Understanding PTSD in Worker’s Compensation: Navigating the Complex Criteria and Ensuring Accurate Diagnosis
The Growing Concern: PTSD in Worker’s Compensation Claims
A diagnosis that is occurring with increasing frequency is post-traumatic stress disorder, a.k.a. PTSD. This specific diagnosis is a mental health malady that has very specific criterion before it should be applied in every scenario. The media has outlined a modification to the standards, and several state jurisdictions have expanded the definition with particular attention to “first responders” and this becomes a critical concern for claim file handlers in the Worker’s Compensation scenario.
What Defines a Traumatic Event? Understanding the First Criterion
The first criterion is that the “injured individual” has been exposed to or witnessed a traumatic event. There is specific criterion identified in the DSM-5 that should be applied whenever there is a suggested diagnosis of PTSD.
To be clear, two separate individuals participating in the same situation could have vastly different responses to that identified event. The first criterion is that there must be exposure to a specific traumatic event. The next question becomes what is a trauma? Some authors suggest this is a deeply distressing or disturbing event, or a series of events, and that this event(s) overwhelms an individual’s ability to cope. These scenarios are mostly thought of as a life-threatening situation, a compromise to personal safety or integrity. The applications of this particular criterion have grown. However, in the scenario of PTSD, there needs to be clear clinical evidence of significant psychological response, physiological response, and emotional response to the noted stressor.
Others believe the events need to be outside the normal course of human experience. Clearly combat exposure, sexual assault are outside this norm. How does one establish a natural disaster as being outside the normal course? There will be fires, there will be rain and floods, and all sorts of natural phenomenon. Understanding the definitions noted in the medical literature, one has some difficulty correlating the two.
The DSM-5 Criteria: Key Symptoms for a PTSD Diagnosis
The next criterion is classified as intrusive symptoms. Often recurrent, involuntary, and specific sequelae such as nightmares occur with this diagnosis. The psychological distress results in an intensive scenario that compromises ordinary daily activities. The DSM-5 requires at least one of these intrusive symptoms to be present prior to making this diagnosis.
Next would be the objectification of avoidance behaviors, alterations in mood, and cognition. Individuals with this diagnosis experience significant negative alterations in their patterns and mood. In some situations, there is a marked change in arousal and reactivity resulting in irritable behavior, aggressive anger outbursts, or self-destructive behavior. Again, noting the DSM 5 standards to arousal symptoms must be present prior to making this diagnosis.
Beyond that, several additional findings must be identified. The symptoms must be present for more than a month, the need to be significant compromise to social or occupational scenarios, and these findings cannot be attributed to any other clinical situation.
Conclusion
The point is, this is a truly traumatic diagnosis, unfortunately this diagnosis gets assigned inappropriately or prematurely, particularly in the Worker’s Compensation scenario. Not everyone who witnesses a motor vehicle collision should be considered with a diagnosis of posttraumatic stress disorder.
The standards as outlined in the DSM 5 need to be the checklist utilized in the standards to be met then independently reviewed and endorsed prior to making this clinical assessment. The unfortunate aspect is that this particular diagnosis often times never resolves and the injured individual who sustains such a significant mental health injury can require extended if not lifetime treatment. Please ensure that all appropriate steps and safeguards are taken prior to accepting this diagnosis so that the most appropriate treatment can be delivered where necessary.