(B) Mental Trauma Injuries
(1) Post Traumatic Stress
Post traumatic stress disorder is the classic mental trauma injury, by definition arising out of a single event and typically connected with a shocking event or circumstance that causes those involved in the claims process to recoil.
But at the margins, PTSD can be problematic for both sides. PTSD creates problems for claimants when it arises out of circumstances that are not grossly traumatic, and merely would be seen by most as upsetting and stressful, but not life-altering. PTSD can also, oddly enough, create problems for claimants when the circumstances are clearly traumatic, but the response itself is not initially consistent with that. Adjusters (and triers of fact) may expect a claimant to go immediately into shell-shock. And if a claimant does not do so, not only does it raise a fact question, it may also create a legal barrier, because the suppression of mental trauma injuries, though psychologically plausible, does not open up any exceptions to legal requirements of reporting or filing.[18]
PTSD is still not really well understood:
The idea that PTSD is one of the few disorders for which we know the etiology is mistaken. Most people who were exposed to trauma don't develop PTSD, and those who do usually have past symptomatology.[19]
To prove PTSD, you must show the following:
The DSM-V definition combines a putative cause (a traumatic event) with a set of characteristic symptoms. Criterion A describes the trauma: an event that is either life-threatening, could lead to serious injury, or rape. However, the diagnosis has been broadened by allowing incidents that consist only of hearing about trauma, which could expand the prevalence of PTSD.[20]
The controversy begins with the most malleable of terms, and that is the “trauma” criterion:
First and foremost is the criterion A problem, as it is not clear what is meant by the word "traumatic."[21]
As psychiatrist Joel Paris, MD describes the problem:
Is trauma a stressor that everyone would feel deeply upset by (such as a direct threat to one's own life), or is it really enough to be a bystander or a distant observer (e.g., watching a terrorist attack on TV)? Do you have to be flooded with fear or or at the time, as DSM-IV required? Do common experiences such as loss and grief qualify as traumas?[22]
A skilled expert will be prepared to reserve to himself, rather than the layman, the right to judge what is traumatic or not, and thus to bolster or brush off the claimant's allegation of a traumatic incident. This has some support in the DSM's idea that the book is not to be used woodenly, but as a guide for the trained and experienced clinician.
However, the DSM seems to recognize that, although it is defined as a mental trauma with certain features in response to a trauma, the condition may be largely tied to who the person is experiencing the trauma, and how they handle it (or, are predisposed to handle it).
. . . The nature of the trauma makes little difference to response, suggesting that this is a syndrome that reflects more about intrinsic sensitivity and about a reaction to life – threatening events. There are four groups of symptoms characterizing the syndrome; intrusion (re-experiencing the trauma), avoidance (avoiding situations that elicit memories), alternations in cognition and mood, as well as increased arousal. All must last for more than a month.[23]
This should make little difference in the workers' compensation context in practice, but in reality painting the claimant as an “eggshell” claimant from a mental trauma standpoint can be effective as a defense strategy.
Relevant to those familiar with the “zone of danger” concept in tort law, limiting recovery to those directly experiencing a trauma to a close relative, the PTSD criteria are now broadly defined in terms of how remote one must be from the traumatic event in order to experience it in a way that qualifies as PTSD:
Specifically DSM-V allows being a witness to disaster, or even reactions to learning about disasters, to be a traumatic event.[24]
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