Forensic Diagnostics and Treatment – Complete Summary
Week 1 – Posttraumatic Stress Disorder (PTSD)
Forensic Psychological Assessment in Practice: Case studies – Forensic Mental Health
Assessment (p11-15) DeRuiter (2015)
Transformation from clinical to forensic psychology
Clinical Forensic
Diagnosing & treatment Legal decision-making
Therapeutic & supportive role Objective scientist
Distorted response styles more likely
(socially desired, defensive)*
High stakes
Psychopathology
Use of multiple collateral data sources,
including observations of others and
(medical, criminal, educational) file
information
Psycholegal referral questions require
specific forensic assessment instruments
(FAIs)
*Self-report questionnaires are highly vulnerable to distortive response styles, and FMHA
requires the use of self-report instruments which allow for a judgment of response style
MMPI-2 and PAI should be included in FMHA. When results on these tests raise concern,
further testing (e.g. malingering) should be conducted.
Performance-based personality tests (e.g. Rorschach Inkblot Method) are just as prone to
response style distortion. Still, performance-based personality tests can make a unique
contribution to FMHA because they are comparatively less transparent to the assessee.
Also, using using multiple methods of assessment allows the evaluator to examine the
concordance between the findings
,DSM-5: Posttraumatic Stress Disorder, acute stress disorder and adjustment disorder
Posttraumatic Stress Disorder
Diagnostic criteria (adults, adolescents, and children older than 6 years)
,Diagnostic features
- The essential feature of posttraumatic stress disorder (PTSD) is the development of
characteristic symptoms following exposure to one or more traumatic events
- The clinical presentation of PTSD varies: in some individuals the re-experiencing may
be most prominent while in others negative cognitions are most distressing
- The traumatic event can be reexperienced in various ways:
Recurrent involuntary, and intrusive recollections of the event. These usually include
sensory, emotional, or physiological behavioral components
Distressing dreams
Dissociative states, during which components of the event are relived and the
individual behaves as if the event were occurring at that moment
- The negative alterations can take various forms, including an inability to remember
an important aspect of the traumatic event or persistent and exaggerated negative
expectations regarding important aspects of life applied to oneself, others, or the
future
- Individuals with PTSD may be quick tempered and may even engage in aggressive
verbal and/or physical behavior with little or no provocation. They may also engage
, in reckless or selfdestructive behavior such as dangerous driving, excessive alcohol or
drug use, or selfinjurious or suicidal behavior
- PTSD is often characterized by a heightened sensitivity to potential threats, including
those that are related to the traumatic experience and those not related to the
traumatic event
- Concentration difficulties and sleep problems are commonly reported symptoms
Associated features supporting diagnosis
- Developmental regression, such as loss of language in young children, may occur
- Auditory pseudo-hallucinations can be present
- Following prolonged, repeated, and severe traumatic events, the individual may
additionally experience difficulties in regulating emotions or maintaining stable
interpersonal relationships, or dissociative symptoms
Prevalence
- Although different groups have different levels of exposure to traumatic events, the
conditional probability of developing PTSD following a similar level of exposure may
also vary across cultural groups
- Rates of PTSD are higher among veterans and others whose vocation increases the
risk of traumatic exposure (e.g., police, firefighters, emergency medical personnel)
- Highest rates are found among survivors of rape, military combat and captivity, and
ethnically or politically motivated internment and genocide
- Compared with U.S. non-Latino whites, higher rates of PTSD have been reported
among U.S. Latinos, African Americans, and American Indians, and lower rates have
been reported among Asian Americans
Development and course
- PTSD can occur at any age, beginning after the first year of life
- Symptoms usually begin within the first 3 months after the trauma, although there
may be a delay of months, or even years, before criteria for the diagnosis are met
(delayed expression)
- Frequently, an individual's reaction to a trauma initially meets criteria for acute stress
disorder in the immediate aftermath of the trauma
- Duration of the symptoms can vary widely (e.g. 3 months to 50 years)
- Symptom recurrence and intensification may occur in response to reminders of the
original trauma, ongoing life stressors, or newly experienced traumatic events
- The clinical expression of reexperiencing can vary across development
Risk and prognostic factors
Pretraumatic factors
- Temperamental – childhood emotional problems by age 6 years and prior mental
disorders
- Environmental – lower socioeconomic status, lower education, exposure to prior
trauma, childhood adversity, cultural characteristics, lower intelligence, minority
racial/ethnic status, and a family psychiatric history
- Genetic and physiological – female gender and younger age at the time of trauma
exposure (for adults)
Week 1 – Posttraumatic Stress Disorder (PTSD)
Forensic Psychological Assessment in Practice: Case studies – Forensic Mental Health
Assessment (p11-15) DeRuiter (2015)
Transformation from clinical to forensic psychology
Clinical Forensic
Diagnosing & treatment Legal decision-making
Therapeutic & supportive role Objective scientist
Distorted response styles more likely
(socially desired, defensive)*
High stakes
Psychopathology
Use of multiple collateral data sources,
including observations of others and
(medical, criminal, educational) file
information
Psycholegal referral questions require
specific forensic assessment instruments
(FAIs)
*Self-report questionnaires are highly vulnerable to distortive response styles, and FMHA
requires the use of self-report instruments which allow for a judgment of response style
MMPI-2 and PAI should be included in FMHA. When results on these tests raise concern,
further testing (e.g. malingering) should be conducted.
