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Tilstra-Ferrell EL, Braden A, Russin S. Military sexual trauma, combat trauma, and disordered eating among United States veterans: An exploration of underlying mechanisms. MILITARY PSYCHOLOGY 2024:1-12. [PMID: 38781487 DOI: 10.1080/08995605.2024.2336639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 03/22/2024] [Indexed: 05/25/2024]
Abstract
Military sexual trauma (MST) and combat trauma (CT) survivors experience disproportionate risk for disordered eating. A survey of MST, CT, disordered eating, trauma-related self-blame, emotion regulation challenges, body dissatisfaction, and dissociation among military personnel with a history of military-related trauma was conducted. These survey-based cross-sectional data were analyzed via parallel mediation analyses and Analyses of Covariance (ANCOVA). Six parallel mediation analyses were conducted examining trauma-related self-blame, emotion regulation challenges, body dissatisfaction, and dissociation as mediators linking MST and CT, separately, with purging, restricting, and bingeing. ANCOVAs were also performed to examine differences in levels of bingeing, restriction, and purging among people exposed to MST, CT, both MST and CT, and neither. MST and CT exposure was indirectly related to bingeing via emotion regulation challenges. MST and CT was also indirectly related to both restriction and purging via emotion regulation challenges and trauma-related self-blame. Dissociation and body dissatisfaction were not significant mediators in any model. Participants endorsed high levels of disordered eating. Individuals exposed to both MST and CT reported greater bingeing, restricting, and purging than individuals exposed to either CT, MST, or neither. Findings highlight the nuanced symptoms that may increase risk for disordered eating among MST and/or CT survivors. Future treatment research should explore how addressing emotion regulation and trauma-related self-blame among individuals with MST and/or CT may help address disordered eating. Implications and future directions for this area of research are discussed.
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Affiliation(s)
| | - Abby Braden
- Department of Psychology, Bowling Green State University (BGSU), Ohio
| | - Sarah Russin
- Department of Psychology, Bowling Green State University (BGSU), Ohio
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Misitano A, Moro AS, Ferro M, Forresi B. The Dissociative Subtype of Post-Traumatic Stress Disorder: A Systematic Review of the Literature using the Latent Profile Analysis. J Trauma Dissociation 2024; 25:349-365. [PMID: 36062756 DOI: 10.1080/15299732.2022.2120155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 08/12/2022] [Indexed: 10/14/2022]
Abstract
A PTSD subtype with dissociative symptoms (D-PTSD) was included in the DSM-5 recognizing the existence of a more severe form of PTSD, associated to past trauma, high comorbidity, and complex clinical management. As research is rapidly growing and results are inconsistent, a better investigation of this subtype is of primary importance. We conducted a systematic review of studies using Latent Profile Analysis to investigate the existence of a D-PTSD subtype. Covariates of D-PTSD were included, to understand additional symptoms, risk factors and comorbidities. The search was performed on PubMed, EBSCOHost, and PTSDPubs according to 2020 PRISMA guidelines. Eligible articles assessed trauma exposure, PTSD symptoms and diagnosis, and dissociation, in adult samples. 13 of 165 articles met the inclusion criteria. All identified a dissociative subtype of PTSD, mainly characterized by higher levels of depersonalization and derealization. D-PTSD profile sometimes presented other dissociative symptoms, such as gaps in awareness and memory, other comorbid disorders, and a history of abuse. Despite some limitations, this review supports the existence of a dissociative subgroup of individuals among those with PTSD. More rigorous studies are needed to clarify these findings and their clinical implications.
