Anxiety and mood (대한불안의학회지)

Korean Academy of Anxiety Disorders (대한불안의학회)
권호 표지

Measuring Symptom Exaggeration in Posttraumatic Stress Disorder using the MMPI-2 and the Personality Assessment Inventory Symptom Validity Scales

MMPI-2와 Personality Assessment Inventory 타당도 척도를 이용한 외상후 스트레스 장애 환자의 증상과장 평가

  • Kong, Sung-Whoi (Department of Psychiatry, Eulji University School of Medicine) ;
  • Chae, Jeong-Ho (Department of Psychiatry, College of Medicine, The Catholic University of Korea) ;
  • Lee, Jong-Hun (Department of Psychiatry3, College of Medicine, The Catholic University of Korea) ;
  • Hahn, Sang-Woo (Department of Psychiatry, Soonchunhyang University of College of Medicine) ;
  • Park, Eun-Jin (Department of Psychiatry, Eulji University School of Medicine) ;
  • Choi, Kyeong-Sook (Department of Psychiatry, Eulji University School of Medicine) ;
  • 공성회 (을지대학교 의과대학 정신건강의학교실) ;
  • 채정호 (가톨릭대학교 의과대학 정신건강의학교실) ;
  • 이종훈 (대구가톨릭대학교 의과대학 정신건강의학교실) ;
  • 한상우 (순천향대학교 의과대학 서울병원 정신건강의학교실) ;
  • 박은진 (을지대학교 의과대학 정신건강의학교실) ;
  • 최경숙 (을지대학교 의과대학 정신건강의학교실) ;
  • 대한불안의학회 PTSD 연구회 (대한불안의학회)
  • Received : 2012.02.15
  • Accepted : 2012.04.10
  • Published : 2012.04.30
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Abstract

Objective : We investigated whether Posttraumatic stress disorder patients have a higher tendency to exaggerate the extent of their psychological symptoms compared to other psychiatric patients. Methods : Medical records of patients, who had received psychiatric treatment at four university hospitals in Korea between January 2009 and December 2010, were retrospectively reviewed. We compared a group of 37 patients diagnosed with PTSD, and another group of 41 patients diagnosed with neurotic, stress-related and somatoform disorders according to the ICD-10. To compare the extent of malingering in the two groups, we compared the validity scales of MMPI-2 and Personality Assessment Inventory. We determined the number of participants in both groups feigning their responses by using various cutoff scores of the validity indicators. Results : The PTSD group showed significantly higher scores on the F (p=0.001), F (B)(p=0.000), F (P)(p=0.030), F-K (p=0.003) scale of the MMPI-2 compared to the other group of psychiatric patients. The PTSD group had a significantly higher NIM score (p=0.001) but a lower PIM score (p=0.020) of the PAI compared to the other group of psychiatric patients. Using the cutoff scores, the PTSD group showed a significantly higher number of patients who feigned responses compared to the other group ($Fb{\geq}75$ (p=0.010), $F-K{\geq}1$ (p=0.005), $F-K{\geq}10$ (p=0.011) from the MMPI-2, and $NIM{\geq}80$ (p=0.001) from the PAI). Conclusion : These results suggest that PTSD patients have a tendency to exaggerate their symptom. This group of patients overreported the severity of their condition during standardized personality assessment that included the MMPI-2 or PAI compared to patients diagnosed with other psychiatric disorders. Additional research is required to determine the factors influencing symptom exaggeration in PTSD.

