Posttraumatic stress disorder in tort actions: forensic minefield

The authors discuss posttraumatic stress disorder (PTSD) as a basis for personal injury litigation. Three case examples raise issues related to: (1) the controversy surrounding expansion of tort liability, (2) the courtroom use of psychiatric nomenclature as represented in the DSM (e.g., PTSD), and (3) ethical concerns regarding psychiatric expert witnesses. Psychiatrists became easy targets when problems related to personal injury "stress" cases developed. A careful analysis, however, demonstrates that the issues are complex and multifaceted. For example, tort liability expansion was primarily instituted to compel a greater provision of liability insurance, not to reward stress claims. The increasing use of psychiatry's DSM in the courtroom has occurred despite explicit precautions against forensic application. Finally, the need for psychiatric expert witnesses has increased because courts have gradually usurped some psychiatric clinical prerogatives and because there has been a trend toward greater consideration of emotional pain and suffering. Although psychiatric expert witnesses have not been beyond reproach, critics have attempted to impeach the entire psychiatric profession for the questionable actions of the minority. The authors provide a detailed analysis of current problems, offer suggestions for improvement, and provide an educational counterpoint to the "hysterical invective" that often greets psychiatric testimony.     

Posttraumatic stress disorder following ethnoreligious conflict in Jos, Nigeria

In September 2001, ethnoreligious rioting occurred in Jos, Nigeria. Using a multistage cluster sampling technique, 290 respondents were recruited in Jos 7 to 9 months after the riot. Data were collected regarding demographics, exposure to traumatic events, and psychological symptoms. Resting pulse and blood pressure were recorded. A total of 145 (52.5%) witnessed or were victims of personal attacks, 165 (59.6%) lost their possessions, 56 (20.7%) had their homes burned, 44 (16.2%) witnessed relatives' deaths, and 8 (2.9%) were robbed. A total of 252 (89.7%) of the respondents met reexperiencing criteria, 138 (49.1%) met avoidance criteria, and 236 (84.0%) met arousal criteria for posttraumatic stress disorder (PTSD). A total of 116 (41%, 95% confidence interval [CI] = 36% to 47%) met all three categories for PTSD. Only personal attacks (adjusted odds ratio = 2.8, 95% CI = 1.7 to 4.7) and a heart rate of 90 beats/min or more (adjusted odds ratio = 2.8, 95% CI = 1.4 to 5.8) were significantly related to PTSD in a multivariate model.     

Posttraumatic stress disorder. A real entity in death investigation

Posttraumatic stress disorder, formally known as battle fatigue, is a real entity in those offices where investigators and pathologists perform the role of death certifiers. Failure to acknowledge this problem may predispose the unsuspecting agency employees to frequent job changes, disruptive behavior, and substance abuse.     

道路交通事故所致精神损害的法医学评价

目的研究RTA所致PTSD的相关法医学问题,为司法实践中精神损害赔偿提供科学依据和司法建议。方法对156例因RTA申请伤残程度鉴定的被鉴定人,通过临床精神病学检查确定PTSD的诊断,法医临床学检查评定躯体损伤的伤残程度,并通过问卷调查进一步确定受害人的心理社会状态。结果156例被调查对象PTSD发生率为51.92%。男女PTSD的发生率具有统计学的显著性差异;随着伤残程度的严重性增加,发生PTSD的可能性也随着增加;PTSD组与非PTSD组在生活质量总均分和生理、心理、社会关系、环境四个维度以及焦虑、抑郁的各项得分中都有显著性差异;获得赔偿将明显降低PTSD的发生率。结论RTA作为创伤性事件,申请赔偿的RTA受害人存在较高的PTSD发生率,获得良好的赔偿可以明显地降低申请赔偿的RTA受害人PTSD的发生率。     

Acute stress disorder as a predictor of post-traumatic stress disorder in physical assault victims

The authors' objective was to examine the ability of acute stress disorder (ASD) and other trauma-related factors in a group of physical assault victims in predicting post-traumatic stress disorder (PTSD) 6 months later. Subjects included 214 victims of violence who completed a questionnaire 1 to 2 weeks after the assault, with 128 participating in the follow-up. Measures included the Harvard Trauma Questionnaire, the Trauma Symptom Checklist, and the Crisis Support Scale. Twenty-two percent met the full PTSD diagnosis and 22% a subclinical PTSD diagnosis. Previous lifetime shock due to a traumatic event happening to someone close, threats during the assault, and dissociation explained 56% of PTSD variance. Inability to express feelings, hypervigilance, impairment, and hopelessness explained another 15% of PTSD variance. The dissociative, the reexperiencing, the avoidant, and the arousal criteria of the ASD diagnosis correctly classified 79% of the subsequent PTSD cases.     

