Evaluating the Reliability of Expert Evidence in Compensation Procedures: Are Diagnosticians Influenced by the Narrative Fallacy when Assessing the Psychological Injuries of Trauma Victims?

Abstract

The current study investigated whether mental health practitioners are influenced by the narrative fallacy when assessing the psychological injuries of trauma victims. The narrative fallacy is associated with our tendency to establish logical links between different facts. In psychodiagnostic assessments, this tendency may result in overdiagnosis of mental disorders when psychological symptoms can be attributed to a traumatic event. Consequently, legal decision makers may be at risk of awarding compensation for psychological injuries which are not severe enough to justify financial reimbursement. To explore this topic, we asked Dutch mental health practitioners whether they would assign a diagnosis of mental disorder to fictitious symptoms of psychological injury. Each participant was presented with two vignettes. The first vignette described symptoms in terms of a generalized anxiety disorder; the second in terms of a major depressive episode. The vignettes varied in the cause (trauma versus cause not specified) and severity (near threshold of DSM diagnosis versus below threshold of DSM diagnosis) of the symptoms. Results indicated that participants more often assigned a diagnosis of mental disorder if the psychological symptoms had been caused by a traumatic event than if that had not been the case. Further analysis of the data suggested that this difference was due to the high numbers of assigned diagnoses of posttraumatic stress and acute stress disorder in the trauma conditions. It was speculated that participants filled in missing information to justify the assignment of such diagnoses, for example by imagining symptoms of intrusion and avoidance.

Full text

Evaluating the Reliability of Expert Evidence in Compensation
Procedures: Are Diagnosticians Influenced by the Narrative
Fallacy when Assessing the Psychological Injuries
of Trauma Victims?
M. J. J. Kunst
1
&M. Van de Wiel
1
Received: 13 May 2016 /Accepted: 29 June 2016 / Published online: 14 July 2016
#The Author(s) 2016. This article is published with open access at Springerlink.com
Abstract The current study investigated whether mental
health practitioners are influenced by the narrative fallacy
when assessing the psychological injuries of trauma vic-
tims. The narrative fallacy is associated with our tendency
to establish logical links between different facts. In
psychodiagnostic assessments, this tendency may result
in overdiagnosis of mental disorders when psychological
symptoms can be attributed to a traumatic event.
Consequently, legal decision makers may be at risk of
awarding compensation for psychological injuries which
are not severe enough to justify financial reimbursement.
To explore this topic, we asked Dutch mental health prac-
titioners whether they would assign a diagnosis of mental
disorder to fictitious symptoms of psychological injury.
Each participant was presented with two vignettes. The
first vignette described symptoms in terms of a general-
ized anxiety disorder; the second in terms of a major de-
pressive episode. The vignettes varied in the cause (trau-
ma versus cause not specified) and severity (near thresh-
old of DSM diagnosis versus below threshold of DSM
diagnosis) of the symptoms. Results indicated that partic-
ipants more often assigned a diagnosis of mental disorder
if the psychological symptoms had been caused by a traumatic
event than if that had not been the case. Further analysis of the
data suggested that this difference was due to the high
numbers of assigned diagnoses of posttraumatic stress
and acute stress disorder in the trauma conditions. It was
speculated that participants filled in missing information to
justify the assignment of such diagnoses, for example by
imagining symptoms of intrusion and avoidance.
Keywords Compensation .Psychological injury .Trauma .
Psychodiagnostic assessment .Narrative fallacy
Introduction
The psychological impact of trauma may play an impor-
tant role in compensation procedures. Partly encouraged
by international and supranational obligations, the major-
ity of Western countries have ensured that trauma victims
can claim compensation for psychological injury through
a number of different routes. In the Netherlands, for ex-
ample, trauma victims can claim compensation for psy-
chological injury through the criminal justice system (in
case of a criminal incident), a civil lawsuit, or a disabil-
ity compensation scheme. Although the legal criteria to
award a request for compensation differ between these
compensation modalities, each modality allows victims
to claim financial compensation for material damages,
such as costs for the treatment of psychological prob-
lems, temporary sick leave, or permanent work disability,
and non-material damages, such as the pain and suffering
characteristic of psychological injury. However, trauma
victims are usually only eligible for compensation if their
psychological problems are recognized as a mental dis-
order by the Diagnostic and Statistical Manual of Mental
Disorders (DSM; American Psychiatric Association,
2013) or another widely accepted diagnostic classifica-
tion system (see Kunst, 2014).
