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 is given.