Clinical Profile of US Combat Veterans with PTSD on M-FAST Items

##plugins.themes.bootstrap3.article.main##

  •   Zack Z. Cernovsky

  •   Stephan C. Mann

  •   Varadaraj R. Velamoor

Abstract

Background: The Miller Forensic Assessment of Symptoms Test (M-FAST; Miller, 2001) is a widely used but controversial instrument promulgated to measure malingering. Its use is encouraged by publications which are methodologically flawed such as the recent meta-analysis by Detullio et al. (2019). In this study, we examine which of M-FAST’s 25 items are most frequently endorsed by veterans with posttraumatic stress disorder (PTSD).


Method: Using tabular data published by Wolf’s team in 2020, we identified from a clinical perspective, the 7 M-FAST items endorsed by the highest proportions of 121 US combat veterans with a probable current diagnosis of PTSD. Since the M-FAST diagnostic cutoff is 6 or more points and each endorsed item counts as one point, the 7 most frequently endorsed M-FAST items provide a clinical profile, via their content, as to which items are most frequently involved in misdiagnosing veterans as malingerers.


Results and Discussion: Item 2 (“feeling depressed most of the time”) was endorsed by 67.8%, Item 23 (“feeling that I don’t really matter”) by 56.2%, Item 20 (formication) by 28.9%, and Item 17 (phantosmia, i.e., “false sensation of an odor”) by 24.0%. Formication and phantosmia are legitimate neuropsychological symptoms that may occur with whiplash injuries and head trauma or exposure to toxic chemicals in combat. Item 21 (“at times hearing music coming from nowhere”) endorsed by 22.3% may describe spontaneous intrapsychic activity of musically inclined persons. Item 14 (“Sometimes it seems as if someone controls my symptoms, turning them on and off”) endorsed by 20.7% may reflect the unpredictable fluctuation of frequency and severity of PTSD symptoms. Item 1 (“restlessness while seated”) endorsed by 19.8% is scored in the M-FAST as a discrepancy between the patient reporting that he “often” feels restless, and the examiner’s observation that no such nonverbal behavior during the brief M-FAST interview was noted. Restlessness is a post-concussive symptom that is not necessarily always present, such as during the M-FAST interview.


Conclusions: All 7 most frequently endorsed items by combat veterans are neither exclusive to malingerers nor pathognomonic of malingering. They form a pattern of legitimate medical symptoms fallaciously scored and interpreted in the M-FAST’s system as indicators of malingering.


Keywords: malingering, M-FAST, veterans, PTSD, post-concussion, whiplash

References

Miller H. A. M-FAST. Miller Forensic Assessment of Symptoms Test. Professional Manual. Lutz, FL: PAR Inc., 2001.

American Educational Research Association, American Psychological Association, National Council on Measurement in Education. Standards for Educational and Psychological Testing. Washington, DC: American Educational Research Association, 2014.

Wolf E., Ellickson-Larew S., Guetta R. E., Escarfulleri S., Ryabchenko K., and Miller M. W. Psychometric performance of the Miller Forensic Assessment of Symptoms Test (M-FAST) in veteran PTSD assessment. Psychological Injury and Law. Published online April 15, 2020. https://doi.org/10.1007/s12207-020-09373-y.

Wolf E. J., Ellickson-Larew S., Guetta R. E., Escarfulleri S., Ryabchenko K., Miller M. W. Correction to: Psychometric Performance of the Miller Forensic Assessment of Symptoms Test (M-FAST) in Veteran PTSD Assessment. Psychological Injury and Law. Published online: 02 September 2020. https://doi.org/10.1007/s12207-020-09388-5.

Cernovsky Z., Mann S., Diamond D. M., Persad E, Oyewumi L. K., Velamoor V., Mendonça J., Woodbury-Fariña M. A., and Husni M. Critical Review of the Content Validity of Miller Forensic Assessment of Symptoms Test (M-FAST). Archives of Psychiatry and Behavioral Sciences. 2020;3(2):16-29.

Rogers R., Bagby R. M., & Dickens S. E. SIRS: Structured Interview of Reported Symptoms: Professional Manual. Odessa, FL.: Psychological Assessment Resources, 1992.

