Type of Evaluation
Roseanne Martin, a 41-year-old aide at a state high-security mental health facility, filed a law suit against her employer alleging that she was repeatedly sexually harassed by her supervisor over a three-year period. She claimed that as a result, she developed severe anxiety, was unable to leave her house, and was unable to sustain an intimate relationship with her significant other. This evaluation was requested by her attorney to determine the nature and extent of any emotional injury Ms. Martin suffered as a result of her employer’s actions.
Sources of Information
Mental status examination
Minnesota Multiphasic Personality Inventory second Edition Restructured Form (MMPI-2-RF)
Clinician-Administered PTSD Scale for DSM-5 (CAPS-5)
Mental health treatment records
Screenshots of images from Ms. Martin’s Facebook account
Ms. Martin, a single mother of four children, had been employed as a mental health worker at a State Hospital for 17 years. This is a high-security facility where individuals who have been found not criminally responsible for violent crimes and who have been adjudicated to be a danger to themselves or others are housed. Ms. Martin worked the night shift which began at 11:00 PM and ended at 7:00 AM. Ms. Martin reported that she enjoyed her job. She preferred working at night because she found it quieter and it allowed her to spend time with her children, who range in age from 13 to 21. Ms. Martin, who has never been married, reported she has always been the sole source of financial support for her family. She was proud of the fact that she had always been able to provide for her children. She had one long-term romantic relationship lasting 12 years. This relationship ended about two years ago.
Ms. Martin reported that about 3.5 years ago, a new supervisor, Gordon Everett was assigned to her unit. According to Ms. Martin, Mr. Everett began making suggestive remarks to her indicating he wished to have a sexual relationship with her. On one occasion he called her into his office, locked the door, and told Ms. Martin it was “just a matter of time until I get you into bed.” She said she was shocked by this and was “speechless.” She told him that she would not sleep with him. When she attempted to leave, Mr. Everett stood between her and the door and told her she could not leave until she kissed him. Ms. Martin reported she felt terrified and was afraid to resist. Ms. Martin then went back to her unit. She said she barely made it through her shift. She did not tell anyone about this incident. She hoped he would leave her alone since she did not encourage him.
However, according to Ms. Martin, Mr. Everett continued to press her for sexual favors. She attempted to avoid him whenever possible. Eventually, Mr. Everett became more insistent. He told her that if she did not start being more “friendly” to him, that she would be sorry and made reference to how one of the patients had recently attacked and seriously injured another staff member. Mr. Everett allegedly told Ms. Martin, “It would be a shame if something like that happened to a nice-looking woman like you.”
Ms. Martin then reported Mr. Everett’s behavior to the human resources department. Although they promised to investigate the allegations, Ms. Martin said that nothing changed. A few weeks later, Ms. Martin said that one of the patients on the unit told her that he had heard that other patients had been approached by someone on staff who offered them $50 to “mess her (Ms. Martin) up.” The following week, Ms. Martin said that she was in a supply room looking for towels when Mr. Everett came into the room behind her and shut the door. She said that he verbally berated her for “snitching” on him. He then told her he “knew what [she] really wanted.” He pushed her against the shelves, forcibly kissed her on the mouth, and groped her breasts. He told her there was “more to come,” and warned her to cooperate or start watching her back.
Ms. Martin left work after her shift and put in for sick leave. She has not returned to work since. She reported she has experienced significant distress, including trouble eating, sleeping, and concentrating; as well as anxiety, panic attacks, and fatigue. She has become increasingly withdrawn and spends most of her time alone in her room. She lost interest in sex and this contributed to the breakdown of her relationship with her significant other. They eventually broke up after more than 12 years together.
Ms. Martin sought mental health treatment from a psychiatrist and a counselor. Despite this, she reported she has had little improvement in her symptoms. She continues to be socially isolated, anxious, fearful, and unable to sleep. She reported suddenly becoming overwhelmed with fear and panic in the grocery store and having to run out of the store, leaving her groceries behind. She said she sometimes has to pull over to the side of the road while driving due to her heart racing and having difficulty catching her breath. She finds herself being irritable and cranky with her children. She is jumpy at home and startles easily. She has lost interest in social activities that she formerly enjoyed. She has not returned to work.
