Monday, January 21, 2008

A Certain Symptom of PTSD May Suggest an Element of Malingering

The DSM-IV (Diagnostic and Statistical Manual of Mental Disorders) describes a formula clinicians can use to screen plaintiffs in lawsuits for malingering of mental disorders. This formula is composed of four elements, one of which is the failure of an individual to cooperate with prescribed treatment. According to the DSM-IV, the clinician should "strongly suspect" malingering when any combination of the four elements is noted.

Clinicians should be careful in concluding there may be malingering even if a recommendation of treatment has not been implemented and even when the individual being assessed has two or more of the four elements described in DSM-IV. There may be alternative reasons why an individual has not followed a recommendation for treatment that have nothing to do with malingering of psychological symptoms.

One of the defining symptoms of Post-traumatic Stress Disorder (PTSD) is a pattern of avoidance of situations that are associated with a trauma. If an individual has been severely traumatized or witnessed the severe injury or death of another person in, for example, an automobile accident, the individual may avoid conversations about that accident because those conversations would be likely to arouse bothersome memories or frightening nightmares about the trauma or other forms of severe emotional distress. Avoiding conversations about an extremely emotionally-charged subject may be one way a traumatized individual may attempt to protect himself or herself from the futher experience of trauma.

A clinician, however, may misinterpret the unwillingness of a plaintiff to participate in treatment as an indicator of malingering.

If malingering is suspected, the clinician should obtain several sources of information, such as data from an interview, psychological tests designed to identify malingering and information from collateral contacts.

What appears to be a sign of malingering may be a genuine symptom of a mental disorder.

For more information on this subject, please visit my Forensic Psychology Services website and click on the button labeled "Articles".

Wednesday, January 16, 2008

Psychological Symptoms are easily exaggerated or faked

Exaggeration or faking of psychological symptoms is a serious problem in Worker's Compensation, disability or personal injury cases because the accuracy of information provided by the plaintiff (injured person) is critical in determination of psychological damages resulting from injury. This is particularly so when damages include psychological symptoms or mental disorders because, unlike physical injuries, there are no x-rays or other tests that can definitively show that an individual is in fact suffering from emotional distress.

Some scientific studies have shown that untrained individuals can easily exaggerate or fake symptoms, such as anxiety or depression, on psychological tests. The reason this can be done by individuals who have little knowledge of psychological matters is that most psychological tests in common use today lack any kind of mechanism to determine that an individual has not responded honestly to a psychological test.

Because of a number of factors, such as time and money limitations, psychologists and psychiatrists often do not utilize the more comprehensive tests that have demonstrated effectiveness in determining that an individual has exaggerated or faked psychological symptoms. Typically, mental health professionals who are providing treatment to an injured person do not engage in efforts to identify exaggeration or faking of psychological symptoms because exaggeration or faking are believed to be relatively rare phenomena in such settings or because the skeptical attitude on the part of the treating doctor suggested by his or her evaluation of exaggeration or faking can be construred by the patient as evidence of mistrust by the psychotherapist. This perceived lack of trust in what the patient is telling the doctor can be harmful in a treatment relationship because trust by the patient in the doctor may be one necessary and important element of successful treatment.

However, individuals who are already in treatment or who begin treatment for psychological problems after a personal or work accident, sometimes seek legal redress for their injuries. Subsequently, the treating doctor can be called upon to provide written reports or courtroom testimony about their treatment. Because the treating doctor had no way of knowing that a legal case was forthcoming, he or she did not have a reason to administer time-consuming and expensive psychological tests designed to identify exaggeration or faking. In this situation, the testimony that can be offered by the treating doctor is based on clinical interviews or notes of treatment sessions. If the treating doctor's patient has been exaggerating or faking psychological symptoms in the treatment setting for the purpose of enhancing a future legal claim, this may be unknown to the treating doctor.

Most research shows that clinical interview alone, without specialized psychological testing, is not an effective method for identifying exaggeration or faking of psychological symptoms or mental disorders.

Only specialized tests such as Minnesota Multiphasic Personality Inventory (MMPI-2), SIRS and M-FAST have been shown to be effective in identifying exaggerated or faked psychological symptoms.