Malingered Posttraumatic Stress Disorder (PTSD) and the Effect of Direct Versus Indirect Trauma Exposure on Symptom Profiles and Detectability

Article

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.

Keywords

Posttraumatic stress disorder Malingering Simulation Witnessed trauma Trauma 

Notes

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

References

  1. Alden, L. E., Regambal, M. J., & Laposa, J. M. (2008). The effects of direct versus witnessed threat on emergency department healthcare workers: implications for PTSD criterion A. Journal of Anxiety Disorders, 22(8), 1337–1346.  https://doi.org/10.1016/j.janxdis.2008.01.013.CrossRefPubMedGoogle Scholar
  2. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, D.C: Author.CrossRefGoogle Scholar
  3. Anders, S. L., Frazier, P. A., & Frankfurt, S. B. (2011). Variations in criterion A and PTSD rates in a community sample of women. Journal of Anxiety Disorders, 25(2), 176–184.  https://doi.org/10.1016/j.janxdis.2010.08.018.CrossRefPubMedGoogle Scholar
  4. Benjet, C., Bromet, E., Karam, E. G., Kessler, R. C., McLaughlin, K. A., Ruscio, A. M., Shahly, V., Stein, D. J., Petukhova, M., Hill, E., Alonso, J., Atwoli, L., Bunting, B., Bruffaerts, R., Caldas-de-Almeida, J. M., de Girolamo, G., Florescu, S., Gureje, O., Huang, Y., Lepine, J. P., Kawakami, N., Kovess-Masfety, V., Medina-Mora, M. E., Navarro-Mateu, F., Piazza, M., Posada-Villa, J., Scott, K. M., Shalev, A., Slade, T., ten Have, M., Torres, Y., Viana, M. C., Zarkov, Z., & Koenen, K. C. (2016). The epidemiology of traumatic event exposure worldwide: Results from the world mental health survey consortium. Psychological Medicine, 46(2), 327–343.  https://doi.org/10.1017/S0033291715001981.CrossRefPubMedGoogle Scholar
  5. Bhushan, B., & Kumar, S. J. (2009). Emotional distress and posttraumatic stress in children: the impact of direct versus indirect exposure. Journal of Loss and Trauma, 14(1), 35–45.  https://doi.org/10.1080/15325020802537047.CrossRefGoogle Scholar
  6. Blanchard, E. B., Jones-Alexander, J., Buckley, T. C., & Forneris, C. A. (1996). Psychometric properties of the PTSD checklist (PCL). Behavioral Research and Therapy, 34(8), 669–673.CrossRefGoogle Scholar
  7. Blevins, C. A., Weathers, F. W., Davis, M. T., Witte, T. K., & Domino, J. L. (2015). The posttraumatic stress disorder checklist for DSM-5 (PCL-5) development and initial psychometric evaluation. Journal of Traumatic Stress, 28, 489–498.  https://doi.org/10.1002/jts.CrossRefPubMedGoogle Scholar
  8. Bovin, M. J., Marx, B. P., Weathers, F. W., Gallagher, M. W., Rodriguez, P., Schnurr, P. P., & Keane, T. M. (2015). Psychometric properties of the PTSD checklist for diagnostic and statistical manual of mental disorders-fifth edition (PCL-5) in veterans. Psychological Assessment, 28, 1379–1391.  https://doi.org/10.1037/pas0000254.CrossRefPubMedGoogle Scholar
  9. Bowman, M. L. (1999). Individual differences in posttraumatic distress: problems with the DSM-IV model. Canadian Journal of Psychiatry, 44, 21–33.CrossRefPubMedGoogle Scholar
  10. Cartwright, A., & Roach, J. (2015). Fraudulently claiming following a road traffic accident: a pilot study of UK residents’ attitudes. Psychiatry, Psychology and Law, 23(3), 446–461.  https://doi.org/10.1080/13218719.2015.1080148.CrossRefGoogle Scholar
  11. Das, L., & Bhushan, B. (2005). From hard poetics to situated reading: a cognitive empirical study of imagery and graded figurative language. In H. Veivo, B. Pettersson, & M. Polvinen (Eds.), Cognition and literary interpretation in practice. Helsinki University Press: Helsinki.Google Scholar
  12. Edens, J. F., Otto, R. K., & Dwyer, T. J. (1998). Susceptibility of the trauma symptom inventory to malingering. Journal of Personality Assessment, 71(3), 379–392.  https://doi.org/10.1207/s15327752jpa7103_7.CrossRefPubMedGoogle Scholar
  13. Elhai, J. D., Butcher, J. J., Reeves, A. N., Baugher, S. N., Gray, M. J., & Jacobs, …. A. (2007). Varying cautionary instructions, monetary incentives, and comorbid diagnostic training in malingered psychopathology research. Journal of Personality Assessment, 88(3), 328–337.CrossRefPubMedGoogle Scholar
