Discriminating malingered from genuine civilian posttraumatic stress disorder: a validation of three MMPI-2 Infrequency scales (F, Fp, and Fptsd)

The Infrequency-Posttraumatic Stress Disorder scale (Fptsd), recently created for the Minnesota Multiphasic Personality Inventory-2 (MMPI-2), has demonstrated incremental validity over other MMPI-2 scales in malingered posttraumatic stress disorder (PTSD) detection. Fptsd was developed with combat-exposed PTSD patients, potentially limiting its use with PTSD patients in general. The current study evaluated the MMPI-2's F, Infrequency-Psychopathology scale (Fp), and Fptsd scales in discriminating genuine civilian PTSD among 41 adult victims of child sexual abuse from a group of 39 students instructed to simulate PTSD. Analyses demonstrated Fptsd's incremental validity over F but not over Fp. Based on the two studies examining Fptsd, Fptsd may be more appropriate for combat trauma victims, and Fp may be more appropriate for civilian trauma victims.     

Differentiating overreporting and extreme distress: MMPI-2 use with compensation-seeking veterans with PTSD

This purpose of this study was to examine overreporting on the Minnesota Multiphasic Personality Inventory-2 (MMPI-2; Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) in compensation-seeking veterans with posttraumatic stress disorder (PTSD). A sample of veterans tested during a V.A. hospital compensation and pension exam were given the MMPI-2 and measures of PTSD, depression, and combat exposure. Veteran's MMPI-2s were only included in the analyses if their profile was extremely exaggerated, as measured by an F scale T score above 80, did not elevate the MMPI-2 VRIN and TRIN scales, and had a primary diagnosis of PTSD (n = 127). Using the Infrequency-Psychopathology, F(p), scale to distinguish overreporting from distress, it was found that 98 veterans elevated profiles due to distress, whereas 29 elevated due to overreporting, F(p) below and above 7, respectively. Differences between groups on MMPI-2 clinical scales and the other measures were assessed. Implications of these findings for assessing veteran response style and using the MMPI-2 with a PTSD population are discussed.     

Differentiating Overreporting and Extreme Distress: MMPI-2 Use With Compensation-Seeking Veterans With PTSD

This purpose of this study was to examine overreporting on the Minnesota Multiphasic Personality Inventory-2 (MMPI-2; Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) in compensation-seeking veterans with posttraumatic stress disorder (PTSD). A sample of veterans tested during a V.A. hospital compensation and pension exam were given the MMPI-2 and measures of PTSD, depression, and combat exposure. Veteran's MMPI-2s were only included in the analyses if their profile was extremely exaggerated, as measured by an F scale T score above 80, did not elevate the MMPI-2 VRIN and TRIN scales, and had a primary diagnosis of PTSD (n = 127). Using the Infrequency-Psychopathology, F(p), scale to distinguish overreporting from distress, it was found that 98 veterans elevated profiles due to distress, whereas 29 elevated due to overreporting, F(p) below and above 7, respectively. Differences between groups on MMPI-2 clinical scales and the other measures were assessed. Implications of these findings for assessing veteran response style and using the MMPI-2 with a PTSD population are discussed.     

The incremental validity and clinical utility of the MMPI-2 infrequency posttraumatic stress disorder scale

The incremental validity and clinical utility of the recently developed Minnesota Multiphasic Personality Inventory-2 (MMPI-2) Infrequency Posttraumatic Stress Disorder Scale (Fptsd) was examined in relation to the family of MMPI-2 F scales in distinguishing feigned post-traumatic stress disorder (PTSD) from disability claimants with PTSD. Research participants instructed to feign PTSD when completing the MMPI-2 scored significantly higher on the MMPI-2 family of F scales and the Fptsd scale compared with their responses when completing the MMPI-2 under standard instructions and the sample of claimants with PTSD. Although comparable in magnitude, effect sizes derived from mean group differences and hierarchical logistic regressions for the Fptsd scale never exceeded those for F(B), and F(P), F, F(B), and F(P) added incrementally to Fptsd in the prediction of feigned PTSD. These results suggest that the Fptsd scale does not afford any incremental predictive utility for detecting feigned PTSD relative to the complement of the existing family of F scales.     

