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Increase in PTSD claims presents diagnosis challenge

Increase in PTSD claims presents diagnosis challenge

As more employees file workers compensation claims for post-traumatic stress disorder following shootings and other violent incidents, medical experts warn the condition can be diagnosed prematurely following an event or misdiagnosed altogether.

It can be tough even for specialist to distinguish between conditions, experts say. Some employees witnessing an event can recover from the trauma without treatment, others may not meet the criteria for a PTSD diagnosis, but others may suffer from the condition.

“Right after a traumatic event, let’s say a mass shooting, in the next weeks it is common to have symptoms of PTSD and for most people, over time, those symptoms reduce until its gone,” said Sonya Norman, a San Diego-based psychologist and PTSD consultation program director for the White River Junction, Vermont-based National Center for PTSD. 

“PTSD is a sort of failure of that natural process,” she said, adding between 10% and 30% of people who witness a traumatic event will succumb to PTSD.

The mental condition is often accompanied by nightmares, stress and anxiety, among a long list of symptoms required for a diagnosis, and it can affect numerous people at one incident. In May, after a shooting at municipal building in Virginia Beach, Virginia, where 12 were killed, upwards of 450 workers filed PTSD workers compensation claims. 

Hundreds of workers were present during the shooting but some of the claims have been rejected, according to a city spokeswoman, who couldn’t elaborate on which classification of workers filed claims — first responders or office workers.

It’s hard to assess whether such a large number of claimants is excessive, experts say.  

Dr. Roger Pitman, a Cambridge, Massachusetts-based psychiatrist and professor of psychiatry at Harvard Medical School who worked with Vietnam veterans as a Department of Veterans Affairs clinician for 30 years, said in the instance of a traumatic event, PTSD is diagnosed using “specific criteria” in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders. 

Commonly referred to as the DSM-5, to be diagnosed with PTSD a patient must have been exposed or witness to a life-threatening event, along with a list of other symptoms that must be present, such as lack of function, irritability, aggression, difficulty sleeping or concentrating.

“Just being in the vicinity of a traumatic event does not qualify,” he said, adding that a person must experience symptoms for 30 days or more to be a PTSD patient, under the guidelines. “You have to look at each individual case.” 

Medical experts say checking the validity of the claims is a delicate issue. PTSD is well-known and those exposed to trauma may assume they have it and it can be faked, according to experts. 

“We have the internet now,” said Dr. Norman, who remains cautious in calling any claim of PTSD manufactured. “People Google their symptoms.”  

“As a clinician I feel like anywhere in life there are people exaggerating their symptoms and as a clinician it is not helpful to focus on that small percentage since there is so much stigma on mental health,” she said. 

Another issue is that a person who experiences trauma may have other conditions that are not PTSD, but still warrant treatment, according to Dr. Spencer Eth, a psychiatrist in Miami, Florida who is affiliated with the Miami Veterans Affairs Healthcare System and works as a professor of psychiatry with the University of Miami. 

“PTSD has become emblematic of trauma, but we shouldn’t lose the fact that there is depression or anxiety after an event, and substance abuse, which becomes very tricky,” he said. “(Those ailments) would warrant treatment and interfere with someone’s ability to work.”

PTSD is “treatable,” said Dr. Norman, but experts point to a mixed bag of solutions that include counseling and medication. 

“The natural course of PTSD is progressive improvement over time,” said Dr. Pitman, adding that relapses triggered by another event can occur, but the condition remains “treatable.”  

“We used to see it as a life sentence, but we’ve come a long way,” said Dr. Norman. “Most people respond to treatment.”