PTSD and Criminal Behavior
A National Center for PTSD Fact Sheet
By Claudia Baker, MSW, MPH and Cessie Alfonso, LCSW
Background
Posttraumatic Stress Disorder (PTSD) is described in the DSM IV as "the
development of characteristic symptoms following exposure to an extreme
traumatic stressor." In recent studies among incarcerated populations,
PTSD has been found in approximately 48% of female inmates and 30% of male
inmates. The following is an overview of PTSD, a discussion about how to arrive
at a diagnosis, an explanation of how PTSD can play a role in criminal
offenses, and a review of how PTSD may be acknowledged in sentencing procedures.
Overview
In order to accurately conceptualize PTSD, it is necessary to clearly
understand what is meant by "extreme traumatic stressor." If an individual has not been exposed to a
traumatic stressor, PTSD cannot be diagnosed. The definition of this term in
the DSM IV is on the one hand very specific but on the other hand somewhat
broad. A traumatic stressor must involve "actual or threatened death or
serious injury or other threat to one's physical integrity." However, this
event can be experienced directly, witnessed, or experienced vicariously.
"Experienced vicariously" is defined as learning that a traumatic event
occurred unexpectedly or violently to a family member or close associate. This
definition includes many different types of experiences, from military combat
to experiencing a natural disaster to growing up in an inner-city environment.
Although the case citations in this fact sheet refer to combat-induced PTSD, it
is very important to keep in mind that the disorder can result from many other
traumatic events.
In addition to having survived such a traumatic event, an individual must
exhibit symptoms from three categories: reexperiencing, avoidance/numbing, and
increased baseline physiological arousal. Reexperiencing symptoms include intrusive
thoughts of the trauma, nightmares, flashbacks, and "trigger
responses" (i.e., becoming distressed when a stimulus reminiscent of the
trauma is encountered). Avoidance/numbing symptoms include avoiding situations
reminiscent of the trauma, amnesia relating to part of the trauma, isolation
from others, and a general feeling of emotional numbness. Arousal symptoms
include insomnia, angry outbursts or irritability, and a general sense of
jumpiness. It is important to note that these symptoms do not always begin
immediately following a traumatic event; often, symptoms of PTSD do not become
evident until many years after the trauma.
How is the diagnosis of PTSD determined?
In order to establish a diagnosis of PTSD, the existence of an "extreme
traumatic stressor" must be verified. In the case of combat-induced PTSD,
this can be easily accomplished by obtaining military records and consulting
with someone experienced in interpreting these documents. With other types of
trauma, establishing the "extreme traumatic stressor" can be more problematic.
However, depending on the nature of the trauma, other public documents or
corroboration of the trauma from neutral sources may be useful..
Once the existence of a traumatic stressor has been established, the diagnosis
of PTSD must be made by a mental-health professional with experience in trauma.
Various instruments have been developed to assess for PTSD, including the
Mississippi Scale for PTSD (combat and civilian versions), the Clinician
Administered PTSD Scale for DSM IV, and certain portions of the Minnesota
Multiphasic Personality Inventory. However, certain behaviors observed by a
layperson can indicate the possibility of PTSD. Individuals with PTSD tend to
be jumpy and irritable and can exhibit difficulty in concentrating. A
psychiatrist with a great deal of experience in assessing for PTSD once stated,
"Show me someone who is relaxed and claims to have PTSD and I will show
you a charlatan." A survivor will exhibit genuine distress when discussing
the traumatic event and will often attempt to avoid discussing it. Someone who
tells the details of a trauma before being asked probably does not have PTSD.
In establishing the credibility of the diagnosis, it is also crucial to
demonstrate that the symptoms and behaviors in question were not present prior
to the trauma. It is also important to establish that the individual's level of
functioning declined after the trauma. This requires obtaining information from
someone who has been around the individual both before and after the trauma.
With PTSD that arises from childhood abuse, this can be problematic because it
is difficult to determine the premorbid level of functioning.
How is PTSD related to criminal behavior?
PTSD can be linked to criminal behavior in two primary ways. First, symptoms
of PTSD can incidentally lead to criminal behavior. Second, offenses can be
directly connected to the specific trauma that an individual experienced.
Many symptoms of PTSD can lead to a lifestyle that is likely to result in
criminal behavior and/or sudden outbursts of violence. Individuals with PTSD
are often plagued by memories of the trauma and are chronically anxious. Often,
attempts are made to self-medicate with drugs and alcohol. The emotional
numbness many trauma survivors experience can lead the survivor to engage in
sensation-seeking behavior in an attempt to experience some type of emotion.
Some combat veterans also may seek to recreate the adrenaline rush experienced
during combat. Feeling the need to be always "on guard" can cause
veterans to misinterpret benign situations as threatening and cause them to
respond with self-protective behavior. Increased baseline physiological arousal
results in violent behavior that is out of proportion to the perceived threat.
It is common for trauma survivors to feel guilt, which can sometimes lead them
to commit crimes that will likely result in their apprehension, punishment,
serious injury, or death.
A direct link between a particular traumatic stressor and a specific crime
can be indicated in three primary ways. First, crimes at times literally or
symbolically recreate important aspects of a trauma. State v. Gregory (Maryland, 1979) provides an example of this type
of case. Mr. Gregory, a Vietnam combat veteran, was charged with eight counts
of kidnapping and assault after an incident at a bank in Silver Springs, MD on
February 9, 1977. He entered the bank dressed in a suit with his military
decorations pinned on it and armed with two M-16 automatic rifles, the weapon
used by U.S. forces in Vietnam. He announced that he was not robbing the bank,
let the women and children go, and took the remaining occupants hostage. Over a
five-hour period, Mr. Gregory fired over 250 rounds of ammunition into the air
and at inanimate objects before the police apprehended him without serious
injury to anyone.
