Trends in Psychological/Psychiatric Injury and Law: Continuing Education, Practice Comments, Recommendations

Abstract

This literature review of the major topics in the field of psychological/psychiatric injury and law is aimed at developing commentary for practice in the area. The field is a fast-developing one, with over ten major topics that it needs to integrate. In particular, the present review focuses current work on: law (evidence, tort); forensic psychology; assessment and testing; psychological injuries (posttraumatic stress disorder, chronic pain, traumatic brain injury, other); the APA DSM-5 draft (Diagnostic and statistical manual of mental disorders; American Psychiatric Association 2010); malingering; causality; multicultural considerations; disability; the American Medical Association (AMA) Guides to the evaluation of permanent impairment (Rondinelli et al. 2008); models; and treatment. At the end of each section of the article, practice comments introduce critical issues in applying the research to psychological work in the area. Whether undertaking tort evaluations, disability, and treatment plan assessments or treating individuals with psychological injuries, the professional needs state-of-the-art information in all the areas listed in order to remain scientifically informed, comprehensive, and impartial. The article concludes with recommendations for an integrated field in psychological/psychiatric injury and law, study in the field, research in its major areas, best practice policies, for example in assessment and treatment, and model building.

Assimilation and Accommodation

“…In 22 articles, accommodation was understood as an adjustment of cultural, environmental, linguistic, political, or testing conditions or, vice versa, as a one-way adaptation of certain groups to specific conditions. Young (2010) reports accommodation as adjusting an environment for disabled psychiatric patients, while Moen (2011) discusses the term "work-family fit" in terms of five challenges. Other authors understood accommodation as a two-way process with both sides having to adjust.…”

Personal injury and other tort matters.

“…Because functional capacity is distinct from diagnosis, it cannot be assumed that the presence of a particular condition is necessarily related to a specific level of functioning. Young (2010) differentiated among symptoms (i.e., subjective experiences of the plaintiff), functional impact (i.e., observable changes in the plaintiff's ability to carry out life activities), impairments (i.e., limitations resulting from a condition), and disabilities (i.e., inability to perform in a specific role or context), stressing that these terms should not be used interchangeably. S.A. Greenberg et al (2004) pointed out that a diagnosis is not an essential element of a legal claim or defense and warned that substituting a diagnosis for an analysis of functioning (a) can be misleading, (b) does not serve the purposes of the court, and (c) has the potential to distort an objective assessment of the plaintiff.…”

“…Piechowski (2011) proposed categorizing functional capacities that are related to mental health conditions in terms of three domains: cognitive, which includes concentration, memory, comprehension, expression, processing, and problem solving; interpersonal, which involves the ability to engage in appropriate interactions with others; and emotional, which focuses on areas such as stress tolerance, emotional control, mood stability, and judgment. Unfortunately, there are no specific psychological tests that can determine the important roles that an individual plays and how each aspect of these roles was affected by the events in question (Young, 2010). Heilbrun et al (2008) noted that despite significant conceptual and empirical advances over the last two decades, there remains considerable inconsistency in the quality of forensic assessment practice.…”

Chronic Pain in the DSM-IV and the DSM-5 Draft: The Pain of It All

“…The draft goes on to state that the symptoms could be initiated, exacerbated, or maintained by combinations of biological, psychological, and social factors. This latter description is a welcome addition to the description of somatic complaints because the biopsychosocial model of pain is increasingly recognized in the field (Gatchel et al 2007;Young 2010). The DSM-5 draft notes that having conditions such as fibromyalgia or diabetes do not necessarily qualify or disqualify the patient from receiving a diagnosis of somatic symptom disorder.…”