The Development and Validation of a Multi-strategy Test for Detection of Malingering of Posttraumatic Stress Disorder

  • Jacqueline Yoxall

Student thesis: Doctoral Thesis


In forensic practice a psychologist must be competent in detection of a specific form of purposeful lying for the purpose of obtaining an external incentive, that is, malingering. The malingering literature base has expanded considerably in the last 10 years and several strategies have been established as effective in differentiating feigning from genuine presentation (Bianchini, Mathias & Greve, 2001; Iverson & Lange, 2005; Rogers, 2008a). In the detection of malingered psychopathology the most notable developments are that of Rogers’ response styles (Rogers, 1984; 2008a; Rogers & Bender, 2003) which form the theoretical basis of the best validated measure of feigned psychopathology, the Structured Interview of Reported Symptoms (Rogers, Bagby & Dickens, 1992). In the etection of malingered neurocognitive deficit, there is an array of strategies that have been validated in detecting insufficient effort or other forms of feigning of dysfunction (Bianchini, Mathias & Greve, 2001; Franzen, Iverson & McCracken, 1990; Slick, Sherman & Iverson, 1999). In addition to these strategies, many researchers have proposed a range of clinical or behavioural markers that may indicative of malingering (Garriga, 2007; Hall & Hall, 2006; Malone & Lange, 2007; Resnick, 1988). However many such approaches to detection of malingering are yet to be operationalised. Most malingering research has focused on the feigning of psychopathology in general. In recent years more attention has been given to the feigning of specific disorders. Posttraumatic stress disorder is particularly vulnerable to malingering because of the subjective nature of the symptoms; the heterogeneity of the genuine clinical group and the appeal of this disorder to the legal fraternity because of the required link to an aetiological event (Hall & Hall, 2006; Lees-Haley, 1986; Rosen, 2004). The challenges in detection malingered PTSD have generated increasing proposals of a multi-strategy approach to Multi-strategy detection of malingering of PTSD detection of malingering and in particular, to the malingering of PTSD (Eakin, 2004; Guriel & Fremouw, 2003; Hall & Hall, 2006; Lebourgeois, 2007). The goal of this research was two fold; firstly to explore current malingering detection practice, gaps in knowledge and strategies that may improve detection of malingering; and secondly, to apply a multi-strategy approach to detection of malingering within the scope of a specific disorder – that is, posttraumatic stress disorder. The research goals were addressed through four interrelated studies. Study One estimated malingering prevalence and explored the current state of knowledge of Australian psychologists (n=102) through a survey of current practices and beliefs in regard to malingering and the detection of malingering. Study Two analysed patterns of validity indices elevation on the Personality Assessment Inventory in a forensic sample (n=792) to explore the manner in which negative distortion may be attempted. The results of these two studies, in addition to a comprehensive literature review, informed the establishment of a multi-strategy measure of malingering specific to the feigning of PTSD. Study Three critically investigated effective strategies for detection of malingering of general psychopathology, but also explored the utility of adaptation of strategies more commonly used to detect feigning of neurocognitive deficits. This study incorporated both research knowledge and applied psychological practice in a multi-pronged approach to the establishment of a new instrument for detection of feigning of PTSD. Study Four comprised the initial validation of the new measure via a simulation study, incorporating a clinical PTSD sample, honest non-clinical respondents and naïve and coached simulators (n=105). The thesis concludes with consideration of the utility of a multi-strategy approach to malingering and discussion of detection strategies found to be most effective in discriminating between simulators and those with genuine PTSD. Key findings are presented Multi-strategy detection of malingering of PTSD and the limitations of the studies are reviewed before recommendations are made for future research.
Date of Award11 Feb 2012
Original languageEnglish
SupervisorMark Bahr (Supervisor)

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