Moyer, D., Burkhardt, B., Gordon, R.M., (2002) Faking PTSD from a Motor Vehicle Accident on the MMPI-2. American Journal of Forensic Psychology, Volume 20, Issue 2, 2002
FAKING PTSD FROM A MOTOR VEHICLE ACCIDENT ON THE MMPI-2
Diane M. Moyer, Ph.D., Barbara Burkhardt, M.A. and Robert M. Gordon, Ph.D.
The MMPI-2 is often used to assess posttraumatic stress disorder (PTSD) in individuals who claim psychological injury, as a result of a motor vehicle accident. There is concern that attorneys can coach plaintiffs to fake PTSD. The purpose of this study was to determine whether prior symptom knowledge increased one’s ability to fake PTSD on the MMPI-2- Eighty-four female undergraduate students completed the MMPI-2 under either of two conditions, informed (given DSM-IV diagnostic criteria for PTSD prior to testing) or uninformed (no diagnostic criteria provided). It was hypothesized that the informed subjects would more accurately fake PTSD than the uninformed subjects. Results indicated that knowledge about the specific symptoms of PTSD did not create a more accurate profile, but rather was likely to produce more invalid (F>T89) profiles, detecting them as malingerers.
Plaintiffs from a motor vehicle accident (MVA) have important incentives to report symptoms whether or not the symptoms actually exist (1, 2). Lees-Haley (3) stated: fake auto accident injuries are rampant in this region [Los Angeles] and pseudo-stress claims are quite common. Individuals known as ‘cappers’ and ‘runners’ recruit patients in the streets, in unemployment lines, and outside of plants that are closing or experiencing layoffs. These cappers persuade people to visit unethical doctors and lawyers, who then file claims for nonexistent injuries. ‘Stagers’ produce deliberate auto accidents for insurance fraud ... Medical and legal organizations known locally as ‘mills’ process thousands of injury claims per year” (3, p. 681-682).
In their extensive research on the assessment and treatment of motor vehicle accident survivors, Blanchard and Hickling (4) stated that each year 1% (3,386,000 in 1995) of the American population are involved in serious motor vehicle accidents. The authors reported that approximately 9% of individuals involved in a serious MVA develop posttraumatic stress disorder (PTSD). Blanchard and Hickling also reported that women are twice as likely to develop the disorder than men. Lees-Haley (5) examined 492 personal injury plaintiffs (230 males and 262 females) on the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) (6) and found that approximately 20 to 30% of the profiles indicated possible malingering. Given the high number of motor vehicle accidents, litigants have strong monetary incentives to fake on the MMPI-2.
There is controversy in current literature as to how effectively one can fake psychological disorders on the MMPI-2, based upon the amount of information one has about a particular disorder. Bagby et al. (7) asked psychiatric residents and fellows, clinical psychology graduate students, and undergraduate students with no clinical training, to fake schizophrenia on the MMPI-2. They compared their scores with a sample of outpatients with schizophrenia under the standard instructions. In general, the clinically trained subjects produced lower scores on the clinical scales and the validity indicators than did the under graduate students. This indicated that training or special ability helped individuals produce more accurate schizophrenic profiles on the MMPI-2.
Some studies however, do not demonstrate that information helps individuals to fake on the MMPI-2. Wetter et al. (8) gave subjects specific symptom information on PTSD and paranoid schizophrenia and offered monetary incentives for successful faking. They found that having specific information about the symptoms of the psychological disorders did not enable fakers to avoid detection and/or produce profiles equivalent to those produced by patients with the disorder. They found that fakers in both groups produced lower K and higher scores on F, FB, F-K, and D as well as on all the clinical scales than actual patients. In another study- Wetter et al. (9) gave one group of normal adults specific information about borderline personality disorder and instructed them to simulate it. A second group was asked to simulate a psychological disturbance without specific symptom information. They found that there were no differences between the uninformed fakers and the informed fakers on the MMPI-2 scales. However, they were both significantly higher than scores from actual patients with borderline personality disorder. The results suggested that specific information is of little help in faking borderline personality disorder.
These studies and others suggest that some diagnoses may be more difficult to fake than others. Cramer (10) compared faking borderline personality disorder to faking depression. Results indicated that subjects had a harder time faking borderline personality disorder. However, borderline personality disorder is more complex and multi-dimensional than is depression. Most people have some familiarity with depression, as compared to borderline personality disorder. When subjects are given a simpler task of faking a neurotic verses psychotic disorder on the MMPI-2, they were more likely to escape detection on the MMPI-2 fake-bad validity scales (10).
What remains unclear from previous studies is how information might help individuals to fake PTSD. Does information help fakers imitate PTSD or help them avoid producing a totally wrong profile? Also, there is a need to put faking PTSD in the context of a motor vehicle accident and suing for monetary reward. Motivation for faking is unclear in previous studies. Finally, previous studies tend to use mean differences between fakers’ profiles and PTSD patients’ profiles, rather than using hit rates. Using a PTSD profile type should provide a better measure of one’s ability to fake PTSD on the MMPI-2. Additionally, in light of the fact that women are twice as likely to develop PTSD from a MVA (4), this study investigated the ability of females to fake PTSD from a MVA.
We hypothesized that informed subjects would produce more PTSD and neurotic profiles, but fewer totally wrong profiles than uninformed subjects. It was additionally hypothesized that the F Scale (F>T89) would be effective in detecting fakers.
Subjects consisted of 84 female undergraduates enrolled in a northeastern college (average age 23.9, SD = 8.9; average years of education = 14.2, SD = 1.2; average income = $48,170, SD = 30,898). Subjects had no prior clinical experience with PTSD nor had they been diagnosed or treated for PTSD.
Subjects were told, “The purpose of this study is to determine to what extent people are able to fake psychological symptoms on the MMPI-2. We are asking you to imagine that you have been in a severe car accident. Individuals who have experienced a car accident often suffer some kind of psychological stress related to the event. Realizing that this task can be difficult, we ask you to do your best to keep symptoms consistent throughout the test and avoid putting your own personality into play.”
Subjects were randomly assigned to either of two groups, informed or uninformed. Both groups received this part of the script: “Approximately six months ago you were in a severe car accident. You are suing the insurance company of the truck driver for a great deal of money. You have been unable to get into a car or go to work since the accident. The insurance company however, has requested that you see a psychologist to verify your symptoms. The psychologist is now asking you to take the MMPI-2.”
In addition to this paragraph, the informed group received the following information which provides the diagnosis of PTSD in an easy to understand description of the criteria based on DSM-IV: “The psychological injury caused by the car accident is posttraumatic stress disorder. You keep having recurrent and intrusive distressing, recollections of the accident, and flashback episodes. The sight of vehicles driving through intersections or the thought of even getting into a car sends you into a panic. Since the accident you try to avoid thoughts, feelings or conversations about it. You try to avoid watching any TV shows that may remind you of the trauma. You sometimes seem to have an inability to recall important aspects of the accident. You don't get pleasure from family, friends and hobbies as you once did. You feel detached and uncertain about the future. You are having difficulty falling and
staying asleep. You are irritable, jumpy and having trouble concentrating. You jump at anything that sounds like a crash. Keep these symptoms in mind while you are trying to fake posttraumatic stress disorder.” The subjects studied their respective scripts and completed the MMPI-2. Subjects also provided demographic and background information at the time of testing.
For the purpose of this study, scores on the MMPI-2 were divided into four categories, or profile types: PTSD, Neurotic, Wrong Diagnosis, and Invalid F>T89. These criteria were used rather than mean score differences between fakers and actual patients PTSD profile. The first category, PTSD, is a traumatic neurosis represented by scales 1, 2, and 3 being greater than T65, and scales 1, 2, and 3 all being greater than scales 4, 6, 8 and 9; and a valid profile of F being less than T90. The second profile type, the Neurotic, involved a close approximation of PTSD. The decision rule used was the Goldberg Index, (L+Pa+Sc)-(Hv+Pt), being less than T45 and F less than T90. The third profile type, Wrong Diagnosis, was any profile that did not fit into the prior two categories and had an F less than T90. These represented profiles indicating character pathology or psychoses. The fourth profile, Invalid F>T89, was distinguished as malingering. Therefore, subjects will demonstrate a PTSD profile, a Neurotic profile approximating a PTSD profile, a Wrong Diagnosis or a profile indicative of malingering. Subjects exhibitin2 a PTSD or Neurotic profile would be simulating PTSD symptoms and considered “good fakers.” Those falling into the Wrong Diagnosis or Invalid F>T89 would be considered “bad fakers.”
A t-test used to assess the demographic differences between the informed and uninformed group revealed no significant difference between good fakers (this in the PTSD and Neurotic groups) and bad fakers (those in the Wrong Diagnosis and Invalid F.89 groups) for age (p=.45), educations in years (p=.15), income level (p=.64), employment history (p=.3 1), prior treatment for anxiety (p=.10), involvement in civil suits for trauma (p=.66), or if they had taken the MMPI before (p =.88).
The overall chi-square between the informed and uninformed groups was significant (p=.014). Subsequent chi-square analyses found that PTSD information did not help subjects to fake PTSD. Four individuals (4.8%) in the uninformed group and four individuals (4.8%) in the informed group were able to produce accurate PTSD profiles: information made no difference for these subjects (X²=.184, p=.67). Seven people (8.3%) in the uninformed group, and four people (4.8%) in the informed group were able to produce Neurotic profiles. We found that information made no difference for these good fakers (X²= 2.23, p=.135).
The uninformed group produced significantly more (X²= 5.41, p=.02) totally wrong profiles (N = 11, 13.1%) than the informed group where only five individuals (6%) produced a totally wrong diagnosis on their MPAPI-2 profile.
However, the informed group produced more than twice as many invalid F (T>89) profiles indicating malingering than the uninformed group. Thirty-five people in the informed group (41.7%) and 14 -in the uninformed group (16.7%) produced High F invalid profiles (X²= 9.8, p=.002).
A Fisher's post hoc was used to compare groups within the 2 X 4 matrix. The Fisher’s post hoc revealed a significant difference (p=.0389) between the Invalid F>T89 and the Neurotic profiles. The more information a subject had about PTSD symptoms, the more likely she was to produce invalid profiles. The Fisher’s post hoc also revealed a significant difference (p=.007) between the Invalid F>T89 and the Wrong Diagnosis profiles. Again, the more information subjects had about PTSD, the more likely they were to produce invalid profiles being detected as malingerers than to produce totally wrong diagnoses. There was no significant difference (p=.943) between the Invalid F>T89 and the PTSD profile.
Blanchard and Hickling (4) reported that approximately 9% of individuals involved in MVAs develop PTSD, with twice as many women developing it than men. As stated previously, plaintiffs from a MVA have strong monetary incentives to report symptoms of a psychological disorder whether or not they actually exist (1, 2). If individuals are able to fake PTSD successfully on the MMPI-2, monetary incentives will benefit not only the attorneys and plaintiffs but also those who develop strategies designed to inform individuals of ways to fake certain disorders on psychological tests such as the MMPI-2. Additionally, those who develop psychological tests need to be made aware of the inherent ability of some individuals to fake on these measures. While validity scales may test for the more obvious faker, a more sensitive scale may be needed to detect the clever, more intuitive, faker.
While faking, PTSD on the MMPI-2 has received much attention in the current literature, few studies have addressed this in the context of a motor vehicle accident. In addition, examining PTSD profile types versus mean hit rates may reveal a more accurate assessment of the disorder than previous studies have indicated. With this in mind, the authors of this study designed this project to address these specific variables.
With regard to the examination of PTSD profile types, the current study found that prior information was only helpful in avoiding producing a totally wrong profile. The more information about PTSD subjects had, the more likely they were to produce totally wrong profiles. In addition, there was no difference between the informed and uninformed subjects with regard to producing PTSD or neurotic profiles. Therefore, knowledge of PTSD did not help subjects produce accurate PTSD profiles. The most important result was not predicted - that subjects who had additional information about PTSD symptoms were more likely to be detected as faking by producing. invalid F scale (F>T89) profiles. This result partially supported our hypothesis on the effectiveness of the F scale in detecting faked PTSD. Perhaps knowledge about a simple more familiar condition such as depression would have produced different results, with information being helpful to faking. However, given that it is a rather complex disorder, PTSD information may have confused those attempting to fake, causing them to exaggerate symptoms and thus be detected as fakers.
The current study focused exclusively on a female population. It is known that women are twice as likely as men to develop PTSD as a result of a motor vehicle accident (4). Although the generalizability of this study is limited, future studies may want to include the analysis of data across gender.
In view of the fact that this study found no difference between the informed and uninformed groups with regard to their ability to fake PTSD on the MMPI-2, future researchers may also want to investigate what makes certain individuals capable of accurately faking this disorder. Perhaps personal characteristics such as intelligence, empathy or personality play a role in deter-mining who is capable of faking PTSD on the MMPI-2.
Given the high rate of plaintiffs faking PTSD on the MMPI-2 (5), it is important to continue research in this area. This includes determining ways to counter the attempts of attorneys to coach their clients to fake. Monetary rewards provide strong incentives to fake and, provided those rewards are in place, there will be individuals seeking to gain from them. With this in mind, attorneys need to take heed---coaching plaintiffs to fake a psychological injury such as PTSD on the MMPI-2 is not only very wrong, but it could backfire, allowing plaintiffs to become more easily detected as fakers.
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ABOUT THE AUTHORS
Diane M. Moyer, Ph.D. is an Associate Professor at Cedar Crest College in Allentown, Pennsylvania. Robert M. Gordon, Ph.D. is in private practice at The Institute for Advanced Psychological Training, in Allentown, Pennsylvania. Barbara Burkhardt, M.A. is affiliated with Lehigh University and currently working in the counseling center at Muhlenberg College in Allentown.
Copyright 2002 American Journal of Forensic Psychology, Volume 20, Issue 2- The Journal is a publication of the American College of Forensic Psychology.