Keywords

References

  1. Eldridge GD. Contextual issues in the assessment of post traumatic stress disorder. J Trauma Stress 1991;4:7-23. https://doi.org/10.1002/jts.2490040104
  2. Sparr LF, Atkinson RM. Posttraumatic stress disorder as an insanity defense: Medicolegal quicksand. Am J Psychiatry 1986;143:608-613. https://doi.org/10.1176/ajp.143.5.608
  3. Guriel J, Fremouw W. Assessing malingered posttraumatic stress disorder: A critical review. Clin Psychol Rev 2003;23:881-904. https://doi.org/10.1016/j.cpr.2003.07.001
  4. Sparr L, Pankratz LD. Factitious posttraumatic stress disorder. Am J Psychiatry 1983;140:1016-1019. https://doi.org/10.1176/ajp.140.8.1016
  5. Burkett BG, Whitley G. Stolen valor: How the Vietnam generation was robbed of its heroes and its history. Dallas, TX: Verity Press; 1998.
  6. Rosen GM. The Aleutian Enterprise sinking and posttraumatic stress disorder: Misdiagnosis in clinical and forensic settings. Prof Psychol Res Pract 1995;26:82-87. https://doi.org/10.1037/0735-7028.26.1.82
  7. Binder LM. Persisting symptoms after mild head injury: a review of the postconcussive syndrome. J Clin Exp Neuropsychol 1986;8:323-346. https://doi.org/10.1080/01688638608401325
  8. Rosen G. Posttraumatic stress disorder, pulp fiction and the press. Bull Am Acad Psychiatry Law 1996;24:267-269.
  9. Franklin CL, Repasky SA, Thompson KE, Shelton SA, Uddo M. Differentiating overreporting and extreme distress: MMPI-2 use with compensation-seeking veterans with PTSD. J Pers Assess 2002;79: 274-285. https://doi.org/10.1207/S15327752JPA7902_10
  10. Pitman RK, Sparr LF, Saunders LS, McFarlane AC. Legal issues in posttraumatic stress disorder. In: van de Kolk BA, McFarlane AC, Weisaeth L, editors. Traumatic stress: the effects of overwhelming experience on mind, body, and society. New York: The Guilford Press; 1996. p.378-397.
  11. Rosen G. DSM's cautionary guideline to rule out malingering can protect the PTSD data base. J Anxiety Disord 2006;20:530-535. https://doi.org/10.1016/j.janxdis.2005.03.004
  12. Rosen G, Taylor S. Pseudo-PTSD. J Anxiety Disord 2007;21:201-210. https://doi.org/10.1016/j.janxdis.2006.09.011
  13. Hickling EJ, Blanchard EB, Mundy E, Galovski TE. Detection of Malingered MVA Related Posttraumatic Stress Disorder. J Forensic Psychol Pract 2002;2:33-53.
  14. Williams CW, Lees-Haley PR, Djanogly SE. Clinical scrutiny of litigants' self-reports. Prof Psychol Res Pract 1999;30:361-367. https://doi.org/10.1037/0735-7028.30.4.361
  15. Hall RCW. Detection of malingered PTSD: an overview of clinical, psychometric, and physiological assessment: where do we stand? J Forensic Sci 2007;52:717-725. https://doi.org/10.1111/j.1556-4029.2007.00434.x
  16. Frueh BC, Elhai JD, Kaloupek DG. Unresolved issues in the assessment of trauma exposure and posttraumatic reactions. In: Rosen GM, editor. Issues and Controversies. New York: Wiley;2004. p.63-84.
  17. Jelicic M, Merckelbach H, van Bergen S. Symptom validity testing of feigned amnesia for a mock crime. Arch Clin Neuropsychol 2004; 19:525-531. https://doi.org/10.1016/j.acn.2003.07.004
  18. Wiley SD. Deception and detection in psychiatric diagnosis. Psychiatr Clin North Am 1998;21:869-893. https://doi.org/10.1016/S0193-953X(05)70046-0
  19. Cunnien AJ. Psychiatric and medical syndromes associated with deception. New York: Guilford Press;1988. p.13-33.
  20. Fairbank JA, McCaffrey RJ, Keane TM. Psychometric detection of fabricated symptoms of posttraumatic stress disorder. Am J Psychiatry 1985;142:501-503. https://doi.org/10.1176/ajp.142.4.501
  21. McCaffrey RJ, Bellamy Campbell R. Psychometric detection of fabricated symptoms of combat related post traumatic stress disorder: A systematic replication. J Clin Psychology 1989;45:76-79. https://doi.org/10.1002/1097-4679(198901)45:1<76::AID-JCLP2270450111>3.0.CO;2-H
  22. Elhai JD, Gold PB, Frueh BC, Gold SN. Cross-validation of the MM-PI-2 in detecting malingered posttraumatic stress disorder. J Pers Assess 2000;75:449-463. https://doi.org/10.1207/S15327752JPA7503_06
  23. Lees Haley PR. Efficacy of MMPI-2 validity scales and MCMI II modifier scales for detecting spurious PTSD claims: F, F K, fake bad scale, ego strength, subtle obvious subscales, DIS, and DEB. J Clin Psychol 1992;48:681-688. https://doi.org/10.1002/1097-4679(199209)48:5<681::AID-JCLP2270480516>3.0.CO;2-Q
  24. Rogers R, Sewell KW, Martin MA, Vitacco MJ. Detection of feigned mental disorders. Assess 2003;10:160-177. https://doi.org/10.1177/1073191103010002007
