Systemic-Caused Iatrogenic Behavioral Health Disability and Contradiction Between Diagnostic Systems

  • Pamela A. Warren


Many laws, such as the American Disability Act (ADA), the American Disability Act Amendments Act of 2008 (ADAAA), and the Health Insurance Portability and Accountability Act (HIPAA) were meant to aid those individuals who have impairment in functioning. The ADA and ADAAA were designed to help individuals with impairment in functioning to continue to work. HIPAA was meant to make insurance portable so that if an individual left a job, then she/he would not be without insurance. However, unintentional consequences have arisen from these laws that may negatively impact on the individual’s ability to continue to work.

In addition, the recent changes to the DSM-5 and the legal mandate to use the ICD-10 diagnostic systems have also caused confusion for many treating professionals. Some of these issues that arise with these changes are discussed.


American Disability Act ADA, American Disability Act Amendments Act ADAAA Health Insurance Portability and Accountability Act HIPAA DSM-5 ICD-10 Behavioral health disability 


  1. American Medical Association. (2017). Current Procedural Terminology; Accessed June 5, 2017.
  2. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5 .Washington. In DC: American Psychiatric Association.Google Scholar
  3. American Psychological Association. (2013). Specialty guidelines for forensic psychology. The American Psychologist, 68, 7–19. Scholar
  4. American Psychological Association. (2016). Ethical Principles of Psychologists and Code of Conduct. Accessed September 1, 2017.
  5. American Recovery and Reinvestment Act of 2009 (ARRA), Pubic Law No. 111–5.Google Scholar
  6. American with Disabilities Act Amendments Act (ADAAA). (2008). ADA Amendments Act of 2008. adaaa.cfm. ADAAA, P.L. 110–325, 2008.
  7. Borkosky, B. (2012). Why forensic records are no longer “owned” by the referral source: Psychologists are required to permit patient access and release of forensic records. The Florida Psychologist, 63(8–9), 22–23. Retrieved from Scholar
  8. Borkosky, B. (2013). Patient access to records: The invisible confidentiality right. National Psychologist, 22, 9–10. Retrieved from Scholar
  9. Borkosky, B. (2014). HIPAA’s patient access rights: What patients and providers need to know when patients want a copy of their records. Retrieved from and
  10. Borkosky, B., & Pellett, J. M. (2013). Can FMHPs refuse to release records to evaluees because the records are “information compiled in reasonable anticipation of” litigation (as defined by HIPAA)? American Journal of Forensic Psychology, 31, 21–40.Google Scholar
  11. Borkosky, B. G. & Smith, D. (2015). The risks and benefits of disclosing psychotherapy records to the legal system: What psychologists and patients need to know for informed consent. International Journal of Psychiatry and Law, 42-43(19–30). Scholar
  12. Borkosky, B., Pellett, J. M., & Thomas, M. S. (2013). Are forensic evaluations “healthcare” and are they regulated by HIPAA? Psychological Injury and Law, 7(1), 1–8. Scholar
  13. Bush, S. S., Demarkis, G. J., & Rohling, M. L. (2017). APA handbook of forensic neuropsychology. Washington, D.C.: American Psychological Association.CrossRefGoogle Scholar
  14. Bush, S. S., & Heilbronner, R. L. (2012). The neuropsychological IME. In S. S. Bush & G. L. Iverson (Eds.), Neuropsychological assessment of work-related injuries (pp. 280–302). New York: Guilford Press.Google Scholar
  15. Bush, S. S., & Martin, T. A. (2008). Confidentiality in neuropsychological practice. In J. A. M. Horton & D. Wedding (Eds.), The neuropsychology handbook (3rd ed., pp. 515–530). New York: Springer.Google Scholar
  16. Bush, S. S., & Martin, T. A. (2010a). The ethical and clinical practice of disclose ng raw test data: Addressing the ongoing debate. Applied Neuropsychology: Adult, 13, 115–124. Scholar
  17. Bush, S. S., & Martin, T. A. (2010b). Privacy, confidentiality, and privilege in for ensic neuropsychology. In A. M. Horton Jr. & L. C. Hartlage (Eds.), The hand book of forensic neuropsychology (2nd ed., pp. 235–244). New York: Springer.Google Scholar
