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.     

Malingered Posttraumatic Stress Disorder (PTSD) and the Effect of Direct Versus Indirect Trauma Exposure on Symptom Profiles and Detectability

Posttraumatic stress disorder (PTSD) is arguably prone to malingering due to its subjective and heterogeneous nature. Various factors can influence PTSD symptom profiles including trauma type and trauma exposure. However, it is unknown whether trauma exposure influences malingered PTSD symptom profiles. We used a malingering simulation design with trauma type controlled to compare (1) PTSD symptom profiles (Posttraumatic Stress Checliklist-5; PCL-5) at the syndrome, symptom cluster, and individual symptom levels and (2) symptom validity profiles (Structured Inventory of Malingered Symptomatology; SIMS) at the overall and subscale level, as a function of direct and indirect trauma exposure. Seventy-three participants were randomly assigned to either the direct (“witnessed” trauma) or indirect (“learned about” trauma) condition. Participants were coached about symptoms and instructed to simulate PTSD. PCL-5 profile analyses revealed that simulators in the direct exposure group reported greater overall PTSD severity. Significant differences were found on cluster D (changes in cognition and mood) and individual symptoms including intrusive thoughts, amnesia, difficulty experiencing positive emotions, and risk-taking. No differences were identified for any other symptom scores nor for the symptom validity profile, except for the SIMS total score (direct: M?=?33.0, SD?=?12.8, indirect: M?=?26.5, SD?=?13.9, t(71)?=?2.06, p?=?.043, d?=?.48). These findings indicate that trauma exposure can influence malingered PTSD profiles at the syndrome, symptom cluster, and individual symptom levels (small effects), but, with one exception for a summary score, it does not produce a detectable difference on symptom validity testing. This study may provide insight for clinicians into the how malingered PTSD profiles can manifest as a result of direct and indirect trauma exposure; however, further research is strongly indicated.     

Group Treatment for Spouse Abuse: Are Women with PTSD Appropriate Participants?

Eighty four abused women seeking therapy with their husbands were accepted into a group treatment program for spouse abuse. In the current study, we evaluated the treatment outcome of those women (n = 27) diagnosed with Posttraumatic Stress Disorder (PTSD). PTSD diagnosis, itself, did not differentiate those women who dropped out of treatment. Results indicated, however, that across all women, avoidance symptomatology significantly differentiated treatment completers from dropouts. Although women with PTSD began treatment in worse condition (lower marital satisfaction, higher depressive symptomatology, greater fear of spouse), post-assessment revealed they achieved positive treatment gains parallel to those of women without PTSD. Women with PTSD improved on each outcome variable measured, including a reduction in fear of spouse. Women with PTSD also did not differentially drop out of either treatment condition (men's/women's versus conjoint groups) which lends support to the appropriateness of conjoint treatment for spouse abuse.     

MMPI-2 profiles in civilian PTSD: an examination of differential responses between victims of crime and industrial accidents

The authors studied MMPI-2 profiles of workers (N = 83) diagnosed with posttraumatic stress disorder (PTSD) and a control group comprising workers with chronic pain (N = 40). Significant differences were seen in profiles between the PTSD groups and the control group, and the authors compared the PTSD profiles according to exposure to two different kinds of traumatic incidents: industrial accidents or criminal events. They found differences in profile elevations based on the type of event: The level of distress and fear is greater in PTSD victims of crime, and the results also suggest that victims of crime are more suspicious and guarded compared with accident victims. Theoretically based reasons for the differences in profile elevations between the two PTSD groups are discussed.     

Posttraumatic stress disorder symptom severity and fear of personal crime: exploring their interrelationship as a function of risk estimation

Both trauma psychology and criminology have studied the psychological correlates of crime victimization. While the former discipline has primarily focused on the development of posttraumatic stress disorder (PTSD) among crime victims, the latter has particularly studied the association between history of victimization and fear of crime. A major difference between both concepts is that PTSD is experienced in relation to previous victimization, while fear of crime does not necessarily follow from previous victimization and is primarily experienced in anticipation of possible future victimization. Despite their different orientations, both perspectives share one central tenet: they both argue that feelings of anxiety are accompanied by increased perceptions of risk for future victimization. Given this theoretical overlap, both types of anxiety may correlate with each other. The current study explored this topic in a sample of Dutch university students (N = 375) and found that PTSD symptom severity and fear of crime were significantly associated with each other, both in univariate and multivariate analyses. This association was stronger for participants who scored higher on perceived risk of personal crime victimization than for those who scored lower. Results were discussed in light of study limitations and directions for future research.     

