Is Your Patient Disabled By A Mental Disorder?

The opinion of a treating physician on the mental status of a patient claiming Social Security disability benefits is considered “competent psychiatric evidence” in federal courts, even if the treating physician is not a board certified psychiatrist.

This article reviews the criteria for “Mental Disorders” set forth in the Social Security Regulations “Listings of Impairments.” If your patient’s impairment meets or equals the requirements of any one of these Listings, your patient will be deemed “disabled” and entitled to disability benefits. An impairment “equals” the Listings if it impairs to the same extent of severity as one of the Listings, even if it does not meet the criteria for the Listing.

These are the mental disorders in the Listings:

  1. Organic mental disorders;
  2. Schizophrenic, paranoid and other psychotic disorders;
  3. Affective disorders;
  4. Mental retardation and autism;
  5. Anxiety related disorders;
  6. Somatoform disorders; and
  7. Personality disorders.

Evaluation of disability based on mental disorders requires not only the documentation of medically determinable impairment(s), but also consideration of how the impairment(s) limits the patient’s ability to work and whether these limitations have lasted or are expected to last at least 12 months.

In addition to manifesting the symptoms listed below, these disorders must also result in at least two or three of the following: 1. marked restriction in activities of daily living; 2. marked difficulties in maintaining social functioning; 3. deficiencies in concentration, persistence or pace resulting in frequent failure to complete tasks in a timely manner; or 4. repeated episodes of deterioration or decompensation in work or work-like settings causing withdrawal or exacerbation of signs and symptom; or, in some cases; 5. inability to function outside of a highly supportive living situation or one’s own home.

Organic mental disorders must involve tests or exam results showing an organic factor causing the abnormal mental state and loss of prior functional abilities. One of the following must also be documented: time/place disorientation; memory impairment; perceptual or thinking disturbances (hallucinations, delusions); change in personality; disturbance in mood; emotional liability and impaired impulse control; or intellectual loss of at least 15 I.Q. points or impairment index in the severely impaired range.

Psychotic disorders involve deteriorated functioning resulting from the medically documented presence (continuous or intermittent) of one or more of the following: delusions or hallucinations; catatonic or other grossly disorganized behavior; incoherence, loose associations, illogical thinking or poverty of speech content associated with an affect which is blunt, flat or inappropriate.

Affective disorders are characterized by a mood disturbance with full or partial manic or depressive syndrome, or “bi-polar” syndrome with episodes showing the full symptoms of both manic and depressive. Depressive syndrome may be shown by 4 of the following: pervasive loss of interest in almost all activities; appetite disturbance with change in weight; sleep disturbance; psychomotor agitation or retardation; decreased energy; feelings of guilt or worthlessness; difficulty concentrating or thinking; thoughts of suicide; or hallucinations, delusions or paranoid thinking. Manic syndrome may be shown by 3 of the following: hyperactivity; pressure of speech; flight of ideas; inflated self-esteem; decreased need for sleep; easy distractibility; unwary involvement in activities having a high probability of painful consequences; or hallucinations, delusions or paranoid thinking.

Mental retardation and autism are characterized by subaverage intellectual functioning and deficits in adaptive behavior evidenced by dependence upon others for personal needs and inability to follow directions which precludes the use of standardized measures of intellectual functioning; or an I.Q. of 59 or less; or an I.Q. of 60 through 70 and other physical or mental impairments imposing work-related functional limitations.

Anxiety disorders involve either a predominant anxiety disturbance or anxious reactions when confronting a dreaded object (phobic disorders) or resisting compulsions and obsessions (obsessive compulsive disorders). A generalized persistent anxiety may be shown by 3 of these: motor tension; autonomic hyperactivity; apprehensive expectation; or vigilance and scanning. Or the patient will exhibit one of these: persistent irrational fear of a specific object, activity or situation causing a compelling desire to avoid it; recurrent (at least weekly) severe “panic attacks” – unpredictable onset of apprehension, fear, terror or sense of impending doom; recurrent obsessions or compulsions which cause marked distress; or recurrent and intrusive recollections of a traumatic experience causing marked distress.

Somatoform disorders involve physical symptoms for which there are no demonstrable organic findings or known physiological mechanisms. This may be shown by: 1) a history of multiple physical symptoms of several years duration, beginning before age 30, causing frequent doctor’s visits and use of medicine and significantly altered life patterns; or 2) persistent nonorganic disturbance of vision or speech or hearing or use of limb or movement and its control; or 3) unrealistic interpretation of physical signs and sensations with preoccupation/belief that one has a serious disease or injury.

Personality disorders involve maladaptive and inflexible personality traits which significantly impair social or occupational functioning or cause subjective distress, as shown by one of these: seclusiveness or autistic thinking; pathologically inappropriate suspiciousness or hostility; oddities of thought, perception, speech and behavior; persistent disturbances of mood or affect; pathological dependence, passivity or aggressivity; or intense and unstable personal relationships and impulsive and damaging behavior.

Including your observations of these symptoms in your chart notes or your referral to a psychiatrist or Ph.D. psychologist will insure your patient has the medical documentation needed should he/she seek Social Security disability status.

This article was prepared by Arthur W. Stevens, III