Malingering of posttraumatic stress disorder

Posttraumatic stress disorder (PTSD) is an anxiety disorder that may develop after an individual experiences a traumatic event.[1] In the United States, the Social Security Administration and the Department of Veterans Affairs each offer disability compensation programs that provide benefits for qualified individuals with mental disorders, including PTSD. Because of the substantial benefits available to individuals with a confirmed PTSD diagnosis, which causes occupational impairment, the distinct possibility of Type I errors (false positive results) exists, some of which are due to malingering of PTSD.

## Motivation

Individuals who malinger PTSD may have several motivations for doing so. First, financial incentives are common. For example, the Department of Veterans Affairs offers substantial annual financial compensation to U.S. veterans who can prove that they suffer from PTSD related to their military service. This potential compensation can create an incentive for veterans to malinger PTSD.[2] Furthermore, the U.S. Social Security Administration offers social security disability payments to individuals documenting a disorder such as PTSD that impedes their ability to work, which additionally provides an incentive to malinger PTSD.[3] Additionally, the potential for workers compensation can motivate individuals reporting a traumatic event at their workplace to fabricate PTSD; and finally the potential for personal injury lawsuits can motivate someone to malinger PTSD and sue an individual for causing PTSD as a result of attack, accident or other stressor.[4]

Some individuals are known to malinger PTSD to obtain inpatient hospital treatment.[5] Persons charged in criminal law cases are motivated to malinger PTSD in order to offset criminal responsibility for the crime or mitigate the associated penalties.[6] Some individuals are motivated to malinger PTSD (e.g., related to combat) in order to gain honor and recognition from others.[7]

## Psychological assessment findings

The Minnesota Multiphasic Personality Inventory-2 (MMPI-2) is the most widely used psychological assessment measure that has been used in research to detect malingered PTSD, typically by comparing genuine PTSD patients with individuals trained and instructed to fabricate PTSD on the MMPI-2.[8] Numerous studies using the MMPI-2 have demonstrated a moderately accurate ability to detect simulated PTSD.[9][10][11][12][13][14][15] Validity scales on the MMPI-2 that are reasonably accurate at detecting simulated PTSD include both the Fp scale developed by Paul Arbisi and Yosef Ben-Porath,[16] and the Fptsd scale developed by Jon Elhai.[11]

Other psychological test instruments have been investigated for PTSD malingering detection ability, but have not approached the accuracy rates of the MMPI-2. These tests include the Personality Assessment Inventory[17][18] and Trauma symptom inventory.[15][19][20]