Signs and symptoms of post-traumatic stress disorder in children

Summary Post-traumatic Stress Disorder in children is a complex interaction of cognitive, affective, and physiological responses to an event that is outside the range of usual human experience and would be markedly distressing to almost anyone. Traumatic stress reactions in children are conscious and unconscious efforts to assimilate an overwhelming event and have been identified in the past as panic reaction, acute grief hysterical reaction, and physical shock. PTSD in children is complicated by multiple issues of developmental stages, family dynamics, physical maturity, genetic predisposition, and cognitive skills. Characteristic symptoms of PTSD which must persist for more than one month include re-experiencing (flashbacks, nightmares); avoidance; numbing of general responsiveness; and persistent autonomic arousal. Children exhibit characteristic PTSD symptoms, but research suggests four criteria specific to traumatized children independent of chronological age and the course of the disorder: 1) visualized and repeatedly perceived memories; 2) repetitive behaviors; 3) trauma-related fears; 4) altered attitudes about life and future orientation. These four criteria appear to remain clustered together in childhood trauma victims even when other diagnosis would appear more appropriate. PTSD in children encompasses a complex spectrum of diagnosis and remains technically intricate for the mental health professional.     

Substance use and PTSD symptoms impact the likelihood of rape and revictimization in college women

The present study utilized a mixed retrospective and prospective design with an 8-month follow-up period to test a model of revictimization that included multiple childhood (i.e., child sexual, physical, and emotional abuse) and situational variables (i.e., substance use, sexual behavior) for predicting rape among 276 college women. It was of particular interest to determine whether traumatic responses (e.g., posttraumatic symptomatology or risky behavior) increased vulnerability for revictimization. During the 8-month follow-up period, 9% of participants were raped; 88% of assaults involved substance use by the victim. Posttraumatic stress disorder (PTSD) symptomatology predicted rape, substance use, and sexual behavior. Substance use, but not sexual behavior, mediated the relation between PTSD symptomatology and rape during the follow-up period. Sexual behavior indirectly impacted risk for rape via substance use. Results suggest that college women with PTSD symptomatology may be at greater risk for rape if they use substances to reduce distress.     

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.     

Treating low-income and minority women with posttraumatic stress disorder: a pilot study comparing prolonged exposure and treatment as usual conducted by community therapists

Twenty-one female psychiatric outpatients with chronic posttraumatic stress disorder (PTSD) are randomly assigned to prolonged exposure (PE; n = 9) for PTSD or treatment as usual (TAU; n = 12). Participants are predominantly low income and African American with complex trauma and psychiatric histories. Treatment is delivered by community therapists with no prior training in behavior therapy for anxiety disorders. Clients who completed PE show a greater improvement in PTSD symptoms, general anxiety, and depression than clients who completed TAU. These findings provide preliminary evidence suggesting that PE is an effective treatment for core PTSD symptoms, even when delivered by community therapists in a front-line services clinic.     

Re-examination of the Controversial Coexistence of Traumatic Brain Injury and Posttraumatic Stress Disorder: Misdiagnosis and Self-Report Measures

The coexistence of traumatic brain injury (TBI) and posttraumatic stress disorder (PTSD) remains a controversial issue in the literature. To address this controversy, we focused primarily on the civilian-related literature of TBI and PTSD. Some investigators have argued that individuals who had been rendered unconscious or suffered amnesia due to a TBI are unable to develop PTSD because they would be unable to consciously experience the symptoms of fear, helplessness, and horror associated with the development of PTSD. Other investigators have reported that individuals who sustain TBI, regardless of its severity, can develop PTSD even in the context of prolonged unconsciousness. A careful review of the methodologies employed in these studies reveals that investigators who relied on clinical interviews of TBI patients to diagnose PTSD found little or no evidence of PTSD. In contrast, investigators who relied on PTSD questionnaires to diagnose PTSD found considerable evidence of PTSD. Further analysis revealed that many of the TBI patients who were initially diagnosed with PTSD according to self-report questionnaires did not meet the diagnostic criteria for PTSD upon completion of a clinical interview. In particular, patients with severe TBI were often misdiagnosed with PTSD. A number of investigators found that many of the severe TBI patients failed to follow the questionnaire instructions and erroneously endorsed PTSD symptoms because of their cognitive difficulties. Because PTSD questionnaires are not designed to discriminate between PTSD and TBI symptoms or determine whether a patient's responses are accurate or exaggerated, studies that rely on self-report questionnaires to evaluate PTSD in TBI patients are at risk of misdiagnosing PTSD. Further research should evaluate the degree to which misdiagnosis of PTSD occurs in individuals who have sustained mild TBI.     

