How Military Forensic Psychologists Assess PTSD in Military Personnel

The United States’ long-standing involvement in both Iraq and Afghanistan has brought about the horrific aftermath of the mental health crisis as a consequence of war into the public eye.

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A large number of service members and veterans with mental health issues like post-traumatic stress disorder (PTSD) has had an impact on the civilian and veteran’s healthcare systems, as well as the military justice and disability systems.
In 2017, in the US a study involved 5,826 United States veterans amongst whom 12.9% were diagnosed with PTSD. This is a strikingly high rate as compared to the incidence of PTSD among the general population: It is estimated that about 6.8% of the U.S. population will experience PTSD at any point in their lives and between 11 and 20 percent of veterans suffer from PTSD.
Within the court system, PTSD is a basis for:

  • Mental impairment/mental harm for benefit programs (e.g., Social Security disability, Veterans’ disability, and workers’ compensation)
  • The insanity defense in criminal cases
  • Mitigating factors at sentencing in capital cases

 

The Forensic Psychologist’s Responsibilities When Performing PTSD Assessments

Forensic psychologists bridge the gap between psychology and law and provide necessary assessments of military personnel when civil or criminal issues arise.

As part of a team of experts, including neuropsychologists and neurologists, forensic psychologists assess PTSD for medical-legal purposes. PTSD is now one of the most widespread, war-related psychological disorders.

Veterans deployed to Iraq and Afghanistan in operations in Iraq displayed about 11 to 20 percent chance to develop PTSD in a given year. Taking into account the context, this would mean that of around 1.9 million veterans who served in these operations, between 209,000 and 380,000 will develop PTSD. And this is the gravity at which PTSD is a given risk for veterans.

Veterans of the Gulf War share a similar risk as about 12 percent of them develop PTSD or about 660,000 of the 5.5 million American military personnel have a high risk of PTSD in that conflict. These veteran PTSD statistics indicate that the Gulf War and Iraq War were similarly traumatic for service members but it doesn’t end here. For unfortunate circumstances, the PTSD rates for other conflicts go much higher.

You would be surprised to know that as many as 500,000 U.S. troops who served in these wars over the past 13 years have been diagnosed with PTSD.

Forensic psychologists are responsible for addressing the medical-legal issues surrounding PTSD, identified as:

  • Competency
  • Criminal responsibility
  • Sexual trauma
  • Disability

Some of the concerns of forensic psychologists when assessing military personnel for PTSD include:

  • PTSD is a psychological injury shrouded in controversy. Ongoing debate surrounds PTSD and its relationship to violence and aggressive behavior in the aftermath of deployment.
  • The validity and usefulness of tools used to diagnose PTSD have been widely criticized.
  • Critics argue the coaching of plaintiffs on how to present the disorder is widespread.

A careful assessment performed by forensic psychologists is necessary to distinguish service personnel who show valid symptoms of PTSD. Forensic psychologists must make determinations of competency and criminal responsibility and inform the courts of the result of their assessments.

Practice Guidelines for Forensic Psychologists Performing PTSD Assessments

Forensic psychologists skilled in PTSD assessment must answer the questions of competency, criminal culpability, and motivation in criminal proceedings. They provide their professional opinion on whether or not the plaintiff suffers from PTSD, and if so, what degree of impairment exists as a result of the condition.
They must also utilize their assessment capabilities in the family courts (domestic violence cases, divorces, custody disputes, etc.) and employment law (ADA accommodations, workers’ compensation claims, etc.).
In most cases, a request by an attorney or court precipitates the assessment of military personnel. The primary goal of the assessment is to persuade a judge or court that the plaintiff suffered a serious psychological injury and therefore deserves compensation or, in the case of criminal proceedings, is not responsible for their actions.
Forensic psychologists utilize several tools when performing assessments on military personnel. The use of assessment instruments in forensic settings reduces the likelihood of false-positive and false-negative findings.
Contemporary forensic assessment in PTSD emphasizes the importance of:

  • Systematic diagnoses
  • Use of standardized measures
  • Inclusion of malingering assessments
  • Independent corroboration of reports
  • Measurement of psychophysiological responses to the recollection of traumatic events

The gold standard in PTSD assessment is the Clinician-Administered PTSD Scale for DMS-5 (CAPS), which is a semi-structured interview that documents the intensity and frequency of PTSD symptoms. Forensic psychologists utilize CAPS to:

  • Make a current diagnosis of PTSD
  • Make a lifetime diagnosis of PTSD
  • Assess PTSD symptoms over the past week

Questions also target:

  • The onset and duration of symptoms
  • Subjective distress
  • The impact of symptoms on social and occupational functioning
  • The improvement in symptoms since a previous CAPS administration
  • Overall response validity
  • Overall PTSD severity

This need for practice guidelines should be treated as a necessity to deal with the diagnosis of such disorders. You will be surprised to hear that 15 out of every 100 Vietnam Veterans (or 15%) were diagnosed with PTSD in a study conducted in the late 1980s. However, The National Vietnam Veterans Readjustment Study (NVVRS) estimated that about 30 out of every 100 (or 30%) of Vietnam Veterans have had PTSD in their lifetime.

Forensic Psychologists Specializing in PTSD: Education and Training Options

Forensic psychologists are state-licensed clinical psychologists and must therefore possess doctoral-level education and training. The completion of a doctoral degree (Ph.D. or PsyD) not only serves as a necessary step to licensure but is also the ideal time for students to focus their education on a specific subfield of forensic psychology, such as psychological disorders in military personnel.

Several institutions offer doctoral degree programs with a focus on the distinct psychological needs of military personnel, veterans, and their families. The curriculum of these programs examines the psychological impact of war, low-level conflicts, terrorism, natural disasters, peacekeeping missions, and humanitarian operations. Students of these programs learn how to manage the psychological consequences of these events.
Coursework typical for these doctoral programs include:

  • Cognitive-behavioral and behavioral treatment interventions in DoD and veteran healthcare systems
  • Mental health law and the Uniform Code of Military Justice
  • Psychology of combat and conflict
  • Treatment modalities for military clients and their families

Newer research has been developing around its treatment and programs in universities are encouraging research in this field of specialization. In 2015, a research study on PTSD had its data analyzed from the National Health and Resilience in Veterans Study, a contemporary, nationally representative survey of 3157 US veterans. The findings demonstrated that 50.1% of all veterans and 72.0% of veterans who screened positive for PTSD reported at least ‘moderate’ PTSD in relation to their worst traumatic event.

Students often focus their internships and post-doctoral fellowships in clinics, hospitals, mental health centers, community organizations, and government agencies at all levels and try to contribute to the field of medicine and research through their findings and studies.

Doctoral programs in clinical psychology train students to become practitioners with expertise in assessment, theory, research, and practice. Graduates are then prepared to become civilian or commissioned military forensic psychologists.

Interested in becoming a Forensic Psychologist? Find forensic psychology programs near you.

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