Skip to main content
SpringerLink
Log in

Neuropsychological and Psychological Aspects of Malingered Posttraumatic Stress Disorder

  • Published:
Psychological Injury and Law Aims and scope Submit manuscript

Abstract

Posttraumatic stress disorder (PTSD) is an anxiety disorder that is frequently encountered in litigation, and as such, there is an increased risk for poor effort on cognitive tests, symptom exaggeration, or frank malingering. These are particularly problematic for accurate diagnosis. This article is divided into four sections. First, we address why individuals malinger PTSD as well as the challenges in detecting an invalid PTSD symptom presentation. Second, we discuss issues of cognitive functioning in PTSD and then the prevalence of and common patterns of poor effort on neuropsychological testing among individuals feigning PTSD. Third, we discuss psychological functioning in PTSD and then the prevalence and patterns of functioning on psychological measures of malingering in this population. Finally, recommendations for detecting invalid PTSD symptom presentations are provided.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington: American Psychiatric Association.

    Google Scholar 

  • 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). Psychologica Assessment, 7, 424–431.

    Article  Google Scholar 

  • 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, 249–261.

    Article  Google Scholar 

  • Burkett, B. G., & Whitley, G. (1998). Stolen valor: how the Vietnam generation was robbed of its heroes and its history. Dallas: Verity.

    Google Scholar 

  • Creamer, M., McFarlane, A. C., & Burgess, P. (2005). Psychopathology following trauma: the role of subjective experience. Journal of Affective Disorders, 86, 175–182.

    Article  PubMed  Google Scholar 

  • Demakis, G. J., Gervais, R. O., & Rohling, M. L. (2008). The effect of failure on cognitive and psychological symptom validity tests in litigants with symptoms of post-traumatic stress disorder. The Clinical Neuropsychologist, 22, 879–895.

    Article  PubMed  Google Scholar 

  • 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, 145–155.

    Article  Google Scholar 

  • 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, 317–326.

    Article  PubMed  Google Scholar 

  • Elhai, J. D., Ford, J. D., & Naifeh, J. A. (2010). Assessing trauma exposure and posttraumatic morbidity. In G. M. Rosen & B. C. Frueh (Eds.), Clinician’s guide to posttraumatic stress disorder (pp. 119–151). Hoboken: Wiley.

    Google Scholar 

  • Elhai, J. D., Frueh, B. C., Davis, J. L., Jacobs, G. A., & Hamner, M. B. (2003). Clinical presentations in combat veterans diagnosed with posttraumatic stress disorder. Journal of Clinical Psychology, 59, 385–397.

    Article  PubMed  Google Scholar 

  • Elhai, J. D., Frueh, B. C., Gold, P. B., Gold, S. N., & Hamner, M. B. (2000). Clinical presentations of posttraumatic stress disorder across trauma populations: a comparison of MMPI-2 profiles of combat veterans and adult survivors of childhood sexual abuse. The Journal of Nervous and Mental Disease, 188, 708–713.

    Article  PubMed  Google Scholar 

  • 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, 449–463.

    Article  PubMed  Google Scholar 

  • Elhai, J. D., Gold, S. N., Sellers, A. H., & Dorfman, W. I. (2001). The detection of malingered posttraumatic stress disorder with MMPI-2 fake bad indices. Assessment, 8, 221–236.

    Article  PubMed  Google Scholar 

  • Elhai, J. D., Grubaugh, A. L., Kashdan, T. B., & Frueh, B. C. (2008). Empirical examination of a proposed refinement to DSM-IV posttraumatic stress disorder symptom criteria using the National Comorbidity Survey Replication data. The Journal of Clinical Psychiatry, 69, 597–602.

    Article  PubMed  Google Scholar 

  • Elhai, J. D., Klotz Flitter, J. M., Gold, S. N., & Sellers, A. H. (2001). Identifying subtypes of women survivors of childhood sexual abuse: an MMPI-2 cluster analysis. Journal of Traumatic Stress, 14, 157–175.

    Article  Google Scholar 

  • Elhai, J. D., Ruggiero, K. J., Frueh, B. C., Beckham, J. C., Gold, P. B., & Feldman, M. E. (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, 531–549.

    Article  PubMed  Google Scholar 

  • Freeman, T., Powell, M., & Kimbrell, T. (2008). Measuring symptom exaggeration in veterans with chronic posttraumatic stress disorder. Psychiatry Research, 158, 374–380.

    Article  PubMed  Google Scholar 

  • Frueh, B. C., Elhai, J. D., Gold, P. B., Monnier, J., Magruder, K. M., & Keane, T. M. (2003). Disability compensation seeking among veterans evaluated for posttraumatic stress disorder. Psychiatric Services, 54, 84–91.

    Article  PubMed  Google Scholar 

  • Frueh, B. C., Elhai, J. D., Grubaugh, A. L., Monnier, J., Kashdan, T. B., Sauvageot, J. A., et al. (2005). Documented combat exposure of U.S. veterans seeking treatment for combat-related posttraumatic stress disorder. The British Journal of Psychiatry, 186, 467–472.

