TSD and its impact often is the basis for a personal injury claim. What is PTSD and when it should be referred for assessment are the subject of this presentation.
Definition & Quantity Effect
PTSD is a term that is commonly (and occasionally incorrectly used) to define a psychological event or injury.
According to the DSM-5 it is in brief a normal response to an abnormal event!
PTSD occurs when an event is experienced or witnessed which involves actual or threatened death or serious injury. Such events involves a physical threat to themselves or others. The effects are numerous in that the traumatic event is re-experienced by way of intrusive thoughts, images or perceptions or recurrent dreams of the event. Typical events include:
- serious accidents
- forensic trauma
The sufferer persistently avoids reminders of the trauma and the individual becomes numb and lacking in general responsiveness. Symptoms include:
- persistent increased arousal
- difficulty concentrating
- chronic anxiety and
- physical symptoms of anxiety
The individual exhibits an exaggerated startled response. Phobias might be present as are feelings of detachment and irrational or impulsive behavior.
PTSD is thought to be a response to a major traumatic event but is also associated with an accumulation of small events. A common form of PTSD is called “Complex PTSD” –it is associated with long term and cumulative stress. This form is associated for example from long term abuse or neglect as well as persistent bullying or unresolved grief. PTSD is a psychiatric disorder and not the result of personality or other organic disorders. It is also common that a person might seemingly recover from a significant trauma and then be reactivated by a less significant event. This is common in the military, fire brigade or police.
Although PTSD is historically significant (e.g. shell shock) it was not until about thirty years ago that it began to be recognized within the legal system. Although PTSD is commonly discussed there are those attempt to discredit or deny its existence.
How is PTSD Diagnosed?
There are specific diagnostic tests which diagnose the disorder and reinforce and/or reinforce the validity of clinical assessment. In ascending order,
- Commonly utilized is “The Impact of Events Scale” and this assesses whether the individual fits the diagnostic criteria of PTSD.
- “Traumatic” (TOM) is a specialized lengthy test which provides more extensive information about the diagnosis and its symptoms.
- PTSD is able to be objectively diagnosed by
- Using in-depth (gold standard) testing such as the “Personality Assessment Inventory” (PAI) which looks in detail at the diagnosis, symptoms and treatment. Furthermore the PAI has four validity scales designed to demonstrate valid reliable results.
It is noteworthy that psychological assessment which utilizes reliable testing provides objective evidence and support for a clinical diagnosis such as a psychiatric assessment.
What are the Vocational consequences of PTSD?
In a word profound and long lasting!
The symptoms of PTSD often preclude individuals from participating in the workforce. If the individual manages to resume employment they tend to be prone to experience symptoms of PTSD which can disrupt their progress in the workforce.
Some of the symptoms which affect employment are concentration difficulties, excessive fatigue; lack of interpersonal trust resulting in conflict within the employment context. An example might be an individual who is unable to sustain employment. Employment instability is frequently due to conflicts with superiors or colleagues. Lives are often plagued with marriage and family difficulties often due to interpersonal sensitivity and an inability to cope with stress.
Many of these consequences are not immediately apparent to an observer. This is particularly evident in the case of chronic or cumulative PTSD. Sufferers might not be particularly reliable employees due to stress or depressive illnesses. It is little wonder that individuals with PTSD have difficulties in the workplace which will impede their progress and material success.
Employability/Vocational Assessment – Why?
Once PTSD has been diagnosed and verified via testing it is necessary to quantify its effect on the individual! A vocational assessment examines the effect of PTSD on employment and the ability to earn a living. It aims to quantify the effects of PTSD on employability and economic loss. Furthermore, the effects of PTSD can persist for a very long time as its effects often manifested in the future and often the distant future.
An example of this can be demonstrated in the case of a gentleman who was featured in the recent Royal Commission into Institutional Abuse. This unfortunate man had been sent to an institution at an early age and was subjected to long term sexual and physical abuse. Despite his disadvantage he gains trade qualifications and by all accounts is an excellent trade’s man.
At the time of the assessment this man was seventy years of age and many years on from his abuse he continued to suffer from the effects of PTSD. His employment history was enlightening in that he could secure employment easily and was considered a good tradesman but found it exceedingly difficult to sustain employment. He preferred solitary workplaces which is hard to find in a trade environment. He has frequent conflicts with superiors and colleagues and was very sensitive to perceived slights and this caused him to leave job after job and move from town to town all over Australia. To quantify he had
worked for 30 different employers and lived in twenty four different towns. He did not stay in a job long enough to reach higher levels of work or self -employment. In his retirement he lived in an isolated part of Tasmania. He had poor relationships with his wife and adult sons.
He continued to suffer from psychological symptoms of PTSD and presented as a very sad, depressed, bitter man. Although it is difficult to make an economic loss claim resulting from personal difficulties the effects of PTSD on employment can indeed be quantified in monetary terms.
In summary the definitive diagnosis of PTSD and its effect in financial terms via Psychological and Vocational Assessment central in the legal context.
Note about the author.
Raynor Lander, principal of Psychs at Work Assessment Services has over 25 years’ experience in therapy and medico-legal assessments. This combination of experiences provides an essential base for the understanding of the requirements of assessments.