*M. J. J. Kunst
m.j.j.kunst@law.leidenuniv.nl
1
Faculty of Law, Institute for Criminal Law and Criminology, Leiden
University, Room C1.03, P.O. Box 9520, 2300
RA Leiden, The Netherlands
Psychol. Inj. and Law (2016) 9:265–271
DOI 10.1007/s12207-016-9263-5
Content courtesy of Springer Nature, terms of use apply. Rights reserved.

Evaluating a Claim for Psychological Injury
Compensation
When evaluating a claim for financial compensation for psy-
chological injury, legal decision makers often rely on infor-
mation provided by a psychological expert (Cutler & Kovera,
2011). Although several authors have argued that therapists
should refrain from engagement in forensic evaluations (e.g.,
Strasburger, Gutheil, & Brodsky, 1997), this is usually a psy-
chologist or psychiatrist who treats the victim for his or her
psychological injuries. Only when information from a thera-
pist is lacking or doubted, an independent psychological ex-
pert is consulted. However, unfortunately, several sources of
bias may question the trustworthiness of psychological prac-
titioners’diagnostic information. In particular, the use of
heuristics during the diagnostic decision process may result
in erroneous conclusions about a victim’s psychological inju-
ry. Heuristics are “strategies that ignore part of the information
(or the lack of information), with the goal of making decisions
more quickly, frugally, and/or accurately than more complex
methods”(Gigerenzer & Gaissmaier, 2011, p. 454). In this
study, we will focus on one specific heuristic: the narrative
fallacy. Taleb (2007,pp.63–64) provides the following de-
scription of the narrative fallacy:
The narrative fallacy addresses our limited ability to
look at sequences of facts without weaving an explana-
tion into them, or, equivalently, forcing a logical link, an
arrow of relationship upon them. Explanations bind
facts together. They make them all the more easily re-
membered; they help them make more sense. Where this
propensity can go wrong is when it increases our im-
pression of understanding.
This definition suggests that we always want to explain
why things happen. This characteristic helps us to create a
plausible story. However, there is a second characteristic of
the narrative fallacy which is not included in this definition:
We sometimes make up things to fill in missing information or
neglect information that does not fit in with our story (for an
example, see Thüring, Großmann, & Wender, 1985).
Consequently, we sometimes base our conclusions on a wrong
story (Menashe & Shamash, 2005).
The Narrative Fallacy in Psychodiagnostic Assessments
The narrative fallacy may also play a role in psychodiagnostic
assessments: If psychological symptoms can be linked to a
particular event, psychologists or psychiatrists may be more
likely to attribute these symptoms to that event. Empirical
studies which addressed this topic are, however, rather scarce.
A few exceptions can be found in the work of Kim and
colleagues. For example, in an experimental vignette study,
Kim and Ahn (2002) asked clinical psychologists to formulate
causal theories about fictitious patients’psychological symp-
toms and found that a traumatic event was thought to be an
important cause of panic attacks in a phobic situation and
excessive fear in response to a specific object or situation. In
another experimental vignette study, Kim and colleagues in-
vestigated how causal information affects clinical psycholo-
gists’tendency to assign a diagnosis of major depressive dis-
order (MDD; Kim, Paulus, Nguyen, & Gonzalez, 2012). More
specifically, they investigated whether clinical psychologists
withhold clients a diagnosis of MDD if their symptoms begin
within 2 months of the loss of a loved one and do not persist
beyond these 2 months. The fourth revised version of the
Diagnostic and Statistical Manual of Mental Disorders
(DSM-IV-TR, American Psychiatric Association, 2000)ad-
vised, though not obliged, clinicians to refrain from a diagno-
sis of MDD in case of a bereavement-related life event.
Results suggested that clinical psychologists were indeed less
likely to assign a diagnosis of MDD when symptoms followed
upon the experience of a stressful life event than when no or a
neutral event had occurred: When a stressful life event had
occurred, a diagnosis of MDD was less advocated than when
such an event had not occurred. However, this applied to both
bereavement-related and non-bereavement-related life events.
