The wars in Iraq and Afghanistan have produced historically low rates of fatalities, injuries, and posttraumatic stress disorder (PTSD) among U.S. combatants. Yet they have also produced historically unprecedented rates of PTSD disability compensation seeking from the U.S. Department of Veterans Affairs. The purpose of this article is to consider hypotheses that might potentially resolve this paradox, including high rates of PTSD, delayed onset PTSD, malingered PTSD, and economic variables.
"Malingering concerns may also impact patient care and patient outcomes, as providers experiencing burnout may be more likely to erroneously suspect malingering, withdraw emotionally, and thus fail to perform optimally in their role as providers. Given the possible scope of malingering in the VHA (McNally & Frueh, 2013), and the potentially negative consequences to the sincere patient, the relationship between suspected malingering and burnout should be further investigated. This study also identified a relationship between provider burnout and comorbid personality disorders among patients in this sample, suggesting VHA providers may benefit from supporting further training in treating patients with comorbid PTSD and personality disorders, or in the use of evidence-based treatments for personality disorders, such as dialectical behaviour therapy (Linnehan, 1993). "
[Show abstract][Hide abstract] ABSTRACT: Objective
Prolonged exposure (PE) and cognitive processing therapy (CPT) – post-traumatic stress disorder (PTSD) treatments now available at the Veterans Health Administration (VHA) – expose the provider to graphic traumatic material. Little is known about the impact of traumatic material on VHA providers. The purpose of this study was to examine the relationship between trauma content, patient characteristics, and burnout among VHA PTSD Clinical Team (PCT) providers. It was hypothesized that trauma content and patient characteristics would significantly predict burnout in this population.DesignThis cross-sectional study consisted of 137 participants. The sample was mostly female (67%), Caucasian (non-Hispanic; 81%), and married (70%) with a mean age of 44.3 years (SD = 11.3).Methods
Participants completed an electronic survey that assessed demographics, patient characteristics (i.e., anger, personality disorder, malingering), trauma content characteristics (e.g., killing of women and children) as well as burnout as measured by the Maslach Burnout Inventory-General Survey (MBI-GS; Maslach et al., 1996, Burnout inventory manual. Palo Alto: Consulting Psychologist Press).ResultsOver half of the study population reported being bothered by trauma content; however, trauma content did not predict burnout. Treating patients with personality disorders and suspected malingering predicted burnout in PCT providers. High numbers (77%) reported perceiving that emotional exhaustion impacted the quality of care they provided.Conclusion
These findings suggest an important role of burnout assessment, prevention, and treatment strategies at the VHA.Practitioner pointsThis paper addresses the impact of provider burnout on perceived quality of care.This paper also addresses potential predictors of burnout in PCT settings.This paper outlines potential remedies to provider burnout in the VHA.
"E-mail: email@example.com (Received 27 January 2014; accepted 30 July 2014) lead to a higher percentage of " service connection " and therefore higher levels of compensation (Chafetz, 2013), an especially notable point, given the particularly high rate of service members from the conflicts in Iraq and Afghanistan seeking disability compensation (McNally & Frueh, 2013); rates of malingered mTBI have been estimated to be 50% (Denning, 2012) and malingered PTSD at 53% or higher (Freeman, Powell, & Kimbrell, 2008). Finally, private disability plans usually determine payments as the amount proportional to pre-injury earnings up to some maximum amount or until the worker goes back to work (i.e., not for life; Buddin & Han, 2012; Chafetz, 2013). "
[Show abstract][Hide abstract] ABSTRACT: Neuropsychologists use performance validity tests (PVTs; Larrabee, 201234.
Larrabee, G. J. (2012). Performance validity and symptom validity in neuropsychological assessment. Journal of the International Neuropsychological Society, 18, 1–7.[CrossRef], [PubMed], [Web of Science ®]View all references) to ensure that results of testing are reflective of the test taker’s true neurocognitive ability, and their use is recommended in all compensation-seeking settings. However, whether the type of compensation context (e.g., personal injury litigation versus disability seeking) impacts the nature and extent of neurocognitive symptom feigning has not been adequately investigated. PVT performance was compared in an archival data set of noncredible individuals in either a personal injury litigation (n = 163) or a disability-seeking context (n = 201). Individuals were deemed noncredible based on meeting Slick, Sherman, and Iverson’s (199944.
Slick, D. J., Sherman, E. M. S., & Iverson, G. L. (1999). Diagnostic criteria for malingered neurocognitive dysfunction: Proposed standards for clinical practice and research. The Clinical Neuropsychologist, 13, 545–561.[Taylor & Francis Online], [PubMed], [Web of Science ®]View all references) criteria including failure on at least two PVTs and a lack of congruency between their low cognitive scores and normal function in activities of daily living (ADLs). In general, disability seekers tended to perform in a less sophisticated manner than did litigants (i.e., they failed more indicators and did so more extensively). Upon further investigation, these differences were in part accounted for by type of diagnoses feigned; those seeking compensation for mental health diagnoses were more likely to feign or exaggerate a wide variety of cognitive deficits, whereas those with claimed medical diagnoses (i.e., traumatic brain injury) were more targeted in their attempts to feign and/or exaggerate neurocognitive compromise.
The Clinical Neuropsychologist 08/2014; 28(6):1-18. DOI:10.1080/13854046.2014.951397 · 1.72 Impact Factor
"Though it is now established that an overreporting response style is frequently observed in PTSD patients, the reason for this effect remains a contentious topic. Some have suggested that overreporting should be interpreted as malingering (McNally & Frueh, 2013), though others have suggested that overreporting reflects a " cry for help " (Garcia, Franklin, & Chamblis, 2010; Guriel & Fremouw, 2003; Hyer, Fallon, Harrison, & Boudewyns, 1987). This is not only a theoretical debate. "
[Show abstract][Hide abstract] ABSTRACT: The current study investigated in a sample of Operation Enduring and Iraqi Freedom (OEF/OIF) veterans how a symptom overreporting response style might influence the association between PTSD diagnostic status and color-naming response latency for trauma-related stimuli during the Modified Stroop Task (i.e., the Modified Stroop Task effect, MST effect). It was hypothesized that, if an overreporting response style reflected feigning or exaggerating PTSD symptoms, an attenuated MST effect would be expected in overreporters with PTSD as compared with PTSD-diagnosed veterans without an overreporting style. If, however, overreporting stemmed from high levels of distress, the MST effect might be greater in overreporters compared with those with a neutral response style. The results showed that veterans with PTSD and an overreporting response style demonstrated an augmented MST effect in comparison with those with a more neutral style of response. Overreporters also reported greater levels of psychopathology, including markedly elevated reports of dissociative experiences. We suggest that dissociation-prone overreporters may misattribute emotional distress to combat experiences leading to the enhanced MST effect. Other possible explanations for these results are also discussed. (PsycINFO Database Record (c) 2013 APA, all rights reserved).
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