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Symptom Validity Testing in Claimants with Alleged Posttraumatic Stress Disorder: Comparing the Morel Emotional Numbing Test, the Structured Inventory of Malingered Symptomatology, and the Word Memory Test

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Abstract

In independent medical examinations, unjustified claims of posttraumatic stress disorder (PTSD) are to be expected at an increased rate. In a prospective study, consecutive cases of patients claiming PTSD who underwent independent neuropsychiatric evaluation were analyzed. For 61 adult patients, results of three symptom validity tests (Morel Emotional Numbing Test, Structured Inventory of Malingered Symptomatology, and Word Memory Test) were available. Seventy percent of all claimants showed probable negative response bias in at least one of the three tests, 25% in all three tests. High probability of negative response bias was associated with symptom overreporting and demonstration of cognitive deficits in performance tests. The results indicate that high rates of uncooperativeness must be expected in civil forensic patients with claimed PTSD. A multi-method approach to the assessment of response distortion in PTSD claimants is indicated.

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References

  • American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington: American Psychiatric Association.

    Google Scholar 

  • Andrews, B., Brewin, C. R., Philpott, R., & Stewart, L. (2007). Delayed-onset posttraumatic stress disorder: A systematic review of the evidence. American Journal of Psychiatry, 164, 1319–1326.

    Article  PubMed  Google Scholar 

  • Arbisi, P. A., Ben-Porath, Y. S., & McNulty, J. (2006). The ability of the MMPI-2 to detect feigned PTSD within the context of compensation seeking. Psychological Services, 3, 249–261.

    Article  Google Scholar 

  • Beers, S. R., & De Bellis, M. D. (2002). Neuropsychological function in children with maltreatment-related posttraumatic stress disorder. American Journal of Psychiatry, 159, 483–486.

    Article  PubMed  Google Scholar 

  • Bonanno, G. A., Rennicke, G., & Dekel, S. (2005). Self-enhancement among high exposure survivors of the September 11th terrorist attack: Resilience or social maladjustment? Journal of Personality and Social Psychology, 88, 984–998.

    Article  PubMed  Google Scholar 

  • Brockhaus, R., & Merten, T. (2004). Neuropsychologische Diagnostik suboptimalen Leistungsverhaltens mit dem Word Memory Test [Neuropsychological assessment of suboptimal performance: The Word Memory Test]. Nervenarzt, 75, 882–887.

    Article  PubMed  Google Scholar 

  • Bury, A. S., & Bagby, R. M. (2002). The detection of feigned uncoached and coached post-traumatic stress disorder with the MMPI-2 in a sample of workplace accident victims. Psychological Assessment, 14, 472–483.

    Article  PubMed  Google Scholar 

  • Bush, S. S., Ruff, R. M., Tröster, A. I., Barth, J. T., Koffler, S. P., Pliskin, N. H., et al. (2005). Symptom validity assessment: Practice issues and medical necessity. Archives of Clinical Neuropsychology, 20, 419–426.

    Article  PubMed  Google Scholar 

  • Cima, M., Hollnack, S., Kremer, K., Knauer, E., Schellbach-Matties, R., Klein, B., et al. (2003). “Strukturierter Fragebogen Simulierter Symptome”. Die deutsche Version des “Structured Inventory of Malingered Symptomatology: SIMS” [The German version of the Structured Inventory of Malingered Symptomatology SIMS]. Nervenarzt, 74, 977–986.

    Article  PubMed  Google Scholar 

  • Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale: Erlbaum.

    Google Scholar 

  • Demakis, G. J., Gervais, R. O., & Rohling, M. L. (2008). The effect of failure on cognitive and psychological symptom validity tests in litigants with symptoms of post-traumatic stress disorder. The Clinical Neuropsychologist, 22, 879–895.

    Article  PubMed  Google Scholar 

  • Derogatis, L. R. (1994). SCL-90-R: Symptom Checklist-90-R. Minneapolis: NCS Pearson.

    Google Scholar 

  • Efendov, A. A., Sellbom, M., & Bagby, R. M. (2008). The utility and comparative incremental validity of the MMPI-2 and Trauma Symptom Inventory validity scales in the detection of feigned PTSD. Psychological Assessment, 20, 317–326.

    Article  PubMed  Google Scholar 

  • Elhai, J. D., Gold, P. B., Frueh, B. C., & Gold, S. N. (2000). Cross-validation of the MMPI-2 in detecting malingered posttraumatic stress disorder. Journal of Personality Assessment, 75, 449–463.

