Trauma in the Courtroom: PTSD Assessments in Legal Cases

Introduction

PTSD, or Post-Traumatic Stress Disorder, is a mental health condition that can be triggered by experiencing or witnessing a traumatic event. The likelihood of developing PTSD increases with the severity and shock of the event. The fifth edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5) classifies Post-Traumatic Stress Disorder as an Anxiety Disorder. The severity of Post Traumatic Stress Disorder can vary from mild or acute with a short duration to chronic and long-lasting conditions. According to the DSM-5, a chronic condition is defined as a condition that lasts for more than three months. To diagnose PTSD, the following criteria must be met:

1. Exposure to a traumatic event
2. Presence of Flashbacks
3. Avoidance Behaviors
4. Symptoms of arousal and reactivity
5. Cognitive and Mood Disturbances

DSM-5 specifies that the person suffering from Post-Traumatic Stress Disorder must have directly experienced it or witnessed it in person as it happened to someone else, learned about the violent or unexpected death of a friend or family member, or had repeated exposure to distressing details of traumatic events and not through social media.

PTSD has been offered in the Judicial system as a criminal basis for criminal defense. These defenses include insanity, unconsciousness, self-defense, diminished capacity, etc. Some courts recognize the testimony from individuals suffering from PTSD as scientifically valid. For example, the appellate court in the U.S. jurisdiction recognizes PTSD as a valid basis for insanity and self-defense. However, when expert testimony fails to show that PTSD met the specific criteria, the courts do not consider PTSD testimony to be relevant or admissible. In such cases where PTSD does not fulfill the requirements of a complete defense, it can be accepted as a partial defense or a mitigating factor in the case. PTSD was introduced in 1980 in the third edition of the Diagnostic and Statistical Manual. Before that, traumatic stress syndromes like traumatic neurosis of war were effectively used as grounds for criminal defense. After the introduction of PTSD in DSM, courts started utilizing it as a defense strategy in both violent and non-violent cases.

Additionally, other trauma-related syndromes, such as battered wife syndrome or battered child syndrome, that are not listed in the DSM, are also used as criminal defenses. These related syndromes are also often considered as a part of Post-Traumatic Stress Disorder. When PTSD was initially introduced in the courts, it raised concerns about its possible misuse, and people were skeptical. Their skepticism grew when there were cases where malingered PTSD was used as a criminal defense. There have been different phenomena associated with PTS that are presented in the court as a criminal defense. These phenomena include-

1. Dissociative Flashbacks
2. Hyperarousal Symptoms
3. Survivor Guilt
4. Sensation-seeking Behaviors

Many researchers suggest that out of all these phenomena, only Dissociative Flashbacks should be used as a criminal defense. All the other phenomena do not qualify to be used for criminal defense.

PTSD as a criminal defense has received mixed success. After the significant reforms in the Insanity Defense in 1984, there had been many cases in which the individual was acquitted because the jury and the court did not accept PTSD as a valid insanity defense. However, in the case of United States vs Razaq, the defendant was charged with aircraft piracy, and he pleaded insanity based on PTSD. To prove that he suffered from Post-Traumatic Stress Disorder, he presented the court with the evaluation by three different psychiatrists who diagnosed him with PTSD. The government sought to exclude the testimony on the basis that the defendant’s PTSD was not sufficient for an insanity plea. The district court, however, denied this motion and stated that the reports by the defendant’s experts“clearly indicate that defendant’s diagnosis of PTSD meets the test of insanity as set out” in federal statutes.