Behavioral Observations and Mental Status
Ms. Martin was accompanied to the evaluation by her adult daughter who remained in the waiting room during the evaluation. Ms. Martin was appropriately dressed in clean, casual attire, with an acceptable level of grooming. She described her mood as “miserable.” She appeared to be quite sad. Her eyes were downcast. Her overt emotional expression was generally flat, although she became tearful when discussing her interactions with Mr. Everett. She moved slowly and appeared tired. She was responsive to all questions and produced coherent, although at times, very lengthy responses. There were no obvious problems with memory or concentration. She appeared to be of roughly average intelligence. She cooperated with all examination procedures.
Summary of Test Results
The MMPI-2-RF was used to obtain additional information about Ms. Martin’s psychological and emotional functioning. The MMPI-2-RF is a 338-item self-report instrument used to assess psychopathology and personality. This test also contains scales to assess under- or over-reporting of symptoms and other ways of responding that compromise validity.
Ms. Martin produced a valid profile. She appeared to understand the content of the questions and responded in a consistent fashion. She reported more symptoms than was typical in the normative sample, but this appeared to reflect a high level of distress rather than an attempt to exaggerate her symptoms. She appeared to be responding frankly to the test items and did not attempt to present herself in an unrealistically positive light.
Ms. Martin’s responses suggest she may be experiencing a high level of anxiety, marked by fear, worry, irritability, and a sense of dread. The degree of anxiety she is experiencing appears to be interfering with her daily activities. In addition to subjective feelings of worry and dread, her anxiety appears to manifest as somatic symptoms including gastrointestinal distress, headaches, tingling and numbness in her limbs, and an overall sense of weakness and exhaustion. She expresses great difficulty trusting other people and reports feeling that others may be intentionally trying to harm her.
The CAPS is a 30-item structured interview that corresponds to the DSM-5 criteria for diagnosing PTSD. In addition to assessing the twenty DSM-5 PTSD symptoms, questions target the onset and duration of symptoms, subjective distress, the impact of symptoms on social and occupational functioning, overall response validity, overall PTSD severity, and specifications for the dissociative subtype (depersonalization and derealization).
A diagnosis of PTSD requires that all criteria A through G are met. Ms. Martin’s responses to the CAPS indicate that the nature of the trauma she described meets Criterion A; she reported four intrusive symptoms, including intrusive memories, distressing dreams, and psychological and physiological reactions related to the trauma (Criterion B); one avoidance symptom—i.e., avoidance of memories associated with the trauma (Criterion C); five cognitive and mood symptoms including exaggerated negative beliefs or expectations, distorted cognitions leading to blame, a persistent negative emotional state, diminished interest or participation in activities, and attachment or estrangement from others (Criterion D); four arousal and reactivity symptoms including irritability, hypervigilance, exaggerated startle response, problems with concentration, and sleep disturbance (Criterion E); the duration of her symptoms has been for more than two years with no delayed onset (Criterion F); and she has experienced subjective distress as well as impairment in her social and occupational functioning (Criterion G).
There is considerable consistency among Ms. Martin’s self-report, the records of her mental health treatment, her performance on psychological testing, and her observed behavior during this examination—all suggesting that Ms. Martin is experiencing an extremely high degree of psychological distress. She is anxious, panicked, hypervigilant, depressed, and withdrawn. She has extremely disrupted sleep resulting in an exacerbation of her subjective distress, as well as physical fatigue and poor concentration.
Diagnostically, Ms. Martin’s symptoms best fit a diagnosis of PTSD. As indicated on the CAPS, she meets every diagnostic criterion and endorsed 14 out of a possible 20 symptoms. Ms. Martin’s daily functioning has been significantly compromised as a result of the stress she has experienced. She has felt unable to function at work. She is irritable with her children. She is avoiding social interaction and broke up with her long-time significant other. She struggles to complete relatively common activities, such as driving and grocery shopping, as a result of her symptoms.