This finding may be explained by what Meehl (1973) has
called the understanding-it-makes-it-normal effect.Thiseffect
refers to people’
s tendency to rate other people’sb
ehaviorsas
less abnormal when they know the cause of those behaviors.
In line with this effect, Kim, Paulus, Nguyen, et al. (2012)also
found that abnormality ratings were lower when depression
symptoms could be ascribed to a stressful life event.
1
Finally,
again in an experimental vignette study, Kim, Paulus,
Gonzalez, and Khalife (2012) found that clinical psycholo-
gists’tendency to rate symptoms of MDD or posttraumatic
stress disorder (PTSD) as abnormal depended on the propor-
tionality of a subject’s psychological response to a particular
stressful event; Severe symptom levels were considered less
abnormal in response to a traumatic event than in response to a
mildly distressing event.
Based on the work of Kim and colleagues, it seems reason-
able to speculate that the narrative fallacy may indeed play a
role in psychodiagnostic decision-making. However, their
findings do not indicate how this fallacy affects clinicians’
tendency to assign a diagnosis of mental disorder based on a
formal classification system, such as DSM. On the one hand,
their results suggest that clinicians are less likely to diagnose
people with a formal mental disorder if symptoms are caused
by a particular event. This fits in with the first characteristic of
the narrative fallacy: our tendency to explain why things
1
Similar findings were found among undergraduate students who were
enrolled in an introductory psychology course (Ahn, Novick, & Kim,
2003; Kim & LoSavio, 2009).
266 Psychol. Inj. and Law (2016) 9:265–271
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happen. On the other hand, the designs of their studies do not
allow such a conclusion to be drawn. First, their studies in-
cluded relatively low numbers of clinical psychologists
(Ns < 80). It can therefore not be ruled out that their results
were biased by sample size. Second, and more important, they
either requested participants to indicate whether they advocat-
ed a particular diagnosis, such as MDD, or to rate symptoms
in terms of abnormality. It can therefore not be ruled out that
participants would have responded differently to a question
which allowed them to advocate any diagnosis of a mental
disorder. Particularly, it cannot be ruled out that participants
would have assigned a diagnosis of a trauma- or stressor-
related disorder (i.e., a diagnosis of acute stress disorder
[ASD], adjustment disorder [AD], PTSD, or reactive attach-
ment disorder) more often in the trauma than in the non-
trauma conditions. For this type of disorders, exposure to a
stressful event is a diagnostic requirement. Consequently,
such an event cannot serve as an indication of the normality
of experienced symptoms. Rather, it may serve as a justifica-
tion to assign a diagnosis of a trauma- or stressor-related dis-
order. Indeed, it might even be the case that this feature trig-
gers the tendency to fill in gaps of missing information or to
neglect information—the second characteristic of the narrative
fallacy. For example, if psychological symptoms are presented
in combination with a traumatic event, psychodiagnostic de-
cision makers may fill in missing symptoms or neglect unfit-
ting information to assign a diagnosis of a trauma- or stressor-
related disorder. However, these contentions have never been
tested empirically.
The Current Study
Given the aforementioned, the current study examined the
narrative fallacy in psychodiagnostic assessments conducted
by Dutch mental health practitioners. More specifically, we
investigated whether the outcomes of psychodiagnostic as-
sessments are affected by cues about the potential cause of
the psychological injury. This is particularly important from
a compensation perspective. On the one hand, if diagnoses of
mental disorder are more frequently assigned to psychological
injuries that can be related to a particular event, then legal
decision makers may be at risk of awarding compensation
for psychological injuries which do not qualify for a diagnosis
of mental disorder according to DSM or another diagnostic
classification system. On the other hand, if diagnoses of men-
tal disorder are less frequently assigned to psychological inju-
ries that can berelated to a particular event, then legal decision
makers may be at risk of withholding compensation for psy-
chological injuries which do qualify for a diagnosis of mental
disorder according to DSM or another diagnostic classifica-
tion system. Both outcomes are unwelcome and should there-
fore be taken into account in compensation procedures.