  18. Caine, E. D. (2003). Determining causation in psychiatry. In K. A. Phillips, M. B. First, & H. A. Pincus (Eds.), Advancing DSM: Dilemmas in psychiatric diagnosis. Washington, DC: American Psychiatric Association.Google Scholar
  19. Centers for Medicare and Medicaid Services. Accessed July 1, 2017.
  20. Connell, M. A., & Koocher, G. P. (2003). HIPAA and forensic practice. AP-LS News, 23, 16–19. Retrieved from Scholar
  21. Department of Health and Human Services, Federal Register 45 CFR 160; 45 CFR 164, 2013. Accessed September 1, 2017.
  22. Garner, B. A., & Black, H. C. (2009). Black’s law dictionary. 9th ed. St. Paul, MN: West.Google Scholar
  23. Genetic Information Nondiscrimination Act (GINA). (2008). Pub. L. 110–233, 122 Stat. 881).Google Scholar
  24. Health Insurance Portability and Accountability Act of 1996 (HIPAA), Public Law No. 104–191.Google Scholar
  25. Heilburn, K. (2001). Principles of forensic mental health assessment. New York: Kluwer Academic/Plenum Publishers.Google Scholar
  26. Heilburn, K., Grisso, T., & Goldstein, A. M. (2009). Foundations of forensic mental health assessment. New York: Oxford University Press. 180 pp.Google Scholar
  27. Heilburn, K., Marczyk, G., & DeMatteo, D. (2002). Forensic mental health assessment: A casebook. New York: Oxford University Press.Google Scholar
  28. Heilburn, K., Marczyk, G., DeMatteo, D., & Mack-Allen, J. (2007). A principles-based approach to forensic mental health assessment: Utility and update. In A. M. Goldstein (Ed.), Forensic psychology: Emerging topics and expanding roles (pp. 45–72). Hoboken, NJ: John Wiley & Sons.Google Scholar
  29. Heilburn, K., Marczyk, G., DeMatteo, D., Zillmer, E., Harris, J., & Jennings, T. (2003). Principles of forensic mental health assessment: Implications for neuropsychological assessment in forensic contexts. Assessment, 10, 329–343.CrossRefGoogle Scholar
  30. Hwang v. Kansas State Uni., 753 F.3d 1159 (10 th Cir. 2014). Google Scholar
  31. Koocher, G. P., & Keith-Spiegel, P. (2016). Ethics in psychology and the mental health professions (4th ed.). Oxford: NY. Oxford University Press.Google Scholar
  32. Koocher, G. P., Norcross, J. C., & Greene, B. A. (2013). Psychologist’ desk reference (3rd ed.). Oxford, NY: Oxford University Press.CrossRefGoogle Scholar
  33. Koocher, G. P., Norcross, J. C., & Hill, S. S. (2005). Psychologists’ desk reference (2nd ed.). Oxford, NY: Oxford University Press.Google Scholar
  34. Pope, K.S. & Vasquez, M.J.T. (2016). Ethics in psychotherapy and counseling, 5th ed. Wiley & Sons, NJ: Hoboken.Google Scholar
  35. U.S. Department of Health and Human Services., 45 C.F.R. 160.103Google Scholar
  36. Warren, P. A. (2013a). Those who hesitate are lost: The case for setting behavioral health treatment and disability standards, part I. Psychological Injury and Law, 6(3), 183–195.CrossRefGoogle Scholar
  37. Warren, P. A. (2013b). Those who hesitate are lost: The case for setting behavioral health treatment and disability standards, part I. Psychological Injury and Law, 6(3), 196–207.CrossRefGoogle Scholar
  38. Weber, M. C. (2008). AAPL guideline for forensic evaluation of psychiatric disabilities: A disability law perspective. Journal of the American Academy of Psychiatry and the Law, 36(4), 558–562.PubMedPubMedCentralGoogle Scholar
  39. Weiner, I., & Hess, A. (Eds.). (2005). The handbook of forensic psychology (3rd ed.). New York: John Wiley & Sons.Google Scholar
  40. World Health Organization. (1992). The ICD-10 classification of mental and behavioural disorders: Clinical descriptions and diagnostic guidelines. Geneva: World Health Organization.Google Scholar
  41. Young, G., Kane, A. W., & Nicholson, K. (2007). Causality of psychological injury: Presenting evidence in court. New York: Springer.Google Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Pamela A. Warren
    • 1
  1. 1.Carle Physician Group and University of Illinois Medical SchoolDepartment of PsychiatryMonticelloUSA

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