Profiles in the offending process of nonserial sexual murderers

The aim of this study was to investigate specific pathways in the offending processes of nonserial sexual murderers and to examine possible relationships with different precrime, per-crime, and postcrime factors. Included in this study were 36 offenders who have committed at least one sexual murder against a female victim and they were classified using cluster analysis. Participants using the sadistic pathway planned their offenses and used physical restraints during the offenses. Furthermore, they mutilated and humiliated their victims. Finally, they hid the bodies of the victims. Participants using the anger pathway had not premeditated the homicide. Mutilation, humiliation, and physical restraints were less predominant with these participants than with those using the sadistic pathway. Moreover, these offenders were more likely to leave the bodies at the crime scenes after the killings occurred. These two profiles are compared with empirical studies addressing sexual homicide.     

A survey of the psycho-social aspects of murderers in Iran

The psycho-social aspects of 72 murderers (one female, 71 males) were studied. The murderers came from the Khoozestan and the Lorestan provinces of Iran. One of them had been transferred from the north of Iran (probably on exile).The murderers were mostly from lower social classes and crowded homes. The majority of them had worked as unskilled labourers or farmers. A great number of them regretted their action but a few were proud of what they had done. They believed that they had saved the chastity of their family which is very important in Islam.None of them were epileptic nor had any history of it. Four claimed to be nervous. Eight were alcoholics and three were addicted to drugs. One of them was suspected of having manic-depressive psychosis and only one had paranoid schizophrenia. The female and four of the males were psychopaths.     

Filicidal abuse in the histories of 15 condemned murderers

This paper describes the family characteristics of 15 Death Row inmates. It documents extraordinary physical and/or sexual abuse in 13 cases. It describes murderous behaviors of parents toward children in 8 cases and documents ongoing hostility and neglect throughout childhood and adulthood. The paper explores the mechanisms by which such abuse may contribute to violent behaviors. It highlights the relevance of these findings to the outcome of sentencing in capital cases.     

伪装创伤后应激障碍的识别

创伤后应激障碍的鉴定是近年来司法精神病学实践中经常遇到的问题,其中如何识别诈病者也相应地成为业内人员关注的焦点之一。但是由于此障碍所涉及的创伤性事件多种多样,症状表现纷繁复杂,且信息来源主观性成分较大,同时又易有其他多种精神疾患与之共病,因而要作出完全正确的诊断或鉴定结论相当困难。本文通过对大量文献资料的归纳整理,分析了国内外在有关伪装创伤后应激障碍的表现特点、识别方法和测试手段等领域开展的研究现状,期望能为精神疾病司法鉴定中处理相关问题提供一定的帮助和参考。     

Women murderers and victims of abuse in a southern state

We consider the hypothesis that abused women who kill their abusers are not socially different from other abused women. Comparing two groups of women from a Deep South state, one group incarcerated for killing their partners (n=21) and the other served by a shelter for battered women (n=273), we find mixed support for the conclusion that the two groups represent a homogeneous general population of abused women. The women incarcerated for killing their male partners appear to be more isolated from the social mainstream and in greater perceived danger than the women who used the shelter. An earlier version of this paper was presented at the 1990 Southern Sociological Society Annual Meetings. Invaluable comments on earlier versions of the paper were received from Judith Stitzel, Shirley Dowdy, Ann Paterson, Sally Maggard, Janet Curry, Jon Conte, Mary Jo Ullom, and Lorrie Hardy.     

Female murderers in a southern city, 1975–1992

A study of a population of 36 females arrested for homicide in a southern, nonurban city from 1975 to 1992 was conducted using both qualitative and quantitative data. The study explored the demographic, social, legal, and offense characteristics of female homicide offenders as well as events leading to the murder. The profile of female homicide offenders in a southern, non-urban setting that emerged from this study is supportive of earlier studies focusing on female homicide offenders in large urban areas.     

Posttraumatic stress disorder in a World War II concentration camp survivor caused by the attack of two German shepherd dogs: case report and review of the literature

A 79-year-old woman suffered from acute posttraumatic stress disorder (PTSD) and a loco typico, non-displaced fracture of her right distal radius due to an incident involving the assault of two unleashed owned dogs, which suddenly ran into her and aggressively jumped on her chest and knocked her down to the ground. Recovery for her damage claim concerning pain and disability due to her right forearm fracture caused by the incident, was not the issue in the litigation concerned. However, the issue of delayed impact of her previous Holocaust experience placed a significant challenge on M.N., as a plaintiff, in establishing a causal link between the posttraumatic stress disorder concerned and the alleged harmful action of the defendants, the owners of the two dogs. The case reported here proved interesting and instructive not only in the sense of addressing main issues relevant to litigation for psychological damage related to reactivated PTSD and delayed PTSD, but also in the sense of pointing at the clinical relevance of dog assaults on humans which, even without dog bite injuries, may result in a severe traumatization and eventual civil lawsuit.     