    Article  PubMed  Google Scholar 

  • 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, 2143–2145.

    Article  PubMed  Google Scholar 

  • Green, P. (2003). Word Memory Test manual for Windows: user’s manual. Edmonton: Green’s Publishing.

    Google Scholar 

  • Greiffenstein, M. F., Baker, W. J., Axelrod, B., Peck, E. A., & Gervais, R. (2004). The Fake Bad Scale and MMPI-2 F-family in detection of implausible psychological trauma claims. The Clinical Neuropsychologist, 18, 573–590.

    Article  PubMed  Google Scholar 

  • Greiffenstein, M. F., Baker, W. J., & Gola, T. (1994). Validation of malingered amnestic measures with a large clinical sample. Psychological Assessment, 6, 218–224.

    Article  Google Scholar 

  • Gurvits, T. V., Metzger, L. J., Lasko, N. B., Cannistraro, P. A., Tarhan, A. S., Gilbertson, M. W., et al. (2006). Subtle neurologic compromise as a vulnerability factor for combat-related posttraumatic stress disorder: results of a twin study. Archives of General Psychiatry, 63, 571–576.

    Article  PubMed  Google Scholar 

  • Heilbronner, R. L., Sweet, J. J., Morgan, J. E., Larrabee, G. J., Millis, S. R., & Participants, C. (2009). American Academy of Clinical Neuropsychology consensus conference statement on the neuropsychological assessment of effort, response bias, and malingering. The Clinical Neuropsychologist, 23, 1093–1129.

    Article  PubMed  Google Scholar 

  • Horner, M. D., & Hamner, M. B. (2002). Neurocognitive functioning in posttraumatic stress disorder. Neuropsychology Review, 12, 15–30.

    Article  PubMed  Google Scholar 

  • Jungwirth, S., Fischer, P., Weissgram, S., Kirchmeyr, W., Bauer, P., & Tragl, K. H. (2004). Subjective memory complaints and objective memory impairment in the Vienna-Transdanube aging community. Journal of the American Geriatrics Society, 52, 263–268.

    Article  PubMed  Google Scholar 

  • Kessler, R. C. (2000). Posttraumatic stress disorder: the burden to the individual and to society. The Journal of Clinical Psychiatry, 61(suppl. 5), 4–12.

    PubMed  Google Scholar 

  • Kessler, R. C., Sonnega, A., Bromet, E., Hughes, M., & Nelson, C. B. (1995). Posttraumatic stress disorder in the National Comorbidity Survey. Archives of General Psychiatry, 52, 1048–1060.

    PubMed  Google Scholar 

  • Klotz Flitter, J. M., Elhai, J. D., & Gold, S. N. (2003). MMPI-2 F scale elevations in adult victims of child sexual abuse. Journal of Traumatic Stress, 16, 269–274.

    Article  PubMed  Google Scholar 

  • 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, 229–235.

    Article  PubMed  Google Scholar 

  • Long, M. E., & Elhai, J. D. (2009). Posttraumatic stress disorder’s traumatic stressor criterion: history, controversy, clinical and legal implications. Psychological Injury and Law, 2, 167–178.

    Article  Google Scholar 

  • Lyons, J. A., & Wheeler-Cox, T. (1999). MMPI, MMPI-2 and PTSD: overview of scores, scales, and profiles. Journal of Traumatic Stress, 12, 175–183.

    Article  PubMed  Google Scholar 

  • Marshall, M. B., & Bagby, R. M. (2006). The incremental validity and clinical utility of the MMPI-2 Infrequency Posttraumatic Stress Disorder Scale. Assessment, 13, 417–429.

    Article  PubMed  Google Scholar 

  • Marx, B. P., Doron-Lamarca, S., Proctor, S. P., & Vasterling, J. J. (2009). The influence of pre-deployment neurocognitive functioning on post-deployment PTSD symptom outcomes among Iraq-deployed Army soldiers. Journal of the International Neuropsychological Society, 15, 840–852.

    Article  PubMed  Google Scholar 

  • McNally, R. J., & Shin, L. M. (1995). Association of intelligence with severity of posttraumatic stress disorder symptoms in Vietnam combat veterans. The American Journal of Psychiatry, 152, 936–938.

    PubMed  Google Scholar 

  • Merten, T., Thies, E., Schneider, K., & Stevens, A. (2009). Symptom validity testing in claimants with alleged posttraumatic stress disorder: comparing the Morel Emotional Numbing Test, the Structured Inventory of Malingering Symptomatology, and the Word Memory Test. Psychological Injury and Law, 2, 284–293.

    Article  Google Scholar 

  • Mittenberg, W., Patton, C., Canyock, E., & Condit, D. C. (2002). Base rates of malingering and symptom exaggeration. Journal of Clinical and Experimental Neuropsychology, 24, 1094–1102.

    Article  PubMed  Google Scholar 

  • Resnick, P. J., West, S., & Payne, J. W. (2008). Malingering of posttraumatic disorders. In R. Rogers (Ed.), Clinical assessment of malingering and deception (3rd ed., pp. 109–127). New York: Guilford Press.

