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.     

Cutoff Scores for the Morel Emotional Numbing Test for PTSD: Considerations for Use in VA Mental Health Examinations

The use of cutoff scores on symptom validity measures has been applied to determine the authenticity of posttraumatic stress disorder (PTSD) in U.S. Department of Veterans Affairs compensation and pension examinations. This approach is controversial due to variations in the interpretation and application of cutoff scores from symptom validity testing. In response to the proposal that the cutoff score on the Morel Emotional Numbing Test for Posttraumatic Stress Disorder (MENT) be increased, the diagnostic accuracy of the standard cutting score for identifying simulated symptoms of PTSD was compared to the proposed alternate cutoff score. The results of decision matrix tables (true positive, true negative, false positive, and false negative) comparing the sensitivity and specificity and deriving confidence intervals for the standard cutoff score and proposed alternate cutoff score are presented. In addition, analyses using binomial probability theory to determine whether the outcome of increasing the cutoff score on the MENT meets reasonable standards for types I and II errors are presented.     

Ecological Validity of the Inventory of Problems-29 (IOP-29): an Italian Study of Court-Ordered,Psychological Injury Evaluations Using the Structured Inventory of Malingered Symptomatology (SIMS) as Criterion Variable

The Inventory of Problems-29 (IOP-29; Viglione, Giromini, & Landis, Journal of Personality Assessment, 99(5), 534–544, 2017) is a 29-item, recently published, self-administered test aimed at assessing the credibility of various symptom presentations. Although available research strongly supports the use of this symptom validity test in malingering-related contexts, to date, only few studies have analyzed data from real-life forensic evaluations. To fill this gap and explore ecological and convergent validity, the current study analyzed data from 74 court-ordered evaluations aimed at establishing the possible presence of psychological injury. Such evaluations are high-stakes situations in which exaggeration or malingering occur relatively often. We used a research-supported and popular symptom validity test, i.e., the Structured Inventory of Malingered Symptomatology (SIMS; Smith & Burger, Journal of the American Academy on Psychiatry and Law, 25:180–183, 1997), as our criterion variable. The IOP-29 produced excellent area under the curve (AUC) values of .98 with a recommended SIMS total score cutoff (≥ 17) and .99 when eliminating too-close-to-classify cases (Rogers & Bender, 2018) and very large Cohen’s d effect sizes of 2.98 and 3.59, respectively. Crucially, when implementing established cut scores from previous research, the IOP-29 yielded very high specificity and sensitivity rates, and the predictions from the two tests were strikingly similar. Taken together, these findings support the strong convergent validity of the IOP-29 and its utility in applied clinical and forensic settings.     

Traumatic Brain Injury Alters Word Memory Test Performance by Slowing Response Time and Increasing Cortical Activation: An fMRI Study of a Symptom Validity Test

The Word Memory Test (WMT) is an established symptom validity test that relies on verbal memory performance to make inferences about “effort.” Previous studies, using a functional MRI (fMRI) adaptation of the WMT with healthy controls, have shown that successful completion of the WMT relies on a widespread network of neural systems associated with high cognitive effort. Additional studies using the same fMRI paradigm with patients with severe traumatic brain injury (TBI) suggest that increased activation of cortical regions associated with cognitive load are recruited to meet the cognitive challenges that the WMT places on a compromised neural system. This study builds on previous findings as a result of highly uncommon circumstances in which fMRI data on the WMT task were made available from the very same individual both 1 year before and 1 year after sustaining a TBI. Interestingly, the effect of TBI did not appear to impair performance on the WMT in terms of standard accuracy measurements, though response times were notably slower. The main fMRI finding was a significantly stronger and more widespread pattern of activation post-injury, particularly in the frontal and parietal brain regions, suggesting that stronger engagement of these networks was necessary to sustain accurate WMT performance compared to pre-injury testing. This unique source of data, together with previous findings, suggests a more complex relationship between effort and performance levels on the WMT than what is commonly assumed.     