  14. 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.CrossRefPubMedGoogle Scholar
  15. 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 child sexual abuse. Journal of Nervous & Mental Disease, 188, 708–713.CrossRefGoogle Scholar
  16. Field, A. (2014). Discovering statistics using IBM SPSS statistics and sex drugs rock ‘n’ roll. London: Sage.Google Scholar
  17. Galatzer-Levy, I. R., & Bryant, R. A. (2013). 636,120 ways to have posttraumatic stress disorder. Perspectives on Psychological Science, 8(6), 651–662.CrossRefPubMedGoogle Scholar
  18. Gibson, L. E., Alloy, L. B., & Ellman, L. M. (2016). Trauma and the psychosis spectrum: a review of symptom specificity and explanatory mechanisms. Clinical Psychology Review, 49, 92–105.CrossRefPubMedPubMedCentralGoogle Scholar
  19. Goenjian, A. K., Steinberg, A. M., Najarian, L. M., Fairbanks, L. A., Tashijian, M., & Pynoos, R. S. (2000). Prospective study of posttraumatic stress, anxiety, and depressive reactions after earthquake and political violence. American Journal of Psychiatry, 157, 911–916.CrossRefPubMedGoogle Scholar
  20. Graham, J., Legarreta, M., North, L., DiMuzio, J., McGlade, E., & Yurgelun-Todd, D. (2016). A preliminary study of DSM-5 PTSD symptom patterns in veterans by trauma-type. Military Psychology, 28(2), 115–122.  https://doi.org/10.1037/mil0000092.CrossRefGoogle Scholar
  21. Guriel, J., & Fremouw, W. (2003). Assessing malingered posttraumatic stress disorder: a critical review. Clinical Psychology Review, 23(7), 881–904.CrossRefPubMedGoogle Scholar
  22. 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. Journal of Forensic Psychiatry & Psychology, 17(4), 577–592.  https://doi.org/10.1080/14789940600895838.CrossRefGoogle Scholar
  23. Kelley, L. P., Weathers, M. E., McDevitt-Murphy, M. E., Eakin, D. E., & Flood, A. M. (2009). A comparison of PTSD symptom patterns in three types of civilian trauma. Journal of Traumatic Stress, 22(3), 227–235.CrossRefPubMedGoogle Scholar
  24. Kirz, J. L., Drescher, K. D., Klein, J. L., Gusman, F. D., & Schwartz, M. F. (2001). MMPI-2 assessment of differential post-traumatic stress disorder patterns in combat veterans and sexual assault victims. Journal of Interpersonal Violence, 16, 619–639.CrossRefGoogle Scholar
  25. Kloep, M. L., Lancaster, S. L., & Rodriguez, B. F. (2014). Sudden unexpected versus violent death and PTSD symptom development. Journal of Aggression, Maltreatment & Trauma, 23, 286–300.  https://doi.org/10.1080/10926771.2014.882464.CrossRefGoogle Scholar
  26. Kristensen, P., Weisæth, L., & Heir, T. (2012). Bereavement and mental health after sudden and violent losses: a review. Psychiatry, 75(1), 76–97.  https://doi.org/10.1521/psyc.2012.75.1.76.CrossRefPubMedGoogle Scholar
  27. Lancaster, S. L., Melka, S. E., Rodriguez, B. F., & Bryant, A. R. (2014). PTSD symptom patterns following traumatic and nontraumatic events. Journal of Aggression, Maltreatment & Trauma, 23(4), 414–429.  https://doi.org/10.1080/10926771.2014.893276.CrossRefGoogle Scholar
  28. Levin, A. P., Kleinman, S. B., & Adler, J. S. (2014). DSM-5 and posttraumatic stress disorder. Journal of the American Academy of Psychiatry and the Law Online, 42(2), 146–158.Google Scholar
  29. Malcore, S. A., Schutte, C., Van Dyke, S. A., & Axelrod, B. N. (2015). The development of a reduced-item Structured Inventory of Malingered Symptomatology (SIMS). Psychological Injury and Law, 8(2), 95–99.  https://doi.org/10.1007/s12207-015-9214-6.CrossRefGoogle Scholar
  30. May, C. l., & Wisco, B. E. (2016). Defining trauma: how level of exposure and proximity affect risk for posttraumatic stress disorder. Psychological Trauma Theory, Research, Practise, and Policy, 8(2), 233–240.CrossRefGoogle Scholar
  31. Merten, T., Lorenz, R., & Schlatow, S. (2010). Posttraumatic stress disorder can easily be faked, but faking can be detected in most cases. German Journal of Psychiatry, 13(3), 140–149.Google Scholar
  32. Miller, M. W., Wolf, E. J., & Keane, T. M. (2014). Posttraumatic stress disorder in DSM-5: new criteria and controversies. Clinical Psychology: Science and Practice, 21(3), 208–220.  https://doi.org/10.1111/cpsp.12070.Google Scholar
