Somatoform Disorders - Cross-Examining Psych Doctors, Tip #84

            The Somatoform Disorders are characterized by the presence of physical signs and/or symptoms that suggest that the individual has a general medical condition accounting for the signs and/or symptoms but those signs and/or symptoms cannot be fully explained by a general medical condition, the direct effects of a substance or another mental disorder.  Essentially, the person presents with medically unexplained physical signs and/or symptoms and there is reason to suspect that their complaints are due to psychological factors or variables and that the individual is not faking or Malingering (V65.2).  The most frequently diagnosed Somatoform Disorders are:  a Somatization Disorder, an Undifferentiated Somatoform Disorder, a Conversion Disorder, Pain Disorders, and Hypochondriasis.  It is important that the doctor diagnosing a Somatoform Disorder explicitly state what evidence they have, in the form of medical records and/or the patient’s clinical presentation at their examination, that indicates that psychological factors or variables are producing the patients symptoms or complaints.  In situations where the doctor has not provided such information in their report, you should ask the doctor, “Where in your report did you cited medical records from such professionals as orthopedists, chiropractors, neurologists and/or physical therapists who stated that not all of the patient’s complaints of pain are completely understandable as being the result of underlying physical pathology?”

Sleep Disorders - Cross-Examining Psych Doctors, Tip #83

            The DSM-IV-TR describes four classes of sleep disorders and categorizes them by their cause.  The four classes are:  Primary Sleep Disorders, Sleep Disorders Related to Another Mental Disorder, Sleep Disorders Due to a General Medical Condition and Substance-Induced Sleep Disorders.  When the doctor diagnoses a disorder under any of these categories, you should review their report to determine if they discussed the qualitative nature, frequency, intensity, duration, onset and course of the patient’s sleeping complaints over time.  Unfortunately, you will likely find that the doctor did not provide any information about what the patient’s sleeping behaviors were like prior to their claimed injury so that the reader has absolutely no idea if the sleep disturbance reported by the doctor represented a change in functioning over time or was simply the patient’s normal sleep pattern.

Activities of Daily Living Questionnaire a psychological test?- Cross-Examining Psych Doctors, Tip #82

The Activities of Daily Living Questionnaire (ADL Questionnaire) is frequently cited in psychological testing sections of psychological reports.  However, the ADL Questionnaire is not a psychological test in the sense that it is administered to a patient.  This measure is simply a list of six functions, “bathing, dressing, toileting, moving, continence and feeding.”  Instead of presenting the patient with any material to respond to, as is done with a psychological test, the doctor examining the patient simply rates the patient either “Yes” or “No” according to what the doctor believes is true about the six functions.  Clearly, the ADL Questionnaire does not obtain any objective measures of the patient but is simply an alternate way of the doctor subjectively stating their opinion about the patient.  Accordingly, in a medical-legal context, the ADL Questionnaire has no known objective relationship to the existence of any DSM psychological disorders.

Hamilton Anxiety Scale - Cross-Examining Psych Doctors, Tip #81

            The Hamilton Anxiety Scale (HAS) is frequently cited in psychological testing sections of psychological reports.  However, the HAS is not a psychological test since it does not administer any physical material to the person being “tested” (Hamilton, 1959).  The HAS is simply a list of what was accepted in 1959 as fourteen frequently accepted symptoms or complaints of anxiety.  Instead of presenting the patient with any material to respond to, as is done with a psychological test, the doctor examining the patient simply rates the patient on a five-point scale according to how extensively the doctor believes the patient is experiencing each of the thirteen symptoms.  As such, the HAS does not obtain any objective measures of the patient but is simply an alternate way of the doctor subjectively stating their opinion that the patient has anxiety.  In a medical-legal context, the Hamilton Anxiety Scale has no known objective relationship to the existence of any DSM psychological disorders.

Use of the Pain Patient Profile (P3) - Cross-Examining Psych Doctors, Tip #80

The Pain Patient Profile is a self-rating instrument that purports to provide measures of an individual on their credibility as well as any possible depression and anxiety in addition to the level of physical symptoms that are produced by psychological factors or variables.  A reading of the psychological literature fails to demonstrate that this instrument has any validity or reliability with regard to assessing psychopathology or providing any information about a patient’s test-taking attitudes or credibility.  Thus, any conclusions drawn from a patient’s performance on this “test” is entirely arbitrary and unsupportable and the use of this instrument in a medical-legal context is a substantial flaw in the psych doctor’s report.

Recent, Remote, and Long-term memory Tasks - Cross-Examining Psych Doctors, Tip #79

            During the course of a Mental Status Examination, it is standard procedure to measure an individual’s memory.  These processes are easily measured with a variety of objective techniques that yield easily reported upon observational data.  For example, to measure long-term or remote memory the doctor typically asks the patient to recall such verifiable personal information as their Social Security number and/or their California driver's license number.  When the doctor has not described their observations of the patient’s long-term or remote memories when taking the doctor’s testimony during a trial or deposition you should ask the doctor; “Doctor, will you please tell me where in your report of your Mental Status Examination you provided your measurements of the patient’s performance on relatively standard examining techniques in the areas of remote, and long-term memory?”