Evaluation of Posttraumatic Stress Disorder

Evaluation of Posttraumatic Stress Disorder


Background


Posttraumatic Stress Disorder (PTSD) is an important impairment to consider in the Social Security disability program, but not always easily identified. Consequently, we are preparing guidance to assist reviewers. We believe you and other members of our stakeholder community, such as individuals with PTSD, their advocates, private industry and state representatives, federal partners, health care providers, members of the academic and research community, and others, have insight that could help to inform our efforts.


We are specifically requesting input in the following areas, but welcome all insight. We want to hear from you!


1. How should we consider evidence about a claimant’s behavior and functioning from non-professional sources, such as parents or friends?

2. What lesser-known symptoms of PTSD might be helpful for adjudicators to know about, and what professional sources support this information?

3. What indicators can be used to rule out PTSD as an impairment, and what professional sources support this information?


This initiative coincides with our release of a final rule, Revised Medical Criteria for Evaluating Mental Disorders, which became effective January 17, 2017. The revised criteria now include new listings for trauma- and stressor-related disorders for both adults (listing 12.15) and children age 3 to attainment of age 18 (listing 112.15). You can review the final rule HERE.


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Campaign: Evaluation of Posttraumatic Stress Disorder

More on Lesser Known Symptoms

What lesser-known symptoms of PTSD might be helpful for adjudicators to know about, and what professional sources support this information? a. Chronic sleep deprivation Chronic partial sleep deprivation is a known symptom of trauma or stressor related disorders. In our experience adjudicators often misunderstand its effects perhaps due to not fully understanding the impact it can have on function. When we mention chronic ...more »

Submitted by (@kliebkemann)

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Campaign: Evaluation of Posttraumatic Stress Disorder

What lesser-known symptoms of PTSD important for adjudicators?

Some of the (lesser known?) symptoms might include irritability, social anxiety (not wanting to go out in public, avoiding crowded places), self-medicating with alcohol / drugs, emotional withdrawal from friends/family, depression, etc. The symptoms of PTSD are quite similar to those of depression, and also nearly identical to those of POST-CONCUSSION SYNDROME / MILD TRAUMATIC BRAIN INJURY. For example, many of our returning ...more »

Submitted by (@patti.goodall)

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Family and Friend Input

Many of the symptoms of post-traumatic conditions that produce functional limitations and behaviors are severe but intermittent. For that reason it is critical for adjudicators to consider evidence from non-professional sources in conjunction with evidence from professional sources. It is consistent with the nature of the post-traumatic impairments that particular symptoms might not be consistently present and observable ...more »

Submitted by (@kliebkemann)

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4 votes
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Children with ODD

Following up on comments offered by Kevin Liebkemann and Emilia Sicilia, many children diagnosed with Oppositional Defiant Order have underlying trauma. Since ODD has been removed from the new Children Mental Impairment Listings at 112.08, it is very important that adjudicators not write off children with ODD diagnoses but explore for trauma issues. Guidance similar to that in SSR 09-2p, which requires adjudicators to ...more »

Submitted by (@kcallery)

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Friend/Family Evidence Should Be Fully Considered

1. How should we consider evidence about a claimant’s behavior and functioning from non-professional sources, such as parents or friends? Answer: Evidence from non-professional sources is highly valuable in cases involving trauma. For many of the reasons documented in other comments, PTSD and other trauma-related disorders are underdiagnosed. (See submission from Kevin Liebkemann noting intermittent nature of symptoms, ...more »

Submitted by (@esicilia)

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3 votes
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Campaign: Evaluation of Posttraumatic Stress Disorder

Family and Friend input

I think it is important to consider what friends and family have to say about PTSD symptoms for two reasons. 1. The family and friends see the patient and may be aware of symptoms that the patient cannot/will not admit they have or are unaware of. 2. The medical records for some are not as descriptive, they may not be complete and/or the patient may not want to admit the full scale of issues they are experiencing because ...more »

Submitted by (@julieengland)

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Gathering information re: PTSD claimant’s behavior, functioning.

Very important to identify and use external sources to establish further corroborating evidence of a claimant's behavior and functioning, particularly in the area of PTSD. The symptoms / results of PTSD are often not readily seen in an office examination or via telephone interview, but can be triggered when a person is under stress or in certain situations (e.g., being in crowds, loud noises, kids screaming). Therefore, ...more »

Submitted by (@patti.goodall)

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Campaign: Evaluation of Posttraumatic Stress Disorder

Response submitted on behalf of Community Legal Services

Dear Social Security Administration: Thank you for the opportunity to provide comments on the following three questions about evaluating Post-traumatic Stress Disorder and other trauma and stressor disorders. CLS agrees with the comments offered by Kevin Liebkemann and Emilia Sicilia. 1. How should we consider evidence about a claimant’s behavior and functioning from non-professional sources, such as parents or friends? ...more »

Submitted by (@jburdick)

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1 vote
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Post Traumatic

Family and friends should always be the first individuals to listen to about a person's behavior. They have known and/or lived with this person most of their lives and knows what is common or unusual behavior. Others not familiar can only relate to what they have observed presently. I oftentimes find professionals have little patience and/or appreciation for a laymen's opinion. Oftentimes, limiting their attention ...more »

Submitted by (@ummesafiyya)

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Campaign: Evaluation of Posttraumatic Stress Disorder

PTSD inquiry

I think its important to know that PTSD does not come with a medication to treat it. Nonetheless, front line professionals that work in mental health clinics still try to find medication and continue to misdiagnose disorders like bipolar disorder or borderline personality disorder when the trauma and effects of trauma are the real problem. Moreover, dissociative disorders often com with PTSD, particularly with early ...more »

Submitted by (@mpacella)

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1 vote
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Non Professional Input

I believe that input from non professional sources, such as parents or friends, should be included in adjudicating PTSD claims. Patients with PTSD are often more likely to display symptoms and speak more openly with family members or friends than with clinicians. Clinician input is valuable and vital and should still be the primary source of information regarding the claimant's status, however, using anecdotal information ...more »

Submitted by

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Noncompliance with Treatment

Individuals who have suffered traumatic experiences often find it difficult to comply with talk therapy treatment. The regulations should do more to address the unfortunate circumstance where BECAUSE OF a mental health impairment, Claimant has difficulty proving the impairment because treatment records are sparse. In this sense, reporting and opinions from non-medical sources should be afforded more weight,

Submitted by

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