Personality disorder expert witness in Scotland
Personality disorders reflect an enduring pattern of personality functioning, ordinarily evident across a substantial period of adult life. In medico-legal cases, an important question is therefore how any pre-existing personality difficulties interact with the consequences attributed to the index event.
He is instructed by pursuer and defender agents in personal injury and clinical negligence actions, by employers in occupational health disputes, by employment tribunals considering vulnerability and reasonable adjustment, and in family and criminal proceedings where personality functioning bears on capacity, risk or credibility. The assessment follows ICD-11's dimensional model of personality disorder, and the report explains that model in terms a solicitor without a clinical background can use.
What Dr Qureshi can advise on
- Whether the evidence supports a diagnosis of personality disorder under ICD-11, its severity, and the domains of personality functioning principally affected.
- How far the personality disorder pre-dates the index event, and the documentary evidence — school, employment, medical and social work records — relied on for that view.
- Whether the index event caused, aggravated or merely coincided with the current presentation, and how that is distinguished from the underlying pattern.
- The effect of personality disorder on engagement with treatment, on reliability of self-report, and on the presentation observed at interview.
- Vulnerability arising from personality disorder relevant to giving evidence, undergoing assessment, or participating in proceedings, and any adjustments that would assist.
- The realistic treatment options, the evidence base for them, and a cautious prognosis, since personality disorder is not resolved by the short-term interventions often proposed in schedules of damages.
- Effect on function — occupational, social and relational — separated as far as possible from the effect of any co-occurring disorder such as depression or substance misuse.
- Where relevant, the interaction between personality disorder and risk, including risk of self-harm, in terms proportionate to the evidence and the question asked.
Personality disorder is frequently co-morbid with depression, anxiety and substance misuse. Where those conditions are also in issue, the report separates their respective contributions as far as the evidence allows rather than treating the presentation as a single undifferentiated whole.
Typical instructions
- Personal injury with a pre-existing personality disorder
- A pursuer with a long-standing diagnosis of emotionally unstable personality disorder claims a significant psychiatric injury following an accident. The defender agent instructs a report to establish what proportion of the current presentation is attributable to the accident against what the underlying condition would probably have produced regardless.
- Poor engagement with treatment
- A pursuer has not attended recommended therapy sessions. The instruction asks whether personality functioning offers an explanation for that non-engagement, and whether it affects the prognosis given for recovery with treatment.
- Vulnerability in giving evidence
- A party or witness with a diagnosed or suspected personality disorder is due to give evidence at proof. The instruction addresses whether special measures or adjustments to the manner of giving evidence are clinically indicated.
- Occupational health dispute involving interpersonal conflict
- An employment tribunal case in which repeated workplace conflict is said by the employer to reflect the employee's personality functioning rather than the working environment. The report addresses diagnosis and the relative contribution of personality and environment to the difficulties described.
What the report includes
The report sets out the instructions received, documents considered, developmental and personal history in some depth — since longitudinal pattern is central to this diagnosis — account of the index event, mental state examination, and a reasoned opinion addressing each question in the letter of instruction by reference to ICD-11's personality disorder criteria.
Because the diagnosis depends heavily on pattern over time, the report identifies the specific historical evidence relied on for each conclusion and distinguishes it from the examinee's own account, particularly where the two differ. Where the records are too limited to support a confident diagnosis, that limitation is stated rather than a diagnosis inferred from the interview alone.
The report closes with a statement of truth and a declaration that the duty to the court or tribunal overrides any duty to the instructing party, in accordance with the Royal College of Psychiatrists' guidance on expert evidence and the relevant procedural rules.