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Post-Traumatic Stress Disorder (PTSD)

Stephen M. Raffle, M.D.

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Curriculum Vitae

By Stephen M. Raffle, M.D.

Post-Traumatic Stress Disorder (PTSD) is an anxiety disorder arising as a result of an emotionally overwhelming experience. In litigation, a forensic psychiatrist is the expert witness best trained in making an accurate diagnosis of PTSD, a medical condition. Psychiatrists recognize PTSD in individuals who have suffered a variety of kinds of trauma. The symptom complex commonly includes nightmares that recapitulate the traumatic event, recurrent intrusive thoughts about the event, phobias (overwhelming fears) when the person is exposed to a situation reminiscent or resembling the traumatic event, and unbidden intrusive thoughts about the event. In my forensic psychiatry practice, I have observed PTSD to be a common, but often erroneous diagnosis.  A treating doctor may make a PTSD diagnosis merely because an individual has been exposed to a situation that might cause PTSD. There are many instances where an individual is exposed to an event that some people would find traumatic, such as being in a train wreck, only to have that particular individual not develop the persisting signs and symptoms (more than one month later) necessary for a PTSD to be diagnosed. Also, if an individual is not emotionally overwhelmed by the experience, then the subsequent appearance of a post-traumatic stress disorder is unusual.

The psychiatric expert, in my opinion, must conduct a careful psychiatric examination of the person claiming PTSD in order to determine how the traumatic experience affected him or her. Only if it can be established that the person was overwhelmed by the experience, such as a person fearing for his life or being helpless in a situation, can the necessary, but not sufficient, criteria for this condition be met.

If an individual is not exposed to an event that is inherently and potentially overwhelming, then this individual, in my opinion cannot develop PTSD. For example, if a person was frightened by a barking dog, this would not constitute a sufficient trauma for a PTSD to develop, but if the individual were bitten by the dog she might develop a PTSD. As in most things in life, the devil is in the details.

Note Regarding Post-Traumatic Stress Disorder: Originally Post-Traumatic Stress Disorder-type injuries were recognized in combatants in warfare. However, over time, non-war-related injuries were found to cause equivalent symptoms. Just as the fact that not every soldier in combat develops Post-Traumatic Stress Disorder, not all individuals who are exposed to potentially traumatic experiences suffer PTSD. “Emotional resilience” appears to be the determining factor. This may be difficult to quantify but it appears related to the level of denial a person carries in his mind as a psychological defense against susceptibility to emotional injury. The less the pre-trauma denial, the more the resilience, or so it seems. Different emotional experiences affect individuals differentially, just as individuals exposed to the same physical challenge will experience it differently. Depending on the muscle mass, elasticity of tendons and ligaments, and bone brittleness, one person might have no injury, a second person a sprain or strain, and a third person a broken bone. The force of the trauma increases the likelihood of a broken bone or sprain and strain, but the outcome is not inevitable except under circumstances exceeding the body’s limits.

[Dr. Raffle was invited by the Industrial Claims Adjusters of San Francisco as keynote speaker on the topic “Post-Traumatic Stress Disorder and Other Stress Response Syndromes”; an interesting discussion followed the presentation on the question of whether Chronic Pain Syndrome could be linked to PTSD.  Dr. Raffle is well-versed on Chronic Pain Syndrome and the psychiatric elements of Chronic Pain (teaching on that subject as Assistant Clinical Professor at U.C. Medical School, San Francisco).  Dr. Raffle comments further on “Chronic Pain,” as one of his Practice Areas.]

[Related topic, see also the FAQ “What is Post-Traumatic Stress Disorder?”]

[Research reported by The New York Times, tells of alarming increases in PTSD, Suicide, and other mental health concerns among service men and women who are, or have recently, served in Afghanistan, Iraq, the Middle East generally, and veterans of the Gulf War.  Some Vietnam war veterans suffering from PTSD provide further information about what can happen over the long term.]

DISCLAIMER: The information provided on this website does not constitute legal or medical advice. Readers should consult with their own legal counsel or physician for the most current information and to obtain professional legal advice or medical advice before acting on any of the information presented.

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