The impact of psychological trauma in the absence of a PTSD diagnosis - a theoretical reflection from two forensic clinical cases

Experiences of high adversity can lead to a very deep and long-lasting psychological impact. Some events, due to their intensity, severity, extraordinarily negative character and, above all, if they put physical and/or psychological integrity at risk, have a very significant traumatic potential. The evaluation of the psychological impact of a given event is a procedure often requested from forensic psychologists, and it is essential to conduct this evaluation in a very rigorous manner, considering that the traumatic character of a given situation is multidetermined and subjective. The experience of traumatic experiences may lead to the development of a set of symptoms that significantly affect several areas: emotional and affective, cognitive, relational, school/work, reducing functionality and exceeding the person's adaptive resources. In response to traumatic situations, in some cases, a more specific set of symptoms develops, described as Post Traumatic Stress Disorder (PTSD), which is characterized, among other elements, by intrusive thoughts, nightmares, or flashbacks of a past traumatic event, avoidance of stimuli, people, situations, or activities that trigger memories associated with the traumatic event, a constant state of alertness, and sleep disturbances. However, it is possible for an event to have a highly significant traumatic effect, without all the symptoms associated with PTSD being present, and it is therefore fundamental to assess psychological trauma from a broader and deeper perspective, in order to be able to correctly and fairly value the damage suffered. The aim of this presentation is to reflect theoretically on the psychological assessment of the traumatic impact of an event when the diagnostic criteria for PTSD (defined in DSM V) are not met, but there is clinically significant symptomatology due to its intensity, duration, severity and ability to affect various areas of psychological functioning in a relevant way. This discussion will be conducted from two forensic cases: a survivor of a serious assault in traffic and a survivor of an attempted murder (in both cases the father of each of the examinees were fatal victims of these same events, that is, in either case the examinees witnessed the assault on their parents). In both cases the presence of a very deep psychological trauma picture was diagnosed, with very significantly negative psychological impact, namely the presence of debilitating anxious and depressive symptomatology, but without the presence of all the symptoms attributed to PSPT. We discuss the implications of these data for forensic assessment and correct valuation of situations related to psychological trauma and their implications for victim reparation.