The Detection of Feigned Psychiatric Disorders Using the MMPI-2-RF Overreporting Validity Scales: An Analog Investigation

Individuals who are motivated to feign psychological problems to achieve a desired outcome (e.g., insanity defense) may overreport symptoms of psychopathology, with type of pathology being dependent on the setting. In the current investigation, we examined the utility of the overreporting validity scales (infrequent responses [F-r], infrequent psychopathology responses [F_P-r], infrequent somatic responses [Fs], and symptom validity [FBS-r]) on the Minnesota Multiphasic Personality Inventory-2-Restructured Form (Ben-Porath and Tellegen 2008) to detect research participants instructed to simulate one of three mental disorders: major depressive disorder (MDD), schizophrenia (SCH), or post-traumatic stress disorder (PTSD). The restructured clinical (RC) and overreporting validity scale scores of bona fide psychiatric patients with a primary diagnosis of either MDD, SCH, or PTSD were compared to two groups of simulators—naïve (i.e., undergraduate students with no training in mental disorders) and sophisticated (i.e., individuals with advanced training in psychopathology or personal experience with the disorder asked to overreport symptoms). Examination of the RC Scale profiles revealed that the sophisticated simulators produced symptom profiles more similar to the profiles of the psychiatric patients than did the naïve simulators. For the overreporting validity scales, the sophisticated simulators were less likely to be detected as feigning compared to the naïve simulators; overall, the validity scales were able to distinguish patients from simulators and accurately classify most of the simulators regardless of their level of “symptom” sophistication. Examination and comparison of the validity scales revealed that across disorders and level of research participant symptom sophistication, the F_P-r scale best differentiated simulators from patients.     

The Minnesota Multiphasic Personality Inventory-2 Restructured Form and Posttraumatic Stress Disorder: Forensic Applications and Considerations

This paper reviews the empirical literature on the use of the Minnesota Multiphasic Personality Inventory-2 Restructured Form (RF; Ben-Porath and Tellegen 2008; Tellegen and Ben-Porath, 2008) scales for the assessment of posttraumatic stress disorder (PTSD) and PTSD comorbidity and discusses the use of the instrument in forensic contexts. We focus on prior work that has examined the association between the RF scales and PTSD, PTSD comorbidity, and the utility of the RF validity scales for detecting feigned symptoms of PTSD. We conclude that though the MMPI-2 RF scales show expected patterns of association with PTSD, their most useful application in the forensic arena may be in the identification of comorbid personality-based psychopathology, and in detecting symptom overreporting. We recommend that the MMPI-2 RF be used in the context of a comprehensive assessment that includes an exhaustive record review, detailed history with an emphasis on past trauma, and structured diagnostic interviews.     

Ill-Treatment of Pain in the DSM-5

The just-published psychiatric diagnostic manual, the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), American Psychiatric Association (2013), has been lauded by its organizers (e.g., Regier, Kuhl, and Kupfer in World Psychiatry 12, pp. 92–98, 2013), but has been criticized on multiple grounds, as well. Several of its major diagnostic categories concern the area of psychological injury and law (e.g., tort cases involving posttraumatic stress disorder (PTSD), chronic pain, and traumatic brain injury (TBI)). The one for chronic pain seems the one most greatly changed. The approach to chronic pain in the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, text revision (American Psychiatric Association 2000) and the DSM-5 are compared, leading to an alternative diagnostic criteria list partly based on the changes in the DSM-5. The DSM-5 should be used with caution in forensic assessments. This applies especially to the psychological injury patient, including the pain one, given the high stakes involved and the need for accuracy in assessment based on a reliable and valid diagnostic system. Future iterations of the manual should be improved in both these regards.     

Assessing the Latent Factor Association Between the Dysphoria Model of PTSD and Positive and Negative Affect in Trauma Victims from India

