Types of Malingering in PTSD: Evidence from a Psychological Injury Paradigm

Abstract

The extent to which persons may feign or malinger psychological symptoms is an important concern for civil litigation, specifically in the context of personal injury. The consequences inherent in personal injury cases involving psychological distress require an understanding of how malingering presents in medico-legal contexts, and how it can be assessed using available measures. Symptom validity tests (SVTs) and performance validity tests (PVTs) have been developed to assist in the detection of feigned psychological illness and neurocognitive impairment. While demonstrated divergence between symptom-based and performance-based outcomes have been demonstrated in civil litigants with posttraumatic symptoms after the experience of a physical injury, limited research has evaluated how these measures operate in the context of psychological injury alone. The present study evaluated the relationships among symptom-based and performance-based measures of malingering under a simulated personal injury paradigm in which psychological but not physical injury was sustained. A total of 411 undergraduate participants completed four measures of malingered symptomatology, including both symptom validity and performance validity indicators. Participants were instructed to respond to measures as if they were experiencing common emotional, behavioral, and cognitive symptoms of PTSD following a motor vehicle accident. Using a multi-trait multi-method matrix, weaker correlations were found between PVT and SVTs (ranging from .15 to .28), but moderate significant correlations were found across symptom validity measures (.51 to .65), thus demonstrating an expected dissociation between methods of malingering assessment. Additional analyses support the stability of these findings, when accounting for past exposure to motor vehicle accidents, and replicated the need for a multiple failure approach. Findings are consistent with expectations of convergent and discriminant validity and support the conceptualization of malingered PTSD as a non-unitary construct that is composed of multiple domains or “types,” as reflected by a lack of convergence between SVT and PVT methods. In practice, evaluators of psychological injury are encouraged to utilize more than one measure of malingering, including both PVT and SVT approaches, when PTSD is alleged.