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

[PerfectEmpire]

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.

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.

What you all are proposing is putting people with undiagnosed PTSD through an emotional, financial, and bureaucratic wringer before they are "allowed" to be treated. Can my trauma be legally documented? Probably not. Can I afford to take 2 weeks off from work? No i cannot or I will be homeless. Therefore, no diagnosis and treatment for me. Sounds like a great plan.

I agree with these three outtakes. The patient is burdened enough, and the thought of adding another burden - the burden of proof - to everything else the sufferer is dealing with disturbs me. I don't believe the medical/therapy office is the place for this sort of burden. Such a burden belongs in the courthouse, not a place of trust and healing. If the patient wishes to take the matter to court, let them deal with it there. If the legal system accepts this label without requiring actual proof of trauma, that's a problem of the legal system's! Perhaps reform needs to take place on their end.

To sum up my position: Which is worse? PTSD being faked by many people who go on to take advantage of the system, or increasing the burden placed on the legitimate patient, turning the therapy office into yet another place where the patient feels like their trauma is being minimized and/or surrounded by tension?

It would be a greater shame, in my mind, to filter out ONE legitimate patient from receiving validation, support, and care than it would be to fail to filter out masses of "fakers". If masses of fakers are let through to help ONE legitimate patient, it is worth it in my opinion!

 

[anthony]

For those in doubt about the issues, you could quickly review just the following links to quickly capture a snapshot of the legal and ethical issues of a PTSD diagnosis due to criterion A meeting burden of proof, without actually proving it in the first place, though nothing more than a diagnosis.

[DLMURL]http://www.cfg-lawfirm.com/documents/MTL_PTSD.pdf[/DLMURL]
[DLMURL]http://www.beforeyoutakethatpill.com/2009/3/spitzer.pdf[/DLMURL]
[DLMURL]http://www.mmpi-info.com/psychology-publications/faking-posttraumatic-stress-disorder.html[/DLMURL]
http://onlinelibrary.wiley.com/doi/10.1002/jts.2490090202/abstract
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1324918/pdf/bjpg54-843.pdf

 

[anthony]

It would be a greater shame, in my mind, to filter out ONE legitimate patient from receiving validation, support, and care than it would be to fail to filter out masses of "fakers". If masses of fakers are let through to help ONE legitimate patient, it is worth it in my opinion!

Flipside

Unfortunately, that is already occurring though due to the issue of faking, where legitimate sufferers are having to fight harder to get diagnosed and treatment through insurance, disability, even veterans themselves face being legitimately rejected due to political pressures and Government expenditure, all because some soldiers want to malinger and fake the symptoms to get disability payments.

This is all cutting into legitimate cases due to poor assessment protocols in the therapeutic environment.

 

[anthony]

Awesome conversation by the way... lots of great perspectives coming through.

 

[PerfectEmpire]

This is all cutting into legitimate cases due to poor assessment protocols in the therapeutic environment.

That makes sense.

Having so many non-legitimate cases cheapens the diagnosis and that itself makes life harder for legitimate sufferers (feeling like people don't take the illness seriously, doctors being more hesitant to believe the patient and/or diagnose them).

If lie detector tests were more reliable that would be a simple solution! LOL

 

[anthony]

If lie detector tests were more reliable that would be a simple solution! LOL

That is actually probably the best solution yet... even though a sufferer may feel they have to prove themselves, quite honestly, if you have endure legitimate trauma, and successfully passing a lie detector provides you adequate care and/or compensation if required, then I would have to say that is the best solution so far for each and accuracy to ascertain validity.

Old lie detectors aren't accurate, but the newer style ones are quite accurate as to whether your being truthful or deception is present. I believe when used in conjunction with trained assessors, results are quite accurate from reading. Even if something came up as deceptive, it only has to ascertain if trauma was endured... if every answer was near deceptive, then I guess there would be an issue, but if the assessment was mostly valid in assessing responses... that sounds like a real winner IMO.

 

[shell]

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.

I totally agree, I was one of those people who never reported my rape at age 14, and never told anyone about it. My mother was so abusive that I feared what would happen if I did. I'm sure many people, would have other legitimate reasons due to fear for not reporting it. I don't think it would be practical given the varied causes of PTSD to apply a requirement of proof to receive assistance or compensation. I must say I like the idea of compensation, it really pisses me off that I've had to pay for surgery to repair the damage my mother caused, pay for a therapy to fix me, while my parents get away with it and pay nothing.