Assessment of PTSD

PTSD can be assessed using different kinds of scales, questionnaires, and interviews. Some of these assessment tools and techniques are as follows-

1. Clinician-Administered PTSD Scale for DSM-5 (CAPS-5)- This is a comprehensive 30-item interview. The Clinical Administered PTSD scale (CAPS-5) was developed by the US Department of Veterans Affairs for diagnosing PTSD based on the criteria of DSM-5. This interview is administered by trained clinicians. It evaluates the symptoms over the past week and takes about 45-60 minutes to administer.
2. PTSD Symptom Scale Interview (PSS-I)- This test focuses on identifying the most distressing trauma and associated symptoms based on DSM-IV or DSM-5 criteria. This test consists of 20 symptom-related questions and additional queries about symptom impact and duration. The PTSD Symptom Scale Interview takes 20 minutes to administer.
3. Structured Clinical Interview for DSM (SCID) PTSD Module- This semi-structured interview module is adapted to DSM-5 criteria. This module requires training to administer. It assesses the presence of PTSD symptoms without any quantitative scoring.
4. Treatment-Outcome PTSD Scale (TOP-8)- This scale is a brief, interview-based assessment that is derived from the Structured Interview for PTSD (SIP) assessment scale. The Treatment-Outcome PTSD Scale focuses on eight items across PTSD symptom clusters. This test also helps to monitor treatment response and distinguish drug effects.
5. Davidson Trauma Scale (DTS)- This is a 17-item Likert-scale questionnaire. It is a self-report questionnaire. This scale assesses symptoms using DSM-IV criteria. It has separate scores for frequency and severity of PTSD symptoms.
6. Impact of Event Scale-Revised (IES-R)- This self-report scale comprises 22 items. All of these items are rated on distress levels over the past week. The Impact of Event Scale-Revised evaluates PTSD-related distress but does not diagnose PTSD directly.
7. Mississippi Scale for Combat-related PTSD (M-PTSD)- This self-report scale includes a 35-item version for veterans. It also has a civilian adaptation. It assesses PTSD symptoms using DSM-III criteria. It assesses symptoms related to combat or traumatic experiences.
8. Modified PTSD Symptom Scale (MPSS-SR)- This self-report scale has 17 items that align with DSM-III-R criteria. The Modified PTSD Symptoms Scale offers preliminary diagnosis through cutoff scores or continuous severity measurement.
9. PTSD Checklist for DSM-5 (PCL-5)- This is a 20-item self-report tool. This PTSD Checklist screens for PTSD. It also monitors the change in symptoms over time. This monitoring aids in provisional diagnoses of PTSD.
10. PTSD Symptom Scale Self-Report Version (PSS-SR)- This scale mirrors the PSS-I in the wording of the items. The PTSD Symptom Scale Self-Report Version includes Likert-scale questions to assess the severity of the PTSD symptoms. This self-report scale also has different subscales that indicate the likelihood of PTSD with a score threshold.
11. Short PTSD Rating Interview (SPRINT)- This is an eight-item self-report measure. This scale measures the PTSD symptoms and functional impairment caused by it. It does not look into any DSM-specific criteria. This self-report scale is helpful in effectively tracking symptom changes and treatment outcomes.

Each instrument serves a different purpose. These tools are helpful in addressing the varying needs of individuals. Starting from initial screening to detailed assessment and treatment monitoring for PTSD. These tools can be administered by trained professionals or self-reported by individuals. These assessments and tools contribute to a comprehensive approach to understanding and managing PTSD symptoms across different populations and trauma types. These can also be helpful in the court of law.

References

1. https://www.ptsd.va.gov/professional/assessment/screens/index.asp
2. Berger, O., McNiel, D. E., & Binder, R. L. (2012). PTSD as a criminal defense: a review of case law. Journal of the American Academy of Psychiatry and the Law Online, 40(4), 509-521.
3. https://www.apa.org/ptsd-guideline/assessment
4. https://www.americanbar.org/groups/tort_trial_insurance_practice/publications/the_brief/2018-19/spring/posttraumatic-stress-disorder-proving-and-defending-claims/#:~:text=to%20their%20advantage.-,Expert%20Testimony%20and%20the%20PTSD%20Diagnosis,Qualifications.

Mental health is not a stigma — it’s a real and valid health condition. The good news? It’s treatable. Don’t hesitate to seek help; reaching out to a professional is a courageous and powerful step. Offer yourself the kindness you deserve, and take that hand of healing. You were born to thrive — so choose health, choose hope, and most importantly, choose to love yourself.