Asbestos exposure and posttraumatic stress disorder

In 48 cases of claims of psychic injury due to exposure to asbestos, posttraumatic stress disorder (PTSD) was alleged as a basis for damages in nine (19%). PTSD as currently defined refers to a specific syndrome following exposure to a life-threatening traumatic event, one outside the general range of people's experiences such as military combat, floods, earthquakes, bombing, torture, death camps--events either natural or man-made. The symptoms include reexperiencing of the event with intrusive thoughts or nightmares of the event, startle reactions, psychic numbing, and survival guilt. The application of this concept to chronic illness, often of minor degree, is quite inappropriate. The clinical data in the nine cases reveal no pertinent precipitating event and the lack of a clinical syndrome compatible with the disorder. The cases also generally reflect no psychiatric impairment, inadequate medical review, and lack of background history--common characteristics in asbestos litigation with no disabling pulmonary parenchymal impairment. If the results in this group are typical, then one must suspect the legitimacy of claims of psychic injury such as post-traumatic stress disorder from asbestos exposure and at the very least the reasonableness of the experts who provide input into the medicolegal process.