Skip to main content

Advertisement

SpringerLink
Log in

Types of Malingering in PTSD: Evidence from a Psychological Injury Paradigm

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

A Correction to this article was published on 27 April 2021

This article has been updated

Abstract

The extent to which persons may feign or malinger psychological symptoms is an important concern for civil litigation, specifically in the context of personal injury. The consequences inherent in personal injury cases involving psychological distress require an understanding of how malingering presents in medico-legal contexts, and how it can be assessed using available measures. Symptom validity tests (SVTs) and performance validity tests (PVTs) have been developed to assist in the detection of feigned psychological illness and neurocognitive impairment. While demonstrated divergence between symptom-based and performance-based outcomes have been demonstrated in civil litigants with posttraumatic symptoms after the experience of a physical injury, limited research has evaluated how these measures operate in the context of psychological injury alone. The present study evaluated the relationships among symptom-based and performance-based measures of malingering under a simulated personal injury paradigm in which psychological but not physical injury was sustained. A total of 411 undergraduate participants completed four measures of malingered symptomatology, including both symptom validity and performance validity indicators. Participants were instructed to respond to measures as if they were experiencing common emotional, behavioral, and cognitive symptoms of PTSD following a motor vehicle accident. Using a multi-trait multi-method matrix, weaker correlations were found between PVT and SVTs (ranging from .15 to .28), but moderate significant correlations were found across symptom validity measures (.51 to .65), thus demonstrating an expected dissociation between methods of malingering assessment. Additional analyses support the stability of these findings, when accounting for past exposure to motor vehicle accidents, and replicated the need for a multiple failure approach. Findings are consistent with expectations of convergent and discriminant validity and support the conceptualization of malingered PTSD as a non-unitary construct that is composed of multiple domains or “types,” as reflected by a lack of convergence between SVT and PVT methods. In practice, evaluators of psychological injury are encouraged to utilize more than one measure of malingering, including both PVT and SVT approaches, when PTSD is alleged.

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

Fig. 1

Similar content being viewed by others

Change history

References

  • Alwes, Y., Clark, J., Berry, D., & Granacher, R. (2008). Screening for feigning in a civil forensic setting. Journal of Clinical and Experimental Neuropsychology, 133–140.

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (Fifth ed.). Washington, D.C.: Author.

    Book  Google Scholar 

  • Arce, R., Farina, F., & Buela, G. (2008). Assessing and detecting the ability to faking psychological injury as a consequence of a motor vehicle accident on the MMPI-2 using mock victims. Revista Latinoamericana de Psicologia, 485–496.

  • Berry, D. R., & Nelson, N. (2010). DSM-5 and malingering: A modest proposal. Psychological Injury and Law.

  • Boccaccini, M., & Brodsky, S. (1999). Diagnostic test usage by forensic psychologists in emotional injury cases (pp. 253–259). Professional Psychology: Research and Practice.

  • Boone, K. (2011). Clarification or confusion? A review of Rogers, bender, and Johnson's a critical analysis of the MND criteria. Psychological Injury and Law, 157–162.

  • Boone, K. B. (2009). The need for continuous and comprehensive sampling of effort/response bias during neuropsychological examinations. The Clinical Neuropsychologist, 23, 729–741.

    Article  PubMed  Google Scholar 

  • Brand, B. L., McNary, S. W., Loewenstein, R. J., Kolos, A. C., & Barr, S. R. (2006). Assessment of genuine and simulated dissociative identity disorder on the structured interview of reported symptoms. Journal of Trauma & Dissociation, 7, 63–85.

    Article  Google Scholar 

  • Brand, B. L., Turisch, M., Tzall, D., & Loewenstein, R. J. (2014). Utility of the SIRS-2 in distinguishing genuine from simulated dissociative identity disorder. Psychological Trauma Theory, Research Practice and Policy, 6(4), 308–317.

    Article  Google Scholar 

  • Briere, J. (1995). Trauma symptom inventory professional manual. Odessa, FL: Psychological Assessment Resources.

  • Briere, J. (2011). Trauma symptom inventory - 2: Professional manual. Lutz: PAR.

  • Butcher, J., Dahlstrom, W., Graham, J., Tellegen, A., & Kreammer, B. (1989). The Minnesota multiphasic personality Inventory-2 (MMPI-2) manual for administration and scoring. Minneapolis, MN: University of Minneapolis Press.

    Google Scholar 

  • Campbell, D., & Fiske, D. (1959). Convergent and discriminant validation by the multitrait-multimethod matrix. Psychological Bulletin, 81–105.