    Article  PubMed  Google Scholar 

  • Elhai, J. D., Gold, S. N., Sellers, A. H., & Dorfman, W. I. (2001). The detection of malingered posttraumatic stress disorder with MMPI-2 fake bad indices. Assessment, 8, 221–236.

    Article  PubMed  Google Scholar 

  • Faust, D. (1995). The detection of deception. Neurologic Clinics, 13, 255–265.

    PubMed  Google Scholar 

  • Faust, D., Hart, K., Guilmette, T. J., & Arkes, H. R. (1988). Neuropsychologists' capacity to detect adolescent malingerers. Professional Psychology: Research and Practice, 5, 508–515.

    Article  Google Scholar 

  • Freeman, T., Hart, H., & Kimbrell, T. (2005). Symptom exaggeration in Veterans populations with PTSD: Preliminary findings. Unpublishedmanuscript, Department of Psychiatry, University of Arkansas Medical Sciences, Little Rock. Cit. in Taylor et al. (2007).

  • Freeman, T., Powell, M., & Kimbrell, T. (2008). Measuring symptom exaggeration in veterans with chronic posttraumatic stress disorder. Psychiatry Research, 158, 374–380.

    Article  PubMed  Google Scholar 

  • Frueh, B. C., Hamner, M. B., Cahill, S. P., Gold, P. B., & Hamlin, K. L. (2000). Apparent symptom overreporting in combat veterans evaluated for PTSD. Clinical Psychology Review, 20, 853–885.

    Article  PubMed  Google Scholar 

  • Geraerts, E., Jelicic, M., & Merckelbach, H. (2006). Symptom overreporting and recovered memories of childhood sexual abuse. Law and Human Behavior, 30, 621–630.

    Article  PubMed  Google Scholar 

  • Gilbertson, M. W., Paulus, L. A., Williston, S. K., Gurvits, T. V., Lasko, N. B., Pitman, R. K., et al. (2006). Neurocognitive function in monozygotic twins discordant for combat exposure: Relationship to posttraumatic stress disorder. Journal of Abnormal Psychology, 115, 484–495.

    Article  PubMed  Google Scholar 

  • Green, P. (2003). Green's Word Memory Test for Windows: User's manual. Edmonton: Green's Publishing.

    Google Scholar 

  • Green, P. (2007). Spoiled for choice: Making comparisons between forced-choice effort tests. In K. B. Boone (Ed.), Assessment of feigned cognitive impairment. A neuropsychological perspective (pp. 50–77). New York: Guilford.

    Google Scholar 

  • Green, P., Rohling, M. L., Lees-Haley, P. R., & Allen, L. M. (2001). Effort has a greater effect on test scores than severe brain injury in compensation claimants. Brain Injury, 15, 1045–1060.

    Article  PubMed  Google Scholar 

  • Greiffenstein, M. F., & Baker, W. J. (2008). Validity testing in dually diagnosed post-traumatic stress disorder and mild closed head injury. The Clinical Neuropsychologist, 22, 565–582.

    Article  PubMed  Google Scholar 

  • Greiffenstein, M. F., Baker, W. J., & Gola, T. (1994). Validation of malingered amnesia measures with a large clinical sample. Psychological Assessment, 6, 218–224.

    Article  Google Scholar 

  • Greiffenstein, M. F., Baker, W. J., Axelrod, B., Peck, E. A., & Gervais, R. (2004). The Fake Bad Scale and MMPI-2 F-family in detection of implausible psychological trauma claims. The Clinical Neuropsychologist, 18, 573–590.

    Article  PubMed  Google Scholar 

  • Heaton, R. K., Smith, H. H., Lehman, R. A. W., & Vogt, A. T. (1978). Prospects for faking believable deficits on neuropsychological testing. Journal of Consulting and Clinical Psychology, 46, 892–900.

    Article  PubMed  Google Scholar 

  • Hartman, D. E. (2002). The unexamined lie is a lie worth fibbing. Neuropsychological malingering and the Word Memory Test. Archives of Clinical Neuropsychology, 17, 709–714.

    PubMed  Google Scholar 

  • Horner, M. D., & Hamner, M. B. (2002). Neurocognitive functioning in posttraumatic stress disorder. Neuropsychology Review, 12, 15–30.