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Affiliation(s)
- Alberto Misitano
- Department of Psychology, Sigmund Freud University, Milan, Italy
| | - Andrea Stefano Moro
- Department of Psychology, Sigmund Freud University, Milan, Italy
- Center for Behavioral Neuroscience and Communication (BNC), Vita-Salute San Raffaele University, Milan, Italy
| | - Mattia Ferro
- Department of Psychology, Sigmund Freud University, Milan, Italy
- Center for Behavioral Neuroscience and Communication (BNC), Vita-Salute San Raffaele University, Milan, Italy
| | - Barbara Forresi
- Department of Psychology, Sigmund Freud University, Milan, Italy
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3
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Kremyar AJ, Ben-Porath YS, Sellbom M, Gervais RO. Assessing posttraumatic stress disorder symptom clusters with the Minnesota Multiphasic Personality Inventory-3 in a forensic disability sample. J Clin Psychol 2023; 79:2798-2822. [PMID: 37597252 DOI: 10.1002/jclp.23581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 07/17/2023] [Accepted: 08/08/2023] [Indexed: 08/21/2023]
Abstract
OBJECTIVE Previous evidence indicates that scales from the Minnesota Multiphasic Personality Inventory (MMPI) family of instruments can measure self-reported posttraumatic stress disorder (PTSD) symptomology and differentiate symptom clusters, including in forensic disability assessments. However, limited research has examined assessment of PTSD symptoms with the MMPI-3, the most recent MMPI instrument. The goal of the current study was to identify the strongest MMPI-3 scale predictors of individual PTSD symptom clusters, measured via self-report. METHODS Using a sample of 716 disability claimants (54.2% men; Mage = 42.98, SD = 10.87; 81.8% White), correlation, regression, and dominance analyses were performed to examine associations between scores on MMPI-3 scales and latent PTSD symptom cluster factors derived using confirmatory factor analyses from items of the Detailed Assessment of Posttraumatic Stress (DAPS), and to identify the strongest predictor of each symptom cluster when MMPI-3 scales were concurrently considered. RESULTS Results indicate that conceptually expected MMPI-3 scale scores were meaningfully associated with PTSD symptom cluster factors, with the MMPI-3 Anxiety-Related Experiences (ARX) scale demonstrating the strongest and most consistent associations across symptom clusters. CONCLUSIONS Results of the current study largely converge with previous empirical studies of self-reported PTSD symptoms in disability claimant settings with the MMPI instruments. Interpretive implications for the MMPI-3, limitations, and future research directions are discussed.
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Affiliation(s)
- Andrew J Kremyar
- Department of Psychological Sciences, Kent State University, Kent, Ohio, USA
| | - Yossef S Ben-Porath
- Department of Psychological Sciences, Kent State University, Kent, Ohio, USA
| | - Martin Sellbom
- Department of Psychology, University of Otago, Dunedin, New Zealand
| | - Roger O Gervais
- Neurobehavioural Associates Inc., Edmonton, Alberta, Canada
- Department of Educational Psychology, University of Alberta, Edmonton, Alberta, Canada
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İçin ZN, Koşe Ç, Şar V. Turkish Adaptation of Dissociative Subtype of Post Traumatic Stress Disorder Scale. J Trauma Dissociation 2023; 24:624-639. [PMID: 36994469 DOI: 10.1080/15299732.2023.2195396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 02/21/2023] [Indexed: 03/31/2023]
Abstract
After the changes in DSM-5, dissociative subtype was added to post-traumatic stress disorder. That caused a necessity for a scale to measure the mentioned change. A scale named Dissociative Subtype of Post-Traumatic Stress Disorder (DSPS) was developed to measure this subtype and help the diagnosis. The purpose of this study is to adapt the Dissociative Subtype of Post-Traumatic Stress Disorder to Turkish and examine its reliability and validity. The Dissociative Subtype of PTSD (DSPS) was translated into Turkish. DSPS, Turkish forms of The Posttraumatic Diagnostic Scale and Dissociative Experiences Scale were sent to participants via Google Forms and data from 279 people aged 18-45 were analyzed. Reliability tests and factor analysis were conducted. Factor analysis showed that scale has good model fit scores and items were loaded to the factors the same as the original study. Scales internal consistency was examined, and a good score was obtained (α=.84). Fit index values of confirmatory factor analysis were found as χ2/df = 2.51, GFI=.90, RMSEA=.07, RMR=.02. As a result of the high reliability scores and sufficient model fit scores, this scale is considered as a dependable measure to evaluate the dissociative subtype of PTSD.