Methods
Participants
Participants were mental health care practitioners who were
registered in Vektis. This is a digital database and includes,
among other things, contact details of most health care pro-
viders in the Netherlands. This database can be consulted via
www.vektis.nl. At the time of our data collection, 11,964
mental health care practitioners were registered in this
database with an e-mail address (≈75 % of all registrants).
Of these, 2369 (19.8 %) agreed to participate in our research.
Each of them was randomly assigned to either of two
substudies: the current study or a study about another fallacy
(i.e., other than the narrative fallacy) that can bias the outcome
of a diagnostic assessment. Of those assigned to the current
study (n=1282), 1154 (90.0 %) provided complete responses
on questions about background characteristics and responded
to at least one vignette. The large majority of respondents were
female (n=907, 78.6 %), had the Dutch nationality (n=1096,
95.0 %), worked as a mental health psychologist (n= 807,
69.9 %) and were employed by a mental health institution
(n= 637, 55.2 %). On average, they were 46.6 years old
(SD = 11.9).
Procedure and Materials
Each participant was presented two vignettes: one about a 35-
year-old man who suffered from symptoms of generalized
anxiety disorder (GAD; vignette 1) and one about a 55-year-
old woman who suffered from symptoms of a major depres-
sive episode (MDE; vignette 2). Vignette descriptions were
obtained from two previous studies about the impact of pay-
ment method on psychologists’diagnostic decisions
(Kielbasa, Pomerantz, Krohn, & Sullivan, 2004;Pomerantz
&Segrist,2006
2
) and were translated in Dutch. Participants
were randomly assigned to one of four conditions: (1) symp-
tom level near threshold of DSM diagnosis (severe symptom
level), a victim of a traumatic event (trauma); (2) symptom
level near threshold of DSM diagnosis (severe symptom lev-
el), not a victim of a traumatic event (non-trauma); (3) symp-
tom level below threshold of DSM diagnosis (moderate symp-
tom level), a victim of a traumatic event (trauma); or (4) symp-
tom level below threshold of DSM diagnosis (moderate symp-
tom level), not a victim of a traumatic event (non-trauma). For
the two trauma conditions, the vignette descriptions were
slightly extended to indicate that symptoms had started after a
violent street robbery. For each vignette, participants had to
indicate whether they would assign a diagnosis according to
DSM (“yes”or “no”) if the person described in the vignette
2
These references provide the unadapted full texts of the vignettes we
used.
Psychol. Inj. and Law (2016) 9:265–271 267
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would come to them for therapy. Those who answered “yes”to
this question were additionally asked to indicate what specific
diagnosis they would assign. This question could be answered
by filling in a blank space. To ensure that the order of vignettes
would not affect our results, we randomly varied the order of
vignettes in each condition.
Support for the first characteristic of the narrative fallacy
would be delivered if participants in the trauma conditions
more frequently assigned a DSM diagnosis than participants
in the non-trauma conditions. If an eventual difference would
be due to a largenumber of diagnoses of ASD and PTSD, then
support for the second characteristic of the narrative fallacy
would also be delivered. Symptoms of GAD or MDE may
fulfill the criteria for a diagnosis of adjustment disorder, but
not for a diagnosis of ASD or PTSD. After all that would
require the presence of additional symptoms, particularly
symptoms of intrusion and avoidance. Assigning a diagnosis
of ASD or PTSD would therefore indicate that participants
imagined additional symptoms.
Statistical Analyses
For both vignettes, we performed a series of three chi-square
tests. We first compared the proportions of assigned DSM
diagnoses between respondents in the trauma conditions and
those in the non-trauma conditions, irrespective of symptom
level. Then, we compared the proportions of assigned DSM
diagnoses between respondents in the two severe symptom
level conditions (trauma versus non-trauma) and between re-
spondents in the two moderate symptom level conditions
(trauma versus non-trauma). To reduce the likelihood of mak-
ing type I errors, we set the alpha level at p<0.0083toaccount
for the number of comparisons (p< 0.0083 [p< 0.05/6]).
Finally, we calculated the frequencies and corresponding per-
centages of assigned DSM diagnoses. This would give us an
idea of differences in types of assigned diagnoses between the
different vignettes and conditions.
