about some of the pitfalls that can arise when PTSD is assessed or treated in the context of disability and injury claims. Here are just some examples:
Pitfall #1: The Unsatisfactory Interview
A flawed clinical interview can lead to two types of diagnostic errors: a diagnosis of PTSD being made when PTSD does not exist; and, a diagnosis of PTSD being missed when PTSD does exist. Some of the critical mistakes that lead to these errors in PTSD assessment include:
- Not asking an individual about “Criterion A” (which is considered the “gatekeeper” in PTSD diagnosis). This requires a determination of whether the person experienced, witnessed, or was confronted with a potentially traumatic event and that the person’s emotional reaction at the time of the event involved a sense of fear, helplessness or horror.
- Not asking or having misunderstandings about the expression of PTSD symptoms.
- Not determining that the person experiences significant emotional distress and functional impairment as a direct consequence of the event.
- Inadequate inquiry about a person’s emotional status and functioning before being injured.
Pitfall #2: An Absence of PTSD Complaints Does Not Necessarily Mean an Absence of PTSD
If collateral documents, treatment notes and medical reports do not contain complaints related to the specific symptoms of post traumatic stress, evaluators can mistakenly jump to the conclusion that a person does not have PTSD. These records can be problematic because it is often the co-occurring problems that drive PTSD patients’ (or family members’) complaints, including excessive alcohol use, marital/relationship problems, persistent irritability and anger, sleep difficulties, mood problems, workplace disability, etc. This is why a systematic mental health review by a clinician with expertise in PTSD is critical in determining the presence or absence of PTSD.
Pitfall #3: Sole Reliance on Clinical Experience and Patient Self-Reports
Reliance on clinical experience and patients’ self-reports can lead to many different types of subjective biases and inaccurate conclusions. For an evaluation to be effective and objective, a clinician should adopt a “multi-method” approach that includes thorough clinical interviews, a battery of standardized psychological questionnaires with multiple indicators of response bias, structured interviews that have been developed by experts in the field, collateral data and reports, and an understanding of how the evaluation results reflect the current scientific literature.
Pitfall #4: The Effectiveness of Available Treatments Versus the Availability of Effective Treatments
There are many providers who claim that they treat trauma and PTSD. Unfortunately, the vast majority of treatment providers do not offer those treatments that have been demonstrated to provide significant reduction in PTSD symptoms. In a recent survey in the United States, as many as 85 percent of those claiming a specialization in treating psychological trauma do not offer treatments using exposure-based methods, which have been shown to provide the greatest symptom reductions. A lack of training, a reluctance to engage in these potentially distress-provoking strategies, favouring other types of therapies that are not scientifically supported, and limited financial coverage for psychological services may all be factors in only a few clinicians using the best treatments for PTSD.