Detection of Malingered PTSD: An Overview of Clinical, Psychometric, and Physiological Assessment: Where Do We Stand?

Abstract

Posttraumatic stress disorder (PTSD) is a condition that can be easily malingered for secondary gain. For this reason, it is important for physicians to understand the phenomenology of true PTSD and indicators that suggest an individual is malingering. This paper reviews the prevalence of PTSD for both the general population and for specific events, such as rape and terrorism, to familiarize evaluators with the frequency of its occurrence. The diagnostic criteria for PTSD, as well as potential ambiguities in the criteria, such as what constitutes an exposure to a traumatic event, are reviewed. Identified risk factors are reviewed as a potential way to help differentiate true cases of PTSD from malingered cases. The question of symptom overreporting as a feature of the disease versus a sign of malingering is discussed. We then examine how the clinician can use the clinical interview (e.g., SIRS, CAPS), psychometric testing, and the patient's physiological responses to detect malingering. Particular attention is paid to research on the MMPI and the subscales of infrequency (F), infrequency-psychopathology (Fp), and infrequency-posttraumatic stress disorder (Fptsd). Research and questions regarding the accuracy of self-report questionnaires, specifically the Mississippi Scale (MSS) and the Personality Assessment Inventory (PAI), are examined. Validity, usability, and cutoff values for other psychometric tests, checklists, and physiological tests are discussed. The review includes a case, which shows how an individual used symptom checklist information to malinger PTSD and the inconsistencies in his story that the evaluator detected. We conclude with a discussion regarding future diagnostic criteria and suggestions for research, including a systematic multifaceted approach to identify malingering.

A Practical Guide to Conducting VA Compensation and Pension Exams for PTSD and Other Mental Disorders

“…A substantial literature exists regarding interview strategies for detecting feigning or malingering, particularly when it comes to PTSD cases (Hall & Hall, 2007;Guriel & Fremouw, 2003;Resnick, West, & Payne, 2008;Taylor, Frueh, & Asmundson, 2007;Knoll & Resnick, 2006;Rogers, 2008;Simon, 2003). We highly recommend that the reader consult the aforementioned references for detailed guidance, but some general interview guidelines from this literature include the following:…”

Enhancing self‐report assessment of PTSD: Development of an item bank

“…Another limitation of this work is that we did not address the issue of malingering, which has been identified as a challenge in assessing PTSD, especially when benefits may be at stake (Hall & Hall, 2007). Concerns about losing benefits may motivate some individuals to feign PTSD symptoms.…”

Fraudulently Claiming Following a Road Traffic Accident: A Pilot Study of UK Residents’ Attitudes

“…Research has consistently indicated the ease at which PTSD can be simulated (Guriel & Fremouw, 2003;Hall & Hall, 2007, Taylor, Frueh & Asmundson, 2007Sullivan & King 2010) and the majority of research investigating malingering utilises PTSD as the illness that is simulated. The findings of the present study raise the suggestion that the issue of malingering should not be examined exclusively using PTSD as the findings imply that malingering in the context of RTA claims may not be bound by any one complaint.…”

“…Unsurprisingly, research to date has focused mainly on malingered PTSD, and what is apparent is that due to the subjective nature of PTSD symptoms the illness can be easily malingered 2007;Guriel & Fremouw, 2003), with some researchers concluding: 'there is no one way to identify the malingering of PTSD' and 'it is critical to examine multiple sources of data and to use sound clinical judgement' (Hall & Hall, 2007). Consequently, this is a further area which complicates the assessment of malingering and this paper by no means is a gibe on how forensic mental health assessments are undertaken, it is more the aim to highlight to the reader the difficult task faced by professionals.…”