Posttraumatic Stress Disorder

Although there are many forms of psychological injury that can be the focus of a compensation claim (including chronic pain, cognitive impairment, postconcussive syndrome, depression), this review will focus onposttraumatic stress disorder (PTSD). This condition is diagnosed when the individual has (a) suffered a traumatic experience, and subsequently suffers (b) re-experiencing (e.g. flashbacks, nightmares), (c) avoidance (e.g. effortful avoidance of trauma-related thoughts, emotional numbing), and (d) hyperarousal (e.g. insomnia, irritability) symptoms. According to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV; American Psychiatric Association, 1994), PTSD has the distinctive feature of including a precipitating stressor as part of the disorder's definition. This establishes a straightforward connection between a triggering traumatic event and a variety of observed symptoms (Freckelton, 1997). Such a relationship enables PTSD to be susceptible to both compensation and criminal claims (Bryant, 1996; Erlinder, 1983; McFarlane, 1995). This amenability to compensation claims resulted in the introduction of PTSD in 1980 (DSM-III; APA, 1980) causing considerable concern about potential increases in PTSD-related claims (Lees-Haley and Dunn, 1994; Liljeq-uist, Kinder and Schinka, 1998). These concerns have increased in recent years because claims for psychological injury following trauma have risen dramatically (Neal, 1994). Referring to the North American context, Stone (1993, p. 23) noted that, 'No diagnosis in the history of American psychiatry has had a more dramatic and pervasive impact on law and social justice than posttraumatic stress disorder'. PTSD is an excellent example to discuss many of the major issues that need to be considered in assessing psychological states in the context of compensation claims.

Although these issues are to be addressed in terms of PTSD, they are equally applicable in assessments of many forms of psychological injury that present for compensation.

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