PTSD and Malingering: Practice Pointers

In a 2009 article (which I can provide legally back channel ),  Steve Rubenzer points out that PTSD can be a controversial diagnosis in compensation contexts (e.g., personal injury suits or workers compensation claims). “PTSD is nearly unique among psychiatric disorders, in that the diagnostic criteria specify the presumed etiology: exposure to a significant trauma or stressor. Thus, the very definition of the disorder helps to establish the legal requirement, in a personal injury suit, of proximate cause.”

Yet most PTSD measures are self-reported and face-valid (comprised of obvious questions) and include no effective measures of either malingering or differential diagnosis: “There are at least five explanations for this covariance [comorbidity with other DSM disorders] with very different implications: (a) that the comorbidity is “real,” [e.g., that depression and other symptoms are frequent, co-occurring responses to trauma], (b) that apparent comorbidity is due to intentional symptom overendorsement, (c) that comorbidity reflects underlying neuroticism or negative affectivity (and thus is real, but artifactual), (d) that apparent comorbidity is the result of acquiescent response style, and (e) that apparent comorbidity is the result of a dramatizing communication style. Thus, the basic issue of comorbidity is a morass.”

Dr. Rubenzer goes on to suggest that newer standards of neuropsychological assessment (which include assessment of malingering) can be applied in PTSD assessments in compensation cases as a hedge against bias both by examinees and assessors.

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