    Article  PubMed  Google Scholar 

  • Inman, T. H., & Berry, D. T. R. (2002). Cross-validation of indicators of malingering: A comparison of nine neuropsychological tests, four tests of malingering, and behavioral observations. Archives of Clinical Neuropsychology, 17, 1–23.

    PubMed  Google Scholar 

  • Iverson, G. L. (2005). Outcome from mild traumatic brain injury. Current Opinion in Psychiatry, 18, 301–317.

    Article  PubMed  Google Scholar 

  • Larbig, F., Jelinek, L., Kellner, M., Biesold, K.-H., Barre, K., & Moritz, S. (2008). Subjective premorbid memory in posttraumatic stress disorder. German Journal of Psychiatry, 12, 149–152.

    Google Scholar 

  • Larrabee, G. J. (2008). Aggregation across multiple indicators improves the detection of malingering: Relationship to likelihood ratios. The Clinical Neuropsychologist, 22, 666–679.

    Article  PubMed  Google Scholar 

  • Lees-Haley, P. R. (1997). Attorneys influence expert evidence in forensic psychological and neuropsychological cases. Assessment, 4, 321–324.

    Google Scholar 

  • Lees-Haley, P. R., English, L. T., & Glenn, W. J. (1991). A Fake Bad Scale on the MMPI-2 for personal injury claimants. Psychological Reports, 68, 208–210.

    Article  Google Scholar 

  • Maercker, A., & Schützwohl, M. (1998). Erfassung von psychischen Belastungssfolgen: Die Impact of Event Skala-revidierte Version [Assessment of posttraumatic stress reactions: The Impact of Event Scale—Revised]. Diagnostica, 44, 130–141.

    Google Scholar 

  • McNally, R. J. (2003). Progress and controversy in the study of posttraumatic stress disorder. Annual Review of Psychology, 54, 229–252.

    Article  PubMed  Google Scholar 

  • McNally, R. J. (2007). Can we solve the mysteries of the National Vietnam Veterans Readjustment Study? Journal of Anxiety Disorders, 21, 192–200.

    Article  PubMed  Google Scholar 

  • Merten, T., Bossink, L., & Schmand, B. (2007a). On the limits of effort testing: Symptom validity tests and severity of neurocognitive symptoms in nonlitigant patients. Journal of Clinical and Experimental Neuropsychology, 29, 308–318.

    Article  PubMed  Google Scholar 

  • Merten, T., Friedel, E., & Stevens, A. (2007b). Die Authentizität der Beschwerdenschilderung in der neurologisch-psychiatrischen Begutachtung: eine Untersuchung mit dem Strukturierten Fragebogen Simulierter Symptome. [The authenticity of symptom report in forensic neuropsychiatric assessment: A study with the Structured Inventory of Malingered Symptomatology]. Praxis der Rechtspsychologie, 17, 140–154.

    Google Scholar 

  • Messer, J. M., & Fremouw, W. J. (2007). Detecting malingered posttraumatic stress disorder using the Morel Emotional Numbing Test—Revised (MENT-R) and the Miller Forensic Assessment of Symptoms Test (M-FAST). Journal of Forensic Psychology Practice, 7(3), 33–57.

    Article  Google Scholar 

  • Moore, S. A. (2008). Cognitive abnormalities in posttraumatic stress disorder. Author. Current Opinion in Psychiatry, 22, 19–24.

    Article  Google Scholar 

  • Morel, K. R. (1998a). Manual for the morel emotional numbing test for posttraumatic stress disorder.

  • Morel, K. R. (1998b). Development and preliminary validation of a forced-choice test of response bias for posttraumatic stress disorder. Journal of Personality Assessment, 70, 299–314.

    Article  PubMed  Google Scholar 

  • Morel, K. R. (2007). Morel-Test zum “Gefuehl der Gefuehllosigkeit” bei posttraumatischer Belastungsstoerung (PTBS) [Morel Emotional Numbing Test for posttraumatic stress disorder]. German adaptation by T. Merten and A. Stevens. Author.

  • Morel, K. R. (2008). Comparison of the Morel Emotional Numbing Test for Post-Traumatic Stress Disorder to the Word Memory Test in neuropsychological evaluations. The Clinical Neuropsychologist, 22, 350–362.

