Psychology Articles on Post Traumatic Psychological Conditions & Malingering

PTSD and Malingering in Personal Injury Suits

	Persistent re-experience of the traumatic event in the form of nightmares and fear-evoking memories
	Avoidance of thoughts, feelings and activities that symbolize the trauma
	Increased arousal which may take the form of sleep problems, anger, concentration problems or exaggerated startle response

PTSD may be one of the most common diagnoses assigned to plaintiffs in personal injury suits. Unfortunately, this diagnosis is often misapplied. Some of the main reasons why a diagnosis of PTSD may be incorrect have to do with the context in which the diagnosis is typically made.

When a litigant is alleging that emotional distress has been caused by a traumatic event, the litigant may seek mental health services treatment from a treating psychologist, psychiatrist or social worker. These mental health providers tend to function as follows:

	They may "bond" with their patients and tend to accept, uncritically, what their patients tell them
	They often do not administer psychological tests because this is thought not to be a good use of their patient's "treatment" time
	If they do administer psychological tests, they are often brief, "projective" or "self-administered" and may include the Rorschach test, the Beck Depression Inventory or the SCL-90-R; scientific studies show these tests are not useful because of problems with accuracy and because positive findings can be easily faked
	Because of the time constraints involved in mental health treatment, and the tendency for treatment service providers to bond with their patients, they rarely consider the possibility that their patient may be exaggerating or faking emotional problems ("malingering")
	Mental health patients and their therapists may believe that questioning their a patient's truthfulness and investigating the possibility of malingering is a breach of trust or "boundary violation" and is harmful to the doctor-patient relationship

Mental health therapists may over-utilize the diagnosis of Postraumatic Stress Disorder with patients who are also litigants because:

	This diagnosis seems, conceptually, to "fit" with the litigant's claim of being damaged by a trauma
	PTSD is one of the relatively few diagnoses found in the DSM-IV that is specifically related to traumatic events
	PTSD is one of relatively few diagnoses found in the DSM-IV that depends primarily upon the patient's allegations, rather than upon objective findings
	PTSD is a well-known diagnosis that feels comfortable for the service provider
	The litigant may have been coached by his/her attorney to provide a history and symptoms consistent with this diagnosis
	The service provider may feel pressure from the patient or from the patient's attorney to provide a diagnosis of PTSD

Because the diagnosis of PTSD is sometimes made in error, a careful determination should be made to determine if there is a sound basis for such a diagnosis. Following are some suggestions that will aid in such a determination.

The defense attorney, insurance company or IME company should select mental health experts who are very familiar with the PTSD diagnosis and aware that malingering is always a concern and must be identified or ruled out when emotional distress is alleged within the context of a lawsuit.

Good mental health defense experts have the following characteristics:

	They meet with examinees for extended periods of time (longer than 50 minutes) in order to observe their behavior under conditions of stress and fatigue
	They do not "bond" with examinees; instead they maintain objectivity, are critical of even reasonable-sounding statements made by the examinee and conduct examinations in order to seek facts that can aid claims examiners, judges and juries in determining the veracity of emotional distress complaints
	They usually administer psychological tests because this is one of the best ways of obtaining objective information about the examinee
	They select psychological tests, such as MMPI-2, that utilize "validity" scales that are able to identify exaggeration and faking of emotional distress
	They combine findings from psychological testing with those from interview material and medical records in order to test out diagnostic hypotheses about examinees

The Minnesota Multiphasic Personality Inventory (MMPI-2) is one of the best psychological tests to use in forensic psychological exams because:

	The MMPI-2 is one of the few psychological tests that contain "validity" scales that have been shown, via controlled studies, to be effective in identifying exaggeration and faking of emotional distress
	There have been 10,000 books and articles written about the MMPI-2 attesting to its reliability, validity and usefulness in various contexts
	The MMPI-2 has been translated into many languages; it is a tool that can be used with a variety of populations
	The MMPI-2 has specific scales that are useful in identifying or casting doubt upon the specific diagnosis of Posttraumatic Stress Disorder
	Results of the MMPI-2 have been admitted as evidence into Federal and State courts including those in Michigan and Massachusetts.123 (These legal citations were found in Pope, K.S., Butcher, J.N. & Seelen, J. The MMPI, MMPI-2 & MMPI-A in Court: A practical guide for expert witnesses and attorneys. American Psychological Association, Washington, D.C., 1993).

A forensic psychological examiner who takes a careful history, scrutinizes the medical records and uses psychological tests containing validity scales is in the best position to determine if a diagnosis of PTSD is accurate or not.

¹ Commonwealth v. Goulet, 402 Mass. 299, 522 N.E. 2d 417 (Mass. 1988) MMPI administered to defendant, whom doctor opined was "faking bad".
² Commonwealth v. Meech, 403 N.E. 2d 1174 (Mass. 1980). MMPI used to evaluate defendant on behalf of the defense.
³ Anderson v. MK-Ferguson Co., 191 Mich. App. 129, 477 N.W. 2d 465 (Mich. App. 1991) Employee who was terminated because of his MMPI scores brought action for damages. Personal representative of former employee appealed.