Performance-based personality tests (e.g. Rorschach Inkblot Method) are just as prone to
response style distortion. Still, performance-based personality tests can make a unique
contribution to FMHA because they are comparatively less transparent to the assessee.
Also, using using multiple methods of assessment allows the evaluator to examine the
concordance between the findings
,DSM-5: Posttraumatic Stress Disorder, acute stress disorder and adjustment disorder
Posttraumatic Stress Disorder
Diagnostic criteria (adults, adolescents, and children older than 6 years)
,Diagnostic features
- The essential feature of posttraumatic stress disorder (PTSD) is the development of
characteristic symptoms following exposure to one or more traumatic events
- The clinical presentation of PTSD varies: in some individuals the re-experiencing may
be most prominent while in others negative cognitions are most distressing
- The traumatic event can be reexperienced in various ways:
Recurrent involuntary, and intrusive recollections of the event. These usually include
sensory, emotional, or physiological behavioral components
Distressing dreams
Dissociative states, during which components of the event are relived and the
individual behaves as if the event were occurring at that moment
- The negative alterations can take various forms, including an inability to remember
an important aspect of the traumatic event or persistent and exaggerated negative
expectations regarding important aspects of life applied to oneself, others, or the
future
- Individuals with PTSD may be quick tempered and may even engage in aggressive
verbal and/or physical behavior with little or no provocation. They may also engage
, in reckless or selfdestructive behavior such as dangerous driving, excessive alcohol or
drug use, or selfinjurious or suicidal behavior
- PTSD is often characterized by a heightened sensitivity to potential threats, including
those that are related to the traumatic experience and those not related to the
traumatic event
- Concentration difficulties and sleep problems are commonly reported symptoms
Associated features supporting diagnosis
- Developmental regression, such as loss of language in young children, may occur
- Auditory pseudo-hallucinations can be present
- Following prolonged, repeated, and severe traumatic events, the individual may
additionally experience difficulties in regulating emotions or maintaining stable
interpersonal relationships, or dissociative symptoms
Prevalence
- Although different groups have different levels of exposure to traumatic events, the
conditional probability of developing PTSD following a similar level of exposure may
also vary across cultural groups
- Rates of PTSD are higher among veterans and others whose vocation increases the
risk of traumatic exposure (e.g., police, firefighters, emergency medical personnel)
- Highest rates are found among survivors of rape, military combat and captivity, and
ethnically or politically motivated internment and genocide
- Compared with U.S. non-Latino whites, higher rates of PTSD have been reported
among U.S. Latinos, African Americans, and American Indians, and lower rates have
been reported among Asian Americans
Development and course
- PTSD can occur at any age, beginning after the first year of life
- Symptoms usually begin within the first 3 months after the trauma, although there
may be a delay of months, or even years, before criteria for the diagnosis are met
(delayed expression)
- Frequently, an individual's reaction to a trauma initially meets criteria for acute stress
disorder in the immediate aftermath of the trauma
- Duration of the symptoms can vary widely (e.g. 3 months to 50 years)
- Symptom recurrence and intensification may occur in response to reminders of the
original trauma, ongoing life stressors, or newly experienced traumatic events
- The clinical expression of reexperiencing can vary across development
Risk and prognostic factors
Pretraumatic factors
- Temperamental – childhood emotional problems by age 6 years and prior mental
disorders
- Environmental – lower socioeconomic status, lower education, exposure to prior
trauma, childhood adversity, cultural characteristics, lower intelligence, minority
racial/ethnic status, and a family psychiatric history
- Genetic and physiological – female gender and younger age at the time of trauma
exposure (for adults)
