Utility of the Trauma Symptom Inventory’s Atypical Response Scale in Detecting Malingered Post-Traumatic Stress Disorder

Abstract

The authors examined the Trauma Symptom Inventory's (TSI) ability to discriminate 88 student post-traumatic stress disorder (PTSD) simulators screened for genuine PTSD from 48 clinical PTSD-diagnosed outpatients. Results demonstrated between-group differences on several TSI clinical scales and the Atypical Response (ATR) validity scale. Discriminant function analysis using ATR revealed 75% correct patient classification but only 48% correct simulator classification, with an overall correct classification rate of 59% (positive predictive power [PPP] = .71; negative predictive power [NPP] = .51). Individual ATR cutoff scores did not yield impressive classification results, with the optimal cutoff (T score = 61) correctly classifying only 61% of simulators and patients (PPP = .66, NPP = .54). Although ATR was not developed as a malingered PTSD screen, instead serving as a general validity screen, caution is recommended in its current clinical use for detecting malingered PTSD.

Do Motivations for Malingering Matter? Symptoms of Malingered PTSD as a Function of Motivation and Trauma Type

“…This type of responding allows for a more subjective interpretation of trauma events, where the individual may manipulate their answers according to how they think they are expected to respond (e.g., Candel et al 2003). Further, endorsement of such vague trauma items could lead to higher atypical responding scores as it deviates from the manner in which genuine victims respond (e.g., Elhai et al 2005;Runtz and Roche 1999). Our results also indicated that high levels of fantasy proneness and dissociation were related to higher scores on most of the clinical scales on the TSI, which is consistent with some previous research.…”

“…In general, some research has found that malingered symptom reports tend to be comparable to genuine victims (e.g., Elhai et al 2005;Lees-Haley 1990). For example, McGuire (2002) found that student simulators could not be reliably differentiated from genuine trauma patients in litigation situations on the Impact of Event Scale.…”

Posttraumatic Stress Disorder: Assessing Response Style and Malingering

“…Briere (1995) recommended a cutoff score of T>65 for suspected exaggeration, with scores above 90 deemed invalid. While seven studies (Edens et al 1998;Efendov et al 2008;Elhai et al 2005;Guriel et al 2004;Guriel-Tennant and Fremouw 2006;Rosen et al 2006;Porter et al 2007) have examined the TSI's ability to detect feigning of PTSD, there are no true known group studies and all existing studies are seriously limited. Where high effect sizes occurred, they are due to contrasting students responding honestly with simulators (see "Appendix").…”

Damages and rewards: assessment of malingered disorders in compensation cases

“…As noted by Edens et al (1998), substantial false-positive rates ( > 15%) have been found with clients in outpatient and partial hospitalization settings. Elhai et al (2005) compared simulators with 48 outpatients diagnosed with PTSD. The optimal cut score (ATR 61) resulted in a false-positive rate of 34%, which led the authors to caution about its use for feigned PTSD.…”