News Do You Think Ptsd Criterion A Should Be Proven Before Diagnosed?

[anthony]

Here is an interesting debate topic that I have thought about for many years now, whether or not PTSD criterion A should be proven prior to a diagnosis being given. The military already do this, hence the military is one area where PTSD is not just given, but more has to be substantiated through documentation of location served, incident reports, service history and so forth.

The reason I raise this, is because PTSD is the only diagnosis in the entire mental health doctrine where for legal purposes, the burden of proof is already provided in criterion A. So if having this diagnosis has legal implications in a court, then why shouldn't the diagnosis be first scrutinized to meet such burdens of proof to begin with before being given?

It is becoming more and more common for people trying to falsely obtain a PTSD diagnosis to use in upcoming legal battles as an excuse for their actions or to mitigate themselves, or obtain compensation that their not rightfully entitled too.

I believe this could be easily done even in the civilian populous, through requirement of reporting events to police for investigation, accident documentation can be used that the trauma did exist, other family members can be used to ascertain the validity of abuse to a child, etc etc.

What do you think about the reality of this, taking into account, PTSD is not like any other diagnosis in the world, as it is the only one that meets a legal burden of proof just by having been given it, which states you have endured a traumatic event, by nothing more than your word, without any evidence, not even another family member to substantiate some event or suspicion of event/s that occurred.

Me personally, the more I think about this, and having to meet this criterion of proof myself with the military to be given a PTSD diagnosis based on the traumatic events that I endured, I would have to say yes, I think it would be suitable to atleast require some type of proof to substantiate claims made, even the most simplest, being incidents are reported to police so police can investigate. Maybe more real criminals (abusers), would be put away, outed, shamed and have records, compared to just being an unknown offender.

What do you think?

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[shadowchaser]

Because of my own situation I have seen and heard of many in my area who use the ptsd title as it is to get away with criminal activities and even acquire benefits from the government. Because of the lack of proof required to receive a diagnosis those who do have the condition are often put into a bad light. As I experienced in court even the local judges do not take ptsd as a true condition because of the amount of fraud surrounding it.

Requiring proof of condition would reduce the number of fraudulent individuals using this condition to defraud local agencies.

There must be accommodations made for the type of proof required. Many may find this extreme but in situations where no legal evidence of abuse can be found a 30 day hold in a licensed facility may be used in order to determine evidence needed for a proper diagnosis.

Yes I understand where such a thing may be very triggering for individuals but also helpful. If there are less people who claim this ailment who do not truly suffer from it then there should in theory be more assistance available for those who legitimately require it.

 

[anthony]

If there are less people who claim this ailment who do not truly suffer from it then there should in theory be more assistance available for those who legitimately require it.

That's what I'm thinking as well... abuse stems less support and ignorance to legitimate cases.

 

[Reclusive]

Some situations are hard to provide proof, though. For instance, my workplace harassment that went on 7 years, that I thought was being recorded by HR, never was and I was too naive to document it myself. I'm still in touch with a couple ex-coworkers who might be able to testify. What happened with my mom was in the newspaper, so I guess that would be simple to justify.

My biggest worry are cases like my friend's. She was raped at a nightclub and the police laughed at her and didn't even write a report. Families cover up abuse all the time, so family members aren't a very reliable source. It's a good idea on some fronts - I myself asked here on the forum if I'd even been through enough so I know what that web looks like - but there is a definite possibility for people to fall through the cracks.

 

[anthony]

I believe reporting it to the police formally, making them document it, which they must do, even if one officer dismisses you, one will eventually do their job and record it. Atleast that has some formality to it... becomes recorded, and then if a pattern emerges, police will see it, removing another criminal, and when faced with having to report to police, people tend to think twice on their validity of trying to run scams. I really like:

Many may find this extreme but in situations where no legal evidence of abuse can be found a 30 day hold in a licensed facility may be used in order to determine evidence needed for a proper diagnosis.

Mental health doctrine clearly states a time frame of repeated appointments and assessment before a PTSD diagnosis can be made, yet many seem to just get it walking in the door these days, as physicians have lost scope of their implications of such upon the community at large, and instead only thinking about their own pockets, whether directly or via kickbacks for prescriptions and referrals.

Such assessments could be accurately ascertained with even a 14 day hold within a facility when no evidence exists.

 

[redfox]

It makes sense in theory but I think in practice it could become problematic. With things like rape and abuse, it would probably hinder more than help... what if someone is suffering PTSD from being raped, but did not report the rape at the time (not knowing all the ins and outs of a mental health system they would have no reason to know about prior to the rape) and then cannot get a diagnosis because of the lack of police report? People have a lot of reasons, good and bad for not making formal reports and it seems like this would be denying them help.

Also there are situations like mine, where yes I am sure they could easily find records saying that the person I claimed died did in fact die and did so in the way that I claimed, but there would be no record or report of the other related circumstances that I believe are what led me to develop PTSD. So in this theoretical scenario I could be denied diagnosis and treatment because there is no corroboration or report of my claims. You say family members can be asked, but that opens up a HUGE can of worms for those of us who do not get along with our families or for those whose families caused the PTSD in the first place.

