Exploring the Complicated Nature of PTSD

Post-traumatic stress disorder (PTSD) is one of those terms you hear bandied about, even as a joke, with relatively reckless abandon.

It’s when PTSD hits close to home that you realize the severity of its nature. While we often associate this condition with war veterans, this affliction can affect our children.

In fact, information from the National Center of PTSD shows that 15% to 43% of girls and 14% to 43% of boys experience at least one trauma. Out of those numbers, 3% to 15% of girls and 1% to 6% of boys develop PTSD.

Our firm frequently navigates the turbulent waters of PTSD diagnoses. We’ve had to develop a thorough working knowledge of what it all means. This way, we can superiorly defend clients that have been wrongly accused of mentally abusing their child based on such a diagnosis.

(It’s worth noting that from the study cited above, only 7% of PTSD cases in children result from mental abuse.)

For over 25 years, the PTSD criteria adhered primarily to what’s referred to as the revised Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R). (See Frank W. Weathers, Brian P. Marx, Matthew J. Friedman, Paula P. Schnurr, Posttraumatic Stress Disorder in DSM-5: New Criteria, New Measures, and Implications for Assessment, Psychol. Inj. And Law (2014) 7:93-107.)

During this phase, research and observations about traumatic stress came to light that called for further amendments. Professionals in the field began to raise questions about how trauma and PTSD were conceptualized.

Eventually, this led to DSM-5, which is the current standard-bearer for PTSD criteria. The most impactful updates in this revision declassified PTSD as an anxiety disorder and making it a stress-related condition.

New symptoms were added to what necessitates PTSD, such as:

• Persistent negative emotional state
• Continually distorted cognitions regarding the cause or consequences of the trauma leading to self-destructive behavior

Also, separate criteria were established for preschool children. Lastly, there was also a dissociative subtype (see also here).

The revisions in the DSM and evolution in how PTSD diagnostic criteria are understood come with quite a lot of confusion among mental health professionals.

There are issues regarding the vagueness of definitions and debates of clarity with the new PTSD criteria. Much of this paradigm-shift flies in the face of what clinicians believed to be good practice.

While the DSM provides a degree of direction to clinicians on how to evaluate and diagnose PTSD, many CPS social workers are unfamiliar with the criteria and have little or no working knowledge of how diagnoses are made (and therefore how valid a diagnosis is).

From there comes the need for improved and updated testing and measurements for PTSD symptoms, to make the diagnosis more objectively sound, rather than subjective.

The way post-traumatic stress presents itself is incredibly diverse and multi-layered. While symptoms do include fear and anxiety, PTSD isn’t mutually exclusive to those outcomes.

Other predominant symptoms include dysphoria and anhedonia. Also included are excess anger, aggression, guilt, shame, and dissociation. Often, these are all combined when someone experiences PTSD.

In the article referenced above and being discussed here, despite the necessary amendments being made to how we conceptualize and diagnose PTSD, there are still issues with vagueness.

Namely, some of the stressor criterion used for diagnoses present issues with narrowing and broadening PTSD classification. Of course, if the definition of PTSD is too broad, it presents problems with forensic investigations. For example, a sloppy diagnosis could be used to incriminate someone who is innocent.

On the other hand, if the definition of PTSD is too narrow, then many individuals won’t receive the treatment they need to get better.

If someone is to be diagnosed with PTSD, the article in question suggests that PTSD assessments should rely on multiple sources to provide information. This process should include the following:

• Diagnostic interview
• Psychometric testing
• Review of medical records

Adding these multiple layers to the diagnostic approach will remove much of the bias and subjectivity from the evaluation process conducted by the mental health professional.

When it comes to child abuse, it’s all too easy for emotions to come into play. Even though someone is a professional, they might be susceptible to half-truths and exaggerations due to the delicacy of the situation.

After all, it’s in our nature to believe and want to protect children, especially if they’re claiming to have been victimized.

The most reliable PTSD diagnosis is going to come from the most thorough testing and attention to detail…not from someone who is wrapped up in personal bias and jumps to conclusions.

Based on a PTSD diagnosis being used as evidence against them, falsely accused parents can end up on the Child Abuse Central Index.

That means it’s crucial to understand PTSD to help your child manage the symptoms and mitigate untrue allegations that can tear your family apart.