Gender Differences in PTSD in Israeli Youth Exposed to Terror Attacks

Differences between boys' and girls' exposure to terror and posttraumatic symptoms were examined in a sample of 2,999 Israeli adolescents. Gender differences were also assessed regarding perceived social support, religious beliefs, and ideological commitment. Results indicate that girls reported more posttraumatic symptoms than boys, although boys reported twice the rate of very severe symptoms. Differences were also found between boys and girls in levels of fear, religiosity, ideological commitment, and social support, but not regarding exposure. Path analysis revealed that gender is not a direct predictor of posttraumatic stress disorder (PTSD); however, it does have an indirect effect, especially through fear, which was the best predictor of PTSD. Social extrinsic religiosity and ideological intolerance were positive predictors of PTSD. The study concludes that gender differences in PTSD are largely the result of differences in levels of fear and are not due to differences in political ideology, religiosity, or social support.     

Playing Devil's advocate†: The case against fMRI lie detection

The advent of functional neuroimaging raises the intriguing possibility that investigators might be able to determine (one day) whether an individual is lying or telling the truth, according to the activity of their brain. Ultimately, such techniques might be applied in the forensic sphere. However, the empirical data supporting this conjecture derive from a body of work that is still early on in its development. Hence, when invited to play ‘Devil's advocate’, the author is prompted to critique a pivotal weakness within the current literature. The latter comprises 16 peer‐reviewed functional magnetic resonance imaging studies purporting to describe the neural correlates of lying. Most have demonstrated greater activation of prefrontal regions while participants lie relative to when they tell the truth. Most have failed to detect areas where truthfulness elicits specific activation (consistent with the view that truthfulness constitutes a ‘baseline’ in human cognition and communication; while lying requires something more). However, there is a great deal of variation between the findings described and, crucially, there is an absence of replication by investigators of their own findings. Hence, basic issues of reliability need to be addressed before functional neuroimaging is applied to cases that matter in the ‘real world’.     

Multiple traumatic experiences and the development of posttraumatic stress disorder

This study assesses the differential and combined impacts of multiple lifetime stressors in the development and severity of posttraumatic stress disorder (PTSD) symptoms. One hundred and four clinical and 64 nonclinical participants were assessed for their exposure to four types of interpersonal trauma: physical and sexual abuse in childhood, lifetime community violence, and domestic violence in adulthood. PTSD symptomatology was assessed using the Los Angeles Symptom Checklist (LASC). Results indicated that exposure to lifetime multiple traumatic experiences was positively correlated with severity of PTSD symptoms. Clinical participants had experienced significantly more multiple traumas and had a higher rate of PTSD than the nonclinical participants. Results also suggested that adults who had experienced childhood sexual abuse were at higher risk for the development of PTSD related to interpersonal violence than adults who were not sexually abused as children.     

Probable posttraumatic stress disorder in a sample of urban jail detainees

This study examined the nature and extent of probable posttraumatic stress disorder (PTSD) among men in a substance abuse treatment program in a large urban jail. Specifically, it explored the prevalence of probable PTSD and other psychiatric problems among jail detainees, the types of trauma detainees experienced during different phases of their lives, and how those experiences might have contributed to the development of probable PTSD. Results showed that psychiatric problems were quite serious; nearly one-quarter of the sample reported previous psychiatric hospitalization, and nearly 10% were being currently treated with psychiatric medication. In addition, 21% of the sample met the criteria for probable PTSD, a rate five times greater than that in the general population. The current study suggests that the presence of probable PTSD among male detainees should be incorporated into the creation and implementation of jail-based behavioral healthcare services, including screening, assessment, and clinical interventions. Furthermore, in-custody drug treatment programs should adopt trauma-informed strategies for all program participants as the expected standard of care.     

