Complex Trauma: Missed and Misdiagnosis in Forensic Evaluations

Abstract

Forensic evaluators frequently utilize diagnoses as a way to document the nature and severity of impairment and/or injury in civil and criminal cases despite diagnostic manuals being primarily created for use in clinical and research setting (Frances and Halon, Psychological Injury and Law, 6, 336-344, 2013). Psychological trauma holds a unique place in diagnostic nosology, as it is both an experience and various sets of persistent symptoms that are required to meet criteria for the diagnoses that are most commonly associated with exposure to adverse/traumatic event(s) (Dalenberg et al. 2017; Smith, Temple Law Review, 84(1), 1-70, 2011). A problem exists with being able to directly diagnose complex posttraumatic reactions, including complex PTSD (CPTSD) and dissociative disorders, which are the result of repeated, prolonged, and inescapable abuse most often perpetrated during childhood (Courtois and Ford 2013; Herman, Journal of Traumatic Stress, 5, 377-391, 1992, 1993, 1997; Terr, American Journal of Psychiatry, 148, 10-20, 1991), although also seen in persons tortured or held as prisoners of war as adults. Although a large research and clinical literature has developed to describe this phenomenon CPTSD has only recently been introduced into the International Classification of Diseases-11th Edition (World Health Organization [WHO], 2018), and remains absent from the DSM. The author will discuss the importance of assessing a person’s lifetime exposure to traumatic events in forensic evaluations, emphasizing exposure to multiple and/or inescapable trauma early in development. This article will also explore the very broad range of posttraumatic conditions—particularly those on the more complex end of the spectrum that are frequently either invisible or baffling to forensic evaluators whose training has not included this emerging area of study.