Malingered PTSD

Factitious posttraumatic stress disorder: The veteran who never got to Vietnam.
Lynn, Edward J. and Belza, Mark
Hospital & Community Psychiatry, Vol 35(7), Jul, 1984. pp. 697-701.
Abstract:
Presents 7 cases (aged 28–38 yrs) of factitious posttraumatic stress disorder (PTSD), a classic example of clinical deception found among veterans who were never in combat and, in some cases, were never in Vietnam. Common to all of the cases was that Ss had acquired sufficient knowledge of PTSD to develop tales suited to their needs. Secondary gains arising from hospitalization were common. The etiologies of the disorder and the underlying psychopathology, which suggest either factitious syndromes or malingering, are discussed.

Pseudo-posttraumatic stress disorder.
Hamilton, J. DeVance.
Military Medicine, Vol 150(7), Jul, 1985. pp. 353-356.
Abstract:
Presents the case histories of 3 males (aged 27, 30, and 34 yrs) who presented with simulated posttraumatic stress disorders (PTSD). The 3 Ss falsely claimed to have PTSD symptomatology as a result of combat experiences in Vietnam that were subsequently proven to have never occurred. It is concluded that detection of pseudo-PTSD requires alert history taking and record review to determine whether discrepancies exist between the reported and actual experiences of patients.

Pseudo-posttraumatic stress disorder.
Lees-Haley, Paul R.
Trial Diplomacy Journal, Vol 9(4), Win 1986. pp. 17-20.
Abstract:
Argues that the frequency with which posttraumatic stress disorder (PTSD) is appearing as a diagnosis in legal testimony is inconsistent with the clinical definition of PTSD. It is argued that psychologists and psychiatrists overdiagnose PTSD because they are ignoring alternative causation such as medications, coincidental stressors, preexisting conditions, malingering, and personality disorders. Examples are cited, and it is asserted that PTSD is being applied not only to genuine disasters but to minor injuries from motor traffic accidents, frivolous wrongful termination suits, fabricated toxic exposure claims, and nominal technological and industrial accidents. A typical progression is described to illustrate the development of a pseudo-PTSD. Common mistakes that are seen in expert testimony are identified.

Detecting feigned postconcussional and posttraumatic stress symptoms with the Structured Inventory of Malingered Symptomatology (SIMS).
Parks, Adam C., et al.
Applied Neuropsychology: Adult, Vol 24(5), Sep, 2017. pp. 429-438.
Abstract:
The Structured Inventory of Malingered Symptomatology (SIMS) is a standalone symptom validity test (SVT) designed as a screening measure to detect a variety of exaggerated psychological symptoms. A number of studies have explored the accuracy of the SIMS in litigious and clinical populations, yet few have examined the validity of the SIMS in detecting feigned symptoms of postconcussional disorder (PCD) and posttraumatic stress disorder (PTSD). The present study examined the sensitivity of the SIMS in detecting undergraduate simulators (N = 78) feigning symptoms of PCD, PTSD, and the comorbid presentation of both PCD and PTSD symptomatologies. Overall, the SIMS Total score produced the highest sensitivities for the PCD symptoms and PCD+PTSD symptoms groups (.89 and .85, respectively), and to a lesser extent, the PTSD symptoms group (.69). The Affective Disorders (AF) subscale was most sensitive to the PTSD symptoms group compared to the PCD and PCD+PTSD symptoms groups. Additional sensitivity values are presented and examined at multiple scale cutoff scores. These findings support the use of the SIMS as a SVT screening measure for PCD and PTSD symptom exaggeration in neuropsychological assessment.

