Refrain From Asking Open-Ended Questions - Cross-Examining Psych Doctors, Tip #91

During cross-examination of a psych doctor, the attorney can ask questions in a variety of ways.  One strategy to avoid when questioning the psych doctor is asking open-ended questions.  An example of an open-ended question used during cross-examination of a psych doctor is, Doctor, you mentioned that the patient complained of depression. Will you please tell me about the patient’s depression at the time of your examination?  Questioning the doctor in this manner opens the proverbial door for the doctor to provide information that is not in his or her report that could conceivably support their conclusions.  Obviously, the information provided by the doctor’s response may or may not be correct for a variety of reasons and it would be difficult to verify that information.  A recommended alternative is to ask questions that are directed at the doctor’s report.  For example, Doctor, will you please tell me where in your report you stated the frequency of the patient’s symptom of depression or how often the depression occurs?  Questioning the doctor using this method will help expose the report’s lack of evidence supporting the doctor’s diagnosis.

MMPI-370 - Cross-Examining Psych Doctors, Tip #90

The MMPI-370 is a shortened version of the MMPI-2 that is analogous to the MMPI-168.  Like the MMPI-168, the MMPI-370 is not a “test” in and of itself but a particular use of the MMPI-2 that has some serious problems.  The MMPI-370, as the name implies, involves administering the first 370 questions of the MMPI-2.  This allows for the scoring of the Lie Scale, the F Scale, the K Scale, the F-K Scale or Index and the 10 basic clinical scales.  If you assume that the MMPI-2 is a valid and reasonable instrument to use, the scoring of these scales may be acceptable in a general clinical practice where it can be assumed that the person does not have a deviant test-taking attitude.  However, in a medical-legal context this is not a reasonable assumption and it is necessary to score at least the F(p) Scale, the F(Back) Scale, the VRIN Scale and the Revised Dissimulation Scale to determine if the person is responding in an honest and frank manner and not attempting to simulate dysfunction.  Unfortunately, it is not possible to score these scales if the person responds to only the first 370 items on the MMPI-2.  Therefore, the MMPI-370 is virtually useless in forensic circumstances.  

Male Hypoactive Sexual Desire Disorder Due to a General Medical Condition - Cross-Examining Psych Doctors, Tip #89

When the doctor diagnoses a Male Hypoactive Sexual Desire Disorder Due to a General Medical Condition, be sure to look for the data in their report that shows the patient met the diagnostic criteria for that disorder.  According to the DSM-IV-TR, in order to diagnose correctly either Male Hypoactive Sexual Desire Disorder Due to a General Medical Condition (608.89) it is necessary to show that there is a deficit or absence of sexual fantasies as well as a lack of a desire for sexual activity that is judged to be entirely due to the direct physiological effects of a general medical condition.  As such, there must be evidence from the history, physical examination or laboratory findings that the dysfunction is fully explained by the direct physiological effects of an existing general medical condition.  As specified in the DSM-IV-TR, there are a variety of neurological, endocrine, vascular, and genitourinary conditions such as multiple sclerosis, diabetes mellitus and urethral infections that can produce sexual dysfunction in this manner.  However, simply not wanting to engage in intercourse or other sexual behavior because of pain or some other physical condition does not meet the DSM-IV-TR criteria for establishing that there is dysfunction as a result of a direct physiological mechanism.

Female Sexual Arousal Disorder - Cross-Examining Psych Doctors, Tip #88

When the doctor diagnoses a Female Sexual Arousal Disorder (302.72), be sure to look for the data in their report that shows the patient met the diagnostic criteria for that disorder.  In this regard, according to the DSM-IV-TR, the essential feature of a Female Sexual Arousal Disorder is a persistent or recurring inability to attain or maintain an adequate lubrication-swelling response of sexual excitement until completion of the sexual activity.  Simply losing interest in sexual activity for such reasons as having too much pain from a physical injury is insufficient to meet the diagnostic criteria, which are presented below.

A.    A persistent or reoccurring inability to attain or to maintain “an adequate lubrication-swelling response of sexual excitement” until the completion of the sexual activity.

B.    The inability described in Criterion A causes marked distress and/or interpersonal difficulty.

C.    The inability described in Criterion A is not better accounted for by another Axis I disorder, except another Sexual Dysfunction, and is not due exclusively to the direct physiological effects of a substance and/or a general medical condition.

Primary Sleep Disorders - Cross-Examining Psych Doctors, Tip #87

Primary Sleep Disorders involve disturbances of sleep that are not due to another mental disorder, a general medical condition or a substance.  Primary Sleep Disorders are classified as either Dyssomnias, in which the person exhibits abnormalities in the amount, quality or timing of sleep, or Parasomnias, in which they show abnormal behaviors and/or physiological events during sleep.  When the doctor provides a diagnosis under this category, you should examine their report to see if the doctor provided information in their report about what the patient’s sleeping behavior was like prior to their reported injury.  If no such information exists in the doctor’s report then there is no basis for comparison and concluding that the patient’s sleeping behavior has changed after the claimed injury.

Pain Disorder Associated With a General Medical Condition - Cross-Examining Psych Doctors, Tip #86

The DSM-IV-TR is very clear in stating on page 499 that a Pain Disorder Associated With a General Medical Condition is a disorder in which there is pain that results from a general medical condition.  The DSM-IV-TR is also very explicit in stating, “This subtype of Pain Disorder is not considered a mental disorder and is coded on Axis III.”  Accordingly, if one is concerned with the possibility of an individual having had a psychological disorder, the specification of a Pain Disorder Associated With a General Medical Condition is clearly not relevant since this condition is not a mental disorder. 

Dissociative Disorders - Cross-Examining Psych Doctors, Tip #85

            According to the DSM-IV-TR, the Dissociative Disorders are characterized by prominent features of dissociation or a disruption in the integration of consciousness, memory, identity and/or sensation or perception.  In this regard, dissociation is the partial or total disconnection or dissociation between past memories, awareness of one’s identity, awareness of immediate sensations or perceptions, and the control of body movements.  All of these conditions are thought to be the result of traumatic experiences.  When you have a report where the doctor diagnosed a Dissociative Disorder you should review their report to determine if they discussed the qualitative nature, frequency, intensity, duration, onset and course of the patient’s complaints over time with regard to memory, identity, sensation or perception.  You should also review the Mental Status Examination report to determine if the doctor provided observational data in these areas from their face-to-face interview.