The Minnesota Multiphasic Personality Inventory-2 Restructured Form in National Guard soldiers screening positive for posttraumatic stress disorder and mild traumatic brain injury

The Minnesota Multiphasic Personality Inventory-2 Restructured Form (MMPI-2 RF) was administered to 251 National Guard soldiers who had recently returned from deployment to Iraq. Soldiers were also administered questionnaires to identify posttraumatic stress disorder (PTSD) and mild traumatic brain injury (mTBI). On the basis of responses to the screening instruments, the National Guard soldiers who produced a valid MMPI-2 RF were classified into four groups: 21 soldiers who screened positive for PTSD only, 33 soldiers who screened positive for mTBI only, 9 soldiers who screened positive for both conditions, and 166 soldiers who did not screen positive for either condition. Results showed that the MMPI-2 RF was able to differentiate across the groups with the MMPI-2 RF specific problem scale Anxiety adding incrementally to MMPI-2 Restructured Clinical scales in predicting PTSD. Both MMPI-2 RC1 (Somatic Complaints) and MMPI-2 RF head pain complaints predicted mTBI screen but did not add incrementally to each other. Of note, all of the MMPI-2 RF validity scales associated with overreporting, including Symptom Validity-Revised (FBS-r), were not significantly elevated in the mTBI group. These findings support the use of the MMPI-2 RF in assessing PTSD in non-treatment-seeking veterans. This further suggests that a positive screen for mTBI alone is not associated with significant emotional disturbance.     

The Use of the MMPI-2 Infrequency–Psychopathology Scale in the Assessment of Posttraumatic Stress Disorder in Male Veterans

This study evaluated the use of the F_P (Infrequency–Psychopathology) scale of the Minnesota Multiphasic Personality Inventory—2 (MMPI-2) as a measure of symptom overreporting among 423 service-seeking male veterans with and without PTSD. Results were consistent with several predictions based on the logic of the F_P scale. F_P produced lower scores for PTSD and non-PTSD patients than the other two MMPI-2 measures of infrequent responding; F and F_B. F_P also resulted in fewer invalid protocols than did F or F_B. Finally, F_P yielded lower correlations with MMPI-2 and other measures of psychopathology than did F or F_B. Consistent with previous studies, compensation-seeking status was associated with extreme elevations across clinical and validity scales. Contrary to previous findings, however, compensation-seeking veterans were also more likely to receive a PTSD diagnosis. Implications for the relationship between compensation seeking and symptom overreporting are discussed.     

Anhedonia, Emotional Numbing, and Symptom Overreporting in Male Veterans with PTSD

We used measures of positive affect and emotional expression to distinguish and better understand veterans with PTSD with symptom overreporting presentation styles. Based on prior research, symptom overreporting was defined as scores greater than eight on the F(p) (Infrequency-Psychopathology) scale of the Minnesota Multiphasic Personality Inventory-2 (MMPI-2). Data were drawn from an archival dataset of 227 combat veteran outpatients. Results were consistent with theory and research on the distinction between negative and positive affect. Major findings indicated that (a) veterans endorsing greater anhedonia had a greater likelihood of being classified as a symptom overreporter (controlling for PTSD symptoms), and (b) compared to non-symptom overreporting veterans, overreporters showed greater congruency in their presentation of diminished positive affect and their expression across self- and clinician-ratings. Our data suggest that diminished positive emotions and their behavioral expression are uniquely associated with veterans' psychological experiences, providing insight into the nature of symptom overreporters.     

Cross-validation of the MMPI-2 in detecting malingered posttraumatic stress disorder

We attempted to cross-validate findings from a previous study (Elhai, Gold, Sellers, & Dorfman, in press) using a clinical sample of combat-related war veterans to distinguish genuine from malingered posttraumatic stress disorder (PTSD) on the MMPI-2 (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989). The MMPI-2 scores of 124 male combat war veterans at the PTSD outpatient treatment program of a Veterans Affairs Medical Center were compared with those of 84 adult college students instructed and trained to malinger PTSD. MMPI-2 overreporting variables examined were F, F-Fb, F-K, F(p), Ds2, O-S, OT, and FBS. A stepwise discriminant analysis identified F. F-Fb, F-K, Ds2, O-S, and OT as the best malingering predictors. A predictive discriminant analysis yielded good hit rates for the model with impressive cross-validation results. We assessed cutting scores for the predictors of the model. We discuss clinical implications for using the MMPI-2 to distinguish malingered PTSD from combat-related PTSD.     