Mr. Gregory was initially convicted but the conviction was later overturned
on appeal. The examining psychiatrist determined that Mr. Gregory had been one
of very few survivors of an ambush in Vietnam, and the psychiatrist testified
that the defendant's behavior in the bank was an attempt to recreate an ambush
situation. Also, his behavior was viewed as an attempt at passive suicide in
order to relieve the intense guilt he felt about having survived the ambush in
Vietnam when so many others perished.
The second way that traumatic stressors can be linked to specific crimes is
that environmental conditions similar to those existing at the time of the
trauma can induce behavior (in particular, violent responses) similar to that
exhibited during the trauma. People v.
Wood (Illinois, 1982) is an example of this type of case. Mr. Wood was
charged with attempted murder after shooting his foreman during a dispute. His
prior diagnosis of PTSD and his history of combat duty in Vietnam were
documented. Testimony and actual tape recordings were introduced that showed a
similarity between the noises in the factory and noises Mr. Wood heard during
combat, and it was argued that these conditions set the stage for Mr. Wood's
violent behavior. The jury returned a verdict of not guilty by reason of
insanity.
The final way that traumatic stressors can be linked to specific crimes is
that life events immediately preceding the offense can realistically or
symbolically force the individual to face unresolved conflicts related to the
trauma. This creates a disturbed psychological state in which otherwise
unlikely behaviors emerge. State v. Heads
(Louisiana, 1981) is an example of this type of case. Mr. Heads, a Vietnam
combat veteran with no prior criminal history, was convicted of second degree
murder in 1978 after breaking into his sister-in-law's house and repeatedly
firing a .45 caliber automatic pistol. One of the bullets killed the
sister-in-law's husband. Mr. Heads had recently separated from his wife and had
entered his sister-in-law's home in an attempt to locate her. Because he had
experienced the loss of many friends in Vietnam, the severe emotional threat of
losing his wife disrupted his psychological equilibrium and resulted in
extremely violent behavior. In
addition, the scene of the shooting in Louisiana was described as
"Vietnam-like," which was seen as contributing to his violence. His
conviction was overturned on appeal in 1981 when a jury returned a verdict of
not guilty by reason of insanity.
Crimes that are directly linked to traumatic stressors usually have certain
characteristics. Often, the defendant has no criminal history and cannot offer
a coherent explanation for the behavior. Others may also find it difficult to
discern any current motivation for the crime. The choice of a victim may seem
accidental, and an apparently benign situation may result in violence. There
may be amnesia surrounding all or part of the crime, and the individual may
report that there were numerous stressors prior to the crime that related
literally or psychologically to the original trauma. The act itself may also be
linked symbolically or realistically to the original trauma. However, the
individual is usually unaware of this connection.
How should PTSD be taken into consideration during criminal sentencing?
The presence of PTSD should be considered by the court during sentencing. If
a defendant is diagnosed with PTSD, this information should be introduced as a
mitigating factor during the penalty phase of a capital case. In states with
versions of the "three strikes" law and in federal cases, the
presence of PTSD may be reason for the court to depart from mandatory
sentencing guidelines.
Various issues pertaining to an individual's traumatic experience and
subsequent adjustment are relevant when PTSD is introduced in sentencing
proceedings:
- Was any type of treatment made available to the
defendant either immediately after the event or in the months afterward? Crisis
intervention among survivors of traumatic events is extremely important.
- At what age did the trauma occur and what are the
ramifications for the defendant's personality development? Although trauma at an
early age can have a more pervasive effect on an individual's functioning, it
is easier to document pre- and posttrauma personality changes when the
stressors have been experienced at a later age.
- If a defendant has a history of criminal convictions or
poor adjustment during prior incarcerations, what is the role that undiagnosed
PTSD may have played in this behavior? Because being in prison requires a
person to be constantly vigilant regarding the threat of violence, an
individual with PTSD who is in prison can be profoundly retraumatized and his
or her PTSD symptoms may be exacerbated to the point where he or she will act
out with violence.
- Finally, what is the psychiatric prognosis? Although
PTSD is a chronic condition, with the proper treatment and education, its
symptoms can usually be successfully managed. It is unlikely that survivors
receive the proper treatment for PTSD during incarceration. In fact, because
prison life may retraumatize a person, a lengthy incarceration will likely
seriously exacerbate PTSD symptoms and cause the person's level of functioning
to deteriorate.
Conclusion
In sum, it is important to recognize when PTSD from previous traumatic stressors
may play a role in criminal behavior. Be aware of possible PTSD symptoms, establish
a legitimate and credible diagnosis (including documentation of the traumatic
stressor, if possible), and discern how PTSD symptomatology or a previous traumatic
stressor may have contributed to the criminal act.
Related Fact Sheets
Forensic validity
of PTSD
Explains the components of a PTSD diagnosis in relation to civil and criminal
court cases
Symptoms of PTSD
Learn about how traumatic experiences affect people, what survivors need to
know, and the common symptoms of PTSD
War-related stress
War zone related stress reactions: What veterans need to know
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