“PTSD: [The claimant] meets criteria for a diagnosis of Complex Post Traumatic Stress Disorder (ICD-11 6B41), with symptoms of re-experiencing, avoidance and hyperarousal when triggered. - Re-experiencing includes flashbacks and nightmares. She has intrusive thoughts and ruminations about the abuse which she tries to manage by avoidance. - Avoidance is primarily cognitive, with her engaging in behaviours in order to avoid thinking about the abuse. These are at times extreme and involve what she describes as ‘manic cleaning’. There is also an element of avoiding contact with others, as a means of managing her emotional state. - Hyperarousal when triggered was very evident in the assessment. In talking about the abuse, she became upset and agitated, visibly shaking and requiring frequent breaks. - She also meets the criteria to meet the diagnosis for complexity include, problems in affect regulation, beliefs related to shame and worthlessness and difficulties in relationships. PTSD has affected [the claimant] throughout her life to a greater or lesser extent. By her own account she managed to function to some degree until her mother’s death, when this became overwhelming, leading to disclosure. However, even in those years, her avoidance and focus on appearing as normal as possible, was only successful to a degree. Difficulties in her relationships, problems with intimacy, both sexual and more generally are, on the balance of probabilities, linked to the abuse suffered. From her mother’s death and the subsequent disclosure to the police, symptoms of PTSD have been more difficult to manage and affect her on a daily basis, dictating her routine and what she is and is not able to do. She is plagued by thoughts of shame and self-blame, which despite an understanding of the nature of the abuse, she finds she cannot shake off. She continues to avoid triggers, which in essence means that she avoid many aspects of ordinary and fulfilling life, such as friendships and engaging in activity outside the home. Her anxiety out of the home presents as agoraphobia; however this is primarily due to the PTSD and does not warrant a separate diagnosis. [The claimant] describes dissociative phenomena linked to the abuse suffered. At the time of the abuse and in subsequent sexual relationships, she describes dissociating as a means of coping. She talks of herself as several ‘parts’, which can be termed ‘alters’. This is not a true/complete Dissociative Identity Disorder (in which the alters are not aware of each other), but considering dissociation on a continuum, it expresses how she experiences the struggle to have a coherent identity and sense of self. Depression: Depression is often part of CPTSD which is the case here. However, at times she is likely to have warranted a separate and additional diagnosis of depression. She is currently low in mood linked to the case, but also to her situation and lack of rewarding activity in her life. She meets criteria for a diagnosis of recurrent Depressive Disorder of varying severity throughout her life since the abuse (ICD-11 6A71). She is at moderate risk of self-harm and suicide, with the strong protective factor of her children and grandchildren.”
“[The claimant’s] self-report of life before she met [the defendant] was nevertheless that she was doing reasonably well at school and was a happy child. By contrast, after the abuse by [the defendant] there appears to have been a high level of disturbance and an inability to engage in previous activities such as going to school, focussing on lessons and mixing with peers. The impact of the abuse on her self-esteem was profound: she scrubbed her face and body with pumice stone and ‘hid’ under clothes and make-up. I would state that the abuse suffered and her efforts to avoid thinking about this and appear ‘normal’ shaped her development from that point and has had a profound effect on her subsequent life and mental health. On the balance of probabilities, the abuse perpetrated by [the defendant] is the primary and most significant cause of her CPTSD, with the initial and earliest incidents being most damaging, due to her young age, the seriousness of the abuse and the complexity of the situation involving hr mother. The content of her re-experiencing is related to the abuse by [the defendant]. Her young age and vulnerability at the time and the trauma of this being linked to her mother, add to the complexity and severity, with a profound impact on her developing personality… The abuse suffered has affected her view of herself, causing low self-esteem and self-loathing, which feeds into depression. Her view of the world and her difficulties in relationships when younger, and avoidance of these when older, are factors relevant to her depression. Although other life events, such as domestic violence and coping with her son’s challenging behaviours have been triggers for low mood in the past, the abuse by [the defendant] is highly significant and, on the balance of probabilities, the primary cause.”
“[The claimant] presents as an intelligent woman. Her school achievements and record of employment do not reflect this. Her own account is that, following the commencement of abuse by [the defendant], she was unable to attend to her schoolwork and in fact found being at school too difficult altogether. She stopped attending and did not take any O-levels as a result. This was not truancy in the sense of a teenager losing motivation and becoming rebellious but was a response to trauma. She clearly describes conversations with peers acting as a trigger to distress and thoughts that her peers would know about the abuse by looking at her. Avoidance of school established a pattern of coping with her negative emotions. This was repeated in a work setting, when a peer from school was employed, meaning she had to stop attending work. In my opinion, the major reason for [the claimant] not achieving in education and not being able to work has been avoidance, associated with PTSD caused by the abuse suffered.”
“[3.8] The abuse suffered has had a significant impact on relationships and intimacy. [3.9] The abuse suffered and resultant CPTSD is, on the balance of probabilities, causal in her under achievement educationally and lack of employment. [3.10] [The claimant] would benefit from psychological treatment, focussed on CPTSD, namely Eye Movement Desensitisation and Reprocessing (EMDR). [3.11] In the event she engages in this therapy, the prognosis is cautiously optimistic, and she is likely to experience a reduction in post trauma symptoms and reduced vulnerability to depression.”
“The cases in this section include damages for the sexual and/or physical abuse itself as well as any psychiatric injury caused to the injured person… In many cases there is also an element in the award of general damages for the indignity, mental suffering, humiliation, distress, or anger caused by such an attack. This is sometimes characterised as aggravated damages, but more properly is injury to feelings and is included in the brackets below. Where the element for injury to feelings has been broken down in reported cases, which is usually where there is significant injury, the range is usually in the region of£18,310 to£30,510 . The factors to be taken into account in valuing general damages for the abuse and the psychiatric injury in claims of this nature are as follows: (i) the nature and duration of the abuse and any physical injuries caused; (ii) the nature and duration of the psychological injury and its effect on the injured person’s ability to cope with life, education, and work; (iii) the effect on the injured person’s ability to sustain personal and sexual relationships; (iv) abuse of trust; (v) the extent to which treatment would be successful; (vi) future vulnerability; (vii) prognosis for psychological injury. Aggravating features which would lead to an additional sum for injury to feelings include: (i) the nature of the abuse; (ii) the level of abuse of trust; (iii) any manipulation following the abuse to stop reporting of the abuse, or to seek to put blame on the injured party; (iv) the need for the injured party to give accounts and evidence of the abuse in criminal or civil proceedings, or in any other relevant investigation.”
“Severe:£109,830 to£183,050 . In these cases the injured person will have suffered both serious abuse over a prolonged period and severe or moderately severe and prolonged psychiatric injury. At the upper end the abuse will have had serious effects on their ability to copy with education, work and to sustain personal and sexual relations. There may be elements of false imprisonment.”