Signs and symptoms of post-traumatic stress disorder in children

Summary Post-traumatic Stress Disorder in children is a complex interaction of cognitive, affective, and physiological responses to an event that is outside the range of usual human experience and would be markedly distressing to almost anyone. Traumatic stress reactions in children are conscious and unconscious efforts to assimilate an overwhelming event and have been identified in the past as panic reaction, acute grief hysterical reaction, and physical shock. PTSD in children is complicated by multiple issues of developmental stages, family dynamics, physical maturity, genetic predisposition, and cognitive skills. Characteristic symptoms of PTSD which must persist for more than one month include re-experiencing (flashbacks, nightmares); avoidance; numbing of general responsiveness; and persistent autonomic arousal. Children exhibit characteristic PTSD symptoms, but research suggests four criteria specific to traumatized children independent of chronological age and the course of the disorder: 1) visualized and repeatedly perceived memories; 2) repetitive behaviors; 3) trauma-related fears; 4) altered attitudes about life and future orientation. These four criteria appear to remain clustered together in childhood trauma victims even when other diagnosis would appear more appropriate. PTSD in children encompasses a complex spectrum of diagnosis and remains technically intricate for the mental health professional.     

Probable posttraumatic stress disorder in a sample of urban jail detainees

This study examined the nature and extent of probable posttraumatic stress disorder (PTSD) among men in a substance abuse treatment program in a large urban jail. Specifically, it explored the prevalence of probable PTSD and other psychiatric problems among jail detainees, the types of trauma detainees experienced during different phases of their lives, and how those experiences might have contributed to the development of probable PTSD. Results showed that psychiatric problems were quite serious; nearly one-quarter of the sample reported previous psychiatric hospitalization, and nearly 10% were being currently treated with psychiatric medication. In addition, 21% of the sample met the criteria for probable PTSD, a rate five times greater than that in the general population. The current study suggests that the presence of probable PTSD among male detainees should be incorporated into the creation and implementation of jail-based behavioral healthcare services, including screening, assessment, and clinical interventions. Furthermore, in-custody drug treatment programs should adopt trauma-informed strategies for all program participants as the expected standard of care.     

Female juvenile murderers: Biological and psychological dynamics leading to homicide

The increasing involvement of girls under 18 in violent crime has been a matter of growing concern in the United States in recent years. This article reviews the arrests of female juveniles for violent crime and then focuses specifically on their involvement in homicide. Arrests of girls for murder, unlike arrests for assault, have not risen over the last 30 years, suggesting that the dynamics that propel female juveniles to engage in lethal violence differ from those contributing to assaultive behavior by this same group. A review of the literature indicates that theories as to why female adolescents kill do not take into account recent scientific findings on brain development and the biological effects of early trauma in explaining serious violent behavior by girls. Three cases, evaluated by the authors, involving female adolescents charged with murder or attempted murder, are presented. The authors focus on the biological and psychological dynamics that help explain their violent behavior. They discuss the effects of insecure attachment and child maltreatment, and trace a critical pathway between these early experiences and future risk of violent behavior. The dynamics of child maltreatment in fostering rage and violence are discussed thereafter in terms of offender accountability. The article concludes with a discussion of treatment and recommendations for future research.     

Post traumatic stress disorder, neuroscience, and the law

Post-Traumatic Stress Disorder (PTSD) is a complex psychiatric condition, the effects of which can be seriously debilitating. As it originates from a specific traumatic event, it often impacts soldiers and victims of violent crime. It is currently one of the most frequently litigated mental diseases. Neuroscience is slowly discovering the neural bases of PTSD and other psychiatric ailments and is building tests to distinguish actual patients from non-suffering individuals. We examine the current state of neuroscientific research on PTSD and its biomarkers, focusing on a recent experiment by Apostolos Georgopoulos and coworkers. Then we analyze the legal consequences of these scientific advances, both in civil and criminal law, from a comparative perspective. Neuro-technology is likely to provide courts with a new kind of evidence, which will not replace but add to older behavioral evidence. Furthermore, it will weaken the so far standing distinction between physical and emotional harm. However, even extremely sensitive tests (>95%) can have insufficient accuracy if the prevalence of a condition in the tested population is low. Therefore, the law ought to take into account the prevalence of PTSD and other psychiatric conditions when the decision whether to admit neuro-evidence in courts or not is made.     

The paraphilia-related disorders: an investigation of the relevance of the concept in sexual murderers

Paraphilic disorders (PAs) and sexual preoccupation are known risk factors for recidivism in sexual offenders. Nonparaphilic sexual excessive behaviors-so-called paraphilia-related disorders (PRDs), like paraphilias, are also characterized by sexual preoccupation and volitional impairment and can be diagnosed in paraphilic men. The prevalence and clinical significance of PRDs in sexual homicide perpetrators, however, is unknown. We investigated the relationship between PAs and PRDs retrospectively in a sample of 161 sexual murderers. Four groups were compared: men without a PA or a PRD diagnosis, men with at least one PRD but no PA, men with at least one PA but no PRD, and finally, those with a combination of both (PA+PRD). The PA+PRD group had the most lifetime cumulative sexual impulsivity disorders, more developmental problems, the highest persistent frequency of sexual activity, the highest number of previous sexual offences, more sexual sadism, and compulsive masturbation. Men of the PRD subsample had suffered more from childhood sexual abuse, showed more promiscuity, psychopathy, and alcohol problems. The use of the PRD concept in this special offender group should be further investigated with prospectively designed studies.