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Affiliation(s)
- Zühre Neslihan İçin
- Institute of Forensic Sciences and Legal Medicine, Department of Social Sciences, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Çiğdem Koşe
- Department of Psychology, Topkapı University, Istanbul, Turkey
| | - Vedat Şar
- Department of Psychiatry, Koc University, Istanbul, Turkey
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Wolf EJ, Hawn SE, Sullivan DR, Miller MW, Sanborn V, Brown E, Neale Z, Fein-Schaffer D, Zhao X, Logue MW, Fortier CB, McGlinchey RE, Milberg WP. Neurobiological and genetic correlates of the dissociative subtype of posttraumatic stress disorder. JOURNAL OF PSYCHOPATHOLOGY AND CLINICAL SCIENCE 2023; 132:409-427. [PMID: 37023279 PMCID: PMC10286858 DOI: 10.1037/abn0000795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Abstract
Approximately 10%-30% of individuals with posttraumatic stress disorder (PTSD) exhibit a dissociative subtype of the condition defined by symptoms of depersonalization and derealization. This study examined the psychometric evidence for the dissociative subtype of PTSD in a sample of young, primarily male post-9/11-era Veterans (n = 374 at baseline and n = 163 at follow-up) and evaluated its biological correlates with respect to resting state functional connectivity (default mode network [DMN]; n = 275), brain morphology (hippocampal subfield volume and cortical thickness; n = 280), neurocognitive functioning (n = 337), and genetic variation (n = 193). Multivariate analyses of PTSD and dissociation items suggested a class structure was superior to dimensional and hybrid ones, with 7.5% of the sample comprising the dissociative class; this group showed stability over 1.5 years. Covarying for age, sex, and PTSD severity, linear regression models revealed that derealization/depersonalization severity was associated with: decreased DMN connectivity between bilateral posterior cingulate cortex and right isthmus (p = .015; adjusted-p [padj] = .097); increased bilateral whole hippocampal, hippocampal head, and molecular layer head volume (p = .010-.034; padj = .032-.053); worse self-monitoring (p = .018; padj = .079); and a candidate genetic variant (rs263232) in the adenylyl cyclase 8 gene (p = .026), previously associated with dissociation. Results converged on biological structures and systems implicated in sensory integration, the neural representation of spatial awareness, and stress-related spatial learning and memory, suggesting possible mechanisms underlying the dissociative subtype of PTSD. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Erika J. Wolf
- National Center for PTSD at VA Boston Healthcare System, Boston, MA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA
| | - Sage E. Hawn
- National Center for PTSD at VA Boston Healthcare System, Boston, MA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA
| | - Danielle R. Sullivan
- National Center for PTSD at VA Boston Healthcare System, Boston, MA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA
| | - Mark W. Miller
- National Center for PTSD at VA Boston Healthcare System, Boston, MA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA
| | - Victoria Sanborn
- National Center for PTSD at VA Boston Healthcare System, Boston, MA
| | - Emma Brown
- Translational Research Center for TBI and Stress Disorders and Geriatric Research Educational and Clinical Center, VA Boston Healthcare System, Boston, MA
| | - Zoe Neale
- National Center for PTSD at VA Boston Healthcare System, Boston, MA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA
| | | | - Xiang Zhao
- National Center for PTSD at VA Boston Healthcare System, Boston, MA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA
| | - Mark W. Logue
- National Center for PTSD at VA Boston Healthcare System, Boston, MA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA
- Department of Biostatistics, Boston University School of Public Health Boston, MA
- Biomedical Genetics, Boston University School of Medicine, Boston, MA
| | - Catherine B. Fortier
- Translational Research Center for TBI and Stress Disorders and Geriatric Research Educational and Clinical Center, VA Boston Healthcare System, Boston, MA
- Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Regina E. McGlinchey
- Translational Research Center for TBI and Stress Disorders and Geriatric Research Educational and Clinical Center, VA Boston Healthcare System, Boston, MA
- Department of Psychiatry, Harvard Medical School, Boston, MA
| | - William P. Milberg
- Translational Research Center for TBI and Stress Disorders and Geriatric Research Educational and Clinical Center, VA Boston Healthcare System, Boston, MA
- Department of Psychiatry, Harvard Medical School, Boston, MA
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Danböck SK, Hettegger SE, Anders S, Franke LK, Liedlgruber M, Miedl SF, Gashi A, Kurapov A, Weber RC, Ehring T, Wilhelm FH. Psychometric properties of the dissociative subtype of posttraumatic stress disorder scale: replication and extension in two German-speaking samples. Eur J Psychotraumatol 2023; 14:2238492. [PMID: 37593980 PMCID: PMC10443992 DOI: 10.1080/20008066.2023.2238492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 06/23/2023] [Accepted: 07/05/2023] [Indexed: 08/19/2023] Open
Abstract