  • Christiansen, A., & Vincent, J. (2012). Assessment of litigation context, suggestion, and malingering measures among simulated personal injury litigants. Journal of Forensic Psychology Practice, 238–258.

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

  • Demakis, G. J., & Elhai, J. D. (2011). Neuropsychological and psychological aspects of malingered posttraumatic stress disorder. Psychological Injury and Law, 4, 24–31.

    Article  Google Scholar 

  • Egeland, J., Andersson, S., Sundseth, O. O., & Schanke, A.-K. (2015). Types or modes of malingering? A confirmatory factor analysis of performance and symptom validity tests. Applied Neuropsychology: Adult, 22, 215–226.

    Article  Google Scholar 

  • Elhai, J., Gray, M., Naifeh, J., Butcher, J., Davis, J., Falsetti, S., & Best, C. (2005). Utility of the trauma symptom inventory’s atypical response scale in detecting malingered post-traumatic stress disorder. Assessment, 210–219.

  • Foote, W., & Lareau, C. (2013). Psychological evaluation of emotional damages in tort cases. In R. Otto, & I. Weiner (Eds.), Handbook of psychology: forensic psychology, second edition (pp. 172–200). Hoboken, NJ: John Wiley & Sons, Inc.

  • Frueh, B. C., Elahai, J. D., Gold, P. B., Monnier, J., Magruder, K. M., Keane, T. M., & Arana, G. W. (2005). Disability Compensation Seeking Among Veterans Evaluated for Posttraumatic Stress Disorder. Psychiatric Services, 54, 84–91.

    Article  Google Scholar 

  • Frueh, B. C., Gold, K. L., & de Arellano, M. A. (1997). Symptom over-reporting in combat veterans evaluated for PTSD: differentiation on the basis of compensation seeking status. Journal of Personality Assessment, 68, 369–384.

    Article  PubMed  Google Scholar 

  • Fujita, G., & Nishida, Y. (2008). Association of objective measures of trauma exposure from motor vehicle accidents and posttraumatic stress symptoms. Journal of Traumatic Stress, 21(4), 425–429.

    Article  PubMed  Google Scholar 

  • Galatzer-Levy, I., & Bryant, R. (2013). 636,120 ways to have posttraumatic stress disorder. Perspectives on Psychological Science, 8(6), 651–662.

    Article  PubMed  Google Scholar 

  • Gray, M. J., Elhai, J. D., & Briere, J. (2010). Evaluation of the atypical response scale of the trauma symptom inventory-2 in detecting simulated posttraumatic stress disorder. Journal of Anxiety Disorders, 24, 447–451.

    Article  PubMed  Google Scholar 

  • Green, P. (2003). Word memory test for windows: User’s manual and program. Edmonton: Author.

    Google Scholar 

  • Greiffenstein, M., Gola, T., & Baker, W. (1995). MMPI-2 validity scales versus domain specific measures in detection of factitious traumatic brain injury. The Clinical Neuropsychologist, 230–240.

  • Guriel-Tennant, J., & Fremouw, W. (2006). Impact of trauma history and coaching on malingering of posttraumatic stress disorder using the PAI, TSI, and M-FAST. The Journal of Forensic Psychiatry and Psychology, 577–592.

  • Guy, L., Kwartner, M., & Miller, H. (2006). Investigating the M-FAST: Psychometric properties and utility to detect diagnostic specific malingering. Behavioral Sciences & the Law, 687–702.

  • Hall, R. W., & Hall, R. W. (2007). Detection of malingered PTSD: An overview of clinical, psychometric, and physiological assessment: where do we stand? Journal of Forensic Sciences, 717–725.

  • Heilbronner, R. J., Sweet, J. J., Morgan, J. E., Larrabee, G. J., Millis, S. R., & Conference Participants. (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 

  • Heinze, M. C., & Purisch, A. D. (2001). Beneath the mask: Use of psychological tests to detect and subtype malingering in criminal defendants. Journal of Forensic Psychology Practice, 1(4), 23–52.

    Article  Google Scholar 

  • Jackson, R.L., Rogers, R., & Sewell, K. W. (2005). Forensic applications of the Miller Forensic Assessment of Symptoms Test (MFAST): Screening for feigned disorders in competency to stand trial evaluations. Law and Human Behavior, 29, 199–210.

  • 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.

    Article  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, 269–274.

  • Larrabee, G. (2003). Detection of malingering using neuropsychologically atypical performance patterns on standard neuropsychological tests. Clinical Neuropsychologist, 410–425.

  • Lees-Haley, P. R., & Dunn, J. T. (1994). The ability of naive subjects to report symptoms of mild brain injury, post-traumatic stress disorder, major depression, and generalized anxiety disorder. Journal of Clinical Psychology, 252–256.

