There is evidence that individuals can fake posttraumatic stress symptoms in clinical interviews and self-report symptom inventories with considerable proficiency
(Liljequist et al., 1998; Morel, 1998; Sparr and Pankratz, 1983). On the basis of clinical skills alone, practitioners are considered quite poor in detecting fabricated symptoms (Lees-Haley and Dunn, 1994; Rosen 1995). Clinical experience almost inevitably provides more instances of seeming confirmation than is genuinely the case, fostering inflated confidence for the interviewer (Faust, 1995). Additionally, the extent of a practitioner's experience and the range of their credentials have little or no relation to the outcome of malingering detection (Faust et al., 1988). This pattern seems to be attributable, in part, to the tendency of practitioners to underestimate the knowledge, preparation, and skills of some malingerers (Faust, 1995).
In response to the problems in identifying malingering during interview, there are numerous guidelines available to identify malingered presentations (e.g. Resnick, 1995; Rogers, 1997a). Some of the suggested signs of possible malingering include unvarying and repetitive dreams, over-idealised functioning before the trauma, evasiveness, reporting of rare symptoms, global symptom endorsement, over-endorsement of obvious symptoms, atypical combinations of symptoms, excessive severity of reported symptoms, and reporting of symptoms that are inconsistent with the expected profile (Resnick, 1995; Rogers, 1997a). In addition, other commentators have suggested that malingering during an interview can be detected by resistance or avoidance to questioning (Pankratz, 1988), frequent hesitations in response to questions (Iverson, 1995), idealising prior functioning (Powell, 1991), and vagueness in the respondent's answers (Pitman et al., 1996). It should be noted, however, that there has been very little empirical study of these proposed guidelines, and the available evidence provides mixed support for these alleged indicators of malingering.
Many commentators have suggested that it is useful to draw a distinction between salient symptoms that may be more susceptible to successful malingering and subtle symptoms that malingerers are less likely to report (Rogers, 1997a). Bryant and Harvey (1998) required treatment-seeking PTSD participants and malingerers to listen to a sound effect of a crashing car, and then report their cognitive and affective responses to this stimulus. Their responses were audiorecorded and subsequently rated on a range of domains by independent psychologists. This study found that simulators and PTSD participants could not be distinguished in terms of their levels of imagery, intrusiveness of the reported memories, belief in the reality of the memory, affect, or movement of imagery. Simulators only differed from PTSD participants in that the latter reported trying to distract themselves from their memories to a greater extent than simulators. This study highlights that whereas it is difficult to identify malingerers on the basis of their reported re-experiencing symptoms, they have relative difficulty in mimicking how genuinely distressed people respond to symptoms. McBride and Bryant (2000) asked treatment-seeking PTSD patients and individuals instructed to malinger PTSD to provide information about their symptoms during an open-ended interview. Malingerers were less likely to report subtle symptoms, such as emotional numbing, than genuine patients. In contrast, when all participants were then asked to respond to directive questions about PTSD, malingerers reported emotional numbing more than the genuine patients. These findings indicate that whereas malingerers may be distinguished by an inferior ability to mimic subtle reactions to trauma during uncued interviewing, this difference may be reduced or reversed when the malingerer is provided with cues about expected PTSD symptoms.
There is increasing attention given to the influence of coaching on malingerers' ability to mimic psychological injury (Rogers, 1997a). In a comparison of naive and coached simulators and genuine PTSD patients, one study found that coached simulators scored higher on a range of psychopathology measures than naive simulators (Hickling et al., 1999). Freitag and Bryant (2001) found that both naive and coached malingerers reported dissociative amnesia, emotional numbing, and a sense of a foreshortened future less often than treatment-seeking PTSD patients. Moreover, coached malingerers reported a sense of a foreshortened future more than naive malingerers. These patterns point to the important differences between reports provided in response to open-ended interviews and those made in response to directive questioning about PTSD symptoms.
Attempts have also been made to identify speech patterns of people trying to malinger. Deceptive comments (not pertaining to psychological disorders) tend to be shorter, more general, contain a smaller number of specific references to people and places, and contain over-generalising words (Miller and Stiff, 1993). Deception is also associated with more pauses (Alonso-Quecuty, 1992), slower responses and slower speech rate (Ekman and O'Sullivan, 1991). In terms of PTSD, Carr-Walker and Bryant (2001) found that treatment-seeking patients with posttraumatic stress displayed less hesitation, less exaggeration, and less vagueness than malingerers.
Overall, there is little evidence to support definitive claims about the means of identifying malingering. Although there is some evidence to suggest that exaggeration of symptom reporting, hesitant responses, over-endorsement of obvious symptoms, positive responding to cued questioning, and over-generalising terms are associated with simulated responses, there is a need to recognise that these findings are based on few studies. In the context of defending decisions about malingered presentations in a legal context, it should be conceded that these findings have typically been found in small sample sizes and with non-clinical populations following simulation instructions. More importantly, it should be recognised that many of the other proposed guidelines for detecting malingered PTSD (e.g. unvarying dreams, inconsistent presentations between assessments) have no justification from controlled studies.
Available evidence would suggest that interviews should commence with open-ended interview that does not cue the respondent to desired responses, and then proceed to more directive questioning about the problems that comprise the compensation claim. This procedure has empirical support from evidence that simulators will tend to under-report symptoms (especially subtle symptoms) during open-ended questioning and over-report symptoms during cued questioning (McBride and Bryant, 2001). Interviewers should be cautious in interpreting claimants' responses, however, because many genuine cases may also under-report for genuine reasons. For example, people with PTSD may avoid reporting symptoms because talking about them elicits distress (Schwarz and Kowalski, 1992) or they fail to perceive that some symptoms are related to a stressful event (Solomon and Canino, 1990). This situation points to the simplicity of decision rules that employ dichotomous categories or cut-off scores because there may be numerous reasons why an individual may report a symptom in a particular way (Rogers, 1997b). Until there is a substantive increase in cross-validation studies, there is little evidence to guide interpretation of reporting patterns and one should be careful about placing excessive emphasis on detection strategies based on single studies.
Was this article helpful?