    Article  PubMed  Google Scholar 

  • Morel, K. R., & Marshman, K. C. (2008). Critiquing symptom validity tests for posttraumatic stress disorder: A modification of Hartman's criteria. Journal of Anxiety Disorders, 22, 1542–1550.

    Article  PubMed  Google Scholar 

  • Morel, K. R., & Shepherd, B. E. (2008). Meta-analysis of the Morel Emotional Numbing Test for PTSD: Comment on Singh, Avasthi, and Grover. German Journal of Psychiatry, 11, 128–131.

    Google Scholar 

  • Nelson, N. W., Boone, K., Dueck, A., Wagener, L., Lu, P., & Grills, C. (2003). Relationships between eight measures of suspect effort. The Clinical Neuropsychologist, 17, 263–272.

    PubMed  Google Scholar 

  • Nelson, N. W., Sweet, J. J., Berry, D. T., Bryant, F. B., & Granacher, R. P. (2007). Response validity in forensic neuropsychology: exploratory factor analytic evidence of distinct cognitive and psychological constructs. Journal of the International Neuropsychological Society, 13, 440–449.

    PubMed  Google Scholar 

  • Reitan, R. M. (1992). Trail Making Test. Manual for administration and scoring. South Tucson: Reitan Neuropsychology Laboratory.

    Google Scholar 

  • Resnick, P. J., & Harris, M. R. (2002). Retrospective assessment of malingering in insanity defense cases. In R. I. Simon & D. W. Shuman (Eds.), Retrospective assessment of mental states in litigation: Predicting the past (pp. 101–134). Washington: American Psychiatric Publishing.

    Google Scholar 

  • Resnick, P. J., West, S., & Payne, J. W. (2008). Malingering of posttraumatic disorders. In R. Rogers (Ed.), Clinical assessment of malingering and deception (3rd ed., pp. 109–127). New York: Guilford.

    Google Scholar 

  • Rogers, R., Bagby, R. M., & Dickens, S. E. (1992). Structured Interview of Reported Symptoms (SIRS). Professional Manual. Lutz: Psychological Assessment Resources.

    Google Scholar 

  • Rogers, R., Sewell, K. W., Martin, M. A., & Vitacco, M. J. (2003). Detection of feigned mental disorders: A meta-analysis of the MMPI-2 and malingering. Assessment, 10, 160–177.

    Article  PubMed  Google Scholar 

  • Rosen, G. M. (1995). The Aleutian Enterprise sinking and posttraumatic stress disorder: Misdiagnosis in clinical and forensic settings. Professional Psychology: Research and Practice, 26, 82–87.

    Article  Google Scholar 

  • Rosen, G. M. (ed). (2004). Posttraumatic stress disorder: Issues and controversies. Chichester: Wiley.

    Google Scholar 

  • Rosen, G. M. (2006). DSM's cautionary guideline to rule out malingering can protect the PTSD data base. Journal of Anxiety Disorders, 20, 530–535.

    Article  PubMed  Google Scholar 

  • Rosen, G. M., & Powel, J. E. (2003). Use of a symptom validity test in the forensic assessment of posttraumatic stress disorder. Journal of Anxiety Disorders, 17, 361–367.

    Article  PubMed  Google Scholar 

  • Rosen, G. M., & Taylor, S. (2007). Pseudo-PTSD. Journal of Anxiety Disorders, 21, 201–210.

    Article  PubMed  Google Scholar 

  • Rubenzer, S. (2009). Posttraumatic stress disorder: Assessing response style and malingering. Psychological Injury and the Law, 2, 114–142.

    Article  Google Scholar 

  • Ruiz, M. A., Drake, E. B., Glass, A., Marcotte, D., & van Gorp, W. G. (2002). Trying to beat the system: Misuse of the Internet to assist in avoiding the deception of psychological symptom dissimulation. Psychological Psychology: Research and Practice, 33, 294–299.

    Article  Google Scholar 

  • Ruocco, A. C., Swirsky-Sacchetti, T., Chute, D. L., Mandel, S., Platek, S. M., & Zillmer, E. A. (2008). Distinguishing between neuropsychological malingering and exaggerated psychiatric symptoms in a neuropsychological setting. The Clinical Neuropsychologist, 22, 547–564.

    Article  PubMed  Google Scholar 

  • Schacter, D. L. (1986). On the relation between genuine and simulated amnesia. Behavioral Sciences and the Law, 4, 47–64.

