PhD/PsyD Your input
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In DSM-V, every damn thing meets criteria A these days. In this case, I would be highly skeptical about full-blown PTSD resulting from my experience. Not impossible, just unlikely. How long has it been since the fight?
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All things depend on context. If a teacher got a booboo breaking up a fight between two 5 year olds I'd be hard-pressed to say yes. If someone got decked during a spontaneous biker brawl involving weapons than quite possibly.
Technically, it probably could qualify under DSM V but as WisNeuro said - I would be surprised if other symptoms (not explained by other means...) followed in sufficient severity to warrant a PTSD diagnosis.
Edit: RE DSM-IV it depends on their reaction (for criterion A). I forget the exact wording but its basically horrified, stunned, etc. So if they don't respond to the event in that way, its not PTSD. Though if memory serves, the reason they removed it is because initial responses showed limited/no prediction of long-term symptoms...
Technically, it probably could qualify under DSM V but as WisNeuro said - I would be surprised if other symptoms (not explained by other means...) followed in sufficient severity to warrant a PTSD diagnosis.
Edit: RE DSM-IV it depends on their reaction (for criterion A). I forget the exact wording but its basically horrified, stunned, etc. So if they don't respond to the event in that way, its not PTSD. Though if memory serves, the reason they removed it is because initial responses showed limited/no prediction of long-term symptoms...
If it meets all criteria, I guess so. If there was any primary/secondary gain in the picture though, I'd want to examine that.
My gut says no save for other criteria being extremely pronounced, but even then.. I would think that might be secondary to other issues of the personality and secondary gains variety. Possible yes, for sure. but.. it seems a dilution of the severity associated with the diagnosis imho. I sincerely doubt the other symptoms would manifest.
DSM-IV still needed A2, although it was fairly specific. Depends on the possibility of severity of serious injury.
Not even close to the latter scenario. And...every symptom (using DSM-IV) was endorsed...on a checklist.
Are you using that VA symptom checklist?
Not me. And not a VA clinical case.
I hate checklists. I've seen a few local VAs use this single checklist and it has an average of about 85% endorsement for all symptoms/issues. Highly valid for screening I'm sure. Seems like this might be a poor diagnosis. Like hearing people wanting a CTE diagnosis because they heard their guy fell down at head at age 6.
Even flashbacks? Yeah, I'm highly skeptical.
This.
I'm very skeptical of these types of situations bc they often/mostly involve legal and work considerations, which make $$ a factor in nearly all of the cases.
This is a frustrating part of this field. I think this is preposterous (especially given max sx endorsement), but the diagnosis in the lynch pin here, and if the event technically qualifies, then it opens the door. Now I have to spin a lengthy weave describing how this is just clinically "highly unlikely."
Any more empirical ground to stand on or assert here? Anyone know base rate for endorsement of things like flashbacks and the traumatic amnesia criteria in clinical samples?
Any more empirical ground to stand on or assert here? Anyone know base rate for endorsement of things like flashbacks and the traumatic amnesia criteria in clinical samples?
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2 blows? They probably already contracted CTE
D
deleted343839
If you force a binary decision right now I'm going to go with "no," but this cries out for other assessment (behavioral observations, collateral reports, etc.).
I will probably recommend IME for this. This is a file review only at this point.
Don't know the overall prevalence rates, but in the NVVRS sample of Vietnam Vets, in combat theater, only 1.8% reported experiencing flashbacks.
That is the most ridiculous thing I've heard.
You need more clinical work. This is far from the most ridiculous thing that I have heard. 🙂
If you read the ama book "causation", you can learn to apply hill's model of causation.
I would be reticent to diagnose ptsd, unless the symptoms followed the dose response curve (I.e., relatively mild for a punch to the face), or the person had an underlying personality disorder (following the fragile egg doctrine in torts).
I would be reticent to diagnose ptsd, unless the symptoms followed the dose response curve (I.e., relatively mild for a punch to the face), or the person had an underlying personality disorder (following the fragile egg doctrine in torts).
And you were able to keep the laughter in?
All part of being a psychologist.
Whenever something more ridiculous than normal happens I imagine myself writing the event/comment down on a chalkboard with the note to myself of "come back and laugh about this later"
But sorry, I'd have little understanding for this. My dad, and I know many other men, who were in concentration camps for months, and got tortured, and dealt with their issues mostly by themselves..and now you have people like this suggesting that they have PTSD from accidentally being hit in a fight they were breaking up. It not only annoys me, it angers me.
You have to remember though, everyone is bringing a different life experience, and different set of risk factors (environmental and neurobiological) into traumatic situations. While this particular situation is suspect, you always have to keep an open mind. Shaming and invalidating individuals exposed to trauma is not helpful. In short, assume it's legitimate until a preponderance of evidence shows otherwise.
Sure, you have to be understanding..and I am open minded..but as you said this is suspect, and it is suspect in prob 90% of cases.
Everyone has different sensitivities to the development of psychopathology. There is likely psychological sequela in this case. Is it PTSD proper? No, probably not, and not nearly to the extent posed by this other provider.
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90% would be high, even in the VA, where secondary gain is expected. 40-60% would be the high estimate even in the VA setting based on npsych studies. That base rate varies wildly on setting.
I meant this situation in particular, not in general.
Unspecified trauma and stressor related disorder?
I would think that this would be highly dependent on further details about the severity of the fight. Criterion A states that it must be actual or threatened death or serious injury. Also, trying to tie the other symptoms to beginning or being exacerbated by that specific experience. Many symptoms such as the cluster of negative cognitions/mood may be endorsed, but have always been there versus emerging or worsening after the purported "trauma."
I have these details. Of course serious injury could be reasonable fear here. After further review and research, its not only the debatable and somewhat flimsy index trauma, but also the "relatedness" that is at issue here.
Thanks for the feedback SDN. We never stop learning, thinking, and researching in this field.
Do I detect some positive sincerity? New Year's Resolution?
I also quit heroin
Switch to cocaine, helps with report writing.
Dozens and dozens of SNL writers can't all be wrong.
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