Results
Differences in Proportions of Assigned DSM Disorders
Between the Four Experimental Conditions
As can be seen from Tables 1and 2, respondents in the trauma
conditions assigned DSM diagnoses more often than those in
the non-trauma conditions. For both vignettes, this difference
was significant: χ
2
(1, N= 1096) = 47.58, OR = 2.36, 95 %
CI = 1.85–3.02, p<0.001 for vignette 1 (generalized anxiety
disorder) and χ
2
(1, N= 1079) = 40.53, OR = 2.21, 95 %
CI = 1.73–2.82, p< 0.001 for vignette 2 (major depressive
episode). Moreover, it did not seem to matter whether respon-
dents had read a vignette about severe or moderate symptom
levels. In both cases, participants in the trauma conditions had
assigned a DSM diagnosis more often than those in the non-
trauma conditions: χ
2
(1, N= 546) = 4.21, OR = 1.49, 95 %
CI = 1.02–2.18, p=0.04 for vignette 1/severe symptom level;
χ
2
(1, N= 525) = 16.60, OR = 2.13, 95 % CI = 1.48–3.08,
p< 0.001 for vignette 2/severe symptom level; χ
2
(1,
N= 550) = 57.98, OR = 3.89, 95 % CI = 2.73–5.56, p<0.001
for vignette 1/moderate symptom level; and χ
2
(1,
N= 554) = 32.78, OR = 3.29, 95 % CI = 2.16–5.00, p<0.001
for vignette 2/moderate symptom level. However, given the
more stringent alpha level of p< 0.0083, for vignette 1 this
difference was not significant for respondents in the severe
symptom level condition. Overall, these results provide sub-
stantial support for the first characteristic of the narrative fal-
lacy; the tendency to establish a logical link between different
facts.
Differences in Types of Assigned DSM Disorders
Between the Four Experimental Conditions
A closer look at respondents’diagnostic decisions revealed
that approximately 30 % of them were not willing to assign
a definite diagnosis based on the information provided by the
vignettes. This applied to both vignettes and to severe as well
as moderate symptom levels (see Tables 3and 4). In addition,
some differences appeared to exist between the trauma and
non-trauma conditions in respondents’tendency to assign a
particular type of diagnosis. In the trauma conditions, the
number of assigned diagnoses of ASD and PTSD was much
higher than that in the non-trauma conditions (188 versus 1 for
vignette 1 and 136 versus 0 for vignette 2). Conversely, the
number of assigned diagnoses of anxiety and mood disorders
was much higher in the non-trauma than that in the trauma
conditions (147 versus 37 for vignette 1 and 112 versus 35 for
vignette 2). However, the differences in numbers of assigned
diagnoses of anxiety and mood disorders between the non-
trauma and trauma conditions were not as large as the differ-
ences in the numbers of assigned diagnoses of ASD and
PTSD between the trauma and non-trauma conditions (110
versus 187 for vignette 1 and 77 versus 136 for vignette 2).
Although we need to be cautious in not making the narrative
fallacy ourselves, this might explain why respondents in the
trauma conditions were more likely to assign a diagnosis of
mental disorder than those in the non-trauma conditions.
Indeed, if, in the non-trauma conditions, 77 (187 −110) more
respondents had assigned a diagnosis of mental disorder to the
symptoms described in vignette 1 and if 59 (136−77) more
respondents had assigned a diagnosis of mental disorder to the
symptoms described in vignette 2, then the differences in pro-
portions of assigned diagnoses between the trauma and non-
trauma conditions would have become insignificant. Finally, it
might be speculated that this result also provides some support
for the second characteristic of the narrative fallacy; the
268 Psychol. Inj. and Law (2016) 9:265–271
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tendency to fill in gaps of missing information or to neglect
information to enable the establishment of a logical link be-
tween different facts. After all, the two vignettes did not pro-
vide enough information to justify a diagnosis of ASD or
PTSD.