    Article  Google Scholar 

  • Schellig, D., & Schächtele, B. (2001). VVM—Visueller und Verbaler Merkfähigkeitstest [Visual and Verbal Retention Test]. Göttingen: Hogrefe.

    Google Scholar 

  • Schmand, B., & Lindeboom, J. (2005). The Amsterdam Short-Term Memory Test. Manual. Leiden: PITS.

    Google Scholar 

  • Schroedter, J. H., Lechert, Y., & Lüttinger, P. (2006). Die Umsetzung der Bildungsskala ISCED-1997 für die Volkszählung 1970, die Mikrozensus- Zusatzerhebung 1971 und die Mikrozensen 1976-2004. ZUMA-Methodenbericht 2006/08 [The adaptation of the educational scale ISCED-1997 for the census of 1970, the microcensus of 1971, and the microcensuses 1976 to 2004]. Mannheim: ZUMA.

  • Smith, G. P., & Burger, G. K. (1997). Detection of malingering: Validation of the Structured Inventory of Malingered Symptomatology (SIMS). Journal of the American Academy of Psychiatry and the Law, 25, 183–189.

    PubMed  Google Scholar 

  • Spitzer, R. L., First, M. B., & Wakefield, J. C. (2007). Saving PTSD from itself in DSM-V. Journal of Anxiety Disorders, 21, 233–241.

    Article  PubMed  Google Scholar 

  • Stevens, A., Friedel, E., Mehren, G., & Merten, T. (2008). Malingering and uncooperativeness in psychiatric and psychological assessment: Prevalence and effects in a German sample of claimants. Psychiatry Research, 157, 191–200.

    Article  PubMed  Google Scholar 

  • Taylor, S., Frueh, B. C., & Asmundson, G. J. G. (2007). Detection and management of malingering in people presenting for treatment of posttraumatic stress disorder: Methods, obstacles, and recommendations. Journal of Anxiety Disorders, 21, 22–41.

    Article  PubMed  Google Scholar 

  • Tombaugh, T. N. (1996). Test of Memory Malingering (TOMM). North Tonawanda: Multi-Health Systems.

    Google Scholar 

  • United Nations Educational, Scientific and Cultural Organization (1997). International standard classification of education or ISCED-1997. Retrieved 6 January 2008 from http://www.uis.unesco.org/TEMPLATE/pdf/isced/ISCED_A.pdf.

  • Vasterling, J. J., Duke, L. M., Brailey, K., Constans, J. I., Allain, A. N., & Sutker, P. B. (2002). Attention, learning, and memory performances and intellectual resources in Vietnam veterans: PTSD and no disorder comparisons. Neuropsychology, 16, 5–14.

    Article  PubMed  Google Scholar 

  • Vrij, A. (2000). Detecting lies and deceit. The psychology of lying and the implications for professional practice. Chichester: Wiley.

    Google Scholar 

  • Wechsler, D. (1997). Wechsler Adult Intelligence Scale (3rd ed.). San Antonio: The Psychological Corporation.

    Google Scholar 

  • Weiss, D. S., & Marmar, C. R. (1996). The Impact of Event Scale—Revised. In J. P. Wilson & T. M. Keane (Eds.), Assessing psychological trauma and PTSD (pp. 399–411). New York: Guilford.

    Google Scholar 

  • Widows, M. R., & Smith, G. P. (2005). SIMS—Structured Inventory of Malingered Symptomatology. Professional Manual. Lutz: Psychological Assessment Resources.

    Google Scholar 

  • Youngjohn, J. R. (1995). Confirmed attorney coaching prior to neuropsychological evaluation. Assessment, 2, 279–283.

    Article  Google Scholar 

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  1. Vivantes Netzwerk für Gesundheit, Klinikum im Friedrichshain, Klinik für Neurologie, Landsberger Allee 49, 10249, Berlin, Germany

    Thomas Merten

  2. Medizinisches Gutachteninstitut Tuebingen, Tuebingen, Germany

    Elisabeth Thies, Katrin Schneider & Andreas Stevens

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Merten, T., Thies, E., Schneider, K. et al. Symptom Validity Testing in Claimants with Alleged Posttraumatic Stress Disorder: Comparing the Morel Emotional Numbing Test, the Structured Inventory of Malingered Symptomatology, and the Word Memory Test. Psychol. Inj. and Law 2, 284–293 (2009). https://doi.org/10.1007/s12207-009-9057-0

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