Nightmares: personality dimensions and psychopathological attributes

Malingering of PTSD: forensic and diagnostic considerations, characteristics of malingerers and clinical presentations

OBJECTIVE

This paper aims to study the detection of individuals malingering posttraumatic stress disorder (PTSD) in criminal and civil situations.

METHOD

A brief history of PTSD and its rise to prominence in legal circles are discussed. The characteristics of individuals who malinger and particularly those who fake PTSD are discussed. Diagnostic dilemmas inherent to the condition, such as the definition of a traumatic exposure, what constitutes a PTSD flashback and the potential for normal symptom exaggeration, are explored.

RESULTS

The typical presentation of malingered symptoms is presented to help clinicians detect commonly seen malingering patterns. Suggestions for interview techniques, Minnesota Multiphasic Personality Inventory test values and sources of collateral information to help detect malingering are reviewed.

CONCLUSION

The paper concludes with a review of the typical presentations of malingered PTSD symptoms and a reminder that physicians need to distinguish legitimate symptoms from faked or embellished presentations.

The dual origins of affect in nightmares: The roles of physiological homeostasis and memory

Strong negative affect is a key and distressing ingredient of nightmares. Affect in nightmares arises either from the new generation of affective states due to physiological imbalances that occur during sleep or from the reactivation of affect-laden memories. The disruption of physiological balance produces a negative hedonic state, restoration of this balance produces a positive hedonic state, and when balance is attained, a neutral hedonic state results. As a result, hedonic states provoke behaviors in defense of homeostasis, then guide and terminate them. When, due to inadvertent behavior, a pronounced disruption of homeostasis occurs after sleep onset, the resultant strong negative hedonic state is likely to precipitate a nightmare and may lead to awakening. During normal wakefulness, associations of the interplay between stimuli and behaviors that disrupt homeostasis, those that restore homeostasis, and the affective states generated in the process, are committed to memory as affecto-cognitive ensembles. Sleep serves to build or rebuild neural architecture to effect development or to compensate for use- or disease-related wear (e.g. repair oxidative damage). Dreaming serves to synchronize or resynchronize such modified neural circuits with each other and those not modified. Hence, during dreaming, affecto-cognitive ensembles may get reactivated as part of the synchronization process. Where such an ensemble contains strong negative affect (i.e., due to strong affect generated during the original experience), a nightmare may be precipitated. Although both can occur throughout life, the latter type of nightmare is more likely in adults and the former in young children. For the latter memory-based behavioral therapy and for the former education and care are expected to be useful. For both types of nightmare, because strong negative affect is deemed dependent on noradrenergic outflow from the locus coeruleus, the administration of alpha-adrenergic antagonists will provide relief subject to certain caveats.