  • Martin, P. K., Schroeder, R. W., & Odland, A. P. (2015). Neuropsychologists’ validity testing beliefs and practices: A survey of North American professionals. The Clinical Neuropsychologist, 29, 741–746.

    Article  PubMed  Google Scholar 

  • Melton, G. B., Petrila, J., Poythress, N. G., & Slobogin, C. (2007). Psychological evaluations for the courts (Third ed.). New York: The Guilford Press.

  • 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 malingered symptomatology, and the word memory test. Psychological Injury and Law, 2, 284–293.

    Article  Google Scholar 

  • Messer, J. M., & Fremouw, W. J. (2007). Detecting Malingered Posttraumatic Stress Disorder Using the Morel Emotional Numbing Test-Revised (MENT-R) and the Miller Forensic Assessment of Symptoms Test (M-FAST). Journal of Forensic Psychology Practice, 7(3), 33–57.

    Article  Google Scholar 

  • Miller, H. A. (2001). M-FAST: Miller Forensic Assessment of Symptoms Test Professional Manual. Odessa, FL: Psychological Assessment Resources, Inc..

    Google Scholar 

  • Morel, K. R. (1998). Manual for the Morel Emotional Numbing Test for Posttraumatic Stress Disorder (MENT). Printed in USA.

    Google Scholar 

  • Morey, L. (2007). Personality Assessment Inventory (PAI): Professional Manual. PAR (Psychological Assessment Resources).

  • Neal, T., & Grisso, T. (2014). Assessment Practices and Expert Judgment Methods in Forensic Psychology and Psychiatry. Criminal Justice and Behavior, 1406–1421.

  • Orr, S. P., McNally, R. J., Rosen, G. M., & Shalev, A. Y. (2004). Psychophysiologic reactivity: Implications for conceptualizing PTSD. In G. M. Rosen (Ed.), Posttraumatic stress disorder: Issues and controversies (pp. 101–126). New York: John Wiley & Sons Ltd..

    Chapter  Google Scholar 

  • Orr, S. P., & Pitman, R. K. (1993). Psychophysiologic Assessment of Attempts to Simulate Posttraumatic Stress Disorder. Biological Psychiatry, 33, 127–129.

    Article  PubMed  Google Scholar 

  • Parks, A. (2015). Using Performance Validity and Symptom Validity Tests to Detect Feigned Postconcussion and Posttraumatic Stress Symptomatologies: A Simulation Study. Dissertation.

  • Peace, K. A., & Masliuk, K. A. (2011). Do motivations for malingering matter? Symptoms of malingered PTSD as a function of motivation and trauma type. Psychological Injury and Law, 44–55.

  • Purtle, J., Lynn, K., & Malik, M. (2016). “Calculating the Toll of Trauma” in the headlines: Portrayals of posttraumatic stress disorder in the new york times (1980–2015). American Journal of Orthopsychiatry, 632–638.

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

    Google Scholar 

  • Rogers, R. (2008a). Detection Strategies for Malingering and Defensiveness. In R. Rogers (Ed.), Clinical assessment of malingering and deception (pp. 14–35). New York: The Guilford Press.

    Google Scholar 

  • Rogers, R. (2008b). Researching Response Styles. In R. Rogers (Ed.), Clinical Assessment of Malingering and Deception (Third ed.). New York, NY: The Guilford Press.

  • Rogers, R., Bagby, R., & Dickens, S. (1992). Structured interview of reported symptoms (SIRS) and professional manual. Odessa, FL: Psychological Assessment Resources.

    Google Scholar 

  • Rogers, R., & Bender, S. (2013). Evaluation of malingering and related response styles. In R. Otto & I. Weiner (Eds.), Handbook of psychology, Volume 11: Forensic Psychology (pp. 517–540). Hoboken: John Wiley & Sons, Inc..

    Google Scholar 

  • Rogers, R., Payne, J. W., Correa, A. A., Gilliard, N. D., & Ross, C. A. (2009). A study of the SIRS with severely traumatized patients. Journal of Personality Assessment, 91, 429–438.

    Article  PubMed  Google Scholar 

  • Rogers, R., Robinson, E. V., & Gillard, N. D. (2014). The SIMS screen for feigned mental disorders: The development of detection-based scales. Behavioral Sciences & the Law, 32(4), 455–466.

    Article  Google Scholar 

  • Rogers, R., Sewell, K. W., & Gillard, N. D. (2010). SIRS-2: Structured interview of reported symptoms: professional manual. Lutz, FL: Psychological Assessment Resources.

