Cross-validation of the MMPI-2 in detecting malingered posttraumatic stress disorder

The Development of the Inventory of Problems-29: A Brief Self-Administered Measure for Discriminating Bona Fide From Feigned Psychiatric and Cognitive Complaints

This article describes the development of the Inventory of Problems-29 (IOP-29), a new, short, paper-and-pencil, self-administered measure of feigned mental and cognitive disorders. Four clinical comparison simulation studies were conducted. Study 1 (n = 451) selected the items and produced an index of potential feigning. Study 2 (n = 331) scaled this index to produce a probability score, and examined its psychometric properties. Study 3 tested the generalizability of Study 2's findings with 2 additional samples (ns = 128 and 90). Results supported the utility of the IOP-29 for discriminating bona fide from feigned psychiatric and cognitive complaints. Validity was demonstrated in feigning mild traumatic brain injury, psychosis, posttraumatic stress disorder, and depression. Within the independent samples of Studies 2 and 3, the brief IOP-29 performed similarly to the MMPI-2 and Personality Assessment Inventory, and perhaps better than the Test of Memory Malingering. Classifications within these samples with base rates of .5 produced sensitivity, specificity, positive predictive power, and negative predictive power statistics of about .80. Further research is needed testing the IOP-29 in ecologically valid field studies.

The Incremental Validity and Clinical Utility of the MMPI-2 Infrequency Posttraumatic Stress Disorder Scale

The incremental validity and clinical utility of the recently developed Minnesota Multiphasic Personality Inventory-2 (MMPI-2) Infrequency Posttraumatic Stress Disorder Scale (Fptsd) was examined in relation to the family of MMPI-2 F scales in distinguishing feigned post-traumatic stress disorder (PTSD) from disability claimants with PTSD. Research participants instructed to feign PTSD when completing the MMPI-2 scored significantly higher on the MMPI-2 family of F scales and the Fptsd scale compared with their responses when completing the MMPI-2 under standard instructions and the sample of claimants with PTSD. Although comparable in magnitude, effect sizes derived from mean group differences and hierarchical logistic regressions for the Fptsd scale never exceeded those for F B , and F P , F, F B , and F P added incrementally to Fptsd in the prediction of feigned PTSD. These results suggest that the Fptsd scale does not afford any incremental predictive utility for detecting feigned PTSD relative to the complement of the existing family of F scales.

Utility of the Trauma Symptom Inventory’s Atypical Response Scale in Detecting Malingered Post-Traumatic Stress Disorder

The authors examined the Trauma Symptom Inventory’s (TSI) ability to discriminate 88 student post-traumatic stress disorder (PTSD) simulators screened for genuine PTSD from 48 clinical PTSD-diagnosed outpatients. Results demonstrated between-group differences on several TSI clinical scales and the Atypical Response (ATR) validity scale. Discriminant function analysis using ATR revealed 75% correct patient classification but only 48% correct simulator classification, with an overall correct classification rate of 59% (positive predictive power [PPP] = .71; negative predictive power [NPP] = .51). Individual ATR cutoff scores did not yield impressive classification results, with the optimal cutoff (T score = 61) correctly classifying only 61% of simulators and patients (PPP = .66, NPP = .54). Although ATR was not developed as a malingered PTSD screen, instead serving as a general validity screen, caution is recommended in its current clinical use for detecting malingered PTSD.

Discriminating Malingered From Genuine Civilian Posttraumatic Stress Disorder

The Infrequency-Posttraumatic Stress Disorder scale (Fptsd), recently created for the Minnesota Multiphasic Personality Inventory-2 (MMPI-2), has demonstrated incremental validity over other MMPI-2 scales in malingered posttraumatic stress disorder (PTSD) detection. Fptsd was developed with combat-exposed PTSD patients, potentially limiting its use with PTSD patients in general. The current study evaluated the MMPI-2’s F, Infrequency-Psychopathology scale (Fp), and Fptsd scales in discriminating genuine civilian PTSD among 41 adult victims of child sexual abuse from a group of 39 students instructed to simulate PTSD. Analyses demonstrated Fptsd’s incremental validity over F but not over Fp. Based on the two studies examining Fptsd, Fptsd may be more appropriate for combat trauma victims, and Fp may be more appropriate for civilian trauma victims.

