Can Coached PTSD be detected with the MMPI-2?

I often find that the diagnosis of Posttraumatic Stress Disorder (PTSD) has been assigned to claimants in disability, personal injury and worker’s compensations cases. My experience is that many claimed instances of PTSD are genuine though some are exaggerated or faked.

The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) specifically states that malingering must be ruled out before the diagnosis of PTSD can be made.

Psychologists, aware that some litigants may exaggerate or fake psychological disorders such as PTSD, have developed psychological tests containing special scales or strategies that are used to detect faking. One such test is the Minnesota Multiphasic Personality Inventory, also referred to as the “MMPI-2”. The MMPI-2 contains special “validity scales” that have been scientifically shown to be effective in detecting exaggeration or faking of psychological symptoms. The MMPI-2 is probably the most often used measure of psychopathology that also assesses malingering.

An important question is whether tests, such as the MMPI-2, can distinguish between faked and genuine PTSD when test-takers are given specific information about PTSD and about the MMPI-2.

How do litigants obtain information about PTSD? One way that litigants may learn about PTSD is through exposure to the media. There are more articles in the newspapers and on TV about PTSD today than in past. This may be especially true at the present time, during a war, because combatants may be exposed to severely traumatic situations that can potentially cause mental disorders such as PTSD. In addition, the specific diagnostic criteria for PTSD and a variety of other information about this disorder is available on-line. Some litigants may also learn about PTSD and specific techniques to improve the chances of successful faking PTSD from their attorney. In a study of 70 practicing attorneys and 150 law students conducted in 1995 and published in Professional Psychology: Research and Practice, Wetter and Corrigan found that more than one-third of law students and almost one-half of lawyers believed they were responsible “to inform the client of scales on psychological tests that are designed to detect exaggerated or faked responses”.

Utilizing MMPI-2 scales to distinguish between faked and genuine PTSD among research subjects: Coaching subjects about the symptoms of PTSD or about the validity scales contained within the MMPI-2 has been employed in investigations of whether the MMPI-2 can distinguish between faked and genuine PTSD. Bury and Bagby published such a study in the journal Psychological Assessment in 2002. Investigators in this study randomly assigned 131 research subjects to one of four groups: “uncoached”, “coached about PTSD symptom information”, “coached about MMPI-2 validity scales” and “coached about both symptoms and validity scales”. Following the coaching instructions, subjects were asked to simulate PTSD on the MMPI-2 test. Results from the MMPI-2 tests of coached subjects were then compared to those of individuals who had developed genuine PTSD following workplace accidents. Results of this study were similar to those of previous studies which showed that giving research subjects information about the symptoms of a mental disorder (in this case, PTSD) did not help them to avoid detection as fakers. As in previous investigations, individuals who were taught about the validity scales demonstrated a degree of success in avoiding detection while faking a mental disorder (PTSD in this study).

Conclusions: The MMPI-2 validity scales demonstrate somewhat reduced capacity to identify faking when test-takers are provided with validity scale information. However, the Bury and Bagby study, which provided research subjects with specific information about avoiding detection by the Fp scale of the MMPI-2, showed that Fp remained effective in distinguishing between genuine and faked PTSD.

Recommendations: When insurers and attorneys are concerned that a claimant may be faking PTSD and, especially when there is reason to fear that a claimant may have been coached in techniques for malingering of PTSD, the MMPI-2 can be very helpful in differentiating between faked PTSD and the real disorder. For more information about PTSD and malingering, click on the “articles” button at my website.