Background: The fifth version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) introduced the dissociative subtype of posttraumatic stress disorder (D-PTSD). To assess this subtype, the Dissociative Subtype of PTSD Scale (DSPS), a 15-item self-report measure to identify lifetime and current dissociative symptoms of D-PTSD, was developed. However, so far, the scale has only been validated in war veterans. Moreover, criterion validity and diagnostic utility have not been examined yet.Objective: We aimed to validate the DSPS in two samples of civilian trauma-exposed German-speaking participants.Methods: In Study 1, a pre-registered online study, participants with and without PTSD symptoms (N = 558) answered questionnaires about traumatic experiences, dissociation, PTSD, depression, generalized anxiety disorder, somatic symptom disorder, alcohol use disorder, absorption, and dissociative responding to trauma-related questionnaires. In Study 2, which used secondary data of a pre-registered clinical study, participants with a PTSD diagnosis (N = 71) answered questionnaires about traumatic experiences, dissociation, PTSD, depression, generalized anxiety disorder, somatic symptom disorder, and dissociative responding to standardized trauma exposure. Moreover, PTSD, D-PTSD, and other diagnoses were assessed with structured clinical interviews.Results: Analyses confirmed a three-factor structure as well as high internal consistency, and high convergent, discriminant, and criterion validity of the DSPS. Moreover, the scale was able to identify a latent D-PTSD group and individuals with D-PTSD diagnosis.Conclusions: The DSPS constitutes a reliable and valid tool to assess D-PTSD symptoms in clinical practice and research and thereby may contribute to a better understanding of these debilitating symptoms.
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Affiliation(s)
- Sarah K. Danböck
- Department of Psychology, Division of Clinical Psychology and Psychopathology, Paris Lodron University of Salzburg, Salzburg, Austria
| | - Sabrina E. Hettegger
- Department of Psychology, Division of Clinical Psychology and Psychopathology, Paris Lodron University of Salzburg, Salzburg, Austria
| | - Sofia Anders
- Department of Psychology, Division of Clinical Psychology and Psychopathology, Paris Lodron University of Salzburg, Salzburg, Austria
| | - Laila K. Franke
- Department of Psychology, Division of Clinical Psychology and Psychopathology, Paris Lodron University of Salzburg, Salzburg, Austria
| | - Michael Liedlgruber
- Department of Psychology, Division of Clinical Psychology and Psychopathology, Paris Lodron University of Salzburg, Salzburg, Austria
| | - Stephan F. Miedl
- Department of Psychology, Division of Clinical Psychology and Psychopathology, Paris Lodron University of Salzburg, Salzburg, Austria
| | - Arlinda Gashi
- Department of Psychology, Division of Clinical Psychology and Psychopathology, Paris Lodron University of Salzburg, Salzburg, Austria
- Research Department, Empatia Multidisciplinary Clinic, Prishtina, Kosovo
| | - Anton Kurapov
- Department of Psychology, Division of Clinical Psychology and Psychopathology, Paris Lodron University of Salzburg, Salzburg, Austria
- Faculty of Psychology, Department of Experimental and Applied Psychology, Taras Shevchenko National University of Kyiv, Kyiv, Ukraine
| | | | - Thomas Ehring
- Department of Psychology, Division of Clinical Psychology and Psychological Treatment, Ludwig-Maximilians University of Munich, Munich, Germany
| | - Frank H. Wilhelm
- Department of Psychology, Division of Clinical Psychology and Psychopathology, Paris Lodron University of Salzburg, Salzburg, Austria
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White WF, Burgess A, Dalgleish T, Halligan S, Hiller R, Oxley A, Smith P, Meiser-Stedman R. Prevalence of the dissociative subtype of post-traumatic stress disorder: a systematic review and meta-analysis. Psychol Med 2022; 52:1629-1644. [PMID: 35734787 DOI: 10.1017/s0033291722001647] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The dissociative subtype of post-traumatic stress disorder (PTSD-DS) was introduced in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), and is characterised by symptoms of either depersonalisation or derealisation, in addition to a diagnosis of post-traumatic stress disorder (PTSD). This systematic review and meta-analysis sought to estimate the point prevalence of current PTSD-DS, and the extent to which method of assessment, demographic and trauma variables moderate this estimate, across different methods of prevalence estimation. Studies included were identified by searching MEDLINE (EBSCO), PsycInfo, CINAHL, Academic Search Complete and PTSDpubs, yielding 49 studies that met the inclusion criteria (N = 8214 participants). A random-effects meta-analysis estimated the prevalence of PTSD-DS as 38.1% (95% CI 31.5-45.0%) across all samples, 45.5% (95% CI 37.7-53.4%) across all diagnosis-based and clinical cut-off samples, 22.8% (95% CI 14.8-32.0%) across all latent class analysis (LCA) and latent profile analysis (LPA) samples and 48.1% (95% CI 35.0-61.3%) across samples which strictly used the DSM-5 PTSD criteria; all as a proportion of those already with a diagnosis of PTSD. All results were characterised by high levels of heterogeneity, limiting generalisability. Moderator analyses mostly failed to identify sources of heterogeneity. PTSD-DS was more prevalent in children compared to adults, and in diagnosis-based and clinical cut-off samples compared to LCA and LPA samples. Risk of bias was not significantly related to prevalence estimates. The implications of these results are discussed further.
