Am J Psychiatry 1993; 150:229-234
Copyright © 1993 by American Psychiatric Association
Use of posttraumatic stress disorder to support an insanity defense
PS Appelbaum, RZ Jick, T Grisso, D Givelber, E Silver and HJ Steadman
Department of Psychiatry, University of Massachusetts Medical Center, Northeastern University School of Law, Boston 01655.
OBJECTIVE: The authors examine the allegation that the diagnosis of
posttraumatic stress disorder (PTSD) is frequently abused in the legal
system as the basis for a defense of not guilty by reason of insanity.
METHOD: Data for the investigation were drawn from a study of insanity
pleas gathered from court records in 49 counties in eight states. Data on
the 28 insanity plea defendants for whom PTSD was diagnosed before or
immediately after trial were compared with data on 8,135 defendants whose
insanity pleas were based on other diagnoses. RESULTS: Insanity pleas by
defendants with diagnoses of PTSD constituted only 0.3% of the cases. There
were few significant differences between the two groups on demographic
variables, psychiatric histories, previous involvement in crime, or current
charges. The defendants with PTSD were more likely to have been married,
less likely to have been arrested as juveniles, and less likely to have
been detained after trial. CONCLUSIONS: Contrary to previously expressed
concerns, PTSD was infrequently associated with an insanity defense in the
cases in this study. In the cases in which pleas based on PTSD were used,
they were no more likely to succeed than pleas based on any other
diagnosis. Defendants with PTSD-related insanity defenses differed little
from other insanity defendants, contradicting the stereotype of the person
who is driven by PTSD to commit crimes. The data do not support fears of
widespread misuse of the diagnosis of PTSD in connection with the insanity
defense.