‘Why we should worry about malingering in the VA System: Comment on Jackson et al. (2011)’: Erratum.
McNally, Richard J. and Frueh, B. Christopher.
Journal of Traumatic Stress, Vol 30(5), Oct, 2017. pp. 550.
Abstract:
Reports an error in ‘Why we should worry about malingering in the VA system: Comment on Jackson et al. (2011)’ by Richard J. McNally and B. Christopher Frueh (Journal of Traumatic Stress, 2012[Aug], Vol 25[4], 454-456). In the original article, there was an incorrect sentence on page 455, column 1, line 42. The correct sentence is given in the erratum. (The following abstract of the original article appeared in record 2012-21102-013). In a recent survey, Jackson et al. (2011) found that clinicians who evaluate veterans for service-connected disability pensions rarely use recommended best practices to assess for posttraumatic stress disorder (PTSD) within the Department of Veterans Affairs (VA). We share their dismay, and we hope that their article will help foster evidence-based assessments for diagnosing PTSD in veterans. Jackson et al. briefly discussed scholarship on malingering among applicants for service-connected disability compensation for PTSD, concluding that concerns about malingering are largely unfounded. The data they adduce, however, in support of this conclusion actually provide reasons for concern as we document in this article. We cite recent work by labor economists in support of our argument.

PTSD in Court III: Malingering, assessment, and the law.
Young, Gerald
International Journal of Law and Psychiatry, Vol 52, May-Jun, 2017. pp. 81-102.
Abstract:
This journal’s third article on PTSD in Court focuses especially on the topic’s ‘court’ component. It first considers the topic of malingering, including in terms of its definition, certainties, and uncertainties. As with other areas of the study of psychological injury and law, generally, and PTSD (posttraumatic stress disorder), specifically, malingering is a contentious area not only definitionally but also empirically, in terms of establishing its base rate in the index populations assessed in the field. Both current research and re-analysis of past research indicates that the malingering prevalence rate at issue is more like 15 ± 15% as opposed to 40 ± 10%. As for psychological tests used to assess PTSD, some of the better ones include the TSI-2 (Trauma Symptom Inventory, Second Edition; Briere, 2011), the MMPI-2-RF (Minnesota Multiphasic Personality Inventory, Second Edition, Restructured Form; Ben-Porath & Tellegen, 2008/2011), and the CAPS-5 (The Clinician-Administered PTSD Scale for DSM-5; Weathers, Blake, Schnurr, Kaloupek, Marx, & Keane, 2013b). Assessors need to know their own possible biases, the applicable laws (e.g., the Daubert trilogy), and how to write court-admissible reports. Overall conclusions reflect a moderate approach that navigates the territory between the extreme plaintiff or defense allegiances one frequently encounters in this area of forensic practice.

Malingered posttraumatic stress disorder (ptsd) and the effect of direct versus indirect trauma exposure on symptom profiles and detectability.
Szogi, Elizabeth G., et al.
Psychological Injury and Law, Apr 3, 2018.
Abstract:
Posttraumatic stress disorder (PTSD) is arguably prone to malingering due to its subjective and heterogeneous nature. Various factors can influence PTSD symptom profiles including trauma type and trauma exposure. However, it is unknown whether trauma exposure influences malingered PTSD symptom profiles. We used a malingering simulation design with trauma type controlled to compare (1) PTSD symptom profiles (Posttraumatic Stress Checliklist-5; PCL-5) at the syndrome, symptom cluster, and individual symptom levels and (2) symptom validity profiles (Structured Inventory of Malingered Symptomatology; SIMS) at the overall and subscale level, as a function of direct and indirect trauma exposure. Seventy-three participants were randomly assigned to either the direct (‘witnessed’ trauma) or indirect (‘learned about’ trauma) condition. Participants were coached about symptoms and instructed to simulate PTSD. PCL-5 profile analyses revealed that simulators in the direct exposure group reported greater overall PTSD severity. Significant differences were found on cluster D (changes in cognition and mood) and individual symptoms including intrusive thoughts, amnesia, difficulty experiencing positive emotions, and risk-taking. No differences were identified for any other symptom scores nor for the symptom validity profile, except for the SIMS total score (direct: M = 33.0, SD = 12.8, indirect: M = 26.5, SD = 13.9, t(71) = 2.06, p = .043, d = .48). These findings indicate that trauma exposure can influence malingered PTSD profiles at the syndrome, symptom cluster, and individual symptom levels (small effects), but, with one exception for a summary score, it does not produce a detectable difference on symptom validity testing. This study may provide insight for clinicians into the how malingered PTSD profiles can manifest as a result of direct and indirect trauma exposure; however, further research is strongly indicated.