  33. Nies, K. J., & Sweet, J. J. (1994). Neuropsychological assessment and malingering: a critical review of past and present strategies. Archives of Clinical Neuropsychology, 9, 501–552.  https://doi.org/10.1016/0887-6177(94)90041-8.CrossRefPubMedGoogle Scholar
  34. Patki, G., Solanki, N., & Salim, S. (2014). Witnessing traumatic events causes severe behavioral impairments in rats. International Journal of Neuropsychopharmacology, 17(12), 2017–2029.  https://doi.org/10.1017/S1461145714000923.CrossRefPubMedPubMedCentralGoogle Scholar
  35. Peace, A. K., & 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, 4, 44–55.  https://doi.org/10.1007/s12207-011-9102-7.CrossRefGoogle Scholar
  36. Peace, K. A., & Richards, V. E. S. (2014). Faking it: incentives and malingered PTSD. Journal of Criminal Psychology, 4(1), 19–32.  https://doi.org/10.1108/jcp-09-2013-0023.CrossRefGoogle Scholar
  37. Pitts, B. L., Chapman, P., Safer, M. A., Unwin, B., Figley, C., & Russell, D. W. (2013). Killing versus witnessing trauma: implications for the development of PTSD in combat medics. Military Psychology, 25(6), 537–544.  https://doi.org/10.1037/mil0000025.CrossRefGoogle Scholar
  38. Rogers, R., Bagby, R. M., & Dickens, S. E. (1992). Structured Interview of Reported Symptoms (SIRS) and professional manual. Odessa, FL: Psychological Assessment Resources, Inc.Google Scholar
  39. Rosen, G. M. (2004). Malingering and the PTSD data base. In G. M. Rosen (Ed.), Posttraumatic stress disorder: issues and controversies (pp. 85–99). New York: Wiley.CrossRefGoogle Scholar
  40. Rubenzer, S. (2009). Posttraumatic stress disorder: assessing response style and malingering. Psychological Injury and Law, 2, 114–142.  https://doi.org/10.1007/s12207-009-9045-4.CrossRefGoogle Scholar
  41. Strom, T. Q., Leskela, J., James, L. M., Thuras, P. D., Voller, E., Weigel, R., … Holz, K. B. (2012). An exploratory examination of risk-taking behavior and PTSD symptom severity in a veteran sample. Military Medicine, 177(4), 390–6.Google Scholar
  42. Sullivan, K. A., Kempe, C. B., Edmed, S. L., & Bonanno, G. A. (2016). Resilience and other possible outcomes after mild traumatic brain injury: a systematic review. Neuropsychological Review, 26(2), 173–185.  https://doi.org/10.1007/s11065-016-9317-1.CrossRefGoogle Scholar
  43. Tabachnick, B. G., & Fidell, L. S. (2006). Using multivariate statistics (5th ed.). Boston: Allyn & Bacon.Google Scholar
  44. Taylor, S., Frueh, B. C., & Asmundson, G. J. (2007). Detection and management of malingering in people presenting for treatment of posttraumatic stress disorder: methods, obstacles, and recommendations. Journal of Anxiety Disorders, 21(1), 22–41.  https://doi.org/10.1016/j.janxdis.2006.03.016.CrossRefPubMedGoogle Scholar
  45. Tierens, M., Bal, S., Crombez, G., Loeys, T., Antrop, I., & Deboutte, D. (2012). Differences in posttraumatic stress reactions between witnesses and direct victims of motor vehicle accidents. Journal of Traumatic Stress, 25(3), 280–287.CrossRefPubMedGoogle Scholar
  46. Weathers, F.W., Litz, B.T., Keane, T.M., Palmieri, P.A., Marx, B.P., & Schnurr, P.P. (2013). The PTSD checklist for DSM-5 (PCL-5). Retrieved from http://www.ptsd.va.gov/professional/assessment/documents/PCL-5_Standard.pdf.
  47. Widows, M. R., & Smith, G. P. (2005). Structured Inventory of Malingered Symptomatology professional manual. Odessa, FL: Psychological Assessment Resources.Google Scholar
  48. Zimering, R., Gulliver, S. B., Knight, J., Munroe, J., & Keane, T. M. (2006). Posttraumatic stress disorder in disaster relief workers following direct and indirect trauma exposure to ground zero. Journal of Trauma Stress, 19(4), 553–557.  https://doi.org/10.1002/jts.20143.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.School of Psychology and Counselling, O Block B Wing, Kelvin Grove CampusQueensland University of TechnologyBrisbaneAustralia
  2. 2.Institute of Health and Biomedical InnovationQueensland University of TechnologyBrisbaneAustralia

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