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23.1.2 Post Traumatic Stress Disorder cases


Post-traumatic stress disorder, by definition, is caused by a traumatic event. Although treated by RCG as a 'disease' for some purposes (i.e. in terms of 'contribution') the actual illness nevertheless has the character of a simple injury – i.e. the cause relates to a single traumatic event. The acceptance of liability therefore depends not only on diagnosis, but on the verified reality of the alleged trauma.

In general, Delegates should avoid sending clients alleging Post-Traumatic Stress Disorder for a psychiatric opinion unless and until the factual circumstances of the claim can be verified first. A psychiatrist in those circumstances can do no more than report whether the client exhibits symptoms which appear to meet the DSM-IV criteria. The psychiatrist, however, is logically unable to verify – i.e. bear personal witness – as to whether the alleged causative incident did indeed occur as described by the client. In that regard, the psychiatrist is dependent upon the client's narrative, which does not gain in veracity by being relayed to the Delegate via a professional psychiatrist rather than directly from the client.

Experience has shown that some clients may experience unnecessary distress upon rejection of a medical opinion which although supportive nevertheless uncritically accepts unverified allegations. Typically the client sees the inclusion of his/her alleged history of mental trauma within the report as a professional medical endorsement of the truth of his/her story. Furthermore, the Delegate's rejection may be seen as an unwarranted intrusion by a lay person into what is (incorrectly) perceived to be wholly a medical matter. The Delegate's explanation that the psychiatrist's professional expertise does not extend to 'witnessing' past events at which he/she was not present, is not usually well received.

For these reasons, it is advisable in PTSD cases to focus the client's attention on verifying the alleged trauma, i.e. the alleged causative event, BEFORE seeking to confirm the diagnosis.