Summary of Data Relevant to Psycho-Legal Question
Mental Health Treatment Records
Records from Ms. Martin’s psychiatrist and counselor indicate she has been in treatment for 2.5 years. During her initial psychiatric evaluation, she complained of “persistent feelings of depression and anxiety that interfere with her ability to function and interact with others.” She reported that she had sought help from human resources in dealing with “multiple frequent episodes of sexual harassment…Prior to her complaint and conflicts on the job, the patient enjoyed her place of employment and looked forward to going to work,” but Ms. Martin now “fear[s] for [her] safety and her job.” Ms. Martin’s symptoms included depressed mood, tearfulness, irritability, fatigue, decreased concentration, loss of interest, and social isolation. She reported severe sleep disturbance and was taking up to six Benadryl capsules to sleep. The psychiatrist prescribed Vyvanse, Xanax, Trazodone, and Neurontin. Subsequently, Neurontin and Trazodone were discontinued and Klonopin and Seroquel were added.
Ms. Martin also met with a therapist on a weekly basis. Notes from these sessions indicate Ms. Martin was often agitated and fearful. She reported feeling paralyzed mentally and physically. She complained of poor sleep and loss of interest in activities including socializing and having sexual relations with her significant other.
Memoranda from Employer
A memorandum from Ms. Martin’s employer confirmed that Ms. Martin had lodged a complaint against her supervisor alleging that he had engaged in a pattern of sexual improprieties, unwanted physical contact, physical restraint, and threats of physical harm. Another memorandum described an interview with Mr. Everett about these allegations. According to this memorandum, Mr. Everett acknowledged some “flirtatious behavior” may have transpired. He identified Ms. Martin as the instigator of this contact and reported that she had become angry with him when he told her he was married and was not willing to become involved with her. The memorandum indicated that Mr. Everett should be formally chastised for engaging in flirtatious behavior with one of his subordinates.
During the deposition of the evaluator, the defense counsel presented the evaluator with three pages of images allegedly obtained from Ms. Martin’s Facebook account. These images depicted Ms. Martin wearing a tight-fitting, low cut, short dress and high heels. The defense counsel asked the examiner how she could assert that Ms. Martin had lost interest in sex given that these “provocative” photos were posted on her Facebook account. The examiner responded that without more information and context, that she could not form any opinion about these images and their relationship, if any, to Ms. Martin’s interest in sex.
Ms. Martin’s Account of the Facebook Images
After the deposition, the examiner spoke to Ms. Martin’s lawyer and asked him if she could meet with Ms. Martin to discuss these images with her. At this meeting, Ms. Martin identified the images as being of her and acknowledged the images were posted to her Facebook account. She clarified that she had posted the photos approximately three years ago. At that time, her relationship with her significant other was starting to deteriorate due to her anxiety and to her waning interest in having sexual relations. She reported that she was “pushing” herself to try harder with him because she loved him and did not want to lose the relationship. She stated, “I would try to get dressed up like this because he loved it and I thought it would make me feel better about myself. And it did, for a little while, but I just couldn’t keep it up and I couldn’t follow through.” She reported that the photos in question were taken at a New Year’s Eve party. She indicated that there were several other photos posted to Facebook that were taken that same night of her with her significant other and with other guests at the party which she showed the examiner. The other female guests were dressed in a similar fashion.
Clinical Forensic Opinion
There were no indications that Ms. Martin experienced symptoms of PTSD prior to the alleged events in her workplace. Prior to these events, she was a well-functioning single parent who was able to care for her family both emotionally and financially. Ms. Martin had no history of mental health treatment prior to the alleged events. She had no history of substance abuse. The onset of Ms. Martin’s symptoms and the decrease in her functional capacity appear to be directly related to the events in her workplace. The evaluation of Ms. Martin and review of her medical records did not identify any other life circumstances or potential causative factors unrelated to the alleged sexual harassment and retaliation that could explain the decline in Ms. Martin’s mental health and functional capacity.
No specific recommendations were offered as part of this evaluation.
How Did Social Media Impact This Case?
After the discussion with Ms. Martin, the examiner determined that the Facebook postings did not change her opinion regarding Ms. Martin’s loss of interest in sex as a result of the alleged sexual harassment at her workplace. The reasons for this are as follows. First, the context of the images had not been disclosed by the defense attorney. Placed in the context of a New Year’s Eve party, Ms. Martin’s attire was not unusual. Second, the photos had been posted three years prior to the evaluation. At that time, the alleged sexual harassment had just begun, and Ms. Martin was still able to function at work. Finally, there is no evidence that a person’s attire is dispositive of their interest in sex. It cannot be inferred from Ms. Martin’s clothing that she did or did not have decreased interest in engaging in sexual relations with her significant other.