Skip to main content
SpringerLink
Log in

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

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

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.

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
Fig. 2
Fig. 3

Similar content being viewed by others

Notes

  1. Cloud-based Participant Management Software.

  2. This time frame was used to distinguish PTSD from acute stress disorder.

  3. Self-identified ethnicity was collapsed into two categories (Australian and other). The following variables were each collapsed into three categories: marital status (married, single, other), primary occupation (employed/self-employed, student, retired), education level (school/other, undergraduate degree, postgraduate degree), and income level (≤ $37,000, $37,001–$80,000, ≥ $80,001).

  4. Whether patterns of responding are similar or unique between groups.

References

  • 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.

    Article  PubMed  Google Scholar 

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, D.C: Author.

    Book  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • Bowman, M. L. (1999). Individual differences in posttraumatic distress: problems with the DSM-IV model. Canadian Journal of Psychiatry, 44, 21–33.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  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  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 child sexual abuse. Journal of Nervous & Mental Disease, 188, 708–713.

    Article  Google Scholar 

  • Field, A. (2014). Discovering statistics using IBM SPSS statistics and sex drugs rock ‘n’ roll. London: Sage.

    Google Scholar 

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

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • Guriel, J., & Fremouw, W. (2003). Assessing malingered posttraumatic stress disorder: a critical review. Clinical Psychology Review, 23(7), 881–904.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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 

  • 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.

    Chapter  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • Tabachnick, B. G., & Fidell, L. S. (2006). Using multivariate statistics (5th ed.). Boston: Allyn & Bacon.

    Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

  • Widows, M. R., & Smith, G. P. (2005). Structured Inventory of Malingered Symptomatology professional manual. Odessa, FL: Psychological Assessment Resources.

    Google Scholar 

  • 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.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. School of Psychology and Counselling, O Block B Wing, Kelvin Grove Campus, Queensland University of Technology, Victoria Park Road, Kelvin Grove, Brisbane, QLD, 4059, Australia

    Elizabeth G. Szogi & Karen A. Sullivan

  2. Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia

    Karen A. Sullivan

Authors
  1. Elizabeth G. Szogi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Karen A. Sullivan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Karen A. Sullivan.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest.

Appendix 1: Vignettes

Appendix 1: Vignettes

In real life, people sometimes fake symptoms. They might do this for many reasons, such as trying to get out of work or to influence a compensation claim. When a person decides to fake symptoms, they are usually trying not to get caught. In this experiment, we are interested in how well people can fake symptoms of posttraumatic stress disorder (PTSD), and we want you to do the faking. To get you started, follow these instructions. First, I want you to imagine that: you witnessed the death of a close family member in a motor vehicle accident OR (2) you learnt about the death of a close family member in a motor vehicle accident.

Now I want you to imagine that you are fully recovered after the initial shock. Now, imagine that it is 3 months after the death of a close family member in a car accident. You watch a television show about people receiving monetary compensation in litigation cases when they developed posttraumatic stress disorder following a traumatic event. Although you are well, you decide to pretend (or fake) that you have posttraumatic stress disorder as a result of the death of a close family member to try to get some money. To get this money, you will have to do a test for PTSD. You want the test to show that you have this disorder, but you do not want the test to show that you are faking. If you are not careful, you could be found out and potentially risk prosecution.

You decide to search the internet to find out about PTSD and how it is diagnosed. You find a list of symptoms and decide to study it. We will actually ask you to read and study this list in real life, and to make sure you have studied it properly, we will quiz you at the end. Remember, it is very important that you fake the test carefully and try to respond as you would if you were in the situation.

Once you pass the quiz and you move on to the diagnostic test, you should begin faking. Please remember that you are trying to fake the test but not get caught. Answer the tests imaging that the more convincing you are that you have PTSD, the more likely it is that you would be awarded a large monetary settlement for PTSD if this were a real case. We’ll remind you again right before the diagnostic tests when it’s time to start faking.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Szogi, E.G., Sullivan, K.A. Malingered Posttraumatic Stress Disorder (PTSD) and the Effect of Direct Versus Indirect Trauma Exposure on Symptom Profiles and Detectability. Psychol. Inj. and Law 11, 351–361 (2018). https://doi.org/10.1007/s12207-018-9315-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12207-018-9315-0

Keywords

Search

Navigation