DSM-5 Criteria and Its Implications for Diagnosing PTSD in Military Service Members and Veterans

This review addresses how changes in the Diagnostic and Statistical Manual of Mental Disorders (DSM)-5 posttraumatic stress disorder (PTSD) criteria has the potential to affect the care and careers of those who have served in the military, where the diagnosis often determines fitness for duty and veterans' benefits. PTSD criteria changes were intended to integrate new knowledge acquired since previous DSM editions. Many believe the changes will improve diagnosis and treatment, but some worry these could have negative clinical, occupational, and legal consequences. We analyze the changes in classification, trauma definition, symptoms, symptom clusters, and subtypes and possible impacts on the military (e.g., over- and under-diagnosis, "drone" video exposure, subthreshold PTSD, and secondary PTSD). We also discuss critiques and proposals for future changes. Our objectives are to improve the screening, diagnosis, and treatment of those service members who have survived trauma and to improve policies related to the military mental healthcare and disability systems.

Does the Disorder Matter? Investigating a Moderating Effect on Coached Noncredible Overreporting Using the MMPI-2 and PAI

The use of psychological tests to help identify the noncredible overreporting of psychiatric disorders is a long-standing practice that has received considerable attention from researchers. The purpose of this study was to experimentally determine whether feigning specific psychiatric disorders moderated the influence of coaching on the detection of noncredible overreporting using the Minnesota Multiphasic Personality Inventory–2 (MMPI-2) and the Personality Assessment Inventory (PAI). Using a 2 × 3 experimental analogue design, 265 undergraduates were asked to feign schizophrenia, posttraumatic stress disorder, or generalized anxiety disorder and were either coached about validity scales and disorders or not. The results of this study indicated that the specific psychiatric disorder being feigned did moderate the impact coaching had on the detection of overreported psychopathology using several scales on the MMPI-2 and PAI. Future research examining noncredible overreporting should take into account the impact caused by the interaction of psychiatric disorder with coaching on the detection of symptom overreporting and also identify other important moderating/mediating variables in order to develop more effective means of identifying response bias.

Recalled peritraumatic reactions, self-reported PTSD, and the impact of malingering and fantasy proneness in victims of interpersonal violence who have applied for state compensation

The present study explores the associations between three types of peritraumatic reactions (dissociation, distress, and tonic immobility) and posttraumatic stress disorder (PTSD) symptoms in a sample of 125 victims of interpersonal violence who had applied for compensation with the Dutch Victim Compensation Fund (DCVF). In addition, the confounding roles of malingering and fantasy proneness are examined. Results indicate that tonic immobility did not predict PTSD symptom levels when adjusting for other forms of peritraumatic reactions, whereas peritraumatic dissociation and distress did. However, after the effects of malingering and fantasy proneness had been controlled for, malingering is the only factor associated with increased PTSD symptomatology. Implications for policy practice as well as study strengths and limitations are discussed.

A Comparative Analysis of MMPI-2 Malingering Detection Models Among Inmates

There are several strategies, or models, for combining the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) validity indicators to detect malingered psychiatric symptoms. Some scholars have recommended that an elevated F (Infrequency) score should be followed by the inspection of Fp (Infrequency—Psychopathology), whereas a recent meta-analysis indicated that Fp and Ds (Gough’s Dissimulation Scale) should be examined. For correctional settings, one model of malingering suggests that F, Fp, and F - K (Gough’s Dissimulation Index) should be inspected for one or more elevated scores. Although a large body of research has examined malingering detection with the MMPI-2, this research has typically focused on the contributions of individual validity indicators to differentiate malingered from genuine psychiatric symptoms. Therefore, the current study compared these models of malingering detection on the MMPI-2. Inmate simulators were contrasted with inmates who were hospitalized for psychiatric treatment. Results from classification and logistic regression analyses supported the sequential use of F and Fp in malingering detection.