  25. Calhoun PS, Earnst KS, Tucker DD, Kirby AC, Beckham JC. Feigning combat-related posttraumatic stress disorder on the Personality Assessment Inventory. J Person Assess 2000;75:338-350. https://doi.org/10.1207/S15327752JPA7502_11
  26. Gray MJ, Elhai JD, Briere J. Evaluation of the Atypical Response scale of the Trauma Symptom Inventory-2 in detecting simulated posttraumatic stress disorder. J Anxiety Disord 2010;24:447-451. https://doi.org/10.1016/j.janxdis.2010.02.011
  27. Hathaway SR, McKinley JC. The Minnesota multiphasic personality inventory 2nd ed. Minneapolis: University of Minnesota Press; 1943.
  28. Butcher J, Dahlstrom W, Graham J, Tellegen A, Kaemmer B. Minnesota multiphasic personality inventory-2 (MMPI-2): Manual for administration and scoring. Minneapolis: University of Minnesota Press;1989.
  29. Morey L. An interpretive guide to the Personality Assessment Inventory (PAI). Psychological Assessment Resources, Inc, Odessa FL;1996.
  30. Kim YH, Kim JH, Oh SW, Lim YR, Hong SH. Standardization Stu-dy of Personality Assessment Inventory (PAI) : Reliability and Validity. Korean J Clin Psychol 2001;20:311-329.
  31. Perconte ST, Goreczny AJ. Failure to detect fabricated posttraumatic stress disorder with the use of the MMPI in a clinical population. Am J Psychiatry 1990;147:1057-1060. https://doi.org/10.1176/ajp.147.8.1057
  32. Lange RT, Sullivan KA, Scott C. Comparison of MMPI-2 and PAI validity indicators to detect feigned depression and PTSD symptom reporting. Psychiatry Res 2010;176:229-235. https://doi.org/10.1016/j.psychres.2009.03.004
  33. Elhai JD, Frueh BC. Subtypes of clinical presentations in malingerers of posttraumatic stress disorder: An MMPI-2 cluster analysis. As-ses 2001;8:75-84.
  34. Liljequist L, Kinder BN, Schinka JA. An investigation of malingering posttraumatic stress disorder on the Personality Assessment Inventory. J Pers Assess 1998;71:322-336. https://doi.org/10.1207/s15327752jpa7103_3
  35. McGuire BE. The assessment of malingering in traumatic stress cla-imants. Psychiatry Psychol & L 1999;6:163-173. https://doi.org/10.1080/13218719909524958
  36. Elhai JD, Gold SN, Sellers AH, Dorfman WI. The detection of malingered posttraumatic stress disorder with MMPI-2 fake bad indices. Assess 2001;8:221-336. https://doi.org/10.1177/107319110100800210
  37. Baer RA, Miller J. Underreporting of psychopathology on the M-MPI-2: A meta-analytic review. Psychol Assess 2002;14:16-26. https://doi.org/10.1037/1040-3590.14.1.16
  38. Wilson JP. The historical evolution of PTSD diagnostic criteria: from Freud to DSM-IV. J Trauma Stress 1994;7:681-698. https://doi.org/10.1002/jts.2490070413
  39. Brady KT, Killeen TK, Brewerton T, Lucerini S. Comorbidity of psychiatric disorders and posttraumatic stress disorder. J Clin Psychiatry 2000;61:22-32. https://doi.org/10.4088/JCP.v61n0106
  40. Elhai JD, Ruggiero KJ, Frueh BC, Beckham JC, Gold PB, Feldman ME. The Infrequency-Posttraumatic Stress Disorder Scale (Fptsd) for the MMPI-2: Development and initial validation with veterans presenting with combat-related PTSD. J Pers Assess 2002;79:531-549. https://doi.org/10.1207/S15327752JPA7903_08
  41. Binder LM, Rohling ML. Money matters: Meta-analytic review of the effects of financial incentives on recovery after closed-head injury. Am J Psychiatry 1996;153:7-10.
  42. Rosen GM, Powel JE. Use of a symptom validity test in the forensic assessment of posttraumatic stress disorder. J Anxiety Disord 2003; 17:361-367. https://doi.org/10.1016/S0887-6185(02)00200-1
  43. Millis SR, Putnam SH, Adams KM. Neuropsychological malingering and the MMPI-2: Old and new indicators. Paper presented at the 30th Annual Symposium on Recent Developments in the Use of the MMPI, MMPI-2, and MMPI-A. St. Petersburg Beach FL;1995.
  44. Arbisi PA, Ben-Porath YS. Characteristics of the MMPI-2 F(p) scale as a function of diagnosis in an inpatient sample of veterans. Psychol Assess 1997;9:102-105. https://doi.org/10.1037/1040-3590.9.2.102
  45. Rogers R, Bagby RM, Chakraborty D. Feigning schizophrenic disorders on the MMPI-2: Detection of coached simulators. J Pers Assess 1993;60:215-226. https://doi.org/10.1207/s15327752jpa6002_1
  46. Butcher J. The Minnesota Report: Adult Clinical System-Revised 4th ed. Minneapolis: Pearson Assessments;2001.
  47. Morey LC. Personality assessment inventory: Professional Manual. Odessa, FL: Psychological Assessment Resources;1991.
  48. Blanchard DD, McGrath RE, Pogge DL, Khadivi A. A comparison of the PAI and MMPI-2 as predictors of faking bad in college students. J Pers Assess 2003;80:197-205. https://doi.org/10.1207/S15327752JPA8002_08