 

[anni]

I didn't see this thread earlier- no surprise there. It's a very good one. I can't add anything of extreme value, I don't think-just wished to reiterate on not being able to prove ones trauma in the face of other's denials, especially with an entire and expensive legal system in one's path. My situation was not unique, either-zillions of us out there in the family courts.It's beyond ridiculous. My abuser's lawyer was able to have ME sign a document at one point where I would not harrass HIM- on the grounds that this fine, upstanding doctor might have his reputation besmirched when word of his domestic abuse charges reached the community. Not lying-this happened. I signed that paper because I had zero choice, with a broken leg, backed into a corner by a judge and the abuser's sheer money and power in those days. Later, this became moot when of course he pushed his luck with the Staties who do not fool around with local politics and I managed to get a REAL lawyer but my point is that I'd never have been able to prove any trauma at all had things stayed in the first corrupt scenario. The judge quite literally had things re-written to where it was recorded we must have been sort of shoving each other around, I'd flung myself down the stairs and then kicked my own leg to splinters, apparently. Any other victim of domestic violence in that postion would not have a hope in hell of proving trauma if she needed to, that's all. I was lucky- he shot himself in the foot, I managed to get the money to equal his for these frightening court things, had some policemen who went to the extreme to stop him. Like I said- my case was hardly unique. This stuff goes on all the time.

I do agree proof is a good idea. I also agree with PE, since abuses in the system are inevitable, really and I'd rather have to support those with my tax dollars than worry about the people whose access to help were blocked through paperwork. It's probably different in Australia, though. God. If you gave the government here the chance to have disadvantaged people one more hoop to jump through to get help for pretty much anything, the bureurcrats would die with delight but the disadvantaged would pretty much just quite literally die.

 

[sea]

I'm definitely going to have to say no. Because in a lot of cases it's simply unprovable. How is it possible to prove certain instances of childhood abuse? What happens if your abuser is dead, or was a stranger? What happens if the event/s occurred a very long time ago and there is simply no evidence other than a person's word and what a therapist thinks is wrong with them?

Requiring to prove criterion A within the military is acceptable because the military is supposed to keep records and documents that are able to prove your whereabouts, but even within the military that system is faulty because records can become lost, things can happen outside the record, computers eat information, etc. I knew a guy at the VA who wasn't able to get compensation for PTSD because he couldn't prove he had been in a combat zone despite having clear PTSD as the guy was f*cking mental. Of course the VA says he is lying, except that his whole life is a mess and he'd have to be the best actor in the history of time.

So if even the military's system is flawed, how do you expect a civilian to cope with having to actually prove they were abused or were in danger? If you walk down the street and get pulled into an alley and get raped or something and then decide not to tell anybody about it but developed PTSD and eventually went to get treatment for that and therapy for that...how do you prove you were in danger at all? Nobody saw, nobody heard. That would have a way too serious impact on the ability for PTSD treatment to reach legitimate sufferers. Because not only does this have to do with the whole claims and compensation nonsense but it actually has an impact on what you will get treated for by a therapist. If a therapist requires you to prove criterion A before diagnosis, they will only treat you so far before determining you must not have PTSD due to insufficient proof, therefore your treatment itself can end.

This is a case where the value exponentially outweighs the risk. Even if 50% of all PTSD patients at this point were fakers, it would still be better than suddenly cutting out all the people that are viewed as fakers, and then further cutting out the legitimate PTSD patients who can't actually prove something which happened outside the scope. Better to keep the 50% in my opinion, even if they're wasting resources.

Then of course you would have all the other nonsense - what is defined as "in danger", especially because some situations are dangerous and scary to some people and others are not. Even that concept itself is subjective, as different people view different situations with more or less levity. How could I prove that I thought my life was in danger if other people might not view the situation the same way? If I got into a barfight with someone I could say I thought my life was in danger, how do you know if that is true or false? How do you know if I am being sincere? People get into fights all the time, most people with the understanding that it's just a fight and nothing will really come of it.

While this may sound irritating, until some kind of telepathic mind-scanner can be invented to determine the truthfulness of someone's statements, it's better to treat masses of lies than to deny even one true sufferer on the off-chance that you think they are lying. Basically the system at this point is probably the best balance that can be achieved for what we are able to accomplish technologically (MRIs, PET, etc). People are always going to find ways to beat the system. That is just a fact of life. No matter what you develop or come up with (hell, even the telepathy) someone will find a way to use and exploit it. There is no prevention on that, you can simply do the best you can and use common sense. Try to gather as much proof as possible but don't absolutely demand it just to treat someone.

 

[Kb3]

Some traumas will never be proven. Why should a PTSD victim have to forgo a dx or wear the wrong diagnostic label because the crime that affected them has been covered up? Diagnosis should be made after a series of in-depth interviews with qualified clinical staff. Being disbelieved is a quick route to secondary trauma, which delays/interferes with recovery.

Until a brain scan for PTSD is reliable and made readily available, then unfortunately we are going to have live with people who work the system. Otherwise those who have been truly hurt, and cannot prove it, will be left behind from appropriate treatment. That's inhumane.