The recent release of the DSM-5 comes with the division of posttraumatic stress disorder (PTSD) symptoms across four symptom clusters (American Psychiatric Association, 2013). This division is based on the support garnered by two four-factor models; Emotional Numbing (King et al., 1998) and Dysphoria (Simms et al., 2002) and a five-factor model; Dysphoric Arousal (Elhai et al., 2011). Much debate centered on the validity of the Dysphoria factor as a non-specific factor of PTSD within the Dysphoria model. In line with this, we assessed relations between the four factors of the Dysphoria model (Simms et al., 2002) and positive (PA) and negative affect (NA) in natural disaster victims (N?=?200) from Leh, India, using the PTSD checklist (PCL-S) and Positive and Negative Affect Schedule (PANAS short form). Confirmatory factor analysis was implemented to assess the best-fitting model for both the PCL (PTSD) and the PANAS (affect). Two optimal models (the Dysphoria model and a two-factor model for affect) were subsequently used to assess latent variable associations across constructs. It was hypothesized that differential associations between latent factors would be evident with the Dysphoria factor being highly correlated with negative affect compared to alternative PTSD factors. Significant correlations were found between factors of the Dysphoria model and NA (0.52–0.65, p?<?0.001). Comparing the association of pairs of PTSD factors with NA and PA, Wald’s tests revealed that no single PTSD factor was more related to NA than the other. Avoidance and Hyperarousal factors were correlated with PA. Results are discussed in line with literature questioning Dysphoria factor’s unique association with general distress.     

Co-occurrence and Correlates of Posttraumatic Stress Disorder and Major Depression in Physically Abused Women

Ninety two women presenting for treatment for marital problems and who were physically victimized by their spouses (e.g., pushing, shoving, punching) within the past year participated in this study. There were three study objectives: (1) document rates and co-occurrence of posttraumatic stress disorder (PTSD) and Major Depressive Disorder (MDD), (2) identify predictors of PTSD and depression symptom frequency/severity, and (3) systematically evaluate disorder-specific group differences in marital- and marital violence-related factors. Within the month prior to assessment, 29.8% of the sample met diagnostic criteria for PTSD and 32% for MDD. MDD and PTSD were significantly, but moderately, correlated at both the symptom and diagnosis levels. However, PTSD symptom frequency and depression symptom severity were predicted by different marital- and marital violence-related factors. PTSD symptoms were predicted by spouse's dominance/isolation tactics and intensity of husband-to-wife physical aggression while depressive symptoms were predicted by marital discord and intensity of husband-to-wife physical aggression. Comorbid women and those with PTSD only reported significantly more spousal fear and husband-to-wife physical aggression than those with MDD only or neither disorder. No group differences were found on rate of marital discord or spouse's controlling/isolating tactics. Results are discussed in terms of theoretical and treatment implications for abused women seeking treatment for marital conflict.     

Posttraumatic Stress Disorder in the DSM-5: Group Difference Commentary

This article provides a commentary on the proposed Diagnostic and Statistical Manual of Mental Disorders (DSM)-5 changes with respect to diagnosing posttraumatic stress disorder (PTSD) in diverse cultural groups in clinical and forensic settings. PTSD is the most common diagnosis in personal injury litigants (Koch et al. 2006). By reviewing the symptoms that have been changed in the DSM-5 draft for PTSD in terms of ethnoracial and minority–cultural factors, this article highlights the lack of data needed in the area and that the DSM project should pay more attention to such factors.     

Breaking Bad: DSM-5 Description, Criticisms, and Recommendations

The special issue on the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th edition, American Psychiatric Association, 2013) in the journal Psychological Injury and Law has considered its changes relative to the DSM-IV-TR (Diagnostic and Statistical Manual of Mental Disorders, 4th edition, text revision, American Psychiatric Association, 2000) from both a clinical utility and scientific point of view. Although the manual did not undergo wholesale change, the changes to diagnostic categories relevant to the area of psychological injuries (especially posttraumatic stress disorder, mild traumatic brain injury, and chronic pain) present both practical and forensic conundrums, complicating clinical and legal work in the area. The articles in the special issue number nine (including the present one), and involve ones on the major psychological injuries, as well as personality. Separate articles deal with forensics and ethics, with a final one considering forensic psychiatric work using the DSMs. The authors collectively indicate that the DSM-5 is rife with utility and scientific difficulties, although it still might be used in practice and for court in the context of careful, comprehensive assessments and critical analysis. More importantly, ongoing and future research should be considered in revising the DSM-5. Some of the articles review in depth the extant research on their topics and all make recommendations that are useful. The articles include those (in order in the special issue) by: Zoellner et al. (Psychological Injury and Law, 6, 2013); Biehn et al. (Psychological Injury and Law, 6, 2013); Schultz (Psychological Injury and Law, 6, 2013); Young (2013); Hopwood and Sellbom (Psychological Injury and Law, 6, 2013); Thomas (Psychological Injury and Law, 6, 2013); Gordon and Cosgrove (Psychological Injury and Law, 6, 2013); and an opinion piece by Frances and Halon (Psychological Injury and Law, 6, 2013), the chief chair of the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, 4th edition, American Psychiatric Association 1994).     