## References

1. ↑ Diagnostic and statistical manual of mental disorders. (5 ed.). Washington, D.C.: American Psychiatric Association. 2013. ISBN 978-0890425558. https://archive.org/details/diagnosticstatis0005unse. "A person was exposed to one or more event(s) that involved death or threatened death, actual or threatened serious injury, or threatened sexual violation."
2. ↑ Frueh, B. C., Grubaugh, A. L., Elhai, J. D., & Buckley, T. C. (2007). "US Department of Veterans Affairs disability policies for posttraumatic stress disorder: Administrative trends and implications for treatment, rehabilitation, and research". American Journal of Public Health 97 (12): U2143–2145. doi:10.2105/AJPH.2007.115436. PMID 17971542.
3. ↑ Taylor, S., Frueh, B. C., & Asmundson, G. J. G. (2007). "Detection and management of malingering in people presenting for treatment of posttraumatic stress disorder: Methods, obstacles, and recommendations". Journal of Anxiety Disorders 21 (1): 22–41. doi:10.1016/j.janxdis.2006.03.016. PMID 16647834.
4. ↑ Guriel, J., & Fremouw, W. (2003). "Assessing malingered posttraumatic stress disorder: A critical review". Clinical Psychology Review 23 (7): 881–904. doi:10.1016/j.cpr.2003.07.001. PMID 14624820.
5. ↑ Salloway, S., Southwick, S., & Sadowsky, M. (1990). "Opiate withdrawal presenting as posttraumatic stress disorder". Hospital and Community Psychiatry 41 (6): 666–667. doi:10.1176/ps.41.6.666. PMID 2361672. http://ps.psychiatryonline.org/cgi/content/citation/41/6/666. [yes|permanent dead link|dead link}}]
6. ↑ Resnick, P. J., West, S., & Payne, J. W. (2008). "Malingering of posttraumatic disorders". in R. Rogers. Clinical assessment of malingering and deception (3rd ed.). Guilford Press.. pp. 109–127. ISBN 978-1-59385-699-1.
7. ↑ Burkett, B. G., & Whitley, G. (1998). Stolen valor: How the Vietnam generation was robbed of its heroes and history. Verity Press. ISBN 978-0-9667036-0-3.
8. ↑ Demakis, G. J., & Elhai, J. D. (2011). "Neuropsychological and psychological aspects of malingered posttraumatic stress disorder". Psychological Injury and Law 4: 24–31. doi:10.1007/s12207-011-9099-y.
9. ↑ Elhai, J. D., Gold, S. N., Sellers, A. H., & Dorfman, W. I. (June 2001). "The detection of malingered posttraumatic stress disorder with MMPI-2 fake bad indices". Assessment 8 (2): 221–236. doi:10.1177/107319110100800210. PMID 11428701.
10. ↑ Elhai, J. D., Gold, P. B., Frueh, B. C., & Gold, S. N. (2000). "Cross-validation of the MMPI-2 in detecting malingered posttraumatic stress disorder". Journal of Personality Assessment 75 (3): 449–463. doi:10.1207/S15327752JPA7503_06. PMID 11117156.
11. ↑ 11.0 11.1 Elhai, J. D., Ruggiero, K. J., Frueh, B. C., Beckham, J. C., Gold, P. B., & Feldman, M. E. (December 2002). "The Infrequency-Posttraumatic Stress Disorder scale (Fptsd) for the MMPI-2: Development and initial validation with veterans presenting with combat-related PTSD". Journal of Personality Assessment 79 (3): 531–549. doi:10.1207/S15327752JPA7903_08. PMID 12511019.
12. ↑ Elhai, J. D., Naifeh, J. A., Zucker, I. S., Gold, S. N., Deitsch, S. E., & Frueh, B. C. (2004). "Discriminating malingered from genuine civilian posttraumatic stress disorder: A validation of three MMPI-2 infrequency scales (F, Fp, and Fptsd)". Assessment 11 (2): 139–144. doi:10.1177/1073191104264965. PMID 15171461.
13. ↑ Arbisi, P. A., Ben-Porath, Y. S., & McNulty, J. (2006). "The ability of the MMPI-2 to detect feigned PTSD within the context of compensation seeking". Psychological Services 3 (4): 249–261. doi:10.1037/1541-1559.3.4.249.
14. ↑ Marshall, M. B., & Bagby, R. M. (December 2006). "The incremental validity and clinical utility of the MMPI-2 Infrequency Posttraumatic Stress Disorder Scale". Assessment 13 (4): 417–429. doi:10.1177/1073191106290842. PMID 17050912.
15. ↑ 15.0 15.1 Efendov, A. A., Sellbom, M., & Bagby, R. M. (2008). "The utility and comparative incremental validity of the MMPI-2 and Trauma Symptom Inventory validity scales in the detection of feigned PTSD". Psychological Assessment 20 (4): 317–326. doi:10.1037/a0013870. PMID 19086755.
16. ↑ Arbisi, P. A., & Ben-Porath, Y. S. (1995). "An MMPI-2 infrequent response scale for use with psychopathological populations: The Infrequency Psychopathology scale, F(p)". Psychological Assessment 7 (4): 424–431. doi:10.1037/1040-3590.7.4.424.
17. ↑ Eakin, D. E., Weathers, F. W., Benson, T. B., Anderson, C. F., & Funderbunk, B. (2006). "Detection of feigned posttraumatic stress disorder: A comparison of the MMPI-2 and PAI". Journal of Psychopathology and Behavioral Assessment 28 (3): 145–155. doi:10.1007/s10862-005-9006-5.
18. ↑ Lange, R. T., Sullivan, K. A., & Scott, C. (2010). "Comparison of MMPI-2 and PAI validity indicators to detect feigned depression and PTSD symptom reporting". Psychiatry Research 176 (2–3): 229–235. doi:10.1016/j.psychres.2009.03.004. PMID 20207423. https://eprints.qut.edu.au/18484/1/c18484.pdf.
19. ↑ Elhai, J. D., Gray, M. J., Naifeh, J. A., Butcher, J. J., Davis, J. L., Falsetti, S. A., & Best, C. L. (June 2005). "Utility of the Trauma Symptom Inventory's Atypical Response Scale in detecting malingered post-traumatic stress disorder". Assessment 12 (2): 210–219. doi:10.1177/1073191105275456. PMID 15914722.
20. ↑ Rogers, R., Payne, J. W., Correa, A. A., Gillard, N. D., & Ross, C. A. (2009). "A study of the SIRS with severely traumatized patients". Journal of Personality Assessment 91 (5): 429–438. doi:10.1080/00223890903087745. PMID 19672749.

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