The United States’ long-standing involvement in both Iraq and Afghanistan has brought the mental health consequences of war into the public eye.
The 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.
According to the U.S. Marine Corps, more than 2 million U.S. soldiers have served in Afghanistan and Iraq since September 11, 2001. Of those, 40,000 have received a diagnosis of PTSD while deployed, with countless others receiving the diagnosis at some point after returning home. A Rand Corporation study found that 20 percent—or 300,000—veterans who served in Iraq or Afghanistan have 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.
Forensic psychologists are responsible for addressing the medical-legal issues surrounding PTSD, identified as:
- Criminal responsibility
- Sexual trauma
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 violent 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 in 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 serious psychological injury and therefore deserves compensation or, in the case of criminal proceedings, is not responsible for their actions.
Forensic psychologists utilize a number of tools when performing assessments on military personnel. The use of assessment instruments in the 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
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 (PhD 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.
A number of 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
Students often focus their internships and post-doctoral fellowships in clinics, hospitals, mental health centers, community organizations, and government agencies at all levels.
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.