Symptom Validity Testing for the detection of simulated amnesia: Not robust to coaching

Abstract

Symptom Validity Testing (SVT) has been proposed as a method to assess the veracity of claims of amnesia. Performance below chance levels on a forced choice task is indicative of malingering. Previous research has shown that the Symptom Validity Test is a promising challenge test: at levels of high specificity, it may detect approximately half of those who malinger. The present study investigated the effect of coaching on the sensitivity of the Symptom Validity Test. Participants were instructed to feign complete amnesia and tested about their identity using the Symptom Validity Test. Half of the participants were coached not to perform below chance levels. Results were straightforward: 58% of 19 naive malingerers were detected, but none of 19 coached malingerers were detected. The results show that the Symptom Validity Test is not resistant to coaching.     

Update on Neuroimaging and Cognitive Functioning in Maltreatment-Related Pediatric PTSD: Treatment Implications

This article reviews maltreatment-related pediatric posttraumatic stress disorder (PTSD) neuroimaging and neuropsychology research. Existent interventions that target brain networks associated with PTSD and cognitive impairment are highlighted. Furthermore, the benefits of combining neuroimaging and neuropsychology research in treatment outcomes are discussed. To conduct this review, a literature search was done utilizing the words MRI, structural, functional, neuropsychological testing, children, maltreatment, treatment, and PTSD. This was supplemented with a direct search of developmental trauma experts. Results from the neuroimaging studies found differences in the total cerebral volume, prefrontal cortex, hippocampus, cerebellum, superior temporal gyrus, corpus callosum, and other regions in maltreatment-related childhood PTSD. Neuropsychological findings demonstrate deficits in memory, attention, learning, and executive function that correspond to these brain regions. Existent and novel psychotherapeutic interventions address these deficits. These interventions may be directed at key networks associated with cognitive processing. Future directions include the implementation of treatment outcome research integrating psychotherapy with putative biological and psychological markers.     

Military combat, posttraumatic stress disorder, and criminal behavior in Vietnam veterans

Although data are inconclusive, popular perception has linked military combat, posttraumatic stress disorder (PTSD), and criminal behavior. This paper discusses the multifactorial elements of this association that include both conscious and unconscious parameters of psychologic functioning. Testimony on combat-related PTSD has been presented in the courtroom to support veterans' claims of not guilty by reason of insanity (NGRI) and diminished capacity and for consideration during judicial sentencing. Because there is a known connection between the degree of combat involvement and PTSD, verification through collateral sources of the veteran's report of combat experiences is an important component of forensic assessment. The DSM-III-defined diagnosis of PTSD and the presence of a dissociative state have particular relevance in NGRI determinations. In other aspects of the judicial process demonstration of the absolute presence or absence of PTSD is often irrelevant and should be replaced by efforts to establish plausible links between provable combat experiences and the circumstances of the crime.     

Environmental Considerations for Trauma‐Responsive Juvenile and Family Courts: A Review of the Literature with Recommendations for Practice

Juvenile and family courts serve some of our most vulnerable populations, many of whom have experienced some traumatic event. People suffering with posttraumatic stress disorder (PTSD) are known to be more sensitive to environmental stimuli, and many of the environmental conditions within courts can be challenging for those suffering traumatic stress. Trauma‐responsive practices help foster conditions of healing, which can benefit both the court user and those who work within the court. Research reviewed in this article demonstrates the likelihood of negative behavioral and emotional responses to specific environmental factors for people suffering PTSD and other stress reactions, and offers recommendations to minimize environmental stressors.     

My Life for A Voice: The Influence of Voice on Health-Care Decisions

Are people willing to give up affordable healthcare and future years of their lives in exchange for having a voice in healthcare decision-making? Drawing upon research on the psychology of justice, we claim that the fairness of healthcare decision-making procedures, expressed by the availability of voice, can be more important than critical health-related outcomes. We examined this proposition using a forced-choice paradigm that required participants to choose between voice and better healthcare outcomes (affordable healthcare and greater life expectancy). Findings from three studies revealed that people maintain a strong preference for voice even at the expense of tangible healthcare outcomes. In study 1, participants preferred a healthcare plan that offered them a voice when it was $3,000–$12,000 more costly than a plan that did not offer such voice privileges. In study 2, participants preferred a voice plan to a no-voice plan when the no-voice plan was 5–20 years greater in its average life expectancy compared with the voice plan. In study 3, which used a more demographically diverse, non-student sample, the preference for the voice plan persisted across all conditions, even when the no-voice plan was 25 years greater in its life expectancy, and even when participants’ expected to personally live longer under the no-voice plan. These results are explained by participants’ expectation to enjoy better personal healthcare outcomes and greater autonomy when afforded voice. These findings demonstrate the importance of voice in hypothetical decision-making relevant to policy-making.