Toward a Typology of High-Risk Major Stressful Events and Situations in Posttraumatic Stress Disorder and Related Psychopathology

The diagnosis of posttraumatic stress disorder (PTSD) was introduced in 1980 with the publication of the Diagnostic and Statistical Manual of the American Psychiatric Association, Third Edition (DSM-III). DSM-III put forward a novel syndrome consisting of intrusive, avoidance/numbing, and arousal symptoms as distinctive psychopathology following exposure to traumatic events. The traumatic stressors, although expanded in later editions published in 1987 (DSM-III-R) and 1994 (DSM-IV), focus on life-threatening events and situations. However, at least 12 studies, most of them recent, have found associations between the PTSD symptoms and the PTSD symptom syndrome with stressors, such as unemployment and divorce that would not qualify, even in the broadened DSM-IV diagnosis, as traumatic stressors. These findings challenge the basic assumption on which the PTSD diagnosis is based, the assumption that exposure to life-threatening stressors is the primary cause of a unique set of stress response symptoms. The purpose of this paper is to show how to confront this challenge by developing a typology of stressful situations and events that can be tested systematically for their relation to the PTSD symptom syndrome and other relevant variables. The typology includes but is not limited to the types of situations and events defined as "traumatic" in the DSMs.     

Chronic Pain in the DSM-IV and the DSM-5 Draft: The Pain of It All

The Diagnostic and Statistical Manual, DSM-IV-TR (American Psychiatric Association 2000) includes the diagnosis of pain disorder, and it has been revised in major ways in the DSM-5 draft (American Psychiatric Association 2010). Pain disorder has been relegated as a specifier of the new diagnosis of complex somatic symptom disorder. It cannot be diagnosed prior to 6 months of the pain’s onset. Also, there are still the pejorative connotations with which the disorder is associated. In terms of treatment, it might be more difficult to get treatment plans accepted as a result of the changes, and in terms of the legal arena, it might prove more difficult to have the disorder serve as the basis of action in legal proceedings.     

The Evolving Construct of Posttraumatic Stress Disorder (PTSD): DSM-5 Criteria Changes and Legal Implications

In the DSM-5, the diagnosis of posttraumatic stress disorder (PTSD) has undergone multiple, albeit minor, changes. These changes include shifting PTSD placement from within the anxiety disorders into a new category of traumatic and stressor-related disorders, alterations in the definition of a traumatic event, shifting of the symptom cluster structure from three to four clusters, the addition of new symptoms including persistent negative beliefs and expectations about oneself or the world, persistent distorted blame of self or others, persistent negative trauma-related emotions, and risky or reckless behaviors, and the addition of a dissociative specifier. The evidence or lack thereof behind each of these changes is briefly reviewed. These changes, although not likely to change overall prevalence, have the potential to increase the heterogeneity of individuals receiving a PTSD diagnosis both by altering what qualifies as a traumatic event and by adding symptoms commonly occurring in other disorders such as depression, borderline personality disorder, and dissociative disorders. Legal implications of these changes include continued confusion regarding what constitutes a traumatic stressor, difficulties with differential diagnosis, increased ease in malingering, and improper linking of symptoms to causes of behavior. These PTSD changes are discussed within the broader context of DSM reliability and validity concerns.     

Underlying Dimensions of DSM-5 Posttraumatic Stress Disorder and Major Depressive Disorder Symptoms

This study examined the relationship between the underlying latent factors of major depression symptoms and DSM-5 posttraumatic stress disorder (PTSD) symptoms (American Psychiatric Association, 2013). A nonclinical sample of 266 participants with a trauma history participated in the study. Confirmatory factor analyses were conducted to evaluate the fit of the DSM-5 PTSD model and dysphoria model, as well as a depression model comprised of somatic and nonsomatic factors. The DSM-5 PTSD model demonstrated somewhat better fit over the dysphoria model. Wald tests indicated that PTSD’s negative alterations in cognitions and mood factor was more strongly related to depression’s nonsomatic factor than its somatic factor. This study furthers a nascent line of research examining the relationship between PTSD and depression factors in order to better understand the nature of the high comorbidity rates between the two disorders. Moreover, this study provides an initial analysis of the new DSM-5 diagnostic criteria for PTSD.     