Graue L. O., Berry D. T. R., Clark J. A., Sollman M. J., Cardi M., Hopkins J., & Werline D. Identification of Feigned Mental Retardation Using the New Generation of Malingering Detection Instruments: Preliminary Findings. The Clinical Neuropsychologist. 2007;21(6):929-942. doi: 10.1080/13854040600932137.

Green D., and Rosenfeld B. Evaluating the Gold Standard: A Review and Meta-Analysis of the Structured Interview of Reported Symptoms. Psychological Assessment. 2011, 23(1), 95–107.

Cernovsky Z., Mann S., Diamond D. M., Mendonça J., Tenenbaum S., Persad E., Velamoor V., Woodbury-Fariña M. A., Husni M., Gutierrez J. Irremediably Flawed Nature of Analog Validation Methodology of Malingering Tests. Archives of Psychiatry and Behavioral Sciences. 2020; 3(2): 39-45.

Beck A. T., Steer R. A., Brown G. K. Manual for Beck Depression Inventory-II. San Antonio: TX: Psychological Corporation; 1996.

King N. S., Crawford S., Wenden F. J., Moss N. E. G., Wade D. T. The Rivermead Post Concussion Symptoms Questionnaire: a measure of symptoms commonly experienced after head injury and its reliability. Journal of Neurology. 1995;242:587-592.

Cernovsky Z. Z., Mann S. C., Velamoor V., Oyewumi L. K., Diamond D. M., Litman L. C. Validation of the Rivermead Post-Concussion Symptoms Questionnaire (RPQ) on Patients Injured in High Impact Car Accidents. Archives of Psychiatry and Behavioral Sciences. 2021;4(1):14-22. doi.org/10.22259/2638-5201.0401003.

Cernovsky Z. Z. Symptom profile of injured motorists on the Structured Inventory of Malingered Symptomatology. European Journal of Medical and Health Sciences. 2021;3(2):1-4. doi: 10.24018/ejmed.2021.3.2.739.

Cernovsky Z., Mendonça J. D., Oyewumi L. K., Ferrari J. R., Sidhu G., and Campbell R. Content Validity of the Psychosis Subscale of the Structured Inventory of Malingered Symptomatology (SIMS). International Journal of Psychology and Cognitive Science. 2019;5(3):121-127.

Cernovsky Z. Z., Mendonça J. D., Ferrari J. R., Sidhu G., Velamoor V., Mann S. C., Oyewumi L. K., Persad E., Campbell R., and Woodbury-Fariña M. A. Content Validity of the Affective Disorder Subscale of the SIMS. Archives of Psychiatry and Behavioral Sciences. 2019;2(2):33-39.

Cernovsky Z., Bureau Y., Mendonça J., Varadaraj Velamoor V., Mann S., Sidhu G., Diamond D. M., Campbell R., Persad E., Oyewumi L. K., and Woodbury-Fariña M. A. Validity of the SIMS Scales of Neurologic Impairment and Amnestic Disorder. International Journal of Psychiatry Sciences. 2019;1(1):13-19.

Cernovsky Z. Z., Mendonça J. D., Ferrari J. R., Bureau Y. R. J. Content validity of SIMS low intelligence scale. International Journal of Research in Medical Science. 2019;1(1):21-25.

Widows M. R., Smith G. P. Structured Inventory of Malingered Symptomatology - Professional Manual. Lutz, FL: PAR Inc., 2005.

Cernovsky Z. Z., Mendonça J. D., Ferrari J. R. Meta Analysis of SIMS Scores of Survivors of Car Accidents and of Instructed Malingerers. Archives of Psychiatry and Behavioral Sciences. 2020;3(1):1-11.

Cernovsky Z. Z., Ferrari J. J. R., Mendonça J. D. Pseudodiagnoses of Malingering of Neuropsychological Symptoms in Survivors of Car Accidents by the Structured Inventory of Malingered Symptomatology. Archives of Psychiatry and Behavioral Sciences. 2019; 2(1): 55 65.

Ferrari J. J. R., Cernovsky Z. Z., Mendonça J. D. False Positives in Green’s Tests of Malingering on Chronic Pain Patients. International Journal of Psychology and Cognitive Science, 2019; 5(2): 58 63.

