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Open Access Highly Accessed Research article

Malingering and PTSD: Detecting malingering and war related PTSD by Miller Forensic Assessment of Symptoms Test (M-FAST)

Khodabakhsh Ahmadi*, Zeynab Lashani, Mohammad Hassan Afzali, S Abbas Tavalaie and Jafar Mirzaee

BMC Psychiatry 2013, 13:154  doi:10.1186/1471-244X-13-154

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No evidence for a specific link between malingering and delayed-onset PTSD

Geert E Smid   (2013-07-19 16:22)  Foundation Centrum '45 / Arq Psychotrauma Expert Group

In their abstract, Ahmadi et al. [1] note that malingering is prevalent, especially in delayed-onset PTSD. The propensity of PTSD to occur with delayed onset has been formally recognized since its inclusion in the Diagnostic and Statistical Manual of Mental Disorders (DSM) in 1980. Delayed PTSD was included in the initial definition of PTSD to accommodate the syndrome encountered in Vietnam veterans [2]. The inclusion of PTSD in DSM-III led to its acceptance as a potentially compensable disorder by the U.S. Veterans Administration. Subsequently, a rise in benefit claims by US veterans for the disorder was noted [3]. This historical situation has led to a persistent association between malingering and delayed-onset PTSD in the literature.
Several decades later, there appears to be no evidence for a specific link between malingering and delayed-onset PTSD. A meta-analysis of delayed-onset PTSD [4] as well as a systematic review [5] both found that the delayed progression of PTSD is a consistent finding across studies in many different contexts, which suggests that exaggerated reporting for secondary gain is generally unlikely to be a major factor. Consistent with this view was the relatively low prevalence of delayed-onset PTSD in one litigant sample [4]. Also, asylum seekers presenting apparently trauma-related complaints at later stages following their resettlement may be suspected of exaggerating their complaints, because they may consider the possibility that being in need of medical care might increase chances of obtaining a residence permit. However, a study of unaccompanied refugee minors [6] found no significant differences in percentages of refugees without a residential status across groups with delayed, undelayed, or no PTSD.
Although the potential of malingering, simulation, and aggravation because of secondary gain should always be considered when diagnosing PTSD [7], there is no evidence that presentations of delayed-onset PTSD are particularly likely to actually represent these diagnoses.

1. Ahmadi K, Lashani Z, Afzali M, Tavalaie S, Mirzaee J (2013) Malingering and PTSD: Detecting malingering and war related PTSD by Miller Forensic Assessment of Symptoms Test (M-FAST). BMC Psychiatry 13:154
2. Andreasen NC (2004) Acute and delayed posttraumatic stress disorders: a history and some issues. Am J Psychiatry 161:1321-1323
3. Atkinson RM, Henderson RG, Sparr LF, Deale S (1982) Assessment of Viet Nam veterans for posttraumatic stress disorder in veterans administration disability claims. Am J Psychiatry 139:1118-1121
4. Smid GE, Mooren TTM, Van der Mast RC, Gersons BPR, Kleber RJ (2009) Delayed posttraumatic stress disorder: Systematic review, meta-analysis, and metaregression analysis of prospective studies. J Clin Psychiatry 70:1572-1582
5. Andrews B, Brewin CR, Philpott R, Stewart L (2007) Delayed-onset posttraumatic stress disorder: a systematic review of the evidence. Am J Psychiatry 164:1319-1326
6. Smid GE, Lensvelt-Mulders GJLM, Knipscheer JW, Gersons BPR, Kleber RJ (2011) Late-onset PTSD in unaccompanied refugee minors: Exploring the predictive utility of depression and anxiety symptoms. J Clin Child Adol Psychology 40:742-755
7. Hall RCW, Hall RCW (2006) Malingering of PTSD: forensic and diagnostic considerations, characteristics of malingerers and clinical presentations. Gen Hosp Psychiatry 28:525-535

Competing interests

None declared

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