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Affiliation(s)
- William F White
- Department of Clinical Psychology and Psychological Therapies, Norwich Medical School, University of East Anglia, Norwich, Norfolk, UK
| | - Aaron Burgess
- Department of Clinical Psychology and Psychological Therapies, Norwich Medical School, University of East Anglia, Norwich, Norfolk, UK
| | - Tim Dalgleish
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
| | | | - Rachel Hiller
- Division of Psychology and Language Sciences, University College London, London, UK
- Anna Freud Centre for Children and Families, London, UK
| | - Anna Oxley
- Cambridgeshire Community Services NHS Trust, UK
| | - Patrick Smith
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London & Maudsley NHS Foundation Trust, UK
| | - Richard Meiser-Stedman
- Department of Clinical Psychology and Psychological Therapies, Norwich Medical School, University of East Anglia, Norwich, Norfolk, UK
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8
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Evaluating symptom endorsement typographies of trauma-exposed veterans on the Personality Assessment Inventory (PAI): A latent profile analysis. CURRENT PSYCHOLOGY 2021. [DOI: 10.1007/s12144-019-00486-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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9
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Ellickson-Larew S, Escarfulleri S, Wolf EJ. The Dissociative Subtype of Posttraumatic Stress Disorder: Forensic Considerations and Recent Controversies. PSYCHOLOGICAL INJURY & LAW 2020. [DOI: 10.1007/s12207-020-09381-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Wolf EJ, Ellickson-Larew S, Guetta RE, Escarfulleri S, Ryabchenko K, Miller MW. Psychometric Performance of the Miller Forensic Assessment of Symptoms Test (M-FAST) in Veteran PTSD Assessment. PSYCHOLOGICAL INJURY & LAW 2020; 2020. [PMID: 32431781 DOI: 10.1007/s12207-020-09373-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study examined the psychometric properties of a widely used measure of symptom exaggeration, the Miller Forensic Assessment of Symptoms Test (M-FAST, Miller, 2001), in a sample of 209 (83.7% male) trauma-exposed veterans (57.9% probable current posttraumatic stress disorder; PTSD). M-FAST total scores evidenced acceptable internal consistency, but several subscales showed poor internal consistency. Factor analytic and item-response theory analyses identified seven poorly performing items. Comparisons with other measures of psychopathology and response validity (including subscales from the Minnesota Multiphasic Personality Inventory-2 Restructured Form) revealed that M-FAST scores were highly correlated with indices of psychopathology while less strongly associated with measures of symptom over-reporting. Empirically and clinically-derived (using a follow-up testing-the-limits procedure) revised M-FAST scores failed to improve the measure's psychometric performance. Results raise concerns about the validity of the M-FAST for identifying malingering in veterans with PTSD and carry implications for access to care and forensic evaluations in this population.
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Affiliation(s)
- Erika J Wolf
- National Center for PTSD at VA Boston Healthcare System
- Boston University School of Medicine, Department of Psychiatry
| | | | | | | | - Karen Ryabchenko
- National Center for PTSD at VA Boston Healthcare System
- Boston University School of Medicine, Department of Psychiatry
| | - Mark W Miller
- National Center for PTSD at VA Boston Healthcare System
- Boston University School of Medicine, Department of Psychiatry
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