Posttraumatic Stress Disorder: Assessing Response Style and Malingering

The role of posttraumatic stress symptoms on memory complaints and performance in active-duty service members

OBJECTIVE

Memory complaints are the most common form of cognitive limitation reported by military service members, but prior research suggests that posttraumatic stress symptoms (PTSS) may account for the link between subjective cognitive complaints and objective cognitive performance. The mechanisms underlying this relationship are largely unknown, including whether the finding applies to memory complaints and performance, which clinical dimensions are involved, and how the association varies when memory complaints are non-credible.

METHOD

Using a sample of 196 US military service members, the present study aims to address these gaps by modeling the relationship between objective memory performance and plausible/implausible subjective memory complaints, then evaluating how the association is influenced by PTSS and clinical traits commonly found within PTSS (e.g. depression, anxiety, and somatic concerns).

RESULTS

Overall memory complaints were associated with immediate and delayed recall, but both associations were fully mediated by PTSS (95% CI -0.14, -0.01; 95% CI -0.14, -0.02, respectively). Implausible memory complaints, however, were inconsistently linked to memory performance, and no PTSS mediation was observed. Of the clinical traits, only depression moderated the impact of PTSS, specifically by influencing the link between PTSS and overall memory complaints (β = -0.02, SE = 0.004, p < .001).

CONCLUSIONS

These results corroborate the importance of assessment for PTSS and depression in service members who report subjective memory complaints and highlight how targeted intervention for these conditions may play a key role in the management of memory complaints.

How does malingered PTSD affects continuous performance task performance?

The purpose of this study was to determine how malingered PTSD behavior affects the performance of a continuous performance task (CPT). An analog trauma group, two malingering groups (with or without educational intervention), and a control group were organized according to simulation design. During the CPT, the numbers of errors and response time indicators along with post-error slowing (PES) and recovery (PER) process were measured. Results are as follows: First, the analog trauma group showed deficits of response inhibition and a higher level of PES compared to the control group. Second, malingered PTSD caused a significant number of errors, inconsistent performance, and no PES. Third, there was a significantly more impaired and inconsistent performance in the low level of knowledge of disability. Finally, a discriminant accuracy of more than 90% appeared in the discriminant analysis of all group comparison conditions. Taken together, the results of this study show that post-error behavior indicators are affected by malingered PTSD, and differences according to the degree of knowledge of PTSD can also be confirmed. These results are expected to be used as basic data for the development of tasks for the detection of malingerers in clinical scenes in the future.

Malingering mental disorders: Clinical assessment

Malingering is the dishonest and intentional production of symptoms. It can cause considerable difficulty as assessment runs counter to normal practice, and it may expose clinicians to testing medicolegal situations. In this first part of a two-article review, we explore types of psychiatric malingering and their occurrence across a range of common and challenging scenarios, discussing presentations that may help delineate true from feigned illness. A framework is provided for undertaking an assessment where malingering is suspected, including recommendations on clinician approach, the use of collateral information, and self-evaluation of biases. The uses, and limitations, of psychometric tests are discussed, including ‘general’, malingering-specific and ‘symptom validity’ scales.

Learning Objectives

• Understand the challenges of determining ‘real’ from ‘malingered’ symptomatology across a range of psychiatric conditions

• Have a rational strategy for approaching a clinical assessment where malingering is suspected

• Appreciate the role and limitations of various psychometric tests that can be used in such assessments

Forensic implications of changes in DSM-5 criteria for responses to trauma and stress

DSM-5 significantly changed the diagnostic criteria for Posttraumatic Stress Disorder (PTSD) relative to DSM-IV/DSM-IV-TR. These changes do not alter its basic approach to diagnosing mental disorders, which treats each disorder as a separate category. This article analyzes the strengths and weaknesses of the categorical approach, and reviews empirical evidence regarding the impact of changes within it on the ease or difficulty of receiving the PTSD diagnosis. It especially analyzes the impact of newly included symptoms that are meant to identify cases in which trauma exposure was associated with changes in more serious PTSD cases, known as Complex PTSD (C-PTSD). It proposes some effects that the changes could have on psychological injury claims. Many changes could support plaintiffs' claims while others could support defense claims. Some changes could support either. Overall, DSM-5 PTSD diagnosis is more responsive to individual differences in symptom presentations and appears able to diagnose some C-PTSD cases. The thesis throughout the article is that PTSD diagnostic accuracy could be improved further, especially for C-PTSD cases, by complementing its current exclusive reliance on behavioral symptoms that are characteristic of victims in general with assessment of the meaning that the symptoms have for individual victims. The article proposes some principles to guide interpretation of the individualized meaning of victims' symptoms, which help make the reasoning behind the interpretations explicit.

The MMPI-2 Symptom Validity Scale (FBS) Not Influenced by Medical Impairment: A Large Sleep Center Investigation

The Symptom Validity Scale (Minnesota Multiphasic Personality Inventory—2—FBS [MMPI-2-FBS]) is a standard MMPI-2 validity scale measuring overstatement of somatic distress and subjective disability. Some critics assert the MMPI-2-FBS misclassifies too many medically impaired persons as malingering symptoms. This study tests the assertion of malingering misclassification with a large sample of 345 medical inpatients undergoing sleep studies that standardly included MMPI-2 testing. The variables included standard MMPI-2 validity scales (Lie Scale [L], Infrequency Scale [F], K-Correction [K]; FBS), objective medical data (e.g., body mass index, pulse oximetry), and polysomnographic scores (e.g., apnea/hypopnea index). The results showed the FBS had no substantial or unique association with medical/sleep variables, produced false positive rates <20% (median = 9, range = 4-11), and male inpatients showed marginally higher failure rates than females. The MMPI-2-FBS appears to have acceptable specificity, because it did not misclassify as biased responders those medical patients with sleep problems, male or female, with primary gain only (reducing sickness). Medical impairment does not appear to be a major influence on deviant MMPI-2-FBS scores.