Differentiating genuine versus feigned posttraumatic stress disorder in a sample of torture survivors

As the ethnic diversity continues to increase in the United States, the importance of establishing accurate normative data for diverse groups is increasingly relevant. However, forensic measures are rarely based on normative samples that represent the considerable diversity present in forensic settings. The paucity of this research is particularly evident for psychologists asked to assess asylum seekers, where issues relating to diversity are central. The present study represents one of the first efforts to investigate the validity of measures of feigning, that have potential utility in asylum evaluations, in a non-Western sample. The study evaluated four measures that are commonly used to detect feigned psychiatric symptoms and insufficient cognitive effort, including the Dot Counting Test (DCT), the Test of Memory Malingering (TOMM), the Miller Forensic Assessment of Symptoms Test (M-FAST) and the Atypical Response (ATR) scale on the Traumatic Symptoms Inventory, Second Edition. The study compared performance on these measures among three groups of West and Central African immigrants: honest participants with PTSD, honest participants without PTSD, and participants without PTSD asked to feign symptoms of distress. The data were used to evaluate the ability of these individuals to feign PTSD, to assess the classification accuracy of each measure, and to assess the effect of demographic variables and acculturation on these measures. When possible, the data were also used to derive alternative cutoffs scores that resulted in higher levels of classification accuracy than those previously established. Notably, individuals demonstrated difficulty feigning symptoms of distress. Using both published and optimized cutoff scores, no measure demonstrated high rates of both sensitivity and specificity, although the TOMM, M-FAST and ATR scale displayed valuable, but limited utility. The combined use of TOMM and M-FAST provided the highest rates of classification accuracy. No measures were affected by acculturation, as measured in the study, although the DCT was significantly correlated to years of education. The results emphasize the need for future research in this area