Martin H. Williams is a medical malpractice expert, member of ExpertPages since 1997. To contact this member, click here for his profile page.

Get notified about new articles - join the ExpertPages Mailing List now

A wrongful termination lawsuit is filed. Among the many claims is a claim for emotional damages. Plaintiff states that the unfair firing led to nightmares, anxiety, insomnia, mood swings, disintegrating relationships with friends and family, and a loss of interest in sexual intimacy and in other activities that formerly brought pleasure. In short, the plaintiff claims damages caused by Posttraumatic Stress Disorder (PTSD). Is the plaintiff suffering from this serious psychiatric condition, or is the plaintiff merely angry at what happened? Did the plaintiff experience a trauma, or did the plaintiff merely experience a grievance.

Litigious plaintiffs, or their attorneys, often "diagnose" PTSD even prior to a psychological evaluation. They assume that PTSD occurred in reaction to the stress-inducing events that are the subject of litigation. Attorneys and many members of the general public have learned the term "PTSD" and have come to believe, mistakenly, that it can follow any event that causes, or might cause, a psychological trauma. One patient of mine recently proposed that her three year old daughter suffered from PTSD because the little girl witnessed a fire in a vacant lot in the neighborhood. The girl, in fact, suffered from no psychological problems at all, but the mother assumed that proximity to the stressful event must have caused this disorder-whether symptoms of the disorder were apparent or not

Bona fide PTSD can serve as the basis for large damage awards, so one can easily understand plaintiff's inclination to claim this condition. In actuality, though, many plaintiffs who claim PTSD may be suffering nothing more than anger and outrage at the events over which they are filing suit.

Plaintiff attorneys who fail to understand the true nature of PTSD may find their case falling apart when exposed to effective defense rebuttals. I have worked for the defense in cases where PTSD was alleged to have occurred in reaction to the following precipitating events:

These events may be stressful or reprehensible, but, by definition, they are not the basis for PTSD. Further, to make a claim of PTSD in reaction to such stressors invites the defense to consider the unfavorable and insulting diagnosis of malingering-the intentional exaggeration or simulation of illness for the purpose of yielding some benefit to the person claiming to be ill.

PTSD-Criterion A

Looking at the DSM-IV-TR, the Diagnostic and Statistical Manual of the American Psychiatric Association, Revision Four, Text Revision (2000), one finds the following description of the event (Criterion A) to which the PTSD sufferer must have been exposed for the diagnosis to be made:

1) the person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others, and

2) the person's response involved intense fear, helplessness, or horror. Note: In children, this may be expressed instead by disorganized or agitated behavior

What is most important to note here is that the nature of the event needed to meet Criterion A is not a subjective matter for the victim to decide. The event must be objectively dangerous, even life threatening. Thus, for example, someone with fear of flying who believes that he or she will die because the airplane encounters moderate turbulence has not met Criterion A. Instead, that person is experiencing the emotional consequences of what is called a "simple phobia." Just because someone says, or even believes, that he or she will die from the situation in question does not mean that Criterion A has been met. To take another example, sufferers from Panic Disorder often believe that they are about to die or experience a heart attack. Because no life-threatening circumstances had been encountered, Criterion A is not met, and these people must be diagnosed with Panic Disorder, no matter how similar their anxiety symptoms might be to other aspects of PTSD.

Many individuals, with a wide range of psychological problems, think about death and believe themselves to be, for various reasons, close to death or threatened with death. Such beliefs, as frightening as they may be, are not part of PTSD, and may not even occur in reaction to any particular trauma. They may, instead, result from inherent problems in the sufferer's psyche. PTSD, in contrast, is a diagnosis that is only made following exposure to a truly dangerous event. In sum, Criterion A establishes the presence of a real trauma to which PTSD is a reaction.

PTSD-Criterion B though F

Criteria B through F describe the anxiety disorder that results from exposure to a traumatic event referenced in Criterion A. However-and this cannot be emphasized enough-PTSD cannot be diagnosed, no matter how similar the person's anxiety manifestations are to Criteria B through F, in the absence of a triggering event that conforms to Criterion A. Criteria B through F, including such symptoms as exaggerated startle, disengagement from others, and various form of reliving the trauma, are listed in the left column of the table below.

Anger and PTSD

Because plaintiffs in civil litigation are so often angry over the events that gave rise to their lawsuits, it is worthwhile to consider the similarities between symptoms of PTSD and anger. One of the most likely alternative explanations for the plaintiff's claimed PTSD is that the plaintiff, or the plaintiff's attorney, is merely confusing the everyday experience of grievance-induced anger with this diagnostic entity.

The table below compares PTSD diagnostic criteria with commonplace manifestations of anger.

Posttraumatic Stress Disorder versus the Ordinary Experience of Anger: