Disability Compensation Seeking Among Veterans Evaluated for Posttraumatic Stress Disorder

Frueh, B. Christopher; Elhai, Jon D.; Gold, Paul B.; Monnier, Jeannine; Magruder, Kathryn M.; Keane, Terence M.; Arana, George W.

doi:10.1176/appi.ps.54.1.84

Cited by 109 publications

(76 citation statements)

References 43 publications

(14 reference statements)

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“…Fourthly, results may have been biased by participants' interest in compensation (cf. Frueh et al, 2003). This was not deemed very likely though, as all of them had received a fi nal decision on their claim.…”

Section: Discussionmentioning

confidence: 99%

Affective personality type, post‐traumatic stress disorder symptom severity and post‐traumatic growth in victims of violence

Kunst

2011

Stress and Health

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The current study explored the differential association between affective personality type, post-traumatic stress disorder (PTSD) symptom severity, and post-traumatic growth (PTG) in victims of violence (N = 113). Relying on previous research, median cut off-scores on the Positive and Negative Affect Schedule Short Form were used to classify participants as high affective [i.e. high positive affectivity (PA) and high negative affectivity (NA)], selfactualizing (i.e. high PA and low NA), self-destructive (i.e. low PA and high NA) and low affective (i.e. low PA and low NA). Results indicated that the self-destructive and high affective personality styles were strongly associated with increased PTSD symptoms severity. High affective personality type was found to be the only signifi cant predictor of PTG. Results, study limitations and directions for future research were discussed.

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Section: Discussionmentioning

confidence: 99%

Affective personality type, post‐traumatic stress disorder symptom severity and post‐traumatic growth in victims of violence

Kunst

2011

Stress and Health

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“…Although mental health professionals may seek to understand such behaviours, many in society, particularly military and ex-military personnel, see it as reprehensible, dishonourable and, at the very least, tarnishing the integrity of the ex-service community. This type of behaviour is not uncommon in the US veterans' population, 5,[55][56][57] and it was found in 13% of the only British survey of ESP seeking treatment for combat-related PTSD. 58 The figure for fabrication and/or exaggeration in MAP attendees is at least 10%.…”

Section: Attributionmentioning

confidence: 99%

“…The US military has a large body of research on veterans, but caution is required in interpretation and its lessons may not be transferable to the UK. 4,5 Currently, UK veterans are 'thought' to number 3.8 million, a figure expected to decline by over 50% by 2027 through death of veterans over 65. 6 Approximately 20 000 individuals leave UK armed forces annually, around 5000 from the untrained staff.…”

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confidence: 99%

UK extended Medical Assessment Programme for ex-service personnel: the first 150 individuals seen

Palmer

2012

Psychiatrist

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Aims and method To describe an interim service set up to examine the breadth of UK ex-service personnel's concerns in relation to their mental health and military service and provide a record of the first 150 individuals assessed following conformation of military service and examination of all available military and civilian medical records.Results The majority of attendees were White male ex-soldiers. Average age, service and time to assessment were 44.5, 15.8 and 11.7 years respectively. Two-thirds were receiving help from the National Health Service and ex-service nongovernmental organisations. Rates of post-traumatic stress disorder were similar to previous UK studies. Obsessional symptoms were of relevance to the clinical presentation in a third. Fabrication and/or exaggeration occurred in about 10%. Clinical implicationsThe spread of diagnoses and delay in help-seeking are similar to civilians. The link between mental disorders and military service is seldom straightforward and fabrication or exaggeration is difficult for civilians to recognise. Verification and contextualisation of service using contemporaneous service medical records is important given the possible occupational origin of mental health conditions.Declaration of interest I.P. is employed by the Pensions, Compensation and Veterans Department of the UK Ministry of Defence. The Ministry had no input into the completion or presentation of this paper and sought no changes.

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“…It appears, however, that the average F-K scores for compensation-seeking veterans, though elevated, fall short of the typically accepted cutoff for symptom "exaggeration" per se. 2 Moreover, an equally viable interpretation of this correlation is that individuals seek compensation because they have more severe and disabling symptoms. For this reason, even if we had data available that assessed compensation status in our PTSD veteran sample as hoped for by the writer (which we do not), these data would not provide a basis for resolving the issue of compensation seeking.…”

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confidence: 99%

Drs Gilbertson and Pitman Reply

Gilbertson¹,

Pitman²

2011

J. Clin. Psychiatry

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"the majority of psychiatric symptoms reported by combat veterans with PTSD [posttraumatic stress disorder] would not have been present were it not for their exposure to traumatic events" 1(p1324) on the grounds that "an important factor contributing to reported psychopathology in veterans is compensation status. " This criticism is without merit. Our objective was to explore whether psychopathological symptoms are "acquired" in individuals with PTSD or, alternatively, whether such symptoms reflect general psychiatric psychopathology that would have existed even in the absence of traumatic exposure. The twin methodology employed in our model can show that a certain abnormality observed in PTSD was acquired, but it has limited ability to identify the mechanisms by which it was acquired. Dr Elliot's argument addresses the latter issue and not the former, and therefore in no way conceptually invalidates our conclusion that the majority of symptoms reported by combat veterans would not have existed absent trauma exposure. Trivially stated, even if we were to grant his suggestion that compensation-seeking substantially influenced the Symptom Checklist 90-Revised scores in our study, the combat veterans with PTSD could not have become compensation-seekers had they not experienced traumatic events in the military! Hence, there is no flaw in our original inference. Rather, the appropriate question is, What proportion of the variance in acquired psychiatric symptoms in PTSD versus non-PTSD veterans is accounted for by symptom exaggeration induced by the former's motivation to obtain, or maintain, disability payments? Certainly if the variance attributable to compensation-seeking were substantial, this would influence the meaning of the "acquired" symptomatology. However, the writer's concern is not unique to our study but applies equally to the hundreds of singleton (nontwin) studies that have shown greater psychopathology in veterans with versus without PTSD. Dr Elliot's assertion that we "dismissed the possibility" of the impact of compensation status is unfounded. As he noted himself, our article explicitly acknowledged "the possibility that increased SCL-90-R scores to some degree represent compensation-seeking or general symptom overreporting in the PTSD group." 1(p1328) Even so, in our view, the current literature far from establishes compensation status as a major, delegitimizing factor in PTSD and, consequently, one that must routinely be accounted for in all studies. To date, this interpretation rests upon an assumption that the relationship observed between compensation-seeking and some measure of symptom exaggeration, eg, the F-K index of the Minnesota Multiphasic Personality Inventory, 2 is causally unidirectional, ie, greater symptoms are reported because individuals are seeking compensation. It appears, however, that the average F-K scores for compensation-seeking veterans, though elevated, fall short of the typically accepted cutoff for symptom "exaggeration" per se. 2 Moreover, an equally viable interpret...

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Disability Compensation Seeking Among Veterans Evaluated for Posttraumatic Stress Disorder

Cited by 109 publications

References 43 publications

Affective personality type, post‐traumatic stress disorder symptom severity and post‐traumatic growth in victims of violence

Affective personality type, post‐traumatic stress disorder symptom severity and post‐traumatic growth in victims of violence

UK extended Medical Assessment Programme for ex-service personnel: the first 150 individuals seen

Drs Gilbertson and Pitman Reply

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