Detecting symptom exaggeration in combat veterans using the MMPI-2 symptom validity scales: a mixed group validation

Although validity scales of the Minnesota Multiphasic Personality Inventory-2 (MMPI-2; J. N. Butcher, W. G. Dahlstrom, J. R. Graham, A. Tellegen, & B. Kaemmer, 1989) have proven useful in the detection of symptom exaggeration in criterion-group validation (CGV) studies, usually comparing instructed feigners with known patient groups, the application of these scales has been problematic when assessing combat veterans undergoing posttraumatic stress disorder (PTSD) examinations. Mixed group validation (MGV) was employed to determine the efficacy of MMPI-2 exaggeration scales in compensation-seeking (CS) and noncompensation-seeking (NCS) veterans. Unlike CGV, MGV allows for a mix of exaggerating and nonexaggerating individuals in each group, does not require that the exaggeration versus nonexaggerating status of any individual be known, and can be adjusted for different base-rate estimates. MMPI-2 responses of 377 male veterans were examined according to CS versus NCS status. MGV was calculated using 4 sets of base-rate estimates drawn from the literature. The validity scales generally performed well (adequate sensitivity, specificity, and efficiency) under most base-rate estimations, and most produced cutoff scores that showed adequate detection of symptom exaggeration, regardless of base-rate assumptions. These results support the use of MMPI-2 validity scales for PTSD evaluations in veteran populations, even under varying base rates of symptom exaggeration.     

Validity of the Personality Assessment Inventory Aggression scales and Violence Potential index in veterans with PTSD

In this study, we examined the validity of the Personality Assessment Inventory (PAI; Morey, 1991) Aggression (AGG) scales and Violence Potential index (VPI) in 399 male combat veterans presenting for formal evaluation of posttraumatic stress disorder (PTSD). The AGG scales exhibited convergence with other measures of hostility and violence and demonstrated discriminant validity with alternative constructs. When we examined reports of interpersonal violence in the past year, the AGG composite scale displayed substantial incremental validity over the effects of PTSD severity, demographics, a simple dichotomous question regarding violence in the past 30 days, and MMPI-2 (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) scales measuring aggression. The VPI, however, added no unique explanatory power over the AGG composite scale.     

Associations between Symptom Validity Test failure and scores on the MMPI-2-RF validity and substantive scales

This study examined the association between Symptom Validity Test (SVT) failure and the Minnesota Multiphasic Personality Inventory-2 Restructured Form (MMPI-2-RF; Ben-Porath & Tellegen, 2008), in the Forensic Disability Claimant samples described in the MMPI-2-RF Technical Manual (Tellegen & Ben-Porath, 2008 a, 2008b). SVTs used included the Word Memory Test (Green, 2003), the Computerized Assessment of Response Bias (Allen, Conder, Green, & Cox, 1997), the Medical Symptom Validity Test (Green, 2004), and the Test of Memory Malingering (Tombaugh, 1996). SVT failure was associated with significant elevations throughout the MMPI-2-RF overreporting validity scales and substantive scales. Pairwise contrasts between groups failing 0 and 3 SVTs revealed predominantly large effect sizes for the overreporting validity scales (d = 0.78-1.11), and many of the substantive scales, including the Cognitive Complaints (COG) scale. Results of this study demonstrate an association between SVT performance and elevated scores on the MMPI-2-RF. These results suggest that exaggeration of cognitive symptoms as demonstrated by SVT failure is also associated with overreported emotional, somatic, and neurocognitive complaints on the MMPI-2-RF.     

Detection of Feigned Posttraumatic Stress Disorder: A Comparison of the MMPI-2 and PAI

The Minnesota Multiphasic Personality Inventory-2 (MMPI-2) and Personality Assessment Inventory (PAI) were compared for detecting feigned posttraumatic stress disorder (PTSD) in a simulation research design. Participants were 85 undergraduates in one of three groups: PTSDs (n = 23), Fakers (n = 31), and Controls (n = 31). As expected, both the MMPI-2 and PAI discriminated PTSDs and Controls, with PTSDs scoring significantly higher on fake-bad validity scales and PTSD-relevant clinical scales. However, only the MMPI-2 discriminated Fakers and PTSDs, with Fakers scoring significantly higher on all MMPI-2 scales considered, but on only one PAI scale. Further, in logistic regression analyses the MMPI-2 demonstrated higher overall correct classification of PTSDs and Fakers than did the PAI. Although the MMPI-2 outperformed the PAI in detecting feigned PTSD, a substantial proportion of Fakers avoided detection by MMPI-2 fake-bad validity scales, suggesting that both tests are vulnerable to feigning of PTSD by motivated respondents with relatively limited coaching.     