Cernovsky Z. Z., Velamoor V. R., Mann S. C., Oyewumi L. K., Mendonça J. D., and Litman L. C. Frequency of Formication Symptoms in Injured Motorists and in Normal Controls. European Journal of Medical and Health Sciences. 2021;3(2):48-52.

Cernovsky Z. Z., Mann S. C., Velamoor V. R., and Oyewumi L. K. The Need for Three Separate Parallel WAD Ratings of Whiplash Injuries to Cervical, Lumbosacral, and Thoracic Spine in Clinical Assessments of Injured Motorists. European Journal of Medical and Health Sciences. 2021;3(1):154-159.

doi: 10.24018/ejmed.2021.3.1.699.

Landis B. N. and Burkhard P. R. Phantosmias and Parkinson Disease. Archives of Neurology. 2008; 65(9):1237-1239.

Lötsch J., Ultsch A., Eckhardt M., Huart C., Rombaux P., and Hummel T. Brain lesion-pattern analysis in patients with olfactory dysfunctions following head trauma. Neuroimage: Clinical. 2016; 11: 99–105. doi: 10.1016/j.nicl.2016.01.011.

Doty R. L., Yousem D. M., Pham L. T., Kreshak A. A., Geckle R., Lee W. W. Olfactory Dysfunction in Patients with Head Trauma. Archives of Neurology. 1997 54(9):1131-40.

doi: 10.1001/archneur.1997.00550210061014.

Weiss R. A. and Rosenfeld B. Identifying Feigning in Trauma-Exposed African Immigrants. Psychological Assessment. 2017; 29(7):881-889.

Thawani S., Wang B., Shao Y., Reibman J. and Marmor M. Time to Onset of Paresthesia Among Community Members Exposed to the World Trade Center Disaster. International Journal of Environmental Research and Public Health. 2019, 16, 1429.

Clark J. A. Validation of the Miller Forensic Assessment of Symptoms Test (M-FAST) in a civil forensic population. Master's Thesis, University of Kentucky, 2006.

Maruta J., Lumba-Brown A., and Ghajar J. Concussion Subtype Identification with the Rivermead Post-concussion Symptoms Questionnaire. Frontiers in Neurology. 2018;9:1034. doi: 10.3389/fneur.2018.01034.

Minoudis P. G. Malingering of Cognitive Symptoms. Doctoral Thesis, University College London, London, UK, 2007.

Merten T., Diederich C., Stevens A. Feigned Symptoms after Whiplash Injury: An Experimental Analogue Study. Aktuelle Neurologie. 2008;35:8-15. doi.org/10.1055/s−2007−986232.

Detullio D., Messer S. C., Kennedy T. D., and Millen D. H. A Meta-Analysis of the Miller Forensic Assessment of Symptoms. Test (M-FAST). Psychological Assessment. 2019;31(11):1319-1328. 1040-3590/19/$12.00 http://dx.doi.org/10.1037/pas0000753.

Cernovsky Z. Z., Landmark J. A., O’Reilly R. L. Age of onset and symptom patterns in schizophrenia. European Journal of Psychiatry. 2002; 16(3): 168-173.

Murdoch M., Sayer N. A., Spoont M. R., Rosenheck R., Noorbaloochi S., Griffin J. M., et al. Long-term outcomes of disability benefits in US veterans with posttraumatic stress disorder. Archives of General Psychiatry. 2011;68:1072-1080. doi:10.1001/archgenpsychiatry.2011.105.

Marx B. P., Jackson J. C., Schnurr P. P., Murdoch M., Sayer N. A., Keane T. M., Friedman M. J., Greevy R. A., Owen R. R., Sinnott P. L., and Speroff T. The reality of malingered PTSD among veterans: Reply to McNally and Frueh (2012). Journal of Traumatic Stress. 2012;25:457-460. https://doi.org/10.1002/jts.21714.

##plugins.themes.bootstrap3.article.details##

How to Cite
Cernovsky, Z. Z., Mann, S. C., & Velamoor, V. R. (2021). Clinical Profile of US Combat Veterans with PTSD on M-FAST Items. European Journal of Clinical Medicine, 2(3), 146–153. https://doi.org/10.24018/clinicmed.2021.2.3.53