    Google Scholar 

  • Rogers, R., Sewell, K. W., Martin, M. A., & Vitacco, M. J. (2003). Detection of feigned mental disorders: a meta-analysis of the MMPI-2 and malingering. Assessment, 10, 160–177.

    Article  PubMed  Google Scholar 

  • Roca, V., & Freeman, T. W. (2001). Complaints of impaired memory in veterans with PTSD. The American Journal of Psychiatry, 158, 1738–1739.

    Article  PubMed  Google Scholar 

  • Rohling, M. L., Allen, L. M., & Green, P. (2002). Who is exaggerating cognitive impairment and who is not? CNS Spectrums, 7, 387–395.

    PubMed  Google Scholar 

  • Rohling, M. L., Green, P., Allen, L. M., & Iverson, G. L. (2002). Depressive symptoms and neurocognitive test scores in patients passing symptom validity tests. Archives of Clinical Neuropsychology, 17, 205–222.

    PubMed  Google Scholar 

  • Rosen, G. M. (2004). Litigation and reported rates of posttraumatic stress disorder. Personality and Individual Differences, 36, 1291–1294.

    Article  Google Scholar 

  • Ross, R. J., Ball, W. A., Sullivan, K. A., & Caroff, S. N. (1989). Sleep disturbance as the hallmark of posttraumatic stress disorder. The American Journal of Psychiatry, 146, 697–707.

    PubMed  Google Scholar 

  • Rubenzer, S. (2009). Posttraumatic stress disorder: assessing response style and malingering. Psychological Injury and Law, 2, 114–142.

    Article  Google Scholar 

  • Solomon, Z., & Mikulincer, M. (2006). Trajectories of PTSD: a 20-year longitudinal study. The American Journal of Psychiatry, 163, 659–666.

    Article  PubMed  Google Scholar 

  • Stevens, A., Friedel, E., Mehren, G., & Merten, T. (2008). Malingering and uncooperativeness in psychiatric and psychological assessment: prevalence and effects in a German sample of claimants. Psychiatry Research, 157, 191–200.

    Article  PubMed  Google Scholar 

  • Sullivan, K., Krengel, M., Proctor, S. P., Devine, S., Heeren, T., & White, R. F. (2003). Cognitive functioning in treatment-seeking Gulf War veterans: pyridostigmine bromide use and PTSD. Journal of Psychopathology and Behavioral Assessment, 25, 95–103.

    Article  Google Scholar 

  • 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, 22–41.

    Article  PubMed  Google Scholar 

  • Tombaugh, T. N. (1997). The Test of Memory Malingering (TOMM): normative data from cognitive intact and cognitive impaired individuals. Psychological Assessment, 9, 260–268.

    Article  Google Scholar 

  • Vasterling, J. J., & Brailey, K. (2005). Neuropsychological findings in adults with PTSD. In J. J. Vasterling & C. R. Brewin (Eds.), Neuropsychology of PTSD: Biological, cognitive, and clinical perspectives. New York: Guilford.

    Google Scholar 

  • Vasterling, J. J., Duke, L. M., Brailey, K., Constans, J. I., Allain, A. N., & Sutker, P. B. (2002). Attention, learning, and memory performances and intellectual resources in Vietnam veterans: PTSD and no disorder comparisons. Neuropsychology, 16, 5–14.

    Article  PubMed  Google Scholar 

  • Uddo, M., Vasterling, J. J., Brailey, K., & Sutker, P. B. (1993). Memory and attention in combat-related post-traumatic stress disorder. Journal of Psychopathology and Behavioral Assessment, 15, 43–52.

    Article  Google Scholar 

  • Wise, E. A. (1996). Diagnosing posttraumatic stress disorder with the MMPI clinical scales: a review of the literature. Journal of Psychopathology and Behavioral Assessment, 18, 71–82.

    Article  Google Scholar 

  • Wygant, D. B., Sellbom, M., Gervais, R. O., Ben-Porath, Y. S., Stafford, K. P., Freeman, D. B., et al. (2010). Further validation of the MMPI-2 and MMPI-2-RF Response Bias Scale: findings from disability and criminal forensic settings. Psychological Assessment, 22, 745–756.

    Article  PubMed  Google Scholar 

  • Wygant, D. B., Sellbom, M., Ben-Porath, Y. S., Stafford, K. P., Freeman, D. B., & Heilbronner, R. L. (2007). The relation between symptom validity testing and MMPI-2 scores as a function of forensic evaluation context. Archives of Clinical Neuropsychology, 22, 489–499.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Psychology, University of North Carolina at Charlotte, 9201 University City Blvd., Charlotte, NC, 29223-0001, USA

    George J. Demakis

  2. Department of Psychology, University of Toledo, Toledo, OH, USA

    Jon D. Elhai

Authors
  1. George J. Demakis
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jon D. Elhai
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to George J. Demakis.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Demakis, G.J., Elhai, J.D. Neuropsychological and Psychological Aspects of Malingered Posttraumatic Stress Disorder. Psychol. Inj. and Law 4, 24–31 (2011). https://doi.org/10.1007/s12207-011-9099-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12207-011-9099-y

Keywords

Search

Navigation