The challenge of assessing Posttraumatic Stress Disorder: an umbrella review on the PTSD prevalence following different types of traumatic events

Posttraumatic stress disorder (PTSD) has long been a topic of debate in law courts, in large part due to the fact that the dimensions of the diagnosis impact directly on a multitude of forensic settings. Everywhere in the globe, traumatic events including natural disasters, accidents, sexual assault, and child abuse are frequent, and their mental health effects like posttraumatic stress disorder are equally widespread. However, there is significant confusion and debate surrounding the diagnosis of PTSD, which has been exacerbated by the discrepancies between the PTSD definitions in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) (American Psychiatric Association, 2013) and the eleventh edition of the International Classification of Diseases (ICD-11) (World Health Organization, 2019). This is aggravated by low intermethod concordance in disorder identification, which is primarily due to practitioners' choice of instruments with low validity and interrater reliability. Another challenge in PTSD evaluation is the distinction between the types of traumatic experience observed in therapeutic settings and those that typically define forensic settings. Whereas in the former case the psycholesive events of interest are generally “natural” (e.g., earthquakes, floods, avalanches, etc.) and endowed with measurable characteristics (intensity, duration, etc.), in the latter case the psycholesive events are generally “interpersonal” (aggression, rape, torture, etc.), thus endowed with significant variability and difficult to assess. Moreover, it could be particularly challenging to establish the presence and severity of PTSD in a court environment if there is evidence of malingering. Even therapists with extensive experience treating PTSD may be misled by individuals who fabricate it. For example, in civil cases individuals may be incentivised to simulate PTSD-related symptomatology to receive compensation from a third party for causing the traumatic event or to obtain a higher military or work disability award. Alternatively, in criminal cases, the defendant can rely on a diagnosis of severe PTSD to seek acquittal or a lighter sentence. For this series of reasons, it has been decided to provide a detailed analysis of the scientific literature on PTSD assessment issues and to develop an umbrella review on the prevalence of PTSD following various types of traumatic events, in order to offer references of useful applications in civil and criminal justice.