Civil litigation and posttraumatic stress disorder

 Burton Singerman, MD

There are an ever-increasing number of plaintiffs claiming posttraumatic stress disorder. Why the sudden marked increase in usage of this disorder in litigation?

Posttraumatic stress disorder was first described in the sixth century BC. The symptoms of the illness have not changed although the naming of the condition has repeatedly changed. In world war one  this condition was called “shell shock” related to the close lines between battling armies and the continuous munitions flying across lines. In World War II, this condition was called combat neurosis. The term posttraumatic stress disorder(P.T.S.D.) came into the psychiatric nomenclature in 1980 in the  Diagnostic Manual of the American Psychiatric Association.

The Vietnam conflict increased the awareness of the civilian lay public of this condition through repeated articles in the press, magazines, movies and books depicting the horrors of the invisible wounds of combat. Symptoms of the disorder, the long-standing effect of this disorder on many sufferers, and the rapid hyperarousal which frequently leads to aggressive acts, the loss of family and employment, associated alcohol and/or drug abuse as self-medication of the symptoms, and finally, in severe and usually untreated cases, suicide.

The Iraq and Afghanistan wars again have brought these combat related symptoms to the forefront. Simultaneously, there has been an increasing awareness of the multiple causes that can lead to civilian PTSD. Injuries suffered in accidents, disability from medical malpractice, discrimination with associated harassment, and aggressive rape which has been shown to have the highest probability of development of civilian PTSD in the sufferer.

This increasing population awareness of PTSD is one reason there are more cases utilizing posttraumatic stress disorder in civil lawsuits. Additionally, claiming PTSD has been shown to markedly increase lawsuit compensation. Both of these factors create a great incentive for some to learn the symptoms and act out all the associated behaviors, especially when there is a prospect of a sympathetic group of jurors. Lawyers are increasingly aware of being observant  for all this constellation of symptoms

To meet the newest criteria for this diagnosis requires a severely traumatic event, having flashbacks, dreams and frequent sleep disturbance related to this event. Reactions to environmental stimuli which reminds one of the event often leading to withdrawal to limit exposure to these stimuli is common.   

In all sufferers, there is a marked decrease in their functional level. Compensation and civil litigation using PTSD often depends on the attitudes about the reality of psychiatric disorder by the jurors and judges, and in bogus cases, the capacity to mimic the behaviors seen in this disorder by those who can lie and act convincingly. Coaching by less than honest lawyers has also been described as the size of compensation awards from PTSD continue to increase.

Psychiatric expert disagreement between defense and plaintiff consultants is frequent. Hiring someone with outstanding experience in working with posttraumatic stress disorder in both the military and civilian populations frequently determines whether the defense or plaintiff are successful in their case.

Lawyers should always do thorough background checks determining whether the psychiatrist’s experiences and knowledge of litigation consultation is significant . Deserving clients will be most appreciative.