Critiquing symptom validity tests for posttraumatic stress disorder: a modification of Hartman's criteria

The differential diagnosis of malingering in psychological evaluations for Posttraumatic Stress Disorder (PTSD) is complex and relies upon the integration of clinical knowledge and appropriate psychometric instruments. Over the years, there has been an increase in the use of validity measures, including Symptom Validity Tests (SVTs). In 2005, the National Academy of Neuropsychology published Symptom validity assessment: Practice issues and medical necessity, an official policy statement recognizing the importance of effort on test performance and recommending the utilization of specific SVTs to assess for response bias in neurocognitive and personality evaluations. As new SVTs become available, clinicians need a clear understanding of how to critique these tests and determine the strengths and limitations. This article demonstrates the fundamental principles of critiquing an SVT by applying a modified set of Hartman's [Hartman, D. E. (2002). The unexamined lie is a lie worth fibbing: Neuropsychological malingering and the Word Memory Test. Archives of Clinical Neuropsychology, 17, 709-714] criteria, originally developed for neuropsychological SVTs, to the Morel Emotional Numbing Test for Posttraumatic Stress Disorder (MENT).

Detection of malingered PTSD: an overview of clinical, psychometric, and physiological assessment: where do we stand?

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.

Varying Cautionary Instructions, Monetary Incentives, and Comorbid Diagnostic Training in Malingered Psychopathology Research

In this article, we combine two analogue experiments in which we empirically examined three malingering methodological issues in individuals trained and instructed to simulate posttraumatic stress disorder (PTSD) on the Trauma Symptom Inventory (TSI; Briere, 1995). In Experiment 1, we examined TSI scale effects of the following manipulations using a 2 x 2 design with 330 college students: (a) inclusion or exclusion of cautionary instructions regarding believability of participants' simulation and (b) different financial incentive levels. In Experiment 2, we examined comorbid psychiatric diagnostic training with 180 college students who were either trained to simulate PTSD and comorbid major depressive disorder or trained to simulate only PTSD. Caution main effects were significant for all but two TSI Clinical Scales, incentive main effects and interactions were only significant for one Clinical scale each, and the comorbidity manipulation did not yield any scale differences. We discuss malingering research design implications regarding the use of cautionary instructions, financial incentive levels, and comorbid training.

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.

Meta-Analysis of the MMPI-2 Fake Bad Scale: Utility in Forensic Practice

Some clinical researchers disagree regarding the clinical utility of the MMPI-2 Fake Bad scale (FBS ) within forensic and clinical settings. The present meta-analysis summarizes weighted effect size differences among the FBS and other commonly used validity scales (L, F, K, Fb, Fp, F-K, O-S, Ds2, Dsr2 ) in symptom overreporting and comparison groups. Forty studies that included FBS were identified through exploration of online databases, perusal of published references, and communication with primary authors. Nineteen of the 40 studies met restrictive inclusion criteria, resulting in a pooled sample size of 3664 (1615 overreporting participants and 2049 comparison participants). The largest grand effect sizes were observed for FBS (.96), followed by O-S (.88), Dsr2 (.79), F-K (.69), and the F- scale (.63). Significant within-scale variability was observed for seven validity scales, including FBS (Q = 119.11, p < .001). Several subsequent FBS moderator analyses yielded moderate to large effect sizes and were statistically significant for level of cognitive effort, type of overreporting comparison group, and condition associated with overreporting (e.g., traumatic brain injury, posttraumatic stress, chronic pain). Findings suggest that the FBS performs as well as, if not superior to, other validity scales in discriminating overreporting and comparison groups; the preponderance of the present literature supports the scale's use within forensic settings.

