Post-traumatic Stress Disorder
This diagnosis of PTSD is frequently used when there are allegations
of sexual abuse. However, it is often given in error and is used to buttress
the claim that the alleged abuse is, in fact, true.
According to the DSM-III-R, this diagnosis is made following a traumatic
event that is "outside the range of usual human experience...(and)
would be markedly distressing to almost anyone, and is usually experienced
with intense fear, terror, and helplessness" (American Psychiatric
Association, 1987, p. 247). The DSM-IV is similar: "...extreme traumatic
stressor involving direct personal experience of an event that involves
actual or threatened death or serious injury, or other threat to one's physical
integrity....The person's response must involve intense fear, helplessness,
or horror" (American Psychiatric Association, 1994, p. 424).
But observed behaviors on the part of the alleged victim cannot be used
to reason backwards to prove that the claimed event actually occurred. Such
erroneous reasoning should not be allowed to imply the truthfulness of assertions
about prior events. The Task Force Report of the American Psychiatric Association
(Halleck et al., 1992) maintain that a DSM-III-R diagnosis cannot be used
to conclude that criminally actionable conduct has occurred. They state:
"In the absence of a scientific foundation for attributing a person's
behavior or mental condition to a single past event, such testimony should
be viewed as a misuse of psychiatric expertise." (p. 495)
When a diagnosis of PTSD is made in child sexual abuse allegations, often
the intent is to buttress the allegation by essentially saying these are
symptoms seen now and they are caused by the abuse done in the past. This
is the formal logical error known as affirming the consequence. It may appear
to have the form of a valid argument but relevant facts have been left out,
evaded, or distorted. This logical error is also a confusion between one
way and bidirectional implication. The argument may be like this: If the
child has been sexually abused, she should have night mares. She has nightmares.
Therefore, she has been sexually abused. The fact evaded is that nightmares
can be caused by many things, including eating green apples. Any attempt
to introduce the PTSD diagnosis in this fashion must be challenged. Also
the basis for the diagnosis must include sufficient documented symptomatology
to meet the requirements of DSM-III-R and DSM-IV.
In addition, the event must be traumatic, outside the range of usual human
experience, and experienced with intense fear, helplessness, or horror.
Fondling that causes little discernible distress at the time does not fit
this definition, but we have seen many such cases in which the PTSD diagnosis