Similarities and differences between MMPI and MMPI-2 applications to the assessment of posttraumatic stress disorder

The purpose of this study was to address the question: Is the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) comparable to the original MMPI in its applicability to the assessment of posttraumatic stress disorder (PTSD) among Vietnam combat veterans? The question was addressed by administering both the original MMPI and MMPI-2 to 29 subjects classified as meeting Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev.; DSM-III-R) criteria for PTSD and comparing MMPI and MMPI-2 scores in terms of: degree of association, code-type congruence, diagnostic hit rates (when compared to two other clinical samples, and one normal sample), and congruence of the Keane PTSD Scale (PK). Results reveal highly significant correlations between MMPI and MMPI-2 basic scales for the PTSD sample as well as congruence in 2-point codes comparable to previous studies. The MMPI-2 was found to identify effectively PTSD subjects from the other groups. Results also showed a high degree of association between the MMPI and MMPI-2 in regard to PK scores, although minor differences were found in PK raw scores between the two tests. Overall, the findings suggest a high degree of comparability between the MMPI and MMPI-2 in the assessment of PTSD.     

MMPI-2 Assessment of Varying Levels of Posttraumatic Stress in Vietnam Combat Veterans

The effectiveness of the MMPI-2 in the detection of posttraumatic stress (PTS) symptomatology was investigated. Forty-nine veterans at a VA posttraumatic stress clinic were evaluated for PTS symptomatology according to DSM-III-R criteria. The ability of the MMPI-2 to differentiate between Vietnam combat veterans (VCV) who met DSM-III-R criteria for posttraumatic stress disorder (PTSD; N = 36) and those who reported varying levels of posttraumatic stress symptoms (PTSS; N = 13) was examined. Overall, the MMPI-2 was effective in differentiating between the two groups of veterans. Of the 15 MMPI-2 scales used to evaluate PTS symptomatology, 12 significantly differentiated veterans with PTSD from those with PTSS. Diagnostic efficiency statistics for the MMPI-2 PTSD scales (PS and PK) were calculated at four cutoff points (T 65, 70, 75, and 80). The PS Scale was the most robust and effective index in differentiating between veterans with PTSD and those with PTSS. Implications for the assessment of varying degrees of PTS are discussed.     

Subtypes of clinical presentations in malingerers of posttraumatic stress disorder: an MMPI-2 cluster analysis

This paper investigated subtypes of individuals trained and instructed to malinger Posttraumatic Stress Disorder (PTSD) through a cluster analysis of their Minnesota Multiphasic Personality Inventory-2 (MMPI-2) clinical and validity scales. Participants were 84 men and women college students at a community college in the southeastern United States. Two well fitting MMPI-2 cluster solutions were evaluated with discriminant analyses and multivariate analyses of variance (MANOVAs); a 2-cluster solution was deemed optimal. Significant between-cluster differences emerged in follow-up analyses on most of the content scales of the MMPI-2. Most demographic variables did not account for differences in cluster membership. Clusters differed in their reported clarity of the materials used to educate them about PTSD. Discriminant analyses yielded better correct classification rates than those from previous studies, when the more severely symptomatic cluster was compared with a sample of clinical combat-related PTSD veterans. Implications are considered in conducting future malingered PTSD investigations.     