    Google Scholar 

  • Ruocco, A. C., Swirsky-Sacchetti, T., Chute, D. I., Mandel, S., Platek, S. M., & Zillmer, E. A. (2008). Distinguishing between neuropsychological malingering and exaggerated psychiatric symptoms in a neuropsychological setting. The Clinical Neuropsychologist, 22, 547–564.

    Article  PubMed  Google Scholar 

  • Schreiber, J. B., Nora, A., Stage, F. K., Barlow, E. A., & King, J. (2006). Reporting structural equation modeling and confirmatory factor analysis results: A review. The Journal of Educational Research, 99(6), 323–338.

    Article  Google Scholar 

  • Smith, G., & Burger, G. (1997). Detection of malingering: Validation of the Structured Inventory of Malingered Symptomatology (SIMS). Joucy and the Law, 183–189.

  • Sharland, M., & Gfeller, J. (2007). A survey of neuropsychologists’ beliefs and practices with respect to the assessment of effort. Archives of Clinical Neuropsychology, 213–223.

  • Stone, A. A. (1993). Stress disorder and the law: Critical review of the new frontier. The Bulletin of the American Academy of Psychiatry and the Law, 23–36.

  • Taylor, S., Frueh, B., & Asmundson, G. (2007). Detection and management of malingering in people presenting for treatment of posttraumatic stress disorder: Methods, obstacles, and recommendations. Journal of Anxiety Disorders, 22–41.

  • Thomas, T., & Fremouw, W. (2009). The Stroop interference effect and spontaneous recall in true and malingered motor-vehicle accident-related PTSD. Journal of Forensic Psychiatry & Psychology, 936–949.

  • Tombaugh, T. (1996). TOMM: Test of memory malingering. North Tonawanda: Multi-Health Systems, Inc..

    Google Scholar 

  • Tombaugh, T. N. (2006). Test of memory malingering (TOMM); research monograph: Summary application in clinical and research settings. North Tonawanda: Multi-Health Systems, Inc..

    Google Scholar 

  • van Impelen, A., Merckelbach, H., Jelicic, M., & Merten, T. (2014). The structured invetory of malingered symptomatology (SIMS): A systematic review and meta-analysis. The Clinical Neuropsychologist, 1336–1365.

  • Veazey, C. H., Blanchard, E. B., Hickling, E. J., & Buckley, T. C. (2004). Physiological Responsiveness of Motor Vehcile Accident Survivors with Chronic Posttraumatic Stress Disroder. Applied Psychophysiology and Biofeedback, 29, 51–62.

    Article  PubMed  Google Scholar 

  • Widows, M., & Smith, G. (2005). SIMS: Structured inventory of malingered symptomatology. Lutz, FL: PAR, Inc..

    Google Scholar 

  • Wisdom, N., Callahan, J., & Shaw, T. (2010). Diagnostic utility of the structured inventory of malingered symtomatology to detect malingering in a forensic sample. Archives of Clinical Neuropsychology, 118–125.

  • Wisdom, N. M., Pastorek, N. J., Miller, B. I., Booth, J. E., Romesser, J. M., Linck, J. F., & Sim, A. H. (2014). PTSD and cognitive functioning: Importance of inculding performance validity testing. The Clinical Neuropsychologist, 28, 128–145.

    Article  PubMed  Google Scholar 

  • Young, G., Kane, A., & Nicholson, K. (2007). Causality of psychological injury: Presenting evidence in court. New York, NY: Springer Science + Business Media, LLC..

    Book  Google Scholar 

  • Zatnick, D., Jurkovich, G., Russo, J., Roy-Byrne, P., Katon, W., Wagner, A., Dunn, C., Uehara, E., Wisner, D., & Rivara, F. (2004). Posttraumatic distress, alcohol disorders, and recurrent trauma across level 1 trauma centers. The Journal of Trauma, 57, 360–366.

    Article  Google Scholar 

  • Zoellner, L., Pruitt, L., Farach, F., & Jun, J. (2014). Understanding heterogeneity in PTSD: Fear, dysphoria, and distress. Depression & Anxiety, 97–106.

Download references

Author information

Authors and Affiliations

  1. Department of Psychology, University of Houston, 4800 Calhoun Road, 126 Heyne Building, Houston, TX, 77204-5022, USA

    Katherine A. Fox & John P. Vincent

Authors
  1. Katherine A. Fox
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. John P. Vincent
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Katherine A. Fox.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Fox, K.A., Vincent, J.P. Types of Malingering in PTSD: Evidence from a Psychological Injury Paradigm. Psychol. Inj. and Law 13, 90–104 (2020). https://doi.org/10.1007/s12207-019-09367-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12207-019-09367-5

Keywords

Search

Navigation