How do you distinguish PTSD from adjustment disorder?

The distinction turns on whether the ICD-11 criteria for PTSD — re-experiencing, avoidance and a sense of current threat, following an event of an exceptionally threatening or horrifying nature — are met in full. Where symptoms are significant but do not meet that threshold, or where the stressor is of a lesser severity, adjustment disorder is often the more accurate diagnosis. The report explains the reasoning rather than stating a conclusion.

Can PTSD have a delayed onset and still be caused by the index event?

Yes, ICD-11 recognises delayed presentations. Whether delay supports or undermines causation in a given case depends on the whole picture: the records, the account given, and whether an intervening event offers a better explanation. That analysis is set out in the report rather than assumed either way.

Will the report recommend EMDR or trauma-focused CBT specifically?

Where trauma-focused treatment is indicated, the report identifies which modality is appropriate on the clinical picture, the likely number of sessions, and the basis for costing that treatment, drawing on recognised clinical guidance.

What if the pursuer has a history of earlier trauma unrelated to this claim?

Earlier trauma is addressed directly rather than left unmentioned. The opinion considers whether the current disorder represents a new condition caused by the index event, a reactivation of an earlier condition, or a combination, and apportions accordingly where the evidence allows it.

Do you see examinees who are reluctant to discuss the traumatic event in detail?

Yes, and the assessment is conducted with that in mind. Avoidance of detailed recall is itself a diagnostic feature rather than an obstacle to be overcome by pressing the examinee, and the report records how the assessment was adapted accordingly.

PTSD and psychological trauma expert witness in Scotland

A report on psychological trauma turns on a small number of questions that are easy to state and harder to answer with rigour: whether the pursuer's presentation meets the ICD-11 criteria for post-traumatic stress disorder or complex PTSD, whether an adjustment disorder is the better fit, whether the index event was of a nature capable of causing that disorder, and whether the timing and content of the symptoms are consistent with the account given.

Instructions of this kind arise from road traffic collisions, assaults, workplace incidents, historical abuse claims and exposure to traumatic material in the course of employment. I am instructed by pursuer agents, defender agents and insurers, and the approach to diagnosis and causation does not vary according to who has instructed the report.

Scope of opinion

What I can advise on

Whether the presentation meets ICD-11 criteria for PTSD, for complex PTSD, or for adjustment disorder, and the basis for preferring one diagnosis over another.
Whether the index event was of a kind and severity capable of causing the disorder found.
Whether onset was immediate or delayed, and whether delayed onset is consistent with the diagnosis and the records.
The relationship between the index event and any earlier trauma, including whether an earlier event has been reactivated rather than a new disorder caused.
Prognosis with and without trauma-focused treatment such as EMDR or trauma-focused CBT.
The treatment reasonably required, its likely duration and the basis on which it should be costed.
Effect on sleep, concentration, relationships and capacity to work, including avoidance behaviour that restricts daily activity.
Where relevant, the internal consistency of the account and its consistency with contemporaneous records.

Where the presentation raises questions of neuropsychological impairment following a head injury, or where the causative event is itself in dispute on the medical evidence, I say so and identify the discipline better placed to assist.

Typical instructions

Delayed-onset PTSD after a road traffic collision: A pursuer whose symptoms did not appear until some months after a collision, having initially returned to driving. The instruction asks whether delayed onset is compatible with PTSD on the ICD-11 criteria and whether the collision remains the material cause of the current presentation.
Complex PTSD with a history of earlier trauma: A pursuer with a documented history of childhood adversity who presents after a further traumatic event in adulthood. The question is whether the current disorder is properly characterised as complex PTSD, and how much of the presentation is attributable to the index event as against pre-existing vulnerability.
Workplace assault with an adjustment disorder in issue: An employee assaulted by a colleague whose symptoms are significant but do not meet the full threshold for PTSD. The instruction asks whether adjustment disorder is the more accurate diagnosis, and what that means for prognosis and treatment.
Joint instruction ahead of a proof: Pursuer and defender agree a single joint expert on diagnosis and prognosis, with a fixed proof diet already assigned. Availability is confirmed before the instruction is accepted so the timetable set by the court can be met.

The report

What the report includes

The report sets out the instructions received, the documents considered, background and personal history, a detailed account of the index event and its immediate aftermath, the course of symptoms since, mental state examination, and a reasoned opinion addressing each ICD-11 criterion in turn rather than asserting a diagnosis without showing the working behind it.

Where the account given at interview differs from the contemporaneous records — for example where GP notes record no psychological symptoms for some months after the event — that difference is stated explicitly, together with an assessment of whether it is consistent with a recognised pattern of delayed presentation or points against the diagnosis claimed.

The opinion closes with a statement of the treatment required, a reasoned prognosis with and without that treatment, and the statement of truth and declaration of independence required of expert evidence in the Scottish courts.

Timescales

Timescales and format

Assessment is normally carried out in Greater Glasgow, at an agreed venue elsewhere in Scotland, or by secure video where the presentation and any avoidance symptoms make that appropriate. A trauma-focused assessment usually takes longer than a routine personal injury interview and this is factored into the appointment offered.

Turnaround runs from receipt of complete records: [CLIENT TO CONFIRM: X weeks]. Where a proof diet is fixed, confirm the date at enquiry so that availability is checked before instruction.

Supplementary reports following further disclosure, joint reports with the opposing expert, and attendance at proof are all available on the terms set out under fees and timescales.

Questions

Frequently asked questions

How do you distinguish PTSD from adjustment disorder?: The distinction turns on whether the ICD-11 criteria for PTSD — re-experiencing, avoidance and a sense of current threat, following an event of an exceptionally threatening or horrifying nature — are met in full. Where symptoms are significant but do not meet that threshold, or where the stressor is of a lesser severity, adjustment disorder is often the more accurate diagnosis. The report explains the reasoning rather than stating a conclusion.
Can PTSD have a delayed onset and still be caused by the index event?: Yes, ICD-11 recognises delayed presentations. Whether delay supports or undermines causation in a given case depends on the whole picture: the records, the account given, and whether an intervening event offers a better explanation. That analysis is set out in the report rather than assumed either way.
Will the report recommend EMDR or trauma-focused CBT specifically?: Where trauma-focused treatment is indicated, the report identifies which modality is appropriate on the clinical picture, the likely number of sessions, and the basis for costing that treatment, drawing on recognised clinical guidance.
What if the pursuer has a history of earlier trauma unrelated to this claim?: Earlier trauma is addressed directly rather than left unmentioned. The opinion considers whether the current disorder represents a new condition caused by the index event, a reactivation of an earlier condition, or a combination, and apportions accordingly where the evidence allows it.
Do you see examinees who are reluctant to discuss the traumatic event in detail?: Yes, and the assessment is conducted with that in mind. Avoidance of detailed recall is itself a diagnostic feature rather than an obstacle to be overcome by pressing the examinee, and the report records how the assessment was adapted accordingly.

Instructing

Instructing Dr Qureshi

Instructions are accepted from pursuer and defender agents, insurers, regulatory bodies and occupational health providers. A conflict check is carried out before any instruction is accepted.

Send a letter of instruction Check availability and conflicts

Or call 07739 587092.