This document discusses PTSD and malingering in personal injury suits. It notes that PTSD is commonly diagnosed in these cases but may be incorrectly applied. Mental health providers treating litigants may over-accept their statements and not properly consider malingering. The document recommends that experts conducting independent medical examinations spend significant time with examinees, administer validity tests like the MMPI-2, and combine multiple sources of information to make accurate diagnoses or rule out exaggeration.

1. PTSD and Malingering in Personal Injury Suits
October 8, 2000
Stuart J. Clayman, Ph.D.
Licensed Psychologist
181 Lake Shore Road
Brighton, MA 02135 USA
Tel. (617) 782-8355
Fax: (617) 254-9053
jay@braindoctor.org
www.braindoctor.org
Posttraumatic Stress Disorder (PTSD), a type of anxiety disorder that sometimes
follows exposure to an "extreme traumatic stressor", is manifested by the
following:
• 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")

2. PTSD and Malingering in Personal Injury Suits: Stuart J. Clayman, Ph.D., Page 2
• 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

3. PTSD and Malingering in Personal Injury Suits: Stuart J. Clayman, Ph.D., Page 3
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.