 

[Linda Lee Bogard - King]

Innocent until proven guilty = PTSD until proven otherwise. I believe it is easy to spot someone with PTSD, and I believe this because I have it to the extreme... from many, many traumas... Now, I noticed when I have an 'issue' in public ... others tend to look at me 'as if' I'm a nutcase. One cop in Fl., (1993) radioed in on her shoulder walkie-talkie, "We got a live one here." Mind you, the door slammed into the back of my heel, blood oozing and a baby screaming. Meanwhile, I'm dripping wet from the shower - in a towel - AND, she wants me to move my car, NOW! I flipped-out! Yet, I am suppose to keep my anger issues under control... how far can one submerge crap before things get plugged up? This cop created more PTSD trauma, considering my issues with cops in the first place... However, things have changed. Today, cops are better informed when dealing with people they encounter having mental issues, and PTSD - is one of them.

Any, good therapist can observed someone with PTSD and noticed little "oddities" about their patient that rings true of PTSD patients. Granted, there are those who love to play the system or play the sympathy card to get a free ride, but for the most part, PTSD can be detected. All it takes is the trigger....

 

[cherryblossom]

Interesting discussion. I think the whole proof idea, is good on paper, but as others have said, there will be people who have PTSD but cannot prove criteria A. While I hate the idea of people fraudulently claiming compensation or disability, by claiming they have PTSD, actually having to prove you have endured trauma to get the right help and treatment sounds quite scary to me.

I cannot prove I was raped, by a stranger, at knife point in a public place in 1993. No one saw me, I didn't report it to the police, and I didn't tell anyone for years afterwards. I went into complete denial, and put it all in a locked box, in the back of my brain somewhere. I'd never even heard of PTSD, or thought that I'd be storing up issues for the future. Although now that I know about PTSD, I can look back and see that I had some symptoms and behaviours of PTSD (risky behaviours (promiscuity), easily startled, hypervigilance, occasional anxiety attacks - the nightmares, flashbacks, insomnia, depression etc didn't surface until years later. Although, I told a boyfriend I had 'been assaulted, in the worst way he could imagine', following a hysterical, sobbing, anxiety attack during sex, we never openly talked about it again. The first person, I ever told officially, was my GP around 2001. And that was to describe my symptoms, which by then also included suicidal thoughts, and eventually I told him (actually by writing it on a piece of paper - because I couldn't say the words out loud) I was raped. In 2002 I was seen by 2 different psychiatrists, 2 sessions with both, if I recall, and I was diagnosed as having (delayed onset) PTSD.

I cannot prove in any way that this happened to me. Except I imagine by a lie detector. Having had 9 years to learn about PTSD, accept my diagnosis, and learn to say those words "I was raped" out loud, if I were now needing to claim disability or benefits, or a claim for discrimination, or any other legal needs pertaining to PTSD, then I would take a lie detector test, if it was deemed necessary.

Back in 2001, it took my GP months to get me to open up enough to tell him what my nightmares and flashbacks were about. It then took further weeks/ months for him to persuade me to see a psychiatrist. I was absolutely terrified that I was going crazy, and that a psychiatrist would confirm that I was indeed mad. If I had gone to the psychiatrist and been told that I would have to take a lie detector to prove that I had indeed been raped, I honestly think that I would have run for the hills. Because of overwhelming feeling of shame, humiliation, self-blame, guilt, embarrassment etc, etc, that all go along with being raped, actually admitting it, was (and still is) a massive deal. To be then told, that just my word wasn't enough, and that I had to prove that I was raped, would have been completely horrendous. I don't think I could have dealt with that at all. Clearly, this is just my opinion, based solely on my own circumstances.

Having read plenty of accounts of child abuse on SSA, so many children who are abuse are told not to tell anyone, and that no-one would believe them anyway. And often the children who have spoken out have not been believed, or dismissed - I can't imagine how being told they have to prove they were abused would affect them.

For the genuine PTSD sufferer, many are pretty much at rock bottom, by the time they actually seek help and get that diagnosis. As we read here in the 'introduction' section all the time, many are grateful that they have a diagnosis, and to discover that they are not alone with their symptoms, and they are in fact having a 'normal reaction to abnormal events' and not indeed going crazy! As we know a lot of PTSD sufferers have issues with trust. Having to prove your trauma (when you are already rock bottom, and logical thinking is generally skewed ) sends the message that you are not believed. If the professionals don't trust you (the sufferer), then you are not going to trust the sufferer.

I think that for the genuine sufferer, having to prove their trauma, during initial assessments could be seriously detrimental. And holding out on a diagnosis, until a time that its more appropriate to get proof may prevent getting the appropriate treatment. For example, if PTSD is not diagnosed, the patient may not get a referral to a trauma therapist, or an EMDR therapist.

It would be great to sieve out those just claiming to have PTSD for their own monetary gain, but some dishonest people will always beat the system somehow.

I don't think that proving your trauma at the time of initial assessment/diagnosis is appropriate. Once PTSD is being used for legal purposes, maybe then is the time to seek for proof. But I don't suppose that legalities work that way?