Evaluating the latent structure of the MMPI-2 F(p) scale in a forensic sample: A taxometric analysis

P. A. Arbisi and Y. S. Ben-Porath (1995) originally proposed that the Infrequency Psychopathology scale, F(p), be used as the final step in an algorithm to determine the validity of a Minnesota Multiphasic Personality Inventory-2 (MMPI-2) protocol. The current study used taxometric procedures to determine the latent structure of F(p) among examinees with profiles that would necessitate the interpretation of F(p) when using Arbisi and Ben-Porath's proposed algorithm. Participants included a subsample of 289 consecutively referred pretrial forensic examinees adjudicated incompetent to stand trial with high Infrequency (F) scale scores, thereby providing a sample that would be expected to have a high base rate of persons with bona fide psychopathology and persons with incentive to overreport psychopathology. Using MAMBAC and MAXEIG, F(p) produced a taxonic latent structure within the subgroup of examinees who obtained raw scores on F of greater than 17. These results support Arbisi and Ben-Porath's original proposal to use F(p) to identify a distinct subgroup of overreported MMPI-2 protocols within forensic psychiatric examinees with high elevations on F. Implications and suggestions for future research are provided.

Response style and posttraumatic stress disorder (PTSD): a review

Response style is an important issue that is often not addressed when assessing or treating patients with posttraumatic stress disorder (PTSD). In this paper, various response styles are discussed along with their relevance to clinical work and research with PTSD patients. Two of the most prevalent measures of response style, the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) and Structured Interview of Reported Symptoms (SIRS) scales are evaluated for use in assessing for PTSD. In addition, the Trauma Symptom Inventory's potential for use in evaluating response style is briefly discussed. Implications for future work and directions for future investigation are outlined.

Assessing malingered posttraumatic stress disorder: a critical review

This article is a critical examination of the current state of the literature regarding the assessment of malingered posttraumatic stress disorder (PTSD). First, published empirical studies that examine the assessment of malingering in PTSD claimants using the American Psychiatric Association's Diagnostic and Statistical Manual criteria are summarized. Next, conceptual and methodological strengths, weakness, and limitations of existing research are outlined. Currently, there is no method or single instrument that is universally recognized as being the best tool to detect malingering in PTSD claimants. Lastly, recommendations for future investigations are provided.

Detection of feigned mental disorders: a meta-analysis of the MMPI-2 and malingering

The validity of test data from multiscale inventories is dependent on self-reports that may be easily distorted by malingering. In examining the Minnesota Multiphasic Personality Inventory-2's (MMPI-2) role in the assessment of feigning, this review provides a conceptual analysis of the detection strategies underlying the MMPI-2 validity scales. The conceptual analysis is augmented by comprehensive meta-analysis of 65 MMPI-2 feigning studies plus 11 MMPI-2 diagnostic studies. For the rare-symptoms strategy, Fp (Cohen's d = 2.02) appears especially effective across diagnostic groups; its cut scores evidence greater consistency than most validity indicators. The data supported the F as an effective scale but questioned the routine use of Fb. Among the specialized scales, Ds appeared especially useful because of its sophisticated strategy, consistent cut score, and minimalfalse-positives. General guidelines are offeredfor specific MMPI-2 validity scales in the assessment of malingering with specific diagnoses.

Clinical presentations in combat veterans diagnosed with posttraumatic stress disorder

This article investigated subtypes of symptom patterns among male combat veterans diagnosed with posttraumatic stress disorder (PTSD) through a cluster analysis of their Minnesota Multiphasic Personality Inventory-2 (MMPI-2; Butcher, Graham, Ben-Porath, Tellegen, Dahlstrom, & Kaemmer, 2001) clinical and validity scales. Participants were 126 veterans seeking outpatient treatment for combat-related PTSD at a Veterans Affairs Medical Center. Two well-fitting MMPI-2 cluster solutions (a four-cluster solution and a three-cluster solution) were evaluated with several statistical methods. A four-cluster solution was determined to best fit the data. Follow-up analyses demonstrated between-cluster differences on MMPI-2 "fake bad" scales and content scales, the Beck Depression Inventory (BDI; Beck, Ward, Mendelson, Mock, & Erbaugh, 1961), Dissociative Experiences Scale (DES; Bernstein & Putnam, 1986), Mississippi Combat PTSD scale (M-PTSD; Keane, Caddall, & Taylor, 1988), and Clinician-Administered PTSD Scale (CAPS-1; Blake et al., 1990). Clusters also were different in disability-seeking status, employment status, and income. Implications for research and clinical practice using the MMPI-2 with combat veterans presenting with PTSD are briefly addressed.