Conservative Shift among Liberals and Conservatives Following 9/11/01

Political orientation and political attitudes were measured in two independent adult samples. One sample was taken several months before the terrorist attacks on 9/11/01; the other, shortly after. Liberal and conservative participants alike reported more conservative attitudes following 9/11/01 than before. This conservative shift was strongest on two items with the greatest relevance to 9/11/01: George W. Bush and Increasing Military Spending. Marginally significant conservative shifts were observed on two other items (Conservatives, Socialized Medicine), and the direction of change on eight of eight items was in a conservative direction. These results provide support for the motivated social cognition model of conservatism (Jost et al., 2003) over predictions derived from terror management theory (e.g., Greenberg et al., 1992).     

Do Motivations for Malingering Matter? Symptoms of Malingered PTSD as a Function of Motivation and Trauma Type

Psychological disorders associated with traumatic events, such as post-traumatic stress disorder (PTSD), may be prone to malingering due to the subjective nature of trauma symptomology. In general, symptoms tend to be inflated when an external reward (i.e., compensation) is associated with the claim. The present study was designed to test whether malingered claims of PTSD symptoms differed as a function of the type of trauma being malingered (accident, disaster, sexual assault) and the motivation for malingering (compensation, attention, revenge, no motivation). Participants were randomly assigned into conditions, given malingering instructions, and then asked to complete three measures of trauma symptoms (Impact of Event Scale??Revised; Post-Traumatic Stress Disorder Checklist; Trauma Symptom Inventory). Results indicated that participants in the sexual assault condition produced higher symptom reports on nearly all scales. Revenge and compensation motivations yielded elevated symptom scores. Further, individuals rated high in fantasy proneness and dissociation produced elevated scores on atypical responding and most clinical scales. More research is needed to examine the extent to which different motivations and trauma types influence symptom reporting.     

Surviving the Trenches: The Personal Impact of the Job on Probation Officers

The purpose of this study was to assess traumatic stress and burnout in probation officers who work with criminal offenders. Adult probation officers from five departments in three states (Arizona, California, and Texas) participated in this study (N?=?309). Officers completed several survey instruments including the Impact of Events Scale-Revised (Weiss & Marmar, 1997), the Compassion Satisfaction/Fatigue Self-Test for Helpers (Steed & Bicknell, 2001), and the Probation Personal Impact Scale (PPI). The results indicated officers who reported violent and sexual recidivism on their caseloads, offender suicide, and threats and/or assaults in the line of duty scored significantly higher on measures of traumatic stress and burnout than officers who did not experience these caseload events. Assessments, education, training, and stress management programs are discussed as options to mitigate negative impacts, enhance the resiliency of officers, and improve the quality of evidence-based practices.     

Detecting Feigned PTSD Using the Personality Assessment Inventory

Research generally supports the use of the Personality Assessment Inventory (PAI; Morey 1991) to detect feigned PTSD, although this support has been somewhat mixed. There is also evidence that coaching individuals on the presence of PAI validity indicators may not affect their ability to avoid detection as feigners (Bagby et al. in Journal of Personality Assessment 78:69–86, 2002), although this question has not been specifically addressed with regard to PTSD. Additionally, a new PAI validity indicator, the Negative Distortion Scale (NDS), was developed that may have utility in detecting feigned PTSD, but this has not been tested. The purpose of this study was to further test the operating characteristics of the PAI validity indicators to detect feigned PTSD among naïve and coached respondents and to examine the newly developed NDS for this purpose. Individuals with genuine PTSD were compared to individuals instructed to feign PTSD on PAI validity indicators. Results suggest that: (a) coaching had minimal influence on the ability of the PAI to detect feigned PTSD, (b) the PAI validity indicators all significantly differentiated genuine from feigned PTSD, and (c) the NIM and NDS indicators were particularly effective for detecting feigned PTSD.     

Sexual Harassment, PTSD, and Criterion A: If It Walks Like a Duck …

Sexual harassment and posttraumatic stress disorder (PTSD) are two topics that generate heated debate in the social science literature. When the two are combined in the civil litigation context, the intensity of the debate is heightened by the adversarial context of the courts. The current paper examines research on both sexual harassment and PTSD separately, before addressing the issues that arise for psychologists and psychiatrists who serve as expert witnesses in sexual harassment litigation. Proposed resolutions of controversies are offered that attempt to expand the knowledge base for expert witnesses on the topic of sexual harassment as well as work within the current Diagnostic and Statistical Manual (DSM-IV-TR; American Psychiatric Association 2000) framework of PTSD.     

