F. Barton Evans, Ph.D.

Transcription

1 F. Barton Evans, Ph.D. Clinical & Forensic Psychologist Compensation & Pension Service Charles George VAMC Asheville, NC Clinical Professor of Psychiatry and Behavioral Sciences George Washington University School of Medicine

2 DISCLAIMER This presentation and the opinions stated herein should in no way be construed to reflect the opinions or beliefs of the U.S. Department of Veterans Affairs or the United States government.

3 Outline Cautionary Statement Psycholegal use of clinical information Reconciling clinical with examination findings Special issues for DSM 5

4 Cautionary Statement for Forensic Use of DSM-5 the use of DSM-5 should be informed by an awareness of the risks and limitations of its use in forensic settings. When DSM-5 categories, criteria, and textual descriptions are employed for forensic purposes, there is a risk that diagnostic information will be misused or misunderstood. These dangers arise because of the imperfect fit between the questions of ultimate concern to the law and the information contained in a clinical diagnosis. American Psychiatric Association (2013) Diagnostic and Statistical Manual of Mental Disorders, 5th Edition. Arlington, VA :American Psychiatric Publishing,

5 Psycholegal Use of Clinical Information Proximate cause/misattribution Credibility- multi-method assessment integrating subjective self report, collateral information, objective measures (structured interviews, psychological testing), Response style Under-reporting Over-reporting/feigning/malingering (required in DSM IV)

6 Reconciling Clinical with C&P Evaluation Findings Discrepancies between clinical records and C&P evaluation findings Important differences between a clinical evaluation conducted for treatment purposes and a forensic evaluation conducted for administrative law purposes (such as a C&P exam) (see references below). For example, forensic evaluators, such as C&P examiners, generally:

7 Reconciling Clinical with C&P Evaluation Findings Have access to more sources of information, e.g., C- File including Service Treatment Records (STRs) Have more impetus to review relevant private and/or VA treatment records Are able to use empirically-grounded structured diagnostic interviews such as the Clinician Administered PTSD Scale (CAPS), which are more accurate than unstructured interviews

8 Reconciling Clinical with C&P Evaluation Findings Have more impetus to conduct objective testing Do not have to worry about the impact of their diagnosis on the therapeutic alliance Extensively examine self-reported symptoms and etiological assumptions It is counterproductive for a treating clinician to approach a clinical treatment with any level of suspicion Base precise conclusions on scientific research, rather than solely on clinical judgment or personal experiences

9 Special Issues for DSM 5 PTSD Subsyndromal Fear easing/mst GAF WHODAS Differential diagnosis proximate cause Diagnostic drift: will see a good deal of DSM IV thinking in the age of DSM 5

10 References Special Section on C&P Evaluations Psychological Injury and Law (PIL) Evans, F. Barton (2011) Introduction to Practice Matters Special Section on VA Compensation and Pension Exams for PTSD and Other Mental Disorders. PIL. 4: Moering, Robert G. (2011) Military Service Records: Searching for the Truth. PIL. 4: Ridgeway, James D. (20110) Mind Reading and the Art of Drafting Medical Opinions in Veterans Benefits Claims.. PIL. 4: Worthen, Mark D. & Moering, Robert G. (2011) A Practical Guide to Conducting VA Compensation and Pension Exams for PTSD and Other Mental Disorders. PIL. 4: Forensic vs Clinical Roles Greenberg, SA & Shuman, DW (1997). Irreconcilable Conflict Between Therapeutic And Forensic Roles. Professional Psychology: Research And Practice, 28, Strasburger, LF, Gutheil, TG, & Brodsky, A. (1997). On Wearing 2 Hats: Role Conflict In Serving As Both Psychotherapist And Expert Witness. American Journal Of Psychiatry, 154,