Posttraumatic Stress Disorder in DSM-5: New Criteria,New Measures,and Implications for Assessment

The diagnostic criteria for posttraumatic stress disorder (PTSD) were substantially revised for Diagnostic and Statistical Manual of Mental Disorders—5th edition (DSM-5). This in turn necessitated revision of DSM-correspondent assessment measures of PTSD. We describe the various changes to the PTSD diagnostic criteria and the corresponding changes to National Center for PTSD measures. We also discuss the implications of the new criteria for assessment of trauma exposure and PTSD. Although the DSM-5 version of PTSD departs significantly in some respects from previous versions, we conclude that there is fundamental continuity with the original DSM-III conceptualization of PTSD as a chronic, debilitating mental disorder that develops in response to catastrophic life events.     

Examining the Impact of Posttraumatic Stress Disorder Related to Intimate Partner Violence on Antenatal,Intrapartum and Postpartum Women: A Scoping Review

We undertook a comprehensive scoping review of published academic articles to examine the extent, range and nature of research related to the effects of posttraumatic stress disorder (PTSD) among childbearing women who have experienced intimate partner violence (IPV). Fifty-five sources were identified from the electronic databases and two additional sources were identified after searching reference lists. Among the 57 articles, five met the inclusion criteria of childbearing women who have experienced IPV and PTSD. Numerical analysis revealed considerable heterogeneity among articles, with various aims, methodological approaches, patient populations and outcomes of interest. Inductive thematic content analysis revealed three themes: (1) context; (2) outcomes; and (3) changes in practice. The findings from this first attempt at summarizing literature via a scoping review demonstrate the need for additional research related to: identification of, treatment interventions for, and understanding the mechanisms of impact for IPV related PTSD among childbearing women.     

The Justice Sensitivity Inventory: Factorial Validity, Location in the Personality Facet Space, Demographic Pattern, and Normative Data

This article investigates the psychometric properties of a self-report inventory for measuring individual differences in four components of justice sensitivity (JS): victim sensitivity, observer sensitivity, beneficiary sensitivity, and perpetrator sensitivity. A representative sample (N = 2510) was employed to (a) estimate the reliability of a newly developed perpetrator sensitivity scale, (b) test the factorial validity of this scale together with three previously developed scales (victim, observer, and beneficiary sensitivity), (c) estimate correlations between JS and demographic variables (gender, age, education, employment status, marital status, and residency in East versus West Germany), and (d) provide normative data for the computation of standard scores. A demographically heterogeneous convenience sample (N = 327) was used to locate the JS dimensions in the personality space of narrow facet factors. Results from confirmatory factor analyses demonstrated the factorial validity of the JS scales. Regression analyses with JS scales as criteria and personality facet scales as predictors suggested that JS cannot be reduced to combinations of personality facets. Demographic effects were small, explaining a maximum of 1.4% of JS variance. Women and East Germans were found to be more justice sensitive than men and West Germans, respectively. Victim sensitivity decreased with age; perpetrator sensitivity decreased with education. Taken together, our results corroborate the validity of the JS Inventory and contribute to a better psychological understanding of JS.     

Psychological Assessment of Symptom and Performance Validity,Response Bias,and Malingering: Official Position of the Association for Scientific Advancement in Psychological Injury and Law

Evidence-based forensic psychological opinions require thorough and accurate information about examinees. Psychometric instruments can facilitate diagnostic decision making, but they rely on examinees to respond honestly to questions and put forth good effort on cognitive tests. Given the strong incentives for examinees in psychological injury cases to minimize prior problems and emphasize postaccident or posttrauma problems, the assessment of validity as part of forensic psychological evaluations is essential. Best practices in forensic psychology have their foundation in ethical principles. The purpose of this position statement is to promote ethical psychological practice in legal contexts by reviewing validity assessment issues and their ethical foundations. Because no previously published document focused specifically on symptom and performance validity assessment in psychological injury evaluations performed in forensic contexts, such a position statement provided by a professional organization devoted to the interface of psychological injury and law was needed to inform and guide practitioners and to educate other interested parties. The position statement emphasizes (a) the need for ethical practice in assessing validity, (b) consideration of factors such as culture and functional limitations, and (c) the importance of adopting a comprehensive, impartial, and scientific approach to validity assessment. The position statement acknowledges areas of differing opinions and the need for further research.