Detection of intentional sub-optimal performance on a computerized finger-tapping task

Twenty-four undergraduates were assigned to two groups to determine if the T3 computerized finger-tapping task could discriminate between persons motivated to perform optimally and those motivated to perform sub-optimally. Group HI was instructed to simulate a head-injured person undergoing an insurance evaluation, whereas group J was instructed to simulate an applicant undergoing a job interview. Group HI tapped slower, demonstrated less fatigue, less similarity between their right- and left-hand performance, and showed less of a speed advantage for the preferred hand. While group HI displayed less variability for the non-preferred hand, the groups did not differ on variability for the preferred hand. Therefore, the T3 successfully discriminates on multiple measures between persons simulating optimal and sub-optimal performance.

The detection of feigned uncoached and coached posttraumatic stress disorder with the MMPI-2 in a sample of workplace accident victims

In this study research participants completed the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) under standard instructions and then were asked to fake posttraumatic stress disorder (PTSD) when completing the MMPI-2 for a 2nd time in 1 of 4 conditions with different instructions on how to fake PTSD: (a) uncoached, (b) coached about PTSD symptom information, (c) coached about MMPI-2 validity scales, or (d) coached about both symptoms and validity scales. These MMPI-2 protocols were then compared with protocols of claimants with workplace accident-related PTSD. Participants given information about the validity scales were the most successful in avoiding detection as faking. The family of F scales (i.e., F, FB, FP), particularly FP, produced consistently high rates of positive and negative predictive power.

The Infrequency-Posttraumatic Stress Disorder scale (Fptsd) for the MMPI-2: development and initial validation with veterans presenting with combat-related PTSD

Researchers have identified difficulties associated with the use of traditional Minnesota Multiphasic Personality Inventory-2 (MMPI-2; Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) validity scales with survivors of traumatic events. A new scale, the Infrequency-Posttraumatic Stress Disorder scale (Fptsd), was created from MMPI-2 items that were infrequently endorsed by 940 male combat veterans presenting for treatment at the posttraumatic stress disorder (PTSD) clinics of 2 Veterans Affairs Medical Centers. A variety of statistical methods were implemented that preliminarily established Fptsd's validity with a validation sample of 323 additional PTSD-diagnosed combat veterans. Results indicate that, relative to previously established validity and overreporting scales (F, Fb, and Fp), Fptsd was significantly less related to psychopathology and distress and better at discriminating simulated from genuinely reported PTSD. Clinical implications are discussed concerning the use of Fptsd to assess disability-seeking veterans suspected of overreporting PTSD symptoms.

Subtypes of clinical presentations in malingerers of posttraumatic stress disorder: an MMPI-2 cluster analysis

This paper investigated subtypes of individuals trained and instructed to malinger Posttraumatic Stress Disorder (PTSD) through a cluster analysis of their Minnesota Multiphasic Personality Inventory-2 (MMPI-2) clinical and validity scales. Participants were 84 men and women college students at a community college in the southeastern United States. Two well fitting MMPI-2 cluster solutions were evaluated with discriminant analyses and multivariate analyses of variance (MANOVAs); a 2-cluster solution was deemed optimal. Significant between-cluster differences emerged in follow-up analyses on most of the content scales of the MMPI-2. Most demographic variables did not account for differences in cluster membership. Clusters differed in their reported clarity of the materials used to educate them about PTSD. Discriminant analyses yielded better correct classification rates than those from previous studies, when the more severely symptomatic cluster was compared with a sample of clinical combat-related PTSD veterans. Implications are considered in conducting future malingered PTSD investigations.