Serious physical injuries can leave scars that are not immediately visible. While we are rather conservative about being too quick to label emotional reactions to ordinary types of injuries as psychiatric conditions such as Post-Traumatic Stress Disorder (PTSD), it is important to recognize it when psychological injuries are real. That requires that injury lawyers have at least a working knowledge of psychiatric diagnoses that may relate to physical injuries.
PTSD one of the mental disorders classified within the anxiety section of disorders in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, or “DSM”.
The DSM is recognized all over the world as being the most authoritative manual regarding the diagnosis of mental disorders. The principle purpose of the DSM is to aid clinicians in the diagnosis of mental disorders. However, its primary purpose isn’t forensic. In fact both the DSM-IV and DSM 5 include disclaimers that state the risks that are present within in DSM categories, criteria, and textual descriptions when they are used for forensic purposes. The main concern is that the diagnostic criteria will be misused or misunderstood. In a litigation setting, one must understand a diagnosis does not equate with a particular cause of a psychiatric condition. That is established through a patient’s history and professional opinions in addition to the DSM diagnosis.
Some changes to the DSM that could affect personal injury lawyers include:
1.) Chapter order: DSM-5’s 20 chapters will be restructured based on disorders’ apparent relatedness to one another, as reflected by similarities in disorders’ underlying vulnerabilities and symptom characteristics.
2.) Substance use disorder will combine the DSM-IV categories of substance abuse and substance dependence. In this one overarching disorder, the criteria have not only been combined, but strengthened. Previous substance abuse criteria required only one symptom while the DSM-5’s mild substance use disorder requires two to three symptoms.
3.) Personality disorders: DSM-5 will maintain the categorical model and criteria for the 10 personality disorders included in DSM-IV and will include the new trait-specific methodology in a separate area of Section 3 to encourage further study how this could be used to diagnose personality disorders in clinical practice.
4.) Posttraumatic stress disorder will be included in a new chapter in DSM-5 on Trauma- and Stressor-Related Disorders. DSM-5 pays more attention to the behavioral symptoms that accompany PTSD and proposes four distinct diagnostic clusters instead of three. PTSD will also be more developmentally sensitive for children and adolescents. However, we will continue to view with skepticism any diagnosis of PTSD arising out of a run of the mill car wreck, though the diagnosis may fit perfectly in cases where the incident and its aftermath was extraordinarily horrifying.
5.) Removal of bereavement exclusion: The exclusion criterion in DSM-IV applied to people experiencing depressive symptoms lasting less than two months following the death of a loved one has been removed and replaced by several notes within the text delineating the differences between grief and depression. This reflects the recognition that bereavement is a severe psychosocial stressor that can precipitate a major depressive episode beginning soon after the loss of a loved one.
The DSM provides categorical classifications that divide mental disorders into types based on criteria sets with defining features. It is a classification of mental disorders that was developed for use in clinical, educational and research settings. The DSM is meant to serve as a guideline to be informed by clinical judgment and is not meant to be used in a cookbook fashion. It is essential that the DSM not be applied by untrained individuals, since clinical training, judgment and experience are essential to proper diagnosis. So don’t just read the book and try to diagnose yourself; you will become a psychiatric hypochondriac, thinking half those diagnostic criteria apply to you.
Unlike physical injuries or deformities, the fact that one is depressed, overly nervous, anxious, fearful or withdrawn is usually not immediately recognizable during a trial the lasts a couple of days. Jurors might speculate about the extent to which an injured person has truly suffered because of the incident, and that isn’t good. This is why it is important for lawyers to have a working familiarity with the DSM so as to understand when expert testimony of a psychiatrist or psychologist may be helpful and when it would merely detract from an otherwise solid case.