Discussion
Diagnostic assessments of psychological injury may play an
important role in legal procedures about compensation for
psychological injury following trauma. Unfortunately, the cur-
rent study suggests that such assessments may be biased by
the narrative fallacy: Just as anyone else, mental health care
practitioners appear to make stories to explain why certain
things happen by establishing logical links between certain
facts. Those who participated in our study were more likely
to assign a diagnosis of mental disorder if they had read a
vignette which contained information about the possible cause
of the psychological symptoms than if they had read a vignette
which did not contain such information. Moreover, this find-
ing did not depend on the nature or severity of presented
symptoms. In other words, assigning a diagnosis of mental
disorder is more logical when symptoms can be linked to a
particular cause. Inspection of the types of diagnoses
suggested that the relative difference in assigned diagnoses
between the trauma and non-trauma conditions may have
been due to diagnosticians’tendency to fill in missing infor-
mation to create a symptom picture that justifies a diagnosis of
ASD or PTSD.
Our results suggest that legal decision makers should be
cautious in relying on psychological experts’opinions about
their clients’mental health status. Since psychological experts
are more likely to assign a diagnosis of mental disorder if
symptoms can be attributed to a particular cause, some trauma
victims may fulfill the criteria for compensation, although
their symptoms are actually not severe enough to justify com-
pensation for psychological injury.
To avoid erroneous decisions about compensation, legal
decision makers should confront the expert with the possibil-
ity of the narrative fallacy by asking him or her how he or she
would classify the victim’s symptoms if these had not been
triggered by a traumatic event. This might particularly be
worthwhile if the expert’s report does not explicitly mention
that the victim suffers from symptoms which are typical for a
trauma- or stressor-related disorder, but a diagnosis of such a
disorder is nevertheless assigned. In cases where the stakes are
high (e.g., when high amounts of compensation are request-
ed), it might even be worthwhile to have two or more inde-
pendent experts comment upon the initial expert’s opinion
Tabl e 1 Trauma victimization by DSM diagnosis—vignette 1 (generalized anxiety disorder)
DSM diagnosis
Yes N o
Moderate Severe Total Moderate Severe Total
n%n%n%n%n%n%Total
Trauma Yes 164 67.8 215 53.8 379 59.0 108 35.1 64 43.8 172 37.9 551
No 78 32.2 185 46.3 263 41.0 200 64.9 82 56.2 282 62.1 545
Total 242 100 400 100 642 100 308 100 146 100 454 100 1096
Moderate= moderate symptom level. Severe= severe symptom level
Tabl e 2 Trauma victimization by DSM diagnosis—vignette 2 (major depressive episode)
DSM diagnosis
Yes N o
Moderate Severe Total Moderate Severe Total
n%n%n%n%n%n%Total
Trauma Yes 97 71.3 196 57.1 293 61.7 180 43.1 70 38.5 250 42.2 543
No 39 28.7 147 42.9 186 38.3 238 56.9 112 61.5 350 57.8 536
Total 136 100 343 100 479 100 418 100 182 100 600 100 1079
Moderate= moderate symptom level. Severe= severe symptom level
Psychol. Inj. and Law (2016) 9:265–271 269
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without letting them know that the symptoms to be evaluated
have been caused by a traumatic event and are the subject of a
compensation claim. This strategy is rather laborious and may
not always be feasible, because it requires that references to
the traumatic event are deleted from the initial expert’sreport.
However, if this is possible and if the independent experts
come to another conclusion about the classification of the
victim’s symptoms, then this may be an indication that the
initial expert’s diagnostic conclusions suffered from the narra-
tive fallacy. After all, without information about the potential
cause of the psychological symptoms,independent experts are
probably less prone to making the narrative fallacy
themselves.
Despite the aforementioned, caution should be taken when
interpreting our results and speculating about their practical
implications. After all, our study had several limitations. First,
we did not investigate whether wrongly assigned diagnoses of
mental disorders indeed result in bad decisions about compen-
sation. Our respondents were told that the person described in
the vignette came to them for therapy. It cannot be ruled out
that legal decision makers already more critically evaluate
information from psychological experts who also treat the
litigating victim than information from independent experts.
The former may be seen as hired guns—experts who simply
take the position of their client in return for payment (Ziemke
&Brodsky,2015). Several studies suggest that the opinion of
such experts is often considered with suspicion by legal deci-
sion makers (see Edens, Smith, Magyar, Mullen, Pitta, &
Petrila, 2012;Mossman,1999). Second, we obtained a rather
low response rate. This questions the generalizability of our
results to the entire population of mental health practitioners in
the Netherlands. Third, vignettes differ from real-life diagnos-
tic settings. Participants who assigned a diagnosis to the per-
sons described in our vignettes would perhaps have made
another decision if they had been able to perform a full-
blown diagnostic assessment.
