Paralympian Oscar Pistorius arrives at the high court in Pretoria on Tuesday, 13 May 2014 for his murder trial. Pistorius is charged with murdering his girlfriend Reeva Steenkamp. Picture: Daniel Born/The Times/ Pool

Pretoria - As Oscar Pistorius awaits a ruling on whether he will be kept at a psychiatric facility for observation, the State has spent the morning attacking the diagnosis of a defence psychiatrist.

Returning to the stand on Tuesday morning was psychiatrist, Professor Merryll Vorster.

On Monday, she told the High Court in Pretoria that she had diagnosed the athlete with a general anxiety disorder. She suggested this may have affected Pistorius's actions on the night he shot and killed Reeva Steenkamp.

This prompted prosecutor Gerrie Nel to say he would apply to have Pistorius referred to a psychiatric facility for observation as dictated by the Criminal Procedures Act.

Nel continued his cross-examination by scrutinising Vorster's report on Pistorius's mental state.

He asked about the athlete's general anxiety disorder (GAD), and whether it could affect his behaviour.

Vorster said that a person suffering from GAD would generally perceive reality in a more negative way, and could result in physical symptoms, from eating disorders to insomnia.

She said there were levels of severity for those who have the disorder.

Vorster said it could impact on one's capacity to live a normal lifestyle.

She said someone with a severe form could be incapacitated by their worry, because they need to prepare for hours prior to going to work, for example.

Nel asked if Pistorius was incapacitated to this extent, and Vorster said he was still able to commit to social and work engagements.

Nel asked if his actions on the night of the shooting could have been affected by the GAD. Vorster said that it could have, based on the athlete's version of events.

Nel said that none of the other witnesses had indicated Pistorius was an “anxious person”, but Vorster responded that most people conceal these issues. She said it was unlikely even the athlete or his family were aware of the disorder prior to her diagnosis.

The prosecutor then queried the report's findings that Pistorius was severely anxious about crime in South Africa. Vorster said Pistorius had taken major security measures at his home after his home had been broken into.

After he found out that Silverwoods Country estate had also experienced some crimes, Pistorius bought dogs and had other security systems installed at his home.

“I felt that his security measures were more than that taken by the average South African,” said Vorster.

Nel argued that many people had dogs, eye beams and other security at their homes. But Vorster said that most people don't lock themselves in their rooms at night, like Pistorius does.

Nel then asked why if Pistorius was so security conscious, why had he not repaired a broken window on the ground floor of the home.

She said that considering the estate's rules on not allowing burglar bars, Pistorius would have relied on the other security systems.

But Nel said that this would be fine for a normal person, but someone diagnosed with GAD would be more wary.

He also said Pistorius had not locked up the ladders surrounding his home, which could have helped a criminal gain entry to the upper floors.

Pistorius was also not concerned about whether his alarm was operating, as Nel said Pistorius had said during his testimony that workers had been at his home and may have disabled it. Defence advocate Barry Roux said it was simply the beams that may have been disabled by the workers, not the entire alarm system.

He also argued that Pistorius was able to trust Steenkamp to close his balcony door before bed on the night of the shooting, which someone with extreme anxiety would not have been able to do.

Vorster said that in a trusting relationship, he was able to rely on Steenkamp to close up.

The prosecutor then moved onto an incident where Pistorius and his friend Darren Fresco were pulled over by metro police in 2012. Nel asked if Pistorius would have been more anxious than the average person about getting into trouble.

Vorster said that most people experience anxiety, and that a GAD sufferer could be more distressed than someone without the disorder.

She said it was an incredibly common disorder, affecting between 1 and 6 percent of the population.

Nel then asked about the factors in the report that could affect the merits of the murder case against Pistorius.

Vorster said that GAD diagnosis could effect Pistorius's sentencing should he be found guilty.

Nel inquired about Vorster being brought to the stand to comment on Pistorius's mental state at the time of the shooting based on the athlete's version. She said she'd be willing to comment on the State's version if need be.

“The diagnosis played a role at the time of the offence,” said Vorster. She said GAD was a constant factor in any version.

He asked if Pistorius had intended to kill Steenkamp in the toilet cubicle, whether the GAD would affect his actions.

She said it would, as he would be worried about losing a relationship, and in any build-up to the killing, an argument for example, his GAD could have increased his anxiety during such a fight.

“People suffering from GAD are not dangerous as such… (but they) probably shouldn't have firearms,” said Vorster.

However, she said a person anxious about their personal security would want to purchase a firearm.

When asked about when Pistorius had fully developed his anxiety disorder, she was able to say that even from his teenage years he may have had the added stress of concealing it from his peers.

She said it was likely he'd suffered from the disorder for many years, and even from his first few years of life, the factors that created it were apparent.

Vorster said that while Pistorius was superficially coping in his social spheres, he was still very lonely as he could not confide in them.

His sexual relations were also quite short in duration, according to the psychiatrist.

She added that if the court finds that he shot at a perceived intruder, or even if he intentionally shot at Steenkamp, her diagnosis would be an important factor.

Nel asked if Pistorius had told her whether he had the intention to shoot an intruder. She responded that he had approached the perceived danger in fear and had fired at the noise he heard inside the toilet cubicle.

Nel said that the athlete had denied firing at the noise during his testimony.

“It would appear that there are inconsistencies,” said Vorster.

* By the time of publication, the psychiatric referral application had not yet taken place at the High Court in Pretoria.

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