From a military standpoint this makes sense because if your trauma is military there is presumably a paper trail recording your location at specific times and specific events that happened during those times, so there's no reason NOT to check when that should all be there in the first place. But outside that scenario it becomes really complicated and though fraud is a real issue, i think the bigger issue would be denying diagnosis to people genuinely suffering either because they cannot provide documentation, or, more likely, they are scared or intimidated by a stance that seems to invalidate their claims from the beginning. To someone who is seeking treatment it can easily look like "guilty until proven innocent" and I know that if I had to go into treatment with a binder full of police reports and death certificates and prove of relationship to the deceased and letters from my family saying I was there (as if I could actually get these...) I would have never done it in the first place. And if I was going to be held at a mental hospital for two weeks if I couldn't prove it I absolutely would NEVER have gone !!

 

[shadowchaser]

I agree with required time frame for assessment. Not every incidence of abuse can be proven threw court records. With mine the case was thrown out. This was done due to my mother manipulating me into dropping the charges. When I turned 18 and was free of the influences of an abusive home I tried to go back and reopen the case and was told that due to the statue of limitations nothing could be done. After talking to 7 different individuals including the chief of police I gave up more traumatized for the experience.

I'm using my own experiences as an example because they are the ones easiest to recall. There are several people that have been mentally damaged by this one person but due to the current statue of limitations those who suffered as a child are unable to bring their abuser to court after they are free from the situation.

The best option I can think off without rewriting the laws themselves is a required time of institutionalization. During this time there could be multiple benefits for the individual involved. This includes medication adjustment and the start of a therapy routine.

 

[redfox]

I want to point out that most people can't just drop their life for 2 weeks to be institutionalized.. not to mention the stigma attached and the fear or revulsion many people would have at this possibility. I am sure some people who come to this thread would be fine with it but I have a job that I could not afford to miss 2 weeks of and I would never allow myself to be institutionalized simply to recieve a diagnosis that can be treated in outpatient therapy.

 

[Cheshire]

This is a tricky one. Overall I agree that there should be a requirement to prove in some way the trauma that has caused your PTSD. Because the symptoms of PTSD are so similar to other mental illnesses and disorders, it seems to me that there should be more stringent guidelines on how to diagnose and when to diagnose it. This would also (hopefully) limit the number of self-diagnosed cases of PTSD, and as shadowchaser said, allow for more assistance to people who legitimately require treatment for PTSD.

As things stand, PTSD seems to be gaining a reputation like that of depression or chronic fatigue; something that doctors diagnose to cover a large number of issues, a blanket diagnosis that often has no basis in the reality of the situation. Because of that, it is being frowned upon and overlooked by society as something that isn't as serious as it actually is.

As others have mentioned already though, it is difficult for a lot of cases to prove their trauma. Someone who has been abused throughout their childhood with no family witnesses, or lack of family belief, or any number of other possibilities, obviously has just as legitimate a trauma and trauma-related stresses as a person who has, for example, been a documented physical assault trauma or the like, but it's harder to prove.

From that point of view, it seems that PTSD as a diagnosis would need to be split into categories and defined clearly in DSM etc, and then have guidelines as to how to go about proving those things.

Perhaps a way of proving undocumented trauma would be to delay official diagnosis until a period of assessment has been completed. Psychological observation and assessment would have to be involved here, for whatever period is deemed appropriate, in order to observe and document the specific symptoms a person suffers - a checklist, essentially, covering things like depressive and anxiety-related symptoms as well as flashbacks, nightmares, all the other various things that stem from trauma-related incidents. I guess one way of testing for things such as nightmares is to require possible PTSD sufferers to undertake a sleep test where their sleeping patterns are monitored, and then having them recording their dreams immediately upon waking. I don't know, it gets really tricky around this area.

Anyway.. back to the original point. I agree, there should be a method by which Criterion A needs to be proven before any further diagnosis is undertaken.

 

[shadowchaser]

I do understand this and see your point but if there are no systems put in place to screen those claiming ptsd then how do you propose determining those who claim this ailment from those who have it. Unfortunately all you have to do to receive a ptsd diagnosis is attend weekly sessions with a mental health professional and report symptoms during each visit. There is no true proof required. I would gladly sacrifice a few weeks of my life if it meant proving legitimacy of my own issues. Also for the security of less people defrauding others by falsely claiming this ailment for various reasons.

 

[redfox]

Well the same could be said about any mental illness. I would think it is just as easy to pretend to have bipolar disorder or something as it is to pretend to have PTSD. Fraud is unfortunately a part of life and it's impossible to prevent entirely. Even if a screening system was in place, people could still pretend to have PTSD over something commonplace that actually did happen to them but didn't traumatize them such as a car accident or home burglary or something. There will never be a way to eliminate fraud. I just think this system would put a series of barriers in front of those who really need help and may not have the strength or mental facilities at that time to navigate those barriers. It's like saying "here you can have this diabetes medication, but first you have to run a mile."

 

[anthony]

Perhaps a way of proving undocumented trauma would be to delay official diagnosis until a period of assessment has been completed.

Absolutely... no more, walk in, walk out 30 minutes later with PTSD and off to the insurance or disability agency you go.