Early Intervention with Compensated Lower Back-Injured Workers at Risk for Work Disability: Fixed versus Flexible Approach

Low back pain (LBP), a leading cause of disability, has been linked with profound economic, personal, and social costs (Hills 2006; World Health Organization 2003). This significant effect propels research in identifying modifiable risk factors that protract LBP; these factors can be targeted in early intervention (EI) (Pransky, Journal of Occupational & Environmental Medicine, 49(3):249–251, 2007; Schultz et al., Journal of Occupational Rehabilitation, 17:327–352, 2007, Journal of Occupational Rehabilitation, 18(2), 140–151, 2008; White et al. 2013). This randomized controlled study evaluated the effectiveness of two approaches, fixed versus flexible, in delivering proactive, interdisciplinary EI with 63 workers within a workers' compensation interdisciplinary case management setting (i.e., WorkSafeBC, Canada). Off-work 4 to 10 weeks post-back injury, the workers were also at risk of protracted work disability (N?=?24 at high risk; N?=?39 at moderate risk). Fixed, protocol-driven, interdisciplinary, multimodal, clinical, occupational, and case management-based EI was compared with a flexible, individual need-driven EI with the same modalities as the fixed approach. Results showed a significant narrowing of the outcome gap between the two interventions. High-risk injured workers tended to benefit more from a fixed, protocol-driven approach, as shown in the pilot study (Schultz et al. Journal of Occupational Rehabilitation, 18(2), 140–151, 2008). The results indicated that moderate-risk workers benefitted from a more flexible, need-based, individual, and low-intensity approach as compared with a fixed approach. The flexible approach for moderate-risk workers was also less costly and consumed fewer rehabilitation and health care resources. Recommendations for future research and practice included larger sample sizes, controllability of research interventions, risk for disability-EI matching, and conditions under which a flexible delivery of multimodal EI is more efficacious than a fixed approach, and vice versa.     

Psychological Injury: Systems, Change Processes, Development

This paper presents a model of chronic pain [Young and Chapman (Pain, affect, nonlinear dynamical systems, and chronic pain: Bringing order to disorder. In G. Young, A. W. Kane, & K. Nicholson (Eds.), Causality of psychological injury: Presenting evidence in court (pp. 197–241). New York: Springer, 2007)]. It includes extensive coverage of the systems perspective. The paper expands the model to medically unexplained symptoms and provides a developmental model of how these may unfold and influence adult presentation after events such as accidents. Similarly, the model is examined for the developmental roots of personality disorder. The paper examines other threats to validity of diagnosis in cases of psychological injury.     

Investigating Differences in Truthful and Fabricated Symptoms of Traumatic Stress over Time

False allegations of victimization typically are accompanied by malingered emotional symptomology to corroborate claims. This analog study was designed to compare truthful and fabricated symptom profiles on measures of post-traumatic stress (i.e., Revised Impact of Event Scale, Post-Traumatic Stress Disorder (PTSD) Checklist, Trauma Symptom Inventory) and levels of symptom consistency over time. Participants (undergraduate students) described their mental health symptoms for both traumas at time 1 (N?=?291), time 2 (N?=?252, 3 month), and time 3 (N?=?181, 6 months). Results indicated that fabricated traumas were associated with inflated symptom profiles. Validity scales were not effective at discerning symptom veracity, although reports could be discriminated somewhat by atypical responding and clinical scales. PTSD symptoms in malingerers also were reported more consistently over time. This research offers applicable information for identifying feigned traumatic stress.     

Posttraumatic Stress Disorder Symptoms,Traumatic Reminders,and Partner Aggressive Tendencies Among Veterans

This study examined whether laboratory exposure to traumatic reminders potentiated the relationship between veterans’ posttraumatic stress disorder (PTSD) symptoms and intimate partner aggression (IPA) articulations elicited during an anger-induction task. The sample included 82 male Operation Iraqi Freedom/Operation Enduring Freedom veterans. The Articulated Thoughts in Simulated Situations (ATSS) procedure was used to assess physical IPA articulations (i.e., expressions of physically aggressive intentions toward the partner) and verbal IPA articulations (i.e., statements intended to insult or demean the partner) made during “relationship anger” provoking scenarios. Participants were administered versions of the ATSS both with and without trauma cue presentation. Results indicated that trauma cue exposure potentiated the relationship between veterans’ PTSD symptoms and physical IPA articulations, but did not strengthen the significant relationship between PTSD symptoms and verbal IPA articulations. Findings contribute to the literature on veterans’ PTSD symptoms and IPA perpetration by highlighting the influence of traumatic reminders.