To conclude, our study was the first to investigate the nar-
rative fallacy in a large sample of mental health practitioners.
Tabl e 3 Trauma victimization by diagnostic category—vignette 1 (generalized anxiety disorder)
Diagnostic category
ASD PTSD AD Anxiety Mood Other INFO NS
n%n%n%n%n%n%n%n% Total
Moderate Trauma Yes 2 1.2 80 48.8 18 11.0 12 7.3 0 0.0 3 1.8 43 26.2 6 3.7 164
No 0 0.0 0 0.0 6 7.7 39 50.0 3 3.8 5 6.4 21 26.9 4 5.1 78
Total 2 0.8 80 33.1 24 9.9 51 21.1 3 1.2 8 3.3 64 26.4 10 4.1 242
Severe Trauma Yes 1 0.5 105 48.8 3 1.4 25 11.6 0 0.0 2 0.9 68 31.6 11 5.1 215
No 1 0.5 0 0.0 4 2.2 105 56.8 0 0.0 6 3.2 57 30.8 12 6.5 185
Total 2 0.5 105 26.3 7 1.8 130 32.5 0 0.0 8 2.0 125 31.3 23 5.8 400
Moderate= moderate symptom level. Severe= severe symptom level
ASD acute stress disorder, PTSD posttraumatic stress disorder, AD adjustment disorder, Anxiety anxiety disorder, Mood mood disorder, Other other
diagnosis, INFO not enough information to specify diagnosis, NS diagnosis not specified
Tabl e 4 Trauma victimization by diagnostic category—vignette 2 (major depressive episode)
Diagnostic category
ASD PTSD AD Anxiety Mood Other INFO NS
n%n%n%n%n%n%n%n%Total
Moderate Trauma Yes 9 9.3 38 39.2 14 14.4 2 2.1 11 11.3 2 2.1 16 16.5 5 5.2 97
No 0 0.0 0 0.0 1 2.6 0 0.0 25 64.1 1 2.6 6 15.4 6 15.4 39
Total 9 6.6 38 27.9 15 11.0 2 1.5 36 26.5 3 2.2 22 16.2 11 8.1 136
Severe Trauma Yes 1 0.5 88 44.9 3 1.5 3 1.5 19 9.7 1 0.5 76 38.8 5 2.6 196
No 0 0.0 0 0.0 0 0.0 0 0.0 87 59.2 11 7.5 43 29.3 6 4.1 147
Total 1 0.3 88 25.7 3 0.9 3 0.9 106 30.9 12 3.5 119 34.7 11 3.2 343
Moderate= moderate symptom level. Severe= severe symptom level
ASD acute stress disorder, PTSD posttraumatic stress disorder, AD adjustment disorder, Anxiety anxiety disorder. Mood mood disorder, Other other
diagnosis, INFO not enough information to specify diagnosis, NS diagnosis not specified
270 Psychol. Inj. and Law (2016) 9:265–271
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Future studies might build upon our study by overcoming its
limitations and by addressing several additional issues. In par-
ticular, it would be interesting to see whether our results ex-
tend to other types of trauma than violent crimes, because type
of trauma may strengthen or weaken diagnosticians’tendency
to assign a diagnosis of mental disorder if symptoms can be
explained by a traumatic event. Based on previous research, it
may be suggested that it makes a difference whether someone
is hurt intentionally (as in our study) or accidentally. For ex-
ample, in a series of experiments, Ames and Fiske (2013)
found that intentional harms are considered as more severe
than unintentional harms, also in terms of monetary values,
even if events do not differ in actual harm. Building upon this
study, it would be worthwhile to see whether diagnosticians’
decisions to assign a diagnosis of mental disorder vary by the
intentionality of suffered harm.
Compliance with Ethical Standards The procedures followed in this
study were in accordance with The Netherlands Code of Conduct for
Scientific Practice (Association of Universities in the Netherlands, 2014).
Conflict of Interest The authors declare that they have no conflict of
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