Further validation of the MMPI-2 and MMPI-2-RF Response Bias Scale: findings from disability and criminal forensic settings

The present study extends the validation of the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) and the Minnesota Multiphasic Personality Inventory-2 Restructured Form (MMPI-2-RF) Response Bias Scale (RBS; R. O. Gervais, Y. S. Ben-Porath, D. B. Wygant, & P. Green, 2007) in separate forensic samples composed of disability claimants and criminal defendants. Using cognitive symptom validity tests as response bias indicators, the RBS exhibited large effect sizes (Cohen's ds = 1.24 and 1.48) in detecting cognitive response bias in the disability and criminal forensic samples, respectively. The scale also added incremental prediction to the traditional MMPI-2 and the MMPI-2-RF overreporting validity scales in the disability sample and exhibited excellent specificity with acceptable sensitivity at cutoffs ranging from 90T to 120T. The results of this study indicate that the RBS can add uniquely to the existing MMPI-2 and MMPI-2-RF validity scales in detecting symptom exaggeration associated with cognitive response bias.     

The detection of feigned uncoached and coached posttraumatic stress disorder with the MMPI-2 in a sample of workplace accident victims

In this study research participants completed the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) under standard instructions and then were asked to fake posttraumatic stress disorder (PTSD) when completing the MMPI-2 for a 2nd time in 1 of 4 conditions with different instructions on how to fake PTSD: (a) uncoached, (b) coached about PTSD symptom information, (c) coached about MMPI-2 validity scales, or (d) coached about both symptoms and validity scales. These MMPI-2 protocols were then compared with protocols of claimants with workplace accident-related PTSD. Participants given information about the validity scales were the most successful in avoiding detection as faking. The family of F scales (i.e., F, FB, FP), particularly FP, produced consistently high rates of positive and negative predictive power.     

An ethnocultural study of posttraumatic stress disorder in African-American and white American Vietnam War veterans

This study examined the intensity of Posttraumatic Stress Disorder (PTSD) symptoms as measured by the Mississippi Scale, the Keane (PK), and the PTSD (PS) Scales of the MMPI-2 in a sample of 34 African-American and 34 White American Vietnam War Veterans who sought treatment in a Specialized Inpatient PTSD Unit. The scores of the two groups on the Beck Depression Inventory and the clinical scales of the MMPI-2 were also compared. The ethnoculturally different sample was matched on intensity of combat exposure, marital status, employment status, age, and education. No significant differences on the measures of PTSD symptoms were noted and no significant differences were found on the Beck scale or the MMPI-2 clinical scales.     

Vietnam Veterans: Overreporting Versus Acceptable Reporting of Symptoms

Overreporting of symptoms among Vietnam combat veterans is a problem area with little research. Five hundred thirty Vietnam-era veterans were given the MMPI. They were divided according to two criteria, combat status and reporting status. For combat status, subjects were either in Vietnam (in-country) or in the military but not in Vietnam (Vietnam-era) between 1964 and 1975. For reporting status, the MMPI overreporting criteria of the subtle-obvious (S-O) items given by Green (1986) were used. Overreporters had an S-O total of > 160, and acceptable subjects were at or below this figure. Also, all subjects who responded randomly were excluded (MMPI Test-Retest scales > 4). Results indicated that a high number of subjects randomly responded to the MMPI, and that in-country veterans met the overreporting criteria in greater numbers than the Vietnam-era group. Also, multivariate analyses of variance (MANOVAs) showed significant differences among groups in four distinct areas—MMPI basic scales, Harris-Lingoes, Wiggins, and special subscales—for both reporting status and combat status, but not for the interaction. Post hoc analyses of variance (ANOVAs) showed that reporting status was especially robust. Two Vietnam in-country PTSD types, overreporters and "acceptable" patients, are discussed. Overreporters are more pathological and a distinct challenge in treatment relative to the other in-country veterans.     

Interrelationship Between MMPI-2 and Rorschach Variables in a Sample of Vietnam Veterans With PTSD

We examined interrelationships between theoretically related MMPI-2 and Rorschach variables in a sample of Veterans Affairs outpatients with Posttraumatic Stress Disorder (PTSD). Subjects were 20 White Vietnam combat veterans diagnosed with PTSD who completed the Rorschach and MMPI-2 as part of a comprehensive evaluation. Correlations were calculated for variables in three groups: validity, depression and anxiety, and thought disturbance. Results showed strong relationships between m, MOR, and t he Dramatic special score of the Rorschach and MMPI-2 indices of distress. Positive relationships were also found for some indicators of thought disturbance, whereas correlations for other depressive indicators were not significant. Findings are discussed